Problem In Patients Research Articles

How the General Dental Council and NHS UDAs crushed the compassion out of dentists.

Various actions and policies of governmental agencies and the General Dental Council (GDC) have crushed the compassion out of many dental professionals. Compassion is not the same as sympathy or empathy; compassion involves doing something practical to overcome a patient's problems. However, many compassionate dental professionals now think of the GDC as a bit like being trapped in a lift with a wasp. The statistical probability is that nothing really terrible is going to happen to you for trying to solve a patient's problems pragmatically, but the tension and the worry that it might is always present. One effective way to reduce the chances of a painful experience is not to undertake slightly risky procedures. It is far, far safer to make copious notes but then to refer on anything potentially problematic, especially under the flawed NHS Units of Dental Activity system, 'just to be on the safe side', while bowing low to the GDC and claiming it is 'outside of one's competence'. The net result is a lack of clinical engagement in solving patients' problems practically, coupled with an ongoing lack of experience and confidence in solving similar patients' problems, as well as shifting some problems unnecessarily on to overloaded hospital departments. Who benefits from those perverse outcomes?

Bi-allelic variants in human TCTE1/DRC5 cause asthenospermia and male infertility.

Asthenozoospermia (AZS) is a common male infertility phenotype, accounting for 18% of infertile patients. The N-DRC (Nexin-dynein Regulatory Complex) complex is the motor regulating device in the flagellum, which is found in most eukaryotic organisms with flagellum. The deletion of TCTE1 (T-Complex-Associated Testis-Expressed 1), a component of the N-DRC complex also known as DRC5 (Dynein regulatory complex subunit 5), has been shown to cause asthenospermia in mice. This study mainly introduces a clinical case of male infertility with normal sperm count, normal morphological structure, but low motility and weak forward movement. By whole-exome sequencing, we found that TCTE1 became a frameshift mutant, ENST00000371505.5: c.396_397insTC (p.Arg133Serfs*33), resulting in the rapid degradation of TCTE1 protein and male infertility. This phenotype is similar to the Tcte1-/- (Tcte1 knockout) mice, which showed structural integrity but reduced motility. Further, different from mice, in vitro Fertilization (IVF) could successfully solve the patient's problem of infertility. Our data provides a better understanding of the biological functions of TCTE1 in human flagellum assembly and male fertility.

Experiences with a structured conversation tool: a qualitative study on feasibility in general practice in Norway

Objective To study the feasibility of a structured conversation tool (ICIT) in Norwegian general practice. Design and participants A structured conversation tool with elements from Cognitive Behavioral Therapy (CBT) was developed for use at the encounter in general practice to increase patient’s self-coping ability and the GPs management and sick leave assessment in patients with MUPS. Eight GPs received training and used the ICIT on 49 patients with MUPS. The physicians were gathered into two focus groups. The interviews were recorded on tape, transcribed, and analyzed with systematic text condensation. Main outcome measures The aim of our study was to examine any benefit and the feasibility of the ICIT in general practice. Results The physicians found the ICIT helpful to sort out, clarify and concretize the patients' issues. They felt less fatigued as patients took on a greater responsibility for their own recovery and reported a greater satisfaction and better management with the patients. A salutogenic approach gave the physicians greater insight into their patients’ lives and their issues, opening for new treatment options and aiding in recovery. By focusing on the patient’s potential capabilities despite their medical condition, some physicians experienced that patients on sick leave returned to work quicker. Conclusions The GPs in this study reported that the ICIT was helpful in consultations with patients due to unspecific medical conditions and facilitated a sense of competence for the physician. KEY POINTS GPs need communication skill training for integrated treatment and sick leave assessment for patients with Medically Unexplained Physical Symptoms (MUPS). •The GPs experienced that the structured conversation tool was beneficial in structuring, clarifying, and substantiating the patient's problems. •The GPs experienced a greater insight into their patients and their issues, opening new treatment options and aiding in recovery. •The GPs experienced patients’ quicker recovery and returns to work by starting immediate treatment using the conversation tool.

