Tag: Clinical Uncertainty

You have assessed the patient.

You have an idea of what you think is happening.

You know roughly what you think should happen next.

Then someone asks:

“Why?”

And suddenly the explanation that felt reasonably clear in your head becomes much harder to say out loud.

You start listing everything you noticed.

You add some background information.

You mention another possibility.

Then another.

Halfway through, you realise you are no longer sure what your actual point was.

This can be particularly uncomfortable when you are newly qualified.

You may worry that a more experienced healthcare professional would have explained the situation more clearly.

Or that struggling to articulate your reasoning means you did not really understand it in the first place.

Usually, the reality is simpler.

Knowing what you think and being able to explain how you reached that judgement are related skills. But they are not exactly the same skill.

Learning to connect them is an important part of becoming a healthcare professional.

In Brief

Clinical reasoning is the process of making sense of information so that you can decide what it means and what should happen next.

Different professions use different terms, including clinical reasoning, professional reasoning and clinical decision-making. The exact form varies between roles, but the challenge is similar: interpreting information and deciding what it means for practice.

You increasingly need to communicate enough of that reasoning for colleagues and patients to understand the basis of your judgement.

That does not mean explaining everything you considered.

It means becoming clearer about:

• What you noticed.
• What you think it means.
• What you are uncertain or concerned about.
• What you think should happen next and why.

This is one of the less visible transitions from student to practitioner.

You are no longer only learning to make reasonable decisions.

You are learning to make the reasoning behind them visible.

What is clinical reasoning in healthcare?

Clinical reasoning looks different across healthcare professions.

It might involve interpreting an assessment, reviewing medication, deciding whether a change requires escalation, judging whether someone is safe to progress, or deciding what further information is needed.

The process often moves from:

information → interpretation → judgement → action

Clinical reasoning is therefore not simply about how much you know.

It is about what you do with what you know.

This is particularly relevant during the transition into practice. A UK systematic review of newly qualified allied health professionals found that graduates were generally well prepared in terms of knowledge, while responsibility and decision-making were among the areas where under-preparedness was more consistently identified.

So if this transition feels difficult, the problem may not be a lack of knowledge.

It may be learning how to prioritise, interpret and communicate that knowledge in real practice.

Clinical reasoning is not the same as listing everything you know

Imagine a colleague asks why you are concerned about a patient.

You respond by describing:

their diagnosis;

their medical history;

their medication;

everything they told you;

every assessment finding;

and several things you think might possibly be happening.

All of that information may be accurate.

But the listener may still be waiting for the most important part:

What does it mean?

Early-career practitioners can sometimes communicate the whole case because they are trying to demonstrate that they have been thorough.

Experienced practitioners often communicate something more condensed.

Not necessarily because they considered fewer things.

They may simply be better at recognising which information materially affects the decision.

Information is not the same as interpretation.

Compare:

“His respiratory rate is 25, his temperature is 37.8 and he says he feels tired.”

with:

“His respiratory rate has increased from 17 to 25 over the last two hours and he looks more unwell than earlier. That change concerns me, even though the rest of his observations are relatively stable, so I’d like him reviewed.”

The second explanation makes the reasoning easier to see.

It shows:

what changed → why it matters → what concerns you → what should happen next.

The practitioner has not necessarily gathered more information.

They have made the significance of that information clearer.

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Why can this feel difficult when you are newly qualified?

As a student, your reasoning is often supported by prompts.

A supervisor might ask:

“What do you think that means?”

“What concerns you?”

“What would you do next?”

“Why?”

After qualification, those prompts become less visible.

You are increasingly expected to organise that thinking yourself and communicate it during handover, supervision, MDT discussion, referral, escalation or documentation.

Experienced practitioners can also make this process look deceptively simple.

They may listen to a complicated presentation and summarise the main issue in two or three sentences.

That does not necessarily mean they thought about fewer things.

Experience helps practitioners recognise what matters most, what uncertainty changes the decision and what can remain in the background.

The goal early in your career is not to sound like someone with ten years of experience.

It is to become progressively clearer about the connection between the information you have and the judgement you are making.

Four questions that can make your reasoning clearer

These questions are not a clinical reasoning model.

They are a communication scaffold for moments when your reasoning makes sense internally but is difficult to explain.

1. What have I noticed?

Start with the information that materially matters.

• What changed?
• What did the patient tell you?
• What did you observe?
• What did the assessment, review or record show?

Instead of asking:

“What information do I have?”

try:

“Which information changes the decision?”

