Faculty of Health, Medicine and Life Sciences, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands.
Faculty of Medicine and Health Sciences, Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium.
J Eval Clin Pract. 2021 Oct;27(5):1175-1181. doi: 10.1111/jep.13549. Epub 2021 Feb 16.
Clinical reasoning in general practice is increasingly challenging because of the rise in the number of patients with multimorbidity. This creates uncertainty because of unpredictable interactions between the symptoms from multiple medical problems and the patient's personality, psychosocial context and life history. Case analysis may then be more appropriately managed by systems thinking than by hypothetic-deductive reasoning, the predominant paradigm in the current teaching of clinical reasoning. Application of "systems thinking" tools such as causal loop diagrams allows the patient's problems to be viewed holistically and facilitates understanding of the complex interactions. We will show how complexity levels can be graded in clinical reasoning and demonstrate where and how systems thinking can have added value by means of a case history.
全科医学中的临床推理越来越具有挑战性,因为患有多种疾病的患者数量不断增加。由于多种医疗问题的症状与患者的个性、心理社会背景和生活史之间不可预测的相互作用,这会产生不确定性。因此,病例分析可能更适合通过系统思维而不是假设演绎推理来管理,而假设演绎推理是当前临床推理教学的主要模式。应用“系统思维”工具,如因果关系图,可以全面观察患者的问题,并有助于理解复杂的相互作用。我们将展示如何在临床推理中对复杂程度进行分级,并通过病例展示系统思维如何在何处以及如何增值。