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Rethinking clinical reasoning: time for a dialogical turn


Dr Stephen Loftus, MSc, PhD, Education for Practice Institute, Charles Sturt University, Locked Bag 450, Silverwater, New South Wales 2128, Australia. Tel: 00 61 2 9752 9002; Fax: 00 61 2 9746 3647; E-mail:


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.