METHODOLOGY OF COMMUNICATION OF MILITARY STUDENTS WITH PATIENTS AT CLINICAL DENTAL RECEPTION

Abstract: The effective professional activity of a dentist is due not only to training at a military medical university. Demonstration of the patient at the dentist's appointment is an integral part of teaching dental disciplines at the Higher Military Medical School. The ability to communicate effectively with patients is an important task facing the teacher. Patients always value professional competence, the interaction of the medical staff and a good level of service in the dental office. Patients seeking dental care are quite vulnerable, so they often worry about how they will be treated in the doctor's office. Quite often, they complain about the inability of practicing doctors to listen carefully, to give clear and understandable answers. Ineffective patient communication is an obstacle to dental health. The aim of the study is to analyze the possibilities of optimizing the professional training of a military dentist, aimed at teaching communication with patients and surrounding medical personnel. Materials and methods. The object of the study was students in the specialty "Dentistry" of the Military Medical Academy named after S.M. Kirov. The assessment of the quality of training was carried out on the basis of a questionnaire and the use of visualization methods. Results and discussion. The main goal of the relationship between a doctor and a patient is to convey to the patient information about the causes of his problems and how to solve them. To win the patient's favor, the dentist must show concern for the patient's problems and feelings. Patients should be aware that they themselves can influence their health and feel comfortable in the doctor's office, and this depends on everyone in the office. It is necessary to organize the interview process in a confidential environment that allows the patient to relax. An empathetic and open-minded behavior builds trust and develops contact. Conclusion - the totality of the complex of spiritual qualities of future military doctors studying in the specialty "Dentistry", the culture of communication with the patient, the appearance of the doctor can reduce the number of medical errors, improve the quality of dental care.

The use of machine learning to support the therapeutic process - strengths and weaknesses.

Artificial neural networks, "artificial intelligence" or machine learning now dominate a number of areas, making many activities automatic and thus affecting the safety and comfort of life. Neural networks might provide intelligent decisions with limited human assistance. Medicine also uses artificial intelligence, also in models designed to support the therapeutic process. The aim of this article is to define the main directions of development of machine learning applications in supporting the therapeutic processes. Currently, the literature distinguishes at least a few applications of new technologies of varying degrees of advancement, with machine learning at the forefront [6]. It seems that the researchers are most interested in personalizing notifications of therapeutic applications, modifying therapeutic programs in a manner adapted to the patient's problems, and conducting "intelligent" conversations with them. There are dangers in using machine learning methods to support the therapeutic process. Particular attention should be paid to ensuring the full privacy of the implemented applications; moreover, selling user data of this type to third parties, such as those that sell certain medications or dietary supplements, would be ethically questionable. There are no legal regulations (or a system of recommendations of relevant scientific societies) that would limit proven applications to support the therapeutic process of a given disorder in the future, and which were created solely for the financial purpose of authors who did not conduct substantive consultations.

Effect of intramuscular electrical stimulation of articularis genu muscle with mirror therapy on anterior knee pain in a patient with knee osteoarthritis

Knee osteoarthritis (OA) is a degenerative condition that can develop in people who have quadriceps muscle weakness. Knee OA is more likely to develop in people who have weak quadriceps muscles, which extend the knee. Dysfunction of articularis genu muscle (AGM) is thought to be a cause of anterior knee pain in patients having OA of the knee joint. Herein, we report a case of anterior knee pain caused due to the dysfunction of AGM in a 41-year male who was initially treated with physical therapy, and it failed to ease the patient's problems completely. Intramuscular electrical stimulation (IMES) along with mirror therapy relieved his symptoms with no recurrence till 2 months of follow-up. IMES of the AGM combined with mirror therapy can be a viable therapeutic option for muscle reeducation and anterior knee pain.

Doctor Recommendation Chatbot: A research study

Healthcare is very important in our life. As the population increases, day by day the quality of communication between patients and doctors becomes less effective. So because of a load of patients in hospitals, the quality of treatment decreases day by day. So, there should be a system by which a patient can easily communicate with a chatbot. Then the chatbot will examine the patient's problem and at last, the chatbot will recommend a specific doctor for a patient. With the help of artificial intelligence, the proposed system will be developed using natural language processing that means the chatbot first diagnoses the patient's problem then recommends a doctor for consultation. During the COVID pandemic, the trends of virtual assistance increased, and people are interacting with robots and virtual assistants. In many countries, there are robots in hospital receptionists to solve problems of people and work like humans. Chatbots make it easy to find a particular doctor by telling them problems. In this research study, there are different literature reviews included making a healthcare chatbot.

