A Narrative Approach to the Clinical Reasoning Process in Pediatric Intensive Care: The Story of Matthew |
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| Authors: | Michele A. Carter Sally S. Robinson |
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| Affiliation: | (1) Faculty of Medicine, Centre for Aboriginal Health Research, Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada, R3E 0W3;(2) Department of Geography (Medical), University of British Columbia, 1984 West Mall, Vancouver, BC, Canada, V6T 1Z2 |
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| Abstract: | This paper offers a narrative approach to understanding the process of clinical reasoning in complex cases involving medical uncertainty, moral ambiguity, and futility. We describe a clinical encounter in which the pediatric health care team experienced a great deal of conflict and distrust as a result of an ineffective process of interpretation and communication. We propose a systematic method for analyzing the technical, ethical, behavioral, and existential dimensions of the clinical reasoning process, and introduce the Clinical Reasoning Discussion Tool—a dialogical and interpretive device aimed at improving communication, understanding, empathy, and moral deliberation in the clinical setting. |
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