Section I: Clinical Judgment: Introduction

INTRODUCTION

Clinical judgment has always been a guide for good practitioners. Before physical therapists were able to use theoretically grounded and methodologically tested research hypotheses that provided scientifically sound evidence to guide clinical decision making, they sought guidance from well-developed practice knowledge and clinical reasoning. When good practitioners attempted new interventions, they carefully observed the situation and could recall successes and failures. Studies of expertise in physical therapy have helped us understand this important element in evidence based practice (EBP).^1,2,3,4,5 The deep practice-based knowledge of these experts gives them skill in active reflection.¹ Experts use all three elements of EBP but always modulate what they learn from the literature with their own expert judgment to best meet their patients' needs.

This section begins with Chapter 1, which provides an overview of the language of practice and the important developments over the past decades that allow us to communicate with each other and our health care colleagues. In this chapter we describe two important purposes for a common language in our profession: to describe our patients accurately and to describe our processes and outcomes of care. You will find a useful and context-rich description of models of disability and patient management as well as an introduction to the Guide for Physical Therapist Practice.

In Chapter 2 we present an overview of how physical therapists make clinical decisions. The types of decisions required in practice are highlighted along with an array of approaches to clinical reasoning used by physical therapists and some of their colleagues in medicine, nursing, and occupational therapy.

Chapter 3 presents a perspective on errors in clinical reasoning, drawing from reports in medicine, physical therapy, and occupational therapy. An understanding of the types of errors typically found in physical therapy practice and the sources of influences on errors is an important step in improving clinical reasoning.

Chapter 4, written by Jack Hershey, provides an understanding of how biases affect clinical decisions. Detecting bias in one's own thinking is difficult, but if it is done well and consistently, it will result in more accurate sharing of knowledge with patients.

Chapter 5 deals with the tools available to physical therapists to assist with clinical reasoning. You are encouraged to examine the way physical therapists think and their use of practice algorithms that might facilitate the best clinical reasoning. Policies that improve understanding of what good clinical practice is or what evidence to use in clinical decision making are also introduced in this chapter.

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