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

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.

Multimorbidity and clinical reasoning through the eyes of GPs:a qualitative study

Objectives Despite the high prevalence of patients suffering from multimorbidity,the clinical reasoning processes involved during the longitudinal management are still sparse.This study aimed to investigate what are the different characteristics of the clinical reasoning process clinicians use with patients suffering from multimorbidity,and to what extent this clinical reasoning differs from diagnostic reasoning.Design Given the exploratory nature of this study and the difficulty general practitioners(GPs)have in expressing their reasoning,a qualitative methodology was therefore,chosen.The Clinical reasoning Model described by Charlin et al was used as a framework to describe the multifaceted processes of the clinical reasoning.Setting Semistructured interviews were conducted with nine GPs working in an ambulatory setting in June to September 2018,in Geneva,Switzerland.Participants Participants were GPs who came from public hospital or private practice.The interviews were transcribed verbatim and a thematic analysis was conducted.Results The results highlighted how some cognitive processes seem to be more specific to the management reasoning.Thus,the main goal is not to reach a diagnosis,but rather to consider several possibilities in order to maintain a balance between the evidence-based care options,patient’s priorities and maintaining quality of life.The initial representation of the current problem seems to be more related to the importance of establishing links between the different pre-existing diseases,identifying opportunities for actions and trying to integrate the new elements from the patient’s context,rather than identifying the signs and symptoms that can lead to generating new clinical hypotheses.The multiplicity of options to resolve problems is often perceived as difficult by GPs.Furthermore,longitudinal management does not allow them to achieve a final resolution of problems and that requires continuous review and an ongoing prioritisation process.Conclusion This study contributes to a better understanding of the clinical reasoning processes of GPs in the longitudinal management of patients suffering from multimorbidity.Through a practical and accessible model,this qualitative study offers new perspectives for identifying the components of management reasoning.These results open the path to new research projects.