Insecurity accompanies all clinicians. It may seem that we have everything under control or that we have enough training. But faced with the complexity of the healthcare user (patient), sometimes we feel unable to understand what is really happening, or we apply the usual, what we know works … almost always. Sometimes with experience and training we progress … slowly. In child physiotherapy, all of the above is even more evident. The path to becoming solid, lucid, and competent clinicians in relationship passes through clinical reasoning in pediatric physical therapy.
Clinical reasoning is the art and science of decision making in clinical practice. And as you well know, there are many decisions to make with each baby / child and with each family. It is more of a concept than something clearly well defined universally (1). There are mainly two types of decisions in pediatric physical therapy. On the one hand there are the strategies aimed at diagnosis and on the other hand those aimed at managing the user and the family, even the community in which it is integrated.
Two types of clinical reasoning
Most physical therapists believe that you need training to fully understand the patient’s problem and be able to offer an accurate prognosis (will this be resolved? In how many sessions?). This is the diagnostic reasoning that is based on the elaboration and management of hypotheses and the recognition of clinical patterns. This is an essential part of offering an appropriate and effective treatment plan. The opening of pediatric physiotherapy to a comprehensive monitoring of the baby and the child, beyond the neuro or respiratory, requires more training in clinical reasoning. In fact, the neuromusculoskeletal has its own keys to diagnostic reasoning and its own interventions.
But there is a part of the reasoning that escapes more often, overlooked by the need to get the assessment and treatment right. It is about the decisions around the management of the family user. It is the real accompaniment of the family, making consensual decisions both with it and with other professionals who also support the child and his family. Here too, good decisions, good focus and good communication are essential. It is the other great family of decisions that start from a clinical reasoning process, and probably, it is what gives the soul to our work.
The good news is that clinical reasoning can be learned. It doesn’t take 20 years of experience to be an expert. In fact, experience does not necessarily provide expertise. We all know professionals with a lot of experience anchored to outdated models and with a lack of freshness in their knowledge and in their practice. From TMPI we have launched a training for clinical reasoning in pediatric physiotherapy to offer the security and solidity that we all long for. But I must warn that it is a path of depth and self-reflection. A challenge for the brave who really want to learn to “move by their thinking” (2).
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References:
1. Huhn K, Gilliland SJ, Black LL, Wainwright SF, Christensen N. Clinical Reasoning in Physical Therapy: A Concept Analysis. Phys Ther. 2019;Apr 1(99(4)):440–56.
2. Edwards I, Jones M. Movement in our thinking and our practice. Man Ther. 2013;18:93–5.
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