Rethinking clinical reasoning: time for a dialogical turn
Article first published online: 21 NOV 2012
© Blackwell Publishing Ltd 2012
Volume 46, Issue 12, pages 1174–1178, December 2012
How to Cite
Loftus, S. (2012), Rethinking clinical reasoning: time for a dialogical turn. Medical Education, 46: 1174–1178. doi: 10.1111/j.1365-2923.2012.04353.x
- Issue published online: 21 NOV 2012
- Article first published online: 21 NOV 2012
- Received 3 January 2012; editorial comments to author 13 February 2012, 11 July 2012; accepted for publication 12 July 2012
Medical Education 2012: 46: 1174–1178
Context Clinical reasoning lies at the heart of medical practice and has been the subject of scholarly inquiry and research for some decades. However, despite this, it is still poorly understood. This is largely because current theoretical models are limited in their explanatory power because they are based on particular assumptions of what constitutes clinical reasoning.
Discussion A variety of ways of articulating and conceptualising clinical reasoning can provide us with richer means of understanding what is involved in clinical encounters. A dialogical approach to clinical reasoning is proposed. Dialogism provides a vocabulary that encourages us to integrate insights from different frameworks in ways that combine the strengths of each. Dialogism also puts a focus on the complex ways in which we use language in clinical reasoning to generate meaning. The complexity of language includes narrative, rhetoric and metaphor.
Conclusions A dialogical approach does not require us to discard the findings of earlier theories about clinical reasoning, but provides us with a means of integrating what we know in ways that are more useful in the reality of clinical practice.