Annales françaises de médecine d'urgence

, Volume 1, Issue 1, pp 77–84 | Cite as

Comment les médecins raisonnent-ils pour poser des diagnostics et prendre des décisions thérapeutiques ? Les enjeux en médecine d’urgence

  • T. Pelaccia
  • J. Tardif
  • E. Triby
  • C. Ammirati
  • C. Betrand
  • B. Charlin
Revue de la LittÉrature / Literature Review

Résumé

Le raisonnement clinique est au coeur de la compétence médicale. Pourtant, dans le domaine de l’urgence, il a fait l’objet d’une attention très modeste de la part des chercheurs, au regard des autres déterminants de la performance des médecins. Le raisonnement clinique désigne les processus cognitifs mobilisés pour établir des diagnostics et décider d’actions thérapeutiques. À travers deux récits cliniques, nous décrivons les processus analytiques (réflexifs) et non analytiques (intuitifs) identifiés dans la littérature scientifique. Ceux-ci ont très majoritairement concerné les disciplines dites « conventionnelles ». Nous mettons en évidence le rôle déterminant de la pratique clinique, dans la mesure où elle permet aux praticiens d’élaborer des connaissances organisées et stockées en mémoire à long terme, qui sous-tendent le fonctionnement des processus de raisonnement. Nous évoquons également l’influence considérable du contexte sur le raisonnement, afin de justifier l’intérêt de mener des travaux de recherche visant à identifier si les médecins urgentistes mobilisent des processus cognitifs particuliers, au regard des spécificités qui caractérisent leur cadre d’exercice. La connaissance, par les praticiens, de la façon dont ils raisonnent est associée à des enjeux majeurs en termes de pratique de la médecine d’urgence et de formation dans cette discipline.

Mots clés

Raisonnement clinique Reconnaissance de formes Raisonnement hypothéticodéductif Chaînage avant Intuition 

How do physicians make diagnoses and decisions? Key issues in emergency medicine

Abstract

Clinical reasoning is a major determinant of physicians’ competence. However, it has not been much studied in the emergency medicine literature, when compared to other determinants. Clinical reasoning refers to the cognitive processes used to make diagnoses and decisions. Through a couple of clinical histories, we give a description of the analytical (conscious) and non-analytical (intuitive) processes that have been identified through studies made in conventional fields of medicine. We highlight the importance of clinical practice, since it allows the development of knowledge organized and stored in physicians’ long-term memory, which underlie the functioning of the reasoning processes. We also underline the importance of context in clinical reasoning, which justifies the interest to carry out research works on clinical reasoning in the field of emergency medicine, in regard to the specific characteristics of emergency medicine practice. Physicians’ knowledge of the reasoning processes, which they use to make diagnoses and decisions, is associated with major issues in terms of emergency medicine practice and education.

Keywords

Clinical reasoning Pattern recognition Hypothetico-deductive reasoning Forward reasoning Intuition 

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Copyright information

© Société française de médecine d'urgence and Springer-Verlag France 2011

Authors and Affiliations

  • T. Pelaccia
    • 1
    • 2
  • J. Tardif
    • 3
  • E. Triby
    • 2
    • 4
  • C. Ammirati
    • 5
  • C. Betrand
    • 6
  • B. Charlin
    • 7
  1. 1.Samu 67-Cesu 67hôpitaux universitaires de StrasbourgStrasbourgFrance
  2. 2.Laboratoire de recherche en pédagogie des sciences de la santé, faculté de médecineuniversité de StrasbourgStrasbourgFrance
  3. 3.Département de pédagogie, faculté d’éducationuniversité de SherbrookeQuébecCanada
  4. 4.Faculté des sciences de l’éducationuniversité de StrasbourgStrasbourgFrance
  5. 5.Pôle urgencesCHU d’AmiensAmiensFrance
  6. 6.Samu 94, hôpital Henri-MondorAssistance publique-Hôpitaux de ParisCréteilFrance
  7. 7.Centre de pédagogie appliquée aux sciences de la santé (CPASS), faculté de médecineuniversité de MontréalQuébecCanada

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