Clinical Reasoning in Veterinary Practice

Clinical Reasoning

• Clinical reasoning is the process by which veterinary surgeons integrate clinical and contextual factors to make decisions about diagnoses, treatment options, and prognoses of patients.

Learning Objectives

• Identify different forms of clinical reasoning and understand their application in various veterinary contexts.
• Understand and describe the inductive reasoning process.
• Develop a strategy to help practitioners improve their clinical reasoning.

What is Clinical Reasoning?

• Clinical reasoning is the process by which veterinary surgeons consider many clinical and contextual factors to make decisions about patient diagnoses, treatments, and prognoses.

The Process

• Starts with a presenting clinical sign or case.
• Ends with a (hopefully) successful treatment plan.

How Do We Get Clinical Reasoning Skills?

• Clinical reasoning skills are challenging to teach directly.
• Skills develop through experience, practice, and guidance.
• Veterinarians are often well-prepared for practice when they graduate.

Types of Clinical Reasoning

• Type 1 ("Pattern Recognition"):
  • Non-analytic
  • Occurs quickly and is cost-effective if the diagnosis is correct.
  • Relies on past experiences to recognize patterns (e.g., "pattern recognition").
  • Works well for common veterinary disorders.
  • Relies on established illness scripts.
• Type 2 ("First Principles"):
  • Analytical
  • Takes time and resources to investigate fully.
  • Used to double-check presumptive diagnoses made via pattern recognition.
  • Uses deductive, inductive, and abductive reasoning.

Type 1 vs. Type 2 Reasoning Example

• Shows how both types of reasoning can be applied in a situation where a pet has a fever (e.g., rectal temperature of 40.8°C).
• Type 1 reasoning might identify the clinical sign as "pyrexia" and go straight to a possible cause like a bacterial infection.
• Type 2 reasoning would investigate further to rule out other possibilities (e.g., inflammatory response, non-infectious issues, autoimmune disease, neoplasia).

Inductive Reasoning

• Broad generalizations and tentative hypotheses are common.
• The process is frequently exploratory, aiming to discover more appropriate information.
• Inductive reasoning tends to be a structured approach.

Key Questions

• What is the problem? (Define and refine the problem).
• What system is involved? (Define and refine the system).
• Where within the system is the problem located? (Define the location).
• What is the lesion? (Define the lesion).

The Minimum Database

• Common diagnostic tests often include hematology, serum biochemistry, and urinalysis.
• Important to think before ordering unnecessary tests.

Problem List

• Create a problem list to help clarify clinical problems.
• Important to avoid overlooking key clinical signs.

Defining and Refining the Problem

• Clarify what the problem is (e.g., vomiting, fits, or unusual urine color).
• Consider differing perspectives between pet owners and the veterinarian.

Defining and Refining the System

• Identify the body systems that might be involved in causing the identified clinical signs.
• Understand if the problem is structural or functional.
• Determine if further diagnostic information is needed.

Defining the Location (Within the System)

• Pinpoint the location of the problem within the affected body system.
• Consider if specific diagnostic methods like endoscopy might be useful.

Defining the Lesion

• Determining the nature of the disease process.
• Identify and analyze possible causes for abnormalities, such as a lesion or disease entity.

Example of Differentials List

• Includes potential causes for veterinary conditions (e.g., gastric ulcers, spinal cord lesions, or urinary tract infections).

Conclusion

• Use both Type 1 and Type 2 clinical reasoning.
• Pattern recognition is valuable.
• Remember the existing knowledge to help develop a patient care approach.
• Mastering this process takes time and practice.

This quiz explores the essential concepts of clinical reasoning in veterinary medicine. You'll learn about different forms of reasoning, particularly inductive reasoning, and strategies to enhance these critical skills for better patient outcomes. Ideal for veterinary students and professionals seeking to refine their decision-making processes.