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CHAPTER AIMS
The aims of this chapter are to:
Discuss how clinical reasoning, critical thinking, and the PPCP (Pharmacists’ Patient Care Process) can unite to optimize pharmacist-provided patient-centered care.
Describe elements of a patient-centered approach to care, including the roles of the biopsychosocial model of health.
Describe each step of the PPCP.
Describe and differentiate diagnostic reasoning and therapeutic (management) reasoning.
List common biases and describe how they can impede effective clinical reasoning, and strategies for overcoming and combating implicit bias.
List 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.
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KEY WORDS
• Clinical reasoning • critical thinking • PPCP (Pharmacists’ Patient Care Process) • diagnostic reasoning • therapeutic reasoning • intellectual standards • dual process theory • biopsychosocial model • patient-centered care • cognitive and implicit biases • objectivity
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“Reasoning is our best guide to the truth. It is the process of systematically working toward the solution of a problem, toward the understanding of a phenomenon, toward the truth of the matter.”1
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Reasoning—the forming of conclusions, judgments, or inferences from facts or premises—is our indispensable cognitive tool that enables us to understand and explain reality; to determine truth from falsehood, what to value and why, and how to act and live; to make decisions; and to understand, explain, and solve problems. This includes solving clinical problems, for which clinical reasoning is employed by clinicians from a variety of healthcare disciplines to “integrate clinical information (such as histories, exam findings, and test results), preferences (eg, of the patient), medical knowledge, and contextual (situational) factors to make decisions about the care of patients.”2 The excellent clinician relies on excellent clinical reasoning to rationally investigate, understand, explain, and resolve clinical problems. Pharmacists use clinical reasoning to rationally investigate, understand, explain, and resolve drug therapy problems (DTPs) within the context of the patient’s overall healthcare.
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KEY POINT
Pharmacists use clinical reasoning to rationally investigate, understand, explain, and resolve drug therapy problems.
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To optimize the quality of our reasoning and thinking, we think critically. That is, we “skillfully take charge of the elements inherent in our thinking and impose intellectual standards on them.”3 These elements of our thinking include information and concepts, inferences and conclusions, implications and consequences, different perspectives, questions, and assumptions. The intellectual standards we apply to these elements of thinking are many, and include clarity, accuracy, and objectivity. These and others will be described later in this chapter and applied to patient problem-solving in each chapter of this book. By routinely applying critical thinking standards to our thinking, we can become more effective critical thinkers, which can improve our ability to gather, assess, and communicate relevant information, to formulate problems clearly, and to arrive at ...