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How complete is your knowledge-base?

A clinician faced with a situation in which there is complexity, confusion or doubt will:

  • consider a solution from past experience
  • review the depths of their current knowledge in search of a solution

If experience and knowledge are inadequate to clear up the confusion, the problem cannot be solved by that clinician!

Health assessment is rather like being a detective!

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Health assessment involves collecting clues to point us towards the solution to the problem, critically assessing the likelihood of each potential solution (or diagnosis) against the clues presented.

For a clinician, responding to problems or problem-solving comes from critical thinking and decision-making.

  • the act of choice – drawing on various knowledge sources
  • following deliberation – note: practising this develops the skill
  • applying clinical judgement
  • achieving decision-making (Thompson and Dowding, 2009)

So, your ability to think critically depends not just on cognitive skills, but also upon:

  • a composite of clinical skills, experience, knowledge and attitudes
  • the ability to discriminate between conflicting signs or symptoms
  • a consideration of the logic, the accuracy of evidence and any underlying assumptions

Your task

Think back to the video of Brian’s consultation in Step 1.8 Introducing the Jones family.

Brian mentions some lifestyle choices and occupations which may have had an effect on his health. Think about his smoking habit (he mentions he used to walk to the shop to buy cigarettes or ‘ciggies’), his work in the coal mine and the warehouse; what long-term conditions may be associated with these factors?

Suggest the most likely long-term conditions that Brian may have, or may be likely to develop.

Share your thoughts on the variety of influences, including any biases, that may have affected your critical thinking and clinical decision-making in the case of Brian. You might also wish to add your reflections into your log or portfolio.


Thompson, C., and Dowding, D. (2009) Clinical Decision Making and Judgement in Nursing. Edinburgh: Churchill Livingstone

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This article is from the free online course:

An Introduction to Physical Health Assessment

Coventry University