Preface

As a pharmacist, critical decisions that impact patient care occur every day. Applying critical thinking and clinical reasoning skills in an efficient, objective, stepwise approach is imperative to ensure patients receive excellent medical care. Expanding knowledge and understanding of clinical reasoning and common critical thinking skills is just the beginning of growth in this area.

This book explores the clinical reasoning of pharmacists in a variety of practices as they engage in clinical problem-solving through application of the Pharmacists’ Patient Care Process (PPCP) to patient cases. It also explores the roles that critical thinking can play in enhancing a pharmacist’s reasoning. The general target audience for the book are second- and third-year student pharmacists, with a primary goal of helping them to discover and appreciate how critical thinking, clinical reasoning, and the PPCP can work together to optimize pharmacist-provided patient care and help them develop skills in each of these areas. A secondary goal of the book is to help third-year students prepare to successfully participate in different clinical practices during their Advanced Pharmacy Practice Experiences in their final academic year.

The book begins with an introductory chapter on the PPCP, clinical reasoning, and critical thinking, followed by eight clinical chapters split between four ambulatory care chapters, two inpatient care chapters, and two inpatient/outpatient care chapters. We purposely included a variety of practices to help the reader understand and appreciate the common and unique ways clinical reasoning, critical thinking, and the PPCP can be applied to different cases in different practice settings. The book concludes with an appendix that contains worksheets to help the reader develop critical thinking standards-based questions, apply reasoning and critical thinking in each PPCP step, and identify potential biases and approaches to avoid or mitigate them.

Topics discussed in the introductory chapter include elements of a patient-centered approach to care, the stepwise process of the PPCP, diagnostic and therapeutic (management) reasoning, common inferences and conclusions of each PPCP step, system 1 and system 2 thinking, common biases and how they can impede effective clinical reasoning, and intellectual critical thinking standards and intellectual standards-based questions that can be employed to optimize the pharmacist’s reasoning in each step of the PPCP.

The clinical chapters cover ambulatory care in Chronic Pain Management, Geriatric Care Cardiology, Type 2 Diabetes Management, and Warfarin Management and inpatient care in Critical Care—Diabetic Ketoacidosis and Inpatient Psychiatry Care—Treatment-Resistant Schizophrenia, and inpatient and outpatient care in Pediatric Care—Nephrology Service and Inpatient and Outpatient Infectious Disease Care—Transitions of Care & Outpatient Parenteral Antimicrobial Therapy (OPAT).

Knowing that our target audience would be second- and third-year student pharmacists, we set out to create a writing approach in full recognition of differences in clinical problem-solving between novice students and experienced clinicians. Experienced clinicians, through their many interactions with patients, have a great deal of experience-related knowledge stored in long-term memory. They see patterns in patient data more readily, they have automatized many clinical skills, and are better able to engage the fast and intuitive system 1 thinking described in the introduction chapter. Therefore, for the benefit of the novice students to whom this book is dedicated, we asked each clinician author to engage the reader by first describing their clinical practice and the care provided. Then, with an analytical system 2-like approach, they break down their patient care process, describing the details of their reasoning and critical thinking as they methodically worked through each step of the PPCP in problem-solving a patient case. To help the clinician authors accomplish this, we created a structure for the pain management chapter that would ultimately serve as a template for the remaining clinical chapters. We also created worksheets similar to some of those in the appendices and we worked closely with each author providing guidance, feedback, editing, and other help (eg, concept-mapping) as needed. Prior to their writing the chapters, we recommended that the authors read the introduction chapter to become thoroughly familiar with the concepts and skills we wanted them to impart to their readers.

We hope that in the writing of their chapters, the self-analysis required for these experienced clinicians to break down their patient care process and describe the details of their reasoning and critical thinking was also a process of self-discovery, where they could not only validate their reasoning, but also uncover and correct flaws in their reasoning on a pathway to self-improvement. Thus, by encouraging reasoning and critical thinking skill development in novice student pharmacists and self-analysis in experienced clinicians, it is hoped that this book can achieve its ultimate purpose for which it is dedicated: helping pharmacists provide the best care possible to their patients.

We are very grateful to all of the contributing clinician authors who tirelessly and patiently worked with us in creating their chapters, and who through their writing have allowed the reader to peer into their practice and into their excellent minds. A special thanks go to Michael Weitz, Senior Associate Global Publisher for Medical, Pharmacy & Allied Health Textbooks at McGraw Hill, and Kim Davis, Director, Medical Development at McGraw Hill, and Poonam Bisht, Senior Project Manager at MPS Limited for their enormous patience and guidance. We also thank our pharmacy students who continuously inspire us to improve our craft of teaching. Most importantly, we are each grateful to our families, whose love, support, and patience helped make the writing and editing of this textbook achievable and rewarding. Finally, we thank each other for developing and maintaining a truly synergistic and longstanding working relationship forged from community practice experience and deep interests in epistemology, reasoning, and critical thinking by Cary Mobley with the ambulatory care clinical experience and clinical reasoning acumen of Robin Moorman Li. It is a relationship that has enabled us to develop numerous exercises and programmatic training for our students and has enabled us to create this textbook, which we are grateful to be able to share with the pharmacy academic community with whom we look forward to engaging in a mutual effort to improve the clinical reasoning and critical thinking of student pharmacists.