Diagnosis is Easy, Clinical Reasoning is Hard… or is it?
Clinical reasoning is so much more than just diagnosing / categorising the patient’s problem. Mark will use a post whiplash patient with neck pain and headache to highlight the scope of clinical reasoning judgments that skilled physiotherapists must make. This involves exploring the psychosocial focussed assessment and reasoning to reveal this essential dimension of our practice as this often less structured and thorough than our physical assessment and management. One of the most common clinical reasoning errors in practice is ‘What you see is all there is.’ The most effective strategy to minimise this error will be highlighted along with a psychosocial assessment framework for use with ALL patients. Judging how much to examine to avoid exacerbation of symptoms is a key clinical reasoning judgment with virtually no research evidence to guide clinical practice. The choices made to limit the physical examination in this case will be highlighted along with the scope of factors that should inform this decision.
Another under-researched and challenging clinical reasoning judgment is progression of treatment. The systematic approach of re-assessment guided treatment progression through different interventions will be outlined from the first appointment to discharge including ongoing maintenance. Lastly, and inevitably, patients want to know ‘Can you help me and how long will it take?’ Answering this question requires prognostic reasoning. Mark will consider the hypothesised prognosis for this patient and highlight the range of factors to weigh when making this judgment.
Mark Jones is a Senior Lecturer in the University of South Australia Master of Advanced Clinical Physiotherapy program with 30years experience teaching undergraduate and postgraduate physiotherapy.
Mark graduated from the University of Florida with a B.S. in Psychology and then completed his Physical Therapy studies at the University of Iowa. Having developed an interest in manual therapy Mark travelled to Australia to study Manipulative Physiotherapy and after completing his Graduate Diploma in 1985 under Geoff Maitland he completed his Master degree by Research in 1989. The title of his thesis was “‘Facilitating Students’ Clinical Reasoning in Physiotherapy Education”.
Mark has a special interest in biopsychosocial health care and the teaching and assessment of clinical reasoning in physiotherapy. He has conducted and supervised research in the areas of clinical reasoning and musculoskeletal physiotherapy with over 90 publications (H-index 11) including three editions of the text ‘Clinical Reasoning in the Health Professions’ and the text “Clinical Reasoning for Manual Therapists”. His latest text “Clinical Reasoning in Musculoskeletal Practice” was published in 2019 and is considered the only all-in-one volume of up-to-date clinical reasoning.
Mark has presented 30 Keynote Conference presentations and has taught professional development courses in clinical reasoning and musculoskeletal physiotherapy across 26 countries.