Exploring the clinical reasoning of an advanced clinical practitioner through a respiratory case encountered in primary care

Abstract

Advanced clinical practitioners work autonomously, utilising a high degree of complex decision making within situations of clinical uncertainty. This case report examines the clinical reasoning surrounding the decision to refer a patient for a chest X-ray to confirm the presence of lung cancer. Although advocated for within clinical guidelines, the sensitivity of X-ray in the detection of early lung cancer has been questioned, and the value of alternative imaging in the form of low-dose computed tomography proposed. Conditions within clinical practice, including time constraints and fatigue, may negatively impact clinical reasoning. A national move towards 15-minute appointments in primary care would aid this.