Personally I find reflecting in a blog quite a useful way of thinking about issues that occur during a course. It allows me to link to any web sites that might be pertinent which is handy and hopefully invites others to comment in response to my ramblings. This page will be relections on the Post Grad 2009 Otago Polytechnic course on clinical reasoning.
This is not so much a reflection on the course but on cinical reasoning in general. I wonder if there are different layers (or types) of reasoning. One is at the level of fixing a problem – this is quick problem solving, very pragmatic as it deals with an obvious problem. Examples would be the use of aids, equipment, educational techniques to deal with immediate problems related the cients situation such as difficulties in ADL. Another type are those that are are more abstract and deal with larger issues such as how to fill in your time when you can no longer be so physically active; how to be a productive member of society; how to play a meaningful role within your family. There is not really a problem that can be readily isolated and adressed. The outcomes are not entirely obvious neither are the means to get there. You need to get a good grasp of where the client is coming from. So far I have come up with 2 ‘levels’ – perhaps there are more that I have not even thought about!
Another thought is that you might like to visit Bronwyn’s web site: http://healthskills.wordpress.com/ (also see this identified on the Blog roll) She is a NZ OT who has very interesting things to say about clinical reasoning. Be prepared to be challenged! (You will also need to ask her for a pass word). One thing thing that we have in common is a belief that OTs have a tendency to be in ‘fix-it’ mode. This can be to the detriment of taking time to correctly identify the problem from the clients point of view. On the other hand, clients may be extremely grateful for a quick ‘fix’. What we need is the wisdom to decide when the ‘obvious’ problem from our perspective is actually the one that the client wants to have addressed.
I was reminded by a post in BB of the importance o f what we already know influencing how difficult the problem may appear to be. Its rather like planning out a journey that has multiple ways of getting there. First time round it seems amazingly complex; once we have done the journey and have experienced success, then we can much more readily plan it the 2nd time around. This is applicable to the type C problems (Gagne). For these types of problems the more you know about solutions, the more able you are to notice the appropriate cues (many implications here for student learning). I suspect that the type D problems never get much easier because there is always a ’gap’ and there is never one ’right’ solution. However, as I remember a wise OT saying “I have learnt to trust the process”. Going with the flow can be a nerve wracking experience if you don’t really know where you are going. Having said that it is no doubt worse for the client!
