Binbin ZHANG, Christopher ZASLAWSKI

Abstract

Introduction Clinical reasoning is the bridge between knowledge acquisition and clinical practice. While there has been extensive research into the clinical reasoning processes associated with medicine, nursing and many other allied health services, there is scant research that has been undertaken in the area of Chinese medicine. 

Outcome The research investigates the cognitive reasoning process of experienced practitioners of Chinese Medicine and acupuncture. 

Methodology This project endeavours to analyse the clinical reasoning process associated with Chinese medicine using both qualitative and quantitative research methods. Six experienced (range 6-30 years) Chinese medicine practitioners (4 female/2 male) were supplied with two individual case study concerning migraine and insomnia. The participants were required to reason the most appropriate diagnostic patterns (zheng) for the two case studies. The data collection was audiotaped and analysed for diagnostic reasoning approaches using NVIVO. Furthermore, a second round of analysis occurred when the practitioners were asked to review their initial audiotaped data and explain their reasoning regarding the questions asked and their sequence. Human research ethics approval was obtained prior to data collection.

Result  It was found that the practitioners asked similar questions about the same case. The mean number of questions was 30 for the insomnia case and 37 for the headache case. The top three questions for both cases concerned medical history, sleep and emotional disorders. In addition most of practitioners asked questions concerning patient information in clinical reasoning process. Further research using both qualitative and quantitative methods should be undertaken to identify the unique key characteristics and features of clinical reasoning associated with Chinese medicine. 

Discussion  Clinical reasoning is an important phenomena associated with Chinese medicine clinical practice. Different education and clinical practice backgrounds may affect the way that clinical practitioners reason. The research will promote a better understanding of the clinical reasoning phenomenon and in doing so benefit Chinese medicine education and clinical practice. 

Key Words   clinical reasoning, Chinese medicine, acupuncture, diagnosis, process, clinical practice, education