Expert therapists use specific clinical reasoning processes in the assessment and management of patients with shoulder pain: a qualitative study.
OBJECTIVE
What are the key items in the clinical reasoning process which expert clinicians identify as being relevant to the assessment and management of patients with shoulder pain?


METHODS
Qualitative study using a three-round Delphi procedure.


METHODS
Twenty-six experts in the UK consented to be involved and were contactable, of whom 20 contributed, with 12, 15, and 15 contributing to the different rounds.


RESULTS
Clinical reasoning was mostly about diagnostic reasoning, but also involved narrative reasoning. Diagnostic reasoning involved both pattern recognition and hypothetico-deductive reasoning. Diagnostic reasoning emphasised general history items, a constellation of signs and symptoms to identify specific diagnostic categories, and standard physical examination procedures. Narrative reasoning was highlighted by the communication involved in expert history taking, seeing patients in their functional and psychological context, and collaborative reasoning with the patient regarding management.


CONCLUSIONS
These expert clinicians demonstrated the use of diagnostic pattern recognition, and hypothetico-deductive and narrative clinical reasoning processes. The emphasis was on the history and basic physical examination procedures to make clinical decisions.
May
Stephen
S
Sheffield Hallam University, Sheffield, S10 2BP, United Kingdom. s.may@shu.ac.uk
Greasley
Alison
A
Reeve
Sarah
S
Withers
Sarah
S
D000328:Adult; D003657:Decision Making; D020000:Decision Support Systems, Clinical; D003697:Delphi Technique; D005104:Expert Testimony; D005260:Female; D019538:Health Care Surveys; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D026741:Physical Therapy Modalities; D010865:Pilot Projects; D036301:Qualitative Research; D018570:Risk Assessment; D020069:Shoulder Pain / Q000175:diagnosis* / Q000188:drug therapy / Q000628:therapy; D006113:United Kingdom