Clinical Patterns and the Factors That Shape Good Reasoning

Clinical patterns go well beyond diagnosis. Mark lists patterns of epidemiology, problem categorization, functional limitation, pain mechanism, pathology, symptom source, syndromes such as greater trochanteric pain syndrome, and physiological processes such as degenerative, inflammatory or ischemic changes. There are also patterns of impairments, predisposing factors, safety concerns such as irritability and red flags, management strategies and prognosis. The reasoning process leads to diagnostic, psychosocial, safety, management and prognostic judgments, then to interventions tailored from the guideline to the individual, and to reassessment that tests the hypotheses and feeds back into the clinician's evolving thinking. Reasoning quality depends on knowledge of procedures, patterns and guidelines; on cognition, meaning perception of relevance, interpretation and synthesis; on metacognition, the ability to monitor one's own questions, techniques and limits, which experts show by knowing what they do not know; and on data collection skills, since reasoning is only as good as the information gathered.