Your ultimate guide to clinical reasoning part 1 - Quick diagnosis and analytical reasoning with Mark Jones

Have you had a patient describe lateral hip pain, and almost immediately in your subjective assessment been able to diagnose it as a gluteal tendinopathy? Diagnosing early in the subjective feels great, doesn’t it? Have you also had the less pleasurable experience of discovering later that your early diagnosis of gluteal tendinopathy was less than spot on, and their pain was actually lumbar referred pain or from the hip joint? Or a had a patient present with MRI results like a SLAP or meniscal tear, that ended up being irrelevant and took you down the wrong treatment path? If you’ve been treating for any length of time, you’ll have had at least one (or many) of these experiences where fast, intuitive clinical reasoning has led you astray.

How can we quickly recognise diagnostic patterns, and confirm our diagnoses and treatment decisions with analytical (“slow”) clinical reasoning?

Our clinical reasoning needs a combination of quick recognition and analytical thinking to get the best results for our patients. In this online course series with Dr Mark Jones, Physiotherapist, PhD and co-author of “Clinical reasoning in musculoskeletal practice (2019)” you will discover how to improve your clinical reasoning, subjective history, assessment, diagnosis and treatment results.

You will discover:

• Why your quick, intuitive answers are often incorrect
• The difference between “fast” thinking based on our initial patient information, and analytical (“slow”) thinking with patients
• Common errors in diagnostic reasoning
• Common “fast” reasoning errors you may be unaware you are making, including priming, confirmation bias, memory bias and “What you see is all there is”
• Different types of clinical patterns, including nociceptive, neuropathic, nociplastic and red flags
• How you can use “slow” analytical reasoning to check your fast first impressions, diagnoses and pattern recognition to reduce errors
• What is clinical reasoning?
• How clinical reasoning will help you with your patients
• Types of clinical reasoning
• How does pattern recognition fit into clinical reasoning?
• How you can use deductive, “slow” reasoning to test your clinical judgements & hypotheses
• What process can you use for clinical reasoning?
• How can you test your hypotheses?
• Diagnostic reasoning - comparing medical diagnosis to physiotherapy diagnosis
• Why pathology is important when you are considering precautions, management & prognosis, but can also mislead you

This is part 1 in a 5 part series designed to build your clinical reasoning skills and abilities.

In part 2 you will explore how to identify psychosocial factors, patient perspectives and maladaptive thoughts, beliefs and emotions that affect outcomes and play a role in your clinical reasoning.

Part 3 will take you through how to screen for psychosocial factors in your patient interview, how to unpack your patient’s beliefs and feelings, and important areas & questions you need to include in your subjective assessment.

In Part 4 you will explore types of pain your patients experience, including neuropathic, nociceptive and nociplastic (maladaptive CNS sensitisation). You will discover clinical patterns and tests for cervical spine neuropathic pain, and how to identify strength, ROM, motor control and neurodynamic impairments related to your patients pain.

Part 5 covers precautions and contraindications to assessment and treatment, red flags you need to identify, red flags that masquerade as shoulder pain, and when you need to get your patient immediate medical attention. You will explore how to put all of the information you have gained together with clinical reasoning to develop a treatment plan.