Models of clinical reasoning with a focus on general practice: a critical review

Abstract

Introduction: Diagnosis lies at the heart of general practice.Every day general practitioners (GPs) visit patients with awide variety of complaints and concerns, with often minor butsometimes serious symptoms. General practice has many featureswhich differentiate it from specialty care setting, but during thelast four decades little attention was paid to clinical reasoningin general practice. Therefore, we aimed to critically review theclinical reasoning models with a focus on the clinical reasoningin general practice or clinical reasoning of general practitionersto find out to what extent the existing models explain the clinicalreasoning specially in primary care and also identity the gaps ofthe model for use in primary care settingsMethods: A systematic search to find models of clinical reasoningwere performed. To have more precision, we excluded the studiesthat focused on neurobiological aspects of reasoning, reasoningin disciplines other than medicine decision making or decisionanalysis on treatment or management plan. All the articles anddocuments were first scanned to see whether they include importantrelevant contents or any models. The selected studies whichdescribed a model of clinical reasoning in general practitioners orwith a focus on general practice were then reviewed and appraisalor critics of other authors on these models were included. Thereviewed documents on the model were synthesizedResults: Six models of clinical reasoning were identified includinghypothetic-deductive model, pattern recognition, a dual processdiagnostic reasoning model, pathway for clinical reasoning, anintegrative model of clinical reasoning, and model of diagnosticreasoning strategies in primary care. Only one model hadspecifically focused on general practitioners reasoning.Conclusion: A Model of clinical reasoning that included specificfeatures of general practice to better help the general practitionerswith the difficulties of clinical reasoning in this setting is needed.Keywords: Problem solving, General practitioners, Diagnosis