#19 Mastering Clinical Decision-Making: Insights with The Rehab Podiatrist, Alex Murray

Podcast Outline Overview

I had a wonderful discussion with Alex Murray the rehab Podiatrist which ebbed and flowed and covered a range of topics related broadly to clinical reasoning and decision-making.

I really feel like recent graduates and students will get a lot out of some of the topics including really learning how to tailor assessment and treatment to the individual and their own Values. This is in contrast to what we are often taught through universities and we tend to come out with set plans, procedures, protocols etc. Whilst these are still useful as Alex says, it’s important to know when to deviate from these and how to be a little bit more fluid within your sessions with patience.

Alex’s Journey and Evolution as a Clinician

Alex shared:

• What inspired him to pursue podiatry and later become a clinical educator and mentor?
• Key moments or influences that shaped his approach to clinical reasoning and decision-making.
• How his background in strength and conditioning informs his clinical practice.

3. Clinical Reasoning and Diagnosis

Alex shared:

• The systematic approach he uses to arrive at a diagnosis or differential diagnosis (DD).
• The importance of constantly reviewing and updating the diagnosis.
• How and when to integrate imaging results into clinical reasoning.

4. Treatment Selection and Management

Alex discussed:

• Method for selecting appropriate treatments or management strategies for patients.
• How he monitors progress and updates treatment plans if necessary.
• The role of outcome measures in informing and adjusting treatment strategies.
• How he incorporates clinical evidence into his treatment choices.
• The balance between clinical experience, patient preferences, and research evidence.

5. Philosophical Approaches to Clinical Reasoning

• • Discussed the hierarchy of evidence, with meta-analyses and systematic reviews at the top.
  • Explored the concept of evidential plurality and dispositionalism.
  • Challenged the traditional view that higher forms of evidence always trump lower forms, highlighting the value of various evidence types in different contexts.

More details

Alex really dived into the importance of communication and provided some fantastic insights into how to communicate clearly with the person in front of you to improve your appointments and outcomes.

We discussed the common trap that clinicians fall into. I’ve just trying the next thing when something fails. Rather than getting into this trap of just trying treatment after treatment Alex encourages clinicians to pause and reflect with the patient what it is that they really want. This shows that treatments and treatment outcomes are really tired back to the person’s goal or desired outcome.

Our discussion also touched on patient entered Care and how this doesn’t mean that we need to always have the patient take the lead. There are certain individuals who come to us much prefer the clinician to lead the process and even potentially decision-making process. It comes back to a much more individual approach to treating each person rather than, this dogmatic approach where we consider patient had Care as just reflecting everything back and asking them what they think.

Alex said his process of coming up with a diagnosis and even differential diagnosis and how he tries not to hold too fairly onto these especially initially until he has collected more data. 

He also shares how he approaches treatment and really informs the patient through the process how this treatment works and why it should work for this particular diagnosis that is the latest working hypothesis. 

There are a lot more clinical gems in this podcast and I really hope you enjoy this episode.

Please leave a review

If you do enjoy this episode or any of the episodes, I would really appreciate you taking the time to leave a five star review as it helps the Podcast reach more people and hopefully help spread more evidence informed information within healthcare.

Where can you find more about Alex?

Socials: https://www.instagram.com/therehabpodiatrist/

Education website: https://education.therehabpodiatrist.com/free

Website: https://therehabpodiatrist.com/