That helps you move from reporting everything towards identifying what is significant.

2. What do I think it means?

This is where information becomes interpretation.

You might say:

“The main issue I think we’re dealing with is…”

“That makes me concerned about…”

“I think this matters because…”

You do not have to pretend your interpretation is certain.

Sometimes the most accurate explanation will be:

“I’m not sure what is causing the change, but it is different from earlier and I don’t think it should be ignored.”

That is still reasoning.

3. What am I uncertain or concerned about?

Clear reasoning does not require uncertainty to disappear.

Often it helps to locate it.

For example:

“I’m comfortable with the assessment findings, but I’m uncertain whether the change is significant enough to alter the plan.”

Or:

“There are two reasonable options. My concern with proceeding today is…”

Being specific about uncertainty shows both what you think and where the limits of that judgement are.

If you find yourself waiting until you feel completely certain before you can act, read Confidence as a Newly Qualified Healthcare Professional: Safe Practice Without Certainty →

4. What do I think should happen next and why?

Now make the reasoning actionable.

What are you proposing?

Continue?

Review?

Reassess?

Gather more information?

Seek another opinion?

Escalate?

Then connect the action to your reasoning.

For example:

“Because her symptoms have changed since this morning, I think she needs reassessing before we continue with the original plan.”

Or:

“I’ve reached the limit of what I can establish from my assessment and, because the consequences of missing this could be significant, I’d like another opinion.”

Sometimes good reasoning does not lead to the final answer.

Sometimes it leads to:

“I don’t yet know what this means, but I know enough to recognise that it needs checking.”

That is still professional judgement.

And when another person’s input is needed, knowing how to ask clearly becomes part of the same process. How to Ask for Help Without Feeling Incompetent → explores how to organise that request without pretending that you already know the answer.

A worked example

Imagine a newly qualified occupational therapist assessing a patient who may be returning home.

The patient is independently mobile around the ward and managing basic personal care.

The OT is still concerned.

When asked why, their first explanation is:

“I’m just not sure they’re ready yet. They were a bit muddled earlier and I’m worried about them going home.”

The concern may be reasonable.

But another professional cannot yet see exactly what is driving the judgement.

What have I noticed?

During a kitchen assessment, the patient repeatedly forgot that the hob had been switched on and required prompting.

What do I think it means?

The difficulty appears when the task requires the patient to manage several pieces of information independently.

What am I concerned about?

They live alone and will need to prepare meals without someone present to prompt them.

What do I think should happen next?

The OT explains:

“They’re managing personal care and mobility independently, but during the kitchen assessment they repeatedly forgot the hob was on and needed prompting. Because they live alone, I’m concerned about how safely they can manage meal preparation without support. I’d like to explore that risk further before I’m comfortable supporting the current discharge plan.”

The OT has not suddenly developed more expertise.

They have made the reasoning easier to see.

That allows the wider team to respond to the judgement.

Someone may provide information the OT did not have.

Someone may challenge the interpretation.

The team may identify additional support.

Or the original concern may be reinforced.

Visible reasoning allows professional judgement to become collaborative rather than private.

The hidden curriculum: colleagues gradually learn how you think

Early in your career, it is easy to assume that professional credibility comes mainly from knowing the answer.

Knowledge matters.

But colleagues also gradually learn whether you can:

• identify what is important;
• recognise when something does not fit;
• understand the limits of your knowledge or role;
• respond proportionately to risk;
• explain your judgement; and
• involve other people appropriately.

These expectations are not always taught explicitly.

They are part of healthcare’s hidden curriculum.

The lesson is not:

You must always be right.

It is:

Other people need enough access to your reasoning to understand whether your judgement is reasonable.

That matters for credibility.

But it also matters for safety and learning.

Reasoning that can be seen can also be questioned, refined and improved.

What if someone disagrees with your reasoning?

Making your reasoning clear does not guarantee that another healthcare professional will agree with it.

Nor should it.

Another practitioner may have information you do not have.

A more experienced colleague may notice something you missed.

A different profession may interpret the situation from another perspective.

Being able to say:

“This was my reasoning…”

therefore opens the conversation rather than ending it.

You might hear:

“I can see why you thought that. Have you also considered…?”

A useful question afterwards is not only:

“Was I right?”

Try:

“What did they notice that I didn’t?”

That turns disagreement into information you can use next time.

