Putting the Pieces Together: Reflecting on the Clinical Decision

In our previous two Clinical Insights, we looked at the relationship of the clinician’s emotions and their effects on decision making in the clinic; how we take social and clinical cues from patients to build an understanding; and lastly, some of the subtle clinical reasoning faults that may occur as we move through this.

So, taking this into account, how do we manage this challenge?

Firstly, this is not an easy answer; however here are some tips in how to build around this problem. Leadership theory and models of learning start very much with how we understand ourselves, then how this can impact others. We then use that knowledge effectively to be able to adjust our leadership behaviours to ensure we present as authentic, compassionate and trustworthy.

Presenting as an Authentic Clinician 

This is how a clinician can begin to gain insight and unpick complexity. If we present as the authentic clinician, then the patient is far more likely to disclose, and this deals with one of the pillars of uncertainty, which is not knowing what the patient expects, wants, or is concerned about.

If we are uncertain about that, how do we ever develop an effective management plan?

Use a Framework

Secondly, when dealing with uncertainty we need to be able to place abstract ideas, presentations into a framework, and this requires some sort of testing protocol. In doing so we can improve how we make sense of symptomology and patient experiences. This is challenging, and allows for the therapeutic alliance to be structured. It’s a deep example of creating a research-like question and subsequent protocol within the clinical interaction.

Building a Patient Story 

Lastly, we need to deal with technical uncertainty as we try to apply “test” to the presentation, such as clinical bedside and of course more structured rather like imaging. So, the building of the patient story has to be constructed, when it’s complex, around multiple mini frameworks that then allow the emotional and less structured (but vital) elements to be understood not only from the patient’s perspective, but by the clinician within a more objective framework.

Experts live with uncertainty, however they mitigate for this by having a greater appreciation of their impact on the consultation, by creating developed models of how to deal with less obvious cues that underpin a patient story, and lastly modifying the consultation to try to create a better objective model for dealing with uncertainty.

Read Part 1 and Part 2 of this Clinical Insight series.

References 

Ghosh, A.K., 2004. On the challenges of using evidence-based information: the role of clinical uncertainty. Journal of Laboratory and Clinical Medicine, 144(2), pp.60-64.

Stern, D., Smith, K. and Rone-Adams, S., 2020. Using A Self-Contained Integrated Clinical Education (ICE) Model to Identify Student Deficits.