Intervensi Keperawatan pada Pasien Terkonfirmasi COVID-19 dengan Komorbid DM Tipe 2 dan Hipertensi: Studi Kasus

Comorbidities in COVID-19 patients with the highest percentage are hypertension and diabetes mellitus. Patients with comorbid hypertension and DM have high morbidity and mortality. This study aims to determine the interventions in COVID-19 patients with comorbid DM and hypertension. The method used is a case study with data collection through patient and family interviews, medical record studies and direct observation or through CCTV. The studies showed that the patient was diagnosed with severe COVID-19 by oxygen therapy (NRM 15 L/min), treating COVID-19 and managing comorbid hypertension and DM with medication and monitoring and reducing anxiety. During treatment, the patient was desaturated, blood pressure and blood sugar level had not been controlled, and the anxiety was quite high. It can be said that interventions that can be given to COVID-19 patients with comorbid hypertension and DM are oxygen therapy, medication, anxiety reduction, and comorbid management. Comorbid hypertension and DM were controlled with medication and regular monitoring. the patient's blood pressure and blood sugar level had not been controlled, it is possible that the patient's anxiety is still experienced. So that as health workers in providing care are expected to pay attention to the biopsychosociospiritual aspects so that the patient's problems are resolved.

A Case Report on Mucocutaneous Leishmaniasis

Mucocutaneous Leishmaniasis (ML) can have devastating consequences, although early detection can help avoid difficulties. This research aims to explore clinical markers that can detect ML early. The protozoal infection Leishmaniasis is caused by fungal pathogens. The skin and mucosa are affected by mucocutaneous leishmaniasis (MCL). India is home to species like Leishmania donovani and Leishmania major, which cause visceral and epidermal leishmaniasis, respectively.
 The Main Diagnosis, Therapeutic Intervention and Outcome: Mucocutaneous Leishmaniasis was diagnosed after a physical examination and investigation by the doctor. Patient was treated antiepileptic drug and antianxiety drugs to reduce fear and anxiety.
 Therapeutic Intervention: Antipyretics and antibiotics such as Tab. Paracetamol, Injection Ceftriaxone 1 gm IV (BD), Tablet Pantoprazole 40 Mg iv (OD), Inj. Ondansetron 4 mg iv (TDS) were given for 7 days in this instance with Narcolepsy.
 Outcome: For fever, the patient was given medications prescribed by the doctor, such as paracetamol. In addition, the patient's condition improved as a result of the medical treatment. The patient's problems had subsided, and he reported feeling better.
 Nursing Perspectives: To control fever, the patient was given medications prescribed by the doctor, such as paracetamol. In addition, the patient's condition improved as a result of the medical treatment. The patient's problems had subsided, and he was in better shape.
 Conclusion: The patient was admitted to A.V.B.R. Hospital with a headache, breathing difficulties, muscle weakness, walking difficulties, reduced balance and coordination, and other symptoms. In this case of Mucocutaneous Leishmaniasis, the patient received the necessary treatment and medications. The condition of the patient had improved.

Awareness, perception and acceptability of digital physiotherapy intervention among Malaysian physiotherapist

Digital health intervention (DHI) can solve the patient's problem, such as geographical inaccessibility, delayed provision of care, low-level adherence to clinical protocols, and financial burden. DHI does not necessary to work as a substitution for a functioning health system but helps strengthen its function. Therefore, this study aimed to determine the awareness, perception, and acceptability of digital physiotherapy intervention (DPI) among Malaysian physiotherapists. A total of 209 practicing physiotherapists representing all the regions in Malaysia participated in this online self-reported questionnaire, including demographics profile, continuous professional development, awareness, perception and acceptability of DPI. Analyzed the collected data to determine the knowledge of DPI by using descriptive statistical methods. A 75.1% of the Malaysian physiotherapist aware of digital physiotherapy intervention, 69.38% perceived it reduces the cost for face to face, reduce the time for traveling 47.85%, improve adherence to exercises 42.58%, 78% of them agree with the DPI and 75.1% of them accepted to recommend the digital tools to their patient. Malaysian physiotherapists are aware, agree and recommend the digital physiotherapy intervention to their treatment plan. However, it should still raise awareness about digital physiotherapy intervention to lead them to the future. Developing new digital tools, utilization, and overcoming the various healthcare institutions' low acceptability considering the cost, conventional interventions, and time-consuming should be strategized in Malaysia.

Modified Anterior Z Le Fort III Osteotomy.

