Clinical Decision Making in Physiotherapy Practice

Introduction[edit | edit source]

The majority of time spent working in clinical practice involves thinking and decision making.[1][2][3] Because decisions are so commonly made, it is easy to assume that anyone can make effective decisions.[1] Effectiveness in clinical practice depends on the decisions made which stresses the importance of learning how to optically make decisions.[4][5]Clinical or diagnostic reasoning has been proposed to be the most important core skill of any health care practitioner.[6] The dynamic and ever changing realm of health care demands that practitioners provide meaningful improvements in patients and the clinical decision  process is the only path to achieving it.[5][7] The rate at which practitioners however fail at this critical skill is alarmingly high. Not only has large discrepancies (20-40%) been reported between ante and postmortem diagnoses but many of these postmortem examinations would not have been necessary if the correct diagnosis was made.[8][9]. It has been estimated that nearly 18% ($2.7 trillion) of the United States’ GDP is spent on healthcare, yet more than 30% is wasted on inappropriate care.[10] Up to 80 000 deaths occur annually in hospitalised patients in the United States due to incorrect diagnoses and in the outpatient setting, around 5%  of adults (12 million US adults annually) are incorrectly diagnosed. [11]

The majority of these failures are not attributed to system problems or knowledge failure, but to how practitioners think - how they solve problems, reason and ultimately make decisions[5]. To improve healthcare it is of great importance to improve clinical reasoning and hence clinical decision making.

What is Clinical Decision Making?[edit | edit source]

  1. ↑ 1.0 1.1 Croskerry P, Nimmo GR. Better clinical decision making and reducing diagnostic error. The journal of the Royal College of Physicians of Edinburgh. 2011 Jun 1;41(2):155-62. Available from:http://www.ajustnhs.com/wp-content/uploads/2012/10/croskerry-better-decision-making-2011.pdf DOI: 10.4997/JRCPE.2011.208
  2. ↑ Smyth O, McCabe C. Think and think again! Clinical decision making by advanced nurse practitioners in the Emergency Department. Int Emerg Nurs. 2017 Mar 1;31:72-4. https://www.researchgate.net/profile/Catherine_Mccabe/publication/307524001_Think_and_think_again_Clinical_decision_making_by_advanced_nurse_practitioners_in_the_Emergency_Department/links/5d15caaea6fdcc2462ab655b/Think-and-think-again-Clinical-decision-making-by-advanced-nurse-practitioners-in-the-Emergency-Department.pdf  DOI: 10.1016/j.ienj.2016.08.001
  3. ↑ Whelehan DF, Conlon KC, Ridgway PF. Medicine and heuristics: cognitive biases and medical decision-making. Irish journal of medical science. 2020 May 14;189:1477-1484.       DOI: 10.1007/s11845-020-02235-1
  4. ↑ Croskerry P. Context is everything or how could I have been that stupid. Healthc q. 2009 Aug 15;12(Spec No Patient):e171-176. Available from:https://www.researchgate.net/profile/Pat_Croskerry/publication/51437685_Context_Is_Everything_or_How_Could_I_Have_Been_That_Stupid/links/5776721908aeb9427e27892f/Context-Is-Everything-or-How-Could-I-Have-Been-That-Stupid.pdf
  5. ↑ 5.0 5.1 5.2 Croskerry P. A model for clinical decision-making in medicine. Medical Science Educator. 2017 Dec 1;27(1):9-13. Available from:https://www.researchgate.net/profile/Pat_Croskerry/publication/321510386_A_Model_for_Clinical_Decision-Making_in_Medicine/links/5ae70b4c0f7e9b9793c7e527/A-Model-for-Clinical-Decision-Making-in-Medicine.pdf  DOI: 10.1007/s40670-017-0499-9
  6. ↑ Croskerry P. A universal model of diagnostic reasoning. Academic medicine. 2009 Aug 1;84(8):1022-8. Available from: https://static1.squarespace.com/static/57b5e6e0ebbd1ad42af1f8b6/t/5d7e9e8f79d8cf7718ca18af/1568579215659/Croskerry+A+Universal+Model+of+Diagnostic+Reasoning.pdf  DOI:10.1097/ACM.0b013e3181ace703
  7. ↑ Huhn K, Black L, Christensen N, Furze J, Vendrely A, Wainwright S. Clinical reasoning: survey of teaching methods and assessment in entry-level physical therapist clinical education. Journal of Physical Therapy Education. 2018 Sep 1;32(3):241-7. Available from: https://journals.lww.com/jopte/Fulltext/2018/09000/Clinical_Reasoning___Survey_of_Teaching_Methods.6.aspx    DOI:10.1097/JTE.0000000000000043
  8. ↑ Gawande A. Final cut. In: Complications: A Surgeon’s Notes on an Imperfect Science. New York: Henry Holt and Company; 2002;197-198
  9. ↑ Graber M. Diagnostic errors in medicine: a case of neglect. The Joint Commission Journal on Quality and Patient Safety. 2005 Feb 1;31(2):106-13. Available from: https://www.researchgate.net/profile/Mark_Graber/publication/7943691_Diagnostic_Errors_in_Medicine_A_Case_of_Neglect/links/5c9a5122299bf11169498a6a/Diagnostic-Errors-in-Medicine-A-Case-of-Neglect.pdf
  10. ↑ Berwick DM, Hackbarth AD. Eliminating waste in US health care. Jama. 2012 Apr 11;307(14):1513-6. Available from: http://files.mccn.edu/media/ds/Berwick%20et%20al%202012.pdf   DOI: 10.1001/jama.2012.362
  11. ↑ Singh H, Meyer AN, Thomas EJ. The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations. BMJ quality & safety. 2014 Sep 1;23(9):727-31. Available from: https://qualitysafety.bmj.com/content/qhc/23/9/727.full.pdf   DOI: 10.1136/bmjqs-2013-002627
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