Clinical Decision Making in Familiar Cases: A Model of the Process and Implications for Practice

The main finding was that therapists use schematic processing to speed the identification of problems and to indicate potential solutions and actions that are rapid and automated.

Abstract

This qualitative study describes the clinical reasoning and decision-making processes used by experienced occupational therapists in physical practice when deciding on the first intervention in a familiar type of case. The main finding was that therapists use schematic processing to speed the identification of problems and to indicate potential solutions and actions. Such processing is rapid and automated. Theory appears to become embedded in practice to the point where the therapist is no longer conscious of using it. A model of the mental problem space generated by therapists during decision making is proposed and the implications for practice are discussed. This model may help to explain some of the differences observed in the reasoning of novice and experienced practitioners. The sample is too small to permit generalisation, but the findings are compatible with theories of cognition and problem solving and also with the results of studies into medical decision making.