Surgery of the midface for non-syndromic patients with maxillo-malar hypoplasia exclusively has had many breakthroughs lately. The surgical techniques for midface surgery are varied and must be selected according to the patient's problem. The technique is a modification of the Z Osteotomy, the Modified Anterior Z Le Fort III Osteotomy (MAZLFIIIO), is used to correct posteroanterior midface deficiency of 6mm at most. It can be combined simultaneously with a Le Fort I osteotomy if a greater maxillary advance is needed. MAZLFIIIO advances midface without grafts or distraction osteogenesis. The anterior reposition of the midface is calculated in millimetres and depends on the relation of the eye's most inferior point, as well as the orbital's hard and soft tissues. It is a predictable osteotomy, only for patients without vertical excess of the midface. The osteotomy planned is drawn over a stereolithographic model, and then Z-shaped surgical splints are fabricated over it. Transverse midface deficiencies of no more than 4mm can also be corrected during the malar osteotomy. A great number of patients are operated exclusively with Le Fort I osteotomies, leaving behind an undesirable step between the upper part of the midface and the Le Fort I osteotomy. The Modified anterior Z Le Fort III Osteotomy (MAZLFIIIO) was performed in seven patients, from 2016 to 2018. The results obtained with the proposed osteotomy notably improve the appearance of the patient and provide a better protection of the lower part of the eye, while widening the maxillary sinus. We consider that maxillo-malar hypoplasias are very common; the surgeon pretends not to give importance to the deformity, exclusively using an advance Le Fort type osteotomy, with both functional and aesthetic treatment being limited. In this article, we give all the elements to perform this Le Fort III Modified Osteotomy in anterior Z, and that it is a combined and routine procedure in midface surgery.

PQRST: A framework for case discussion and practice-based teaching in general practice training.

One of the most important roles of the general practice supervisor is that of clinical teacher. Practice-based teaching comprises formal (structured) and informal (opportunistic) teaching, both ofwhich are primarily based on case discussion. There is no simple framework to guide effective case discussion across both forms of practice-based teaching. In this article, a newfive-stage model ofcase discussion is proposed: PQRST. Thestages are: P - What is the patient's problem?, Q - What is the registrar's question?, R - How well does the registrar reason?, S- What is the solution?, and T - What can be taught? The PQRST framework has many benefits. It is a simple framework for case discussion for both formal and informal teaching settings. It emphasises the assessment of clinical reasoning, is time efficient and explicitly prioritises patient and registrar safety. Additionally, it is adaptable for registrars at all levels of training and/or competence.

Literature Review: Effect of Interprofessional Collaboration Implementation of Patient Services

Introduction: At present progress in the health, the sector requires health workers to provide professional services. The patient's problem is also increasingly complex. Health workers are required to work in an integrated manner, therefore good collaboration and collaboration between healthcare professionals is needed in realizing patient satisfaction. Health services in hospitals are carried out by various health professionals. Effective interprofessional collaboration practices are key to providing health services. The management of the patient's health and all actions must be patient-focused. The model of providing care with interprofessional collaboration is very important so that all services are coordinated and there is good communication between caregivers. This study aims to find out about the effect of implementing interprofessional collaboration on patients. Methods: This research is a literature review. The research source was taken from several databases, with the keywords "Interprofessional collaboration, patient safety, health services". The Google Scholar database was found in 15,455 journals, EBSCO found 32, NCBI found 98, MEDLINE 23, and ProQuest 61. From the total database, only 11 met the inclusion criteria. Results: This meta-analysis shows that interprofessional collaboration has a positive impact. There are several benefits obtained from the application of interprofessional collaboration, namely affecting patient safety, patient quality of life, reducing the risk of falls, preventing medication errors, increasing the patient's functional status. elderly patients. Conclusion: Interprofessional collaboration or Interprofessional Collaboration (IPC) is collaboration between people with different professional backgrounds and working together to solve patient health problems and realize professional health services that focus on patients.Keywords: health services, interprofessional collaboration (ipc), patient safety

Quality of life of patients after a myocardial infarction

IntroductionA Latin adage says that "good health is better than the greatest wealth." [3] It has been known for a long time that the heart is the most important organ that works continuously throughout life to properly nourish all tissues, and thus determines the proper functioning and health of the entire human body. Meanwhile, despite the development of science, the advancement of diagnosis and treatment techniques, cardiovascular diseases, often leading to a heart attack, are the leading cause of death in most developed countries. [4]. Estimates of the National Centre For Heart Statistic say that 143 million people worldwide suffer from ischemic heart disease. [6]. A past of myocardial infarction, despite the high mortality, also affects the quality of life of patients. According to the definition of the World Health Organization (WHO), quality of life is an individual way in which an individual perceives his or her position in life in relation to the culture and value system in which he or she functions, as well as in the context of expectations, tasks and standards set by environmental determinants. [5]. The medical approach to the quality of life consists in identifying the patient's problems related to his physical, mental and social activity resulting from the disease and the treatment used, as well as describing his views on health and subjective well-being.

