Understanding and Promoting Clinical Reasoning in Chronic and Multimorbid Conditions: A Call for GPs and Healthcare Professionals

Abstract

Multimorbidity, defined as 2 or more chronic diseases, is of increasing importance for health professionals. Many factors are at play when it comes to multimorbidity, but we still know very little about how clinicians actually weigh up the different factors-medical, social, and psychological-to reach a particular course of action. Further research is therefore required to explore the ways in which clinical reasoning processes are involved in the follow up of patients suffering from multimorbidities, to highlight their potential risks of errors. A better understanding of these clinical processes will also enrich supervision of trainees and collaboration between healthcare professionals involved in primary care.

Understanding GPs’ clinical reasoning processes involved in managing patients suffering from multimorbidity: A systematic review of qualitative and quantitative research

“…For example, our results highlight the challenges relative to the ongoing process of prioritisation, as well as the one of always weighing up the risks and benefits for the patient. In this clinical reasoning, there is no single correct plan, but competing priorities and unavoidable uncertainties 9,12,50 …”

Understanding the clinical reasoning processes involved in the management of multimorbidity in an ambulatory setting: study protocol of a stimulated recall research

“…Firstly, study results will contribute to the scientific community’s overall understanding of clinical reasoning as it is used in the context of patients with multiple chronic conditions by primary care physicians during the long-term follow-up care of their patients in ambulatory settings. Facing the challenge of meeting the complex needs of these patients requires to deeply involve patients and their relatives, as well as different healthcare providers in an interprofessional approach: in this perspective, many issues are still to be considered in order to implement shared decision-making processes as well as a more collaborative reasoning between healthcare professionals [ 20 ].…”

“…Based on theoretical models such as the Chronic Care Model, initiatives targeting improvements in the care of these patients have been implemented worldwide [ 15 , 16 ]. Primary care physicians being at the heart of the practice, puts them in an ideal position to provide the care these patients need [ 17 , 18 ], as this involves patient-centered care, coordination and collaboration between several healthcare professionals [ 19 , 20 ], as well as better knowledge of the various chronic diseases and their possible interactions [ 21 ].…”

“…Despite their relevance in the primary care clinical setting, clinical reasoning processes involved during the management of chronic care remains poorly described in the literature. It is therefore necessary to untangle the different processes at play and to better understand how they articulate with one another during the longitudinal care of patients suffering from multimorbidity [ 20 ].…”

Face à l’incertitude : humilité, curiosité et partage

“…Dans cette perspective, les auteurs soulignent que les médecins généralistes sont tout particulièrement confrontés à l'incertitude. Rencontrant en permanence « des patients aux demandes multiples et variées, présentant des symptômes isolés et peu spécifiques », ou encore souffrant de multi-morbidités nécessitant de revisiter régulièrement la priorisation des démarches de soins en accord avec eux et leurs proches [8], les médecins généralistes, mais aussi tous les soignant(e)s impliqués dans ce genre de pratique clinique, sont en effet au coeur de la gestion de l'incertitude.…”