If having your thinking questioned makes you worry that other people are discovering you are not as capable as they thought, read Why Do New Healthcare Professionals Often Feel Like Imposters? →

Use supervision to learn how experienced practitioners think

One way to improve your reasoning is to ask questions that reveal how another practitioner reached their judgement, rather than only whether your answer was correct.

Instead of asking only:

“Was that right?”

try:

“What were the main things you were paying attention to there?”

“What made that finding important?”

“What would have changed your decision?”

“What did you notice that I hadn’t prioritised?”

You can also reflect afterwards:

• What information turned out to matter most?
• What did I initially focus on that mattered less?
• What changed the decision?
• What might I recognise earlier next time?

Those questions help turn one experience into something you can carry forward.

What clear clinical reasoning can sound like

Clear reasoning does not always sound decisive.

Sometimes it sounds like:

“Based on the information we have at the moment, I think…”

“The most important change is…”

“The part I’m uncertain about is…”

“I need another opinion because…”

“I don’t know yet. I need to check.”

These statements do not necessarily weaken professional credibility.

They make the judgement easier to locate.

The listener can understand what you think, why you think it, what limits that interpretation and what you think should happen next.

Reflection

Think about a recent situation in which you knew roughly what you thought but found it difficult to explain.

Ask yourself:

1. What did I notice?
2. What did I think it meant?
3. What was I uncertain or concerned about?
4. What did I think should happen next and why?

Then ask:

Could another healthcare professional understand my judgement from that explanation?

You are not trying to produce perfect wording.

You are practising the connection between reasoning and communication.

The Core & Oak Perspective

Early in your career, it is easy to believe that credibility comes from knowing the answer.

Knowledge is essential.

But professional practice asks something more of you.

You have to decide which information matters.

You have to interpret it.

You have to recognise uncertainty and risk.

And increasingly, you have to explain the professional basis for what you decide.

That is part of healthcare’s hidden curriculum.

Your reasoning cannot always remain invisible.

Other people need enough access to it to understand, challenge and trust your judgement.

That does not mean sounding impressive.

It does not mean explaining everything you know.

And it does not require perfect certainty.

It means becoming increasingly able to say:

This is what I noticed.

This is what I think it means.

This is what I am uncertain or concerned about.

And this is why I think this is the safest reasonable next step.

That is more than communicating a decision.

It is making professional judgement visible.

Your next step

Continue exploring early practice

If making decisions when you are uncertain is the difficult part:

Confidence as a Newly Qualified Healthcare Professional: Safe Practice Without Certainty → Explore how to make safe, proportionate and defensible decisions when complete certainty is unavailable.

If you know you need another person’s input but struggle to ask clearly

How to Ask for Help Without Feeling Incompetent → Learn how to organise your thinking, explain what you have already considered and ask for support clearly.

If explaining your thinking makes you feel exposed or inexperienced

Why Do New Healthcare Professionals Often Feel Like Imposters? → Explore why professional responsibility can increase faster than confidence, even while your capability is developing.

Want to develop these skills more systematically?

About the author

Dr Michael McCluskey is a Chartered Physiotherapist and Senior Fellow of the Higher Education Academy, with experience across clinical practice, healthcare education, programme leadership, assessment and curriculum development.

He founded Core & Oak to create evidence-informed professional development that makes the hidden expectations of healthcare practice clearer.

Professional education disclaimer

This article provides general professional education. It does not provide individual clinical, employment, legal or other professional advice.

Healthcare professionals should work within their scope of practice and follow the policies, escalation procedures and professional standards relevant to their profession, role and organisation.

Editorial and evidence standards

Core & Oak content is developed using the following principles:

• Content is written or reviewed by a suitably qualified professional.
• Professional and regulatory sources are prioritised where relevant.
• Research evidence is interpreted cautiously and within its limitations.
• Practical guidance is distinguished from individual clinical advice.
• Uncertainty, contextual variation and system pressures are acknowledged.
• Articles are periodically reviewed and updated.
• Commercial links are included only where the resource is relevant to the reader’s identified need.

Further reading

Brennan, N., Burns, L., Mattick, K., Mitchell, A., Henderson, T., Walker, K. and Gale, T. (2024). How prepared are newly qualified allied health professionals for practice in the UK? A systematic review. BMJ Open, 14, e081518.

Brentnall J, Thackray D, Judd B. Evaluating the Clinical Reasoning of Student Health Professionals in Placement and Simulation Settings: A Systematic Review. Int J Environ Res Public Health. 2022 Jan 14;19(2):936. doi: 10.3390/ijerph19020936. PMID: 35055758; PMCID: PMC8775520.

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