A concept analysis of Self-management among diabetes mellitus

The mortality and morbidity due to Diabetes Mellitus (DM) are increasing every year. Effectively in self-management has been demonstrated to conjunction patients with a health provider and support system to solve the patient's problem. Self-management in DM is very popular but still complex and abstract. Ambiguity regarding the intention of self-management in DM can cause confusion and misunderstanding among health professionals about the purpose and the application in the clinical situation. A perceptible definition regarding self-management for diabetes is required for clinical setting implication and future research. The study aimed to clarify and formalize the concept analysis of self-management in DM. We clarify the meaning of self-management in DM with concept analysis as outlined by Walker and Avant (2005). Attributes of self-management in diabetes were glycemic control process and activities, self-control, health-seeking, problem-solving, and decision making. Antecedents, consequences, and empirical referents are explained. Model, borderline, related, and contrary cases are explaining to clear and clarify the concept. Defining the concept can help the researcher solve the patient's problem about conjunction among patients with a health provider. Health professionals can advocate for antecedents in self-management and evolve interventions to support self-management attributes to serve patients in preventing complications

An Analysis of Blood Grouping Discrepancies : Study From Tertiary Hospital based Blood Bank in Vadodara

Background:-ABO and Rhesus blood group system is considered as clinically significant blood groupsystems in transfusion practice . A feature of the ABO system is the regular occurrence of anti A and anti B inthe absence of the corresponding red cell antigen. A Discrepancy exists when results of forward testing doesnot match with reverse testing. Blood donors and patients must be correctly ABO and Rh grouped becausetransfusing ABO incompatible blood transfusions which may lead even death of patient.Aims and Objectives To assess the incidence and cause of blood grouping discrepancies in Blood Bankat Tertiary care teaching hospital during Jan 2019 to December 2019.Methods : Forward and reverse grouping were performed on blood samples from inpatients ,outpatientsand donors during the study period. ABO discrepancies were studied with their clinical details to group theirdiscrepancies and resolve them with suitable steps.Results: A total of 10,048 (patients and donors) who satisfied inclusion criteria were included and ABOtyped among which there were 55 discrepancies were observed (15 donors and 35 patients). The problemin patients was due to expression of weak antigens. The problem in patients were due to clinical conditions,the most common being autoimmune haemolytic anaemia.Conclusions: The ABO blood group discrepancy reported in present study is 0.49%. The study helped todetermine the incidence and causes of discrepancy encountered in tertiary care hospital. Discrepant resultsshould be recorded, and resolved by suitable measures and correct ABO & Rh Blood group should bereleased to avoid any mismatched transfusions.

Evaluation of a novel consultant psychiatric clinic in general practices and its effects on secondary mental health contact and the general practitioners’ perspectives

AimsTo assess whether direct access to a 45 minute screen appointment in a Consultant Psychiatric clinic, based in General Practice, affects; the number of contacts patients have with secondary care pre and post being seen; whether the General Practitioner (GP) would have referred to secondary services if the clinic had not been in operation; the GPs’ views on how helpful the clinic was in understanding the patients’ problems and managing the problems outside of secondary care.BackgroundA Consultant Psychiatrist in Leeds offered bespoke 45 minute screening appointment clinics in three sister GP practices, accepting direct referrals from GPs without requiring referrals to the local Community Mental Health Team (CMHT). This model was created to reduce the number of patients moving repeatedly between GP and secondary mental health services as this was leading to patient dissatisfaction and increased GP and CMHT workloads.MethodWe compared the number of mental health contacts (per month), for each of the 57 patients who had been referred to the clinic, in the months pre and post being seen in the clinic. We also asked the involved GPs to complete a brief survey for each patient who had been referred to determine whether, they would otherwise have been referred to the CMHT and whether the clinic has helped with their understanding and management of the patients’ problems.ResultThe mean number of contacts with secondary services before being seen in clinic was 3.30 per month compared to 0.44 after being seen. The mean difference of 2.86 is statistically significant on a paired-test with a P Value of 0.0149 (95% confidence intervals of 0.58 to 5.13). We received 22 survey responses from GPs of patients referred to the clinic including for patients who did not attend. All 22 responses indicated that the patient would have been referred to the CMHT if the clinic had not been available. 95% were rated as being very helpful or moderately helpful in understanding the patient's problems. 91% were rated as very helpful or moderately helpful in managing the patients’ problems outside secondary care.ConclusionOur evaluation has demonstrated that a model of direct access for GPs to a Consultant Psychiatric clinic can reduce referrals and patient contacts with secondary mental health services. GPs have found this model helpful in understanding patients’ problems and managing the problems outside of secondary care.

