Les complaintes du carabin. Modèle pour un raisonnement clinique pratique

The teaching of clinical reasoning process combines, on the one hand the learning of theoretical knowledge to provide medical representation organized for specific actions to medicine, and on the other hand the transmission of a clinical practice based on these representations. However, the use of theoretical knowledge to clinical practice remains a challenge for the medical student. The concept of clinical reasoning process would then remain at the confluence of the theoretical knowledge and the clinical practice, which could not be derived completely from the theoretical knowledge. This article will thus try to give some keys to solve the problem of clinical reasoning learning. The first part will address the different medical reasoning modalities, around two main dichotomies: the dichotomy between a systematic and an oriented clinical data collection, the dichotomy between analytical and not analytical (intuitive) reasoning. The second part will address some fundamental medical representations that allow structuring the clinical reasoning process around theoretical concepts closer to the clinical action. The proposed representations are: the diagnosis (and the associated concept of syndromes and contextual data), the prognosis (and the associated concepts of disease progressive modalities, and of seriousness and severity) and the therapeutic (and the associated concepts of Evidence-Based Medicine and patient-centered approach).