摘要
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
基金
The study received financial support(CHF50000)from the SGAIM Foundation(Foundation of the Swiss Society of General Internal Medicine),in the context of a call for research projects on multimorbidity(Project title:Understanding the clinical reasoning processes involved in managing multimorbid patients:a key to face future challenges in primary care.
