Clinical reasoning sits at the core of safe and effective healthcare practice. For Occupational Therapists (OTs) and other Allied Health Professionals (AHPs),it underpins everyday clinical decisions- from assessment and intervention planning to risk management and person-centred care. Although clinicians often make these decisions quickly and intuitively, the ability to clearly articulate and document the reasoning behind them is equally critical for safe practice, professional accountability, and effective multidisciplinary collaboration (Higgs et al., 2024).
Clinical reasoning can be defined as the cognitive and decision-making processes clinicians use to gather information, interpret clinical cues, identify problems, plan interventions, evaluate outcomes, and reflect on practice (Vallente, 2024). In practice, it is the mechanism through which clinicians make sense of a patient’s situation and determine the most appropriate course of action.
In complex healthcare environments such as rehabilitation, community services, acute care, and social care, strong clinical reasoning allows AHPs to deliver safe care, make defensible professional decisions, manage uncertainty, and work autonomously. Importantly, it also enables clinicians to learn from experience through reflection, gradually refining judgement and expertise over time (Higgs et al., 2024).
One key aspect of clinical reasoning is that it happens continuously during patient interactions. Clinicians constantly interpret cues and adapt interventions in real time-for example, deciding whether a patient is safe to mobilise, recognising fatigue during therapy, identifying early signs of deterioration, or adjusting positioning during a seating assessment. These moment-to-moment decisions rely on clinical knowledge, pattern recognition, and professional experience.
However, while reasoning occurs continuously in practice, documentation is where reasoning becomes visible. Clinical records should clearly explain what was observed, what conclusions were drawn, and why particular interventions were recommended. For example, rather than simply documenting “riser recliner chair recommended,” stronger documentation would explain that the patient demonstrated increased effort during sit-to-stand transfers and fatigue from low seating, therefore a riser recliner chair is recommended to support safe transfers and reduce physical effort.
Research suggests clinicians draw on several forms of reasoning simultaneously. Hypothetico-deductive reasoning involves forming and testing hypotheses during assessment, while pattern recognition allows clinicians to identify familiar clinical presentations from prior experience. Narrative reasoning focuses on understanding the patient’s story, goals, and values, while pragmatic reasoning considers environmental constraints and available resources. Ethical reasoning ensures that patient autonomy, safety, and risk management are appropriately balanced (Higgs et al., 2024).
Strong clinical reasoning connects assessment findings to intervention decisions. Effective reasoning integrates multiple factors, including physical function, environmental barriers, psychosocial context, patient goals, and risk considerations. Clear justification of recommendations- such as explaining that a shower seat is required due to reduced standing tolerance and increased fall risk- supports transparency and continuity of care.
When reasoning is weak or poorly documented, significant risks can arise. These include patient safety issues, communication breakdowns within multidisciplinary teams, and legal or professional challenges if decisions are questioned. Research suggests that diagnostic error may occur in 10–15% of consultations, often linked to reasoning failures or cognitive bias (Levett-Jones et al., 2010). Clear reasoning and documentation, therefore, play an important role in reducing risk.
Clinical reasoning skills develop through reflection and supervision. Reflecting “in action” during patient care and “on action” after clinical encounters helps clinicians analyse decisions and refine future practice. Clinical supervision provides opportunities to discuss complex cases, challenge assumptions, and strengthen critica lthinking- particularly valuable for early career practitioners but beneficial throughout professional development.
Ultimately, clinical reasoning is not separate from clinical practice- it is clinical practice. Every observation, assessment, and recommendation reflects the clinician’s reasoning process. By making that reasoning visible through clear documentation and reflective practice, AHPs can strengthen patient safety, professional autonomy, and high-quality care.
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Clinics in Integrated Care (2025) The importance of clinical reasoning in differential diagnosis for non-medical prescribers, nurses and pharmacists.
ECU Interprofessional Learning Manual (2023) Clinical Reasoning Literature Review.
Higgs, J., Jensen, G., Loftus, S., Trede, F. and Grace, S. (2024). Clinical Reasoning in the Health Professions. 5th ed. Elsevier.
Levett-Jones, T., Hoffman, K., Dempsey, J., Jeong, S., Noble, D., Norton, C., Roche, J. and Hickey, N.(2010) ‘The five rights of clinical reasoning: An educational model to enhance nursing students’ ability to identify and manage clinically at risk patients’, Nurse Education Today, 30(6), pp. 515–520.
Vallente, R. (2024) Clinical Reasoning. EBSCO Research Starters.
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