Adapting the Clinical Decision Model

An Adaptation of the Clinical Decision Making Model

The clinical decision making model is a framework used by clinicians to guide their decision making process.

It goes something like this – the best clinical decision you can make is by combining a patient’s preferences, with your own experience and expertise, with best available research evidence. Allow me to repeat that. The best clinical decision you can make is a combination of factors.

The beauty in this model is that it recognises the limitations of each stakeholder. It is inadequate to simply use the best evidence for every case you come across. It is inadequate to only use your own clinical experience. It is DEFINITELY inadequate to only go by what the patient wants.

Without patient input, you have less adherence or buy-in.

Without research evidence, you risk going against what works.

Without your own clinical experience, you might as well just give your patient a textbook and ask them to solve their problem themselves.

I believe this framework shouldn’t be limited only to the clinical-health field.

It can very easily transfer over our roles as coaches/fitness professionals.

Whatever the health goal, we will always begin by defaulting to the best available evidence. For example, suppose your client wants to reduce their waist circumference. One of the best ways to achieve this is probably to introduce a diet intervention (best available evidence). However, you come to discover that your client has an unhealthy relationship with food. Your client tells you that they would like to work on the exercise component first because they don’t want to watch their food any more than they should.

Your coaching experience also tells you that those who already have unhealthy relationships with food, are usually made worse by being put on a diet intervention.

Given all the information presented to you, perhaps the best course of action is NOT to introduce a diet intervention despite best available evidence suggesting that you should. Quite often, the ‘evidence’ we are given is not enough to make sound recommendations – we must merge it with client preferences as well as use our individual coaching discretion.

I believe a lot of young coaches make the mistake of believing that their knowledge is enough to make good health decisions. This frequently leads to a mismatch of expectations as well as frustration, as clients generally do not buy in to a program unless they have their preferences heard. Conversely, some trainers rely on what their clients want TOO much, which becomes a problem if the client’s beliefs are empirically and experientially incorrect.

Ultimately as professionals, we must balance all the factors that could lead to the best decision – sometimes, the best decision may not be the quickest. In fact, it might be the slowest. This is the art of coaching.