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" Clinical Reasoning
Clinicians spend most of their time reacting to disorder, rather than preventing it (small editorial comment here on the this - reactive care is a necessary function given the existence of disorder and human suffering; but we DO need other people to be in the prevention business!).

People don't typically arrive at the clinic and report their patho-anatomic diagnosis (some try, just like play-by-play broadcasters 😂). They may report presumed cause (I was hit, or fell, got burned, etc.). Most often, they present with manifestations of disorder = symptoms (because it is them making the observation).

A clinician starts with these symptoms, and attempts to discern as much patho-anatomy and/or etiology as they deem required to guide treatment recommendations or interventions. They will elicit more symptoms (take a history of disorder), observe signs (conduct a physical examination), and/or order lab tests to do so.

While eliciting, and once they have a sufficient set of manifestations of disorder, they can try to deduce what the most likely underlying patho-anatomy and/or etiology of disorder is. This is called clinical reasoning.

This is an exercise in bi-directional Bayesian probability analysis, whether the clinician knows it or not. Clinicians typically don't crunch too many numbers - they are making ballpark estimates of these probabilities, not actually calculating them (some exceptions to this, and it will likely trend in that direction with increased use of AI / machine-learning in diagnosis).

Bayesian analysis uses conditional probabilities. We write P(A|B) to denote the probability of A given B, which means how likely it is that A will exist or occur if we know for sure that B already does or will exist or occur.

In clinical reasoning, we use conditional probabilities in two directions:

P(PA or E | M) = the probability of some Patho-Anatomy or Etiology given the presence of some Manifestation(s)
P(M | PA or E) = the probability of some Manifestation given the presence of some Patho-Anatomy or Etiology
Clinicians go back-and-forth, often multiple times. Starting with what is the most likely PA or E given M, they ask what other manifestations would most likely (not) be present if this presumed PA or E does (not) exist, then look for those, re-order the list of most likely PA or E based on newly larger set of observed manifestations, rinse-and-repeat - until the confidence in a diagnosis is adequate to guide treatment.

I will take you through some examples of this process in the first webinar for this module.

At this point in your careers, you don't need to be facile with executing this, but you should understand what this process is.

From Module 4 onward, as we go through the body region-by-region learning about the most common Patho-Anatomic and Etiologic disorders encountered in sport and exercise medicine, we will indicate what the most common manifestations of these disorders are.

I will also sometimes take the opposite direction of approach, and discuss what the most common patho-anatomy or etiology of some common manifestations (e.g. - knee pain, back pain) are.

So you need to recognize which direction we are approaching these topics from at those times - from the perspective of the manifestations (the clinical perspective), or the perspective of the patho-anatomic or etiologic disorder (the pathologic perspective). " with all the infromation above can you explain the idea/concept to a 15 year old

Sure! Let's break down the concept of clinical reasoning in simpler terms for a 15-year-old:

Imagine you're playing detective, but instead of solving a mystery, you're trying to figure out what's wrong with someone's body when they're not feeling well. People don't always know what's wrong, so they go to a doctor or nurse for help.

When someone goes to the doctor, they usually talk about how they feel - like if they have a headache, stomachache, or a sore throat. These feelings are called symptoms. Doctors start by listening to these symptoms and trying to figure out what might be causing them.

To do this, doctors ask questions about the symptoms, check the person's body, and sometimes do tests like blood tests. This helps them gather information about what might be happening inside the person's body.

Now, here's where it gets a bit more complex. Doctors don't always have a clear answer right away. They use something called "clinical reasoning" to make educated guesses. It's like making smart guesses based on the clues they have.

Imagine you're playing a game, and you have to guess what's inside a box without looking. You can only touch the box from the outside. You might feel it's heavy, and you might hear something rattling inside. Based on these clues, you make a guess about what's in the box - maybe it's a toy or a book.

Doctors do something similar. They think about what could be causing the symptoms based on the information they have. This is where the idea of "Bayesian probability analysis" comes in, but you don't need to worry too much about the fancy terms.

They think about two things:

The probability that a certain problem in the body (like a specific disease or injury) is causing the symptoms.
The probability that a certain symptom would show up if that problem is indeed happening.
Doctors keep going back and forth, adjusting their guesses as they learn more. It's like if you guessed the box contained a toy, but then you heard a meow, you might change your guess to a cat.

Doctors do this until they're pretty confident about what might be causing the problem. Once they figure it out, they can recommend the right treatment or medicine.

As you learn more about medicine, you'll also discover common problems that cause certain symptoms, and you'll get better at this detective work. So, clinical reasoning is like being a medical detective who tries to solve the mystery of why someone is not feeling well based on the clues they have.