Implementing Nursing round to Deal with Unresolved Nursing Problem on Patient with Acute Pain: A Case Report

Background: The determining factors for improvement of health services quality includes nursing services. Furthermore, a method for providing this quality nursing services is professional nursing care model, and comprises nursing round. However, fewer hospitals implement this due to several barriers including lack of knowledge and practices. This study is, therefore, aimed at identifying improvements in quality of nursing care and solving of patient’s problem by frequent nursing rounds.Design and Method: This study employed a single case report design using exploratory and descriptive methods. A 27-year-old male underwent nephrectomy surgery to treat hydronephrosis. The person still revealed persistent pain in the surgery area even though it has been treated for 3 days. The staff nurses administered nursing round to discuss and solve this problem. The study participation was voluntary, while the involved patient gave the informed consent. The steps of nursing round procedure including preround, round, and post-round were used to solve the problem.Results: The results indicated that nurses discovered blood clots in the patient’s drain during nursing round. The cause of the persistent pain was revealed and used to determine the intervention modification needed. It was recommended to evacuate the blood clot and followed by appropriate pain management. Furthermore, the problem in the patient with acute pain was resolved.Results: The results indicated that nurses discovered blood clots in the patient’s drain during nursing round. The cause of the persistent pain was revealed and used to determine the intervention modification needed. It was recommended to evacuate the blood clot and followed by appropriate pain management. Furthermore, the problem in the patient with acute pain was resolved.Significance for public healthThe presence of nursing rounds positively impacted patient satisfaction, and has the potential to improve patient-nurse interactions and promote the quality of care. Furthermore, nursing round is a structured intervention providing nurses with the opportunity to identify and solve patient’s needs and problems respectively. The findings on specific related problems are useful to support the evidence provided with regards to the possible benefits. This facilitates improved nurses decision-making abilities based on clinical observations and patient-centered care.

Recommending no further treatment: Gatekeeping work of generalists at a Japanese university hospital

In medical decision-making, doctors have to take into consideration whether patients' expectations can be satisfied while appropriately allocating medical resources. This study explores how recommendations for no further treatment, or gate-closing recommendations, are resisted by patients and how doctors react to resistance in outpatient consultations at a university hospital in Japan. We show how the type of patient resistance shapes doctors' reactions. Problem-focused resistance problematizes the doctor's understanding of the patient's problem or the treatment itself without focusing on the gate-closing aspect of a recommendation, and is met with doctors' persuasion through diagnosis-based accounts. Provider-focused resistance focuses on the gate-closing aspect of a recommendation, and leads doctors to manage their dual roles as patient advocate and resource steward. Two subtypes of provider-focused resistance further shape this work differently. Unwillingness-focused resistance is met with persuasion mainly through institution-based accounts. Unavailability-focused resistance is met with a concession. Doctors systematically respond to patients' resistance in order to reach an agreement during decision-making. They take measures to reconcile their dual roles, and orient themselves toward the implicit rationale of gatekeeping, which has a moral nature.

Embracing complexity with systems thinking in general practitioners' clinical reasoning helps handling uncertainty.

Clinical reasoning in general practice is increasingly challenging because of the rise in the number of patients with multimorbidity. This creates uncertainty because of unpredictable interactions between the symptoms from multiple medical problems and the patient's personality, psychosocial context and life history. Case analysis may then be more appropriately managed by systems thinking than by hypothetic‐deductive reasoning, the predominant paradigm in the current teaching of clinical reasoning. Application of “systems thinking” tools such as causal loop diagrams allows the patient's problems to be viewed holistically and facilitates understanding of the complex interactions. We will show how complexity levels can be graded in clinical reasoning and demonstrate where and how systems thinking can have added value by means of a case history.