Clinical reasoning is a major component of clinical competence and is a dynamic process that occurs before, during, and after the collection of data through history, physical examination, imaging, and endoscopic and laboratory tests. Thirty-seven contributors to this book have produced 27 chapters on the methods clinicians use in clinical reasoning, methods used in the present and past to teach clinical reasoning, and current research related to improving student instruction in this area. Only one of the book's authors is a physician, and most references pre-date 1993.

Forms of clinical reasoning important to the physician's diagnosis and therapeutic choices are discussed in excellent chapters by Higgs and Jones (chapter 1) and Elstein (chapter 4). The uses of clinical reasoning by nurses, physiotherapists, and occupational therapists are discussed in separate chapters. Chapters on the teaching of clinical reasoning to physicians, students of speech and hearing science, physiotherapists, nurses, students of orthoptics, and occupational therapists appear later in the book. Methods of reasoning often used by inexperienced and expert clinicians are clearly described. Rapid pattern recognition and categorization is a common and rapid means of diagnosis used by experts, whereas more difficult and complex cases require the use of inductive reasoning to develop a set of hypotheses (possible diagnoses) and then the use of deductive reasoning for further testing and data interpretation. This hypothetico-deductive method is usually slower to achieve a diagnosis, and it requires that the expert have a large and case-specific database in memory. The authors point out that problem-solving expertise has been shown to be highly problem-specific and that the reasoning skills used to solve one problem do not guarantee success if the content or nature of the next problem is different.

The book is encyclopedic in scope, and some parts are so concerned with basic definitions and theories of knowledge that they read like sections of a philosophy text. The chapters on reasoning in other health professions frequently repeat what has gone before. They may be attempts to enlarge the book's audience or, more generously, to give guidance to health professionals other than physicians and medical students. Problems in the teaching of clinical reasoning in medicine are discussed, and current and proposed efforts are described. The past failings of patient management problems are well described, as are the difficulties in assessing and scoring student performance on tests of clinical reasoning. Discussions of computer-assisted reasoning are somewhat sketchy; this is an important deficiency, because computer assistance is needed to solve clinical problems with a high rate of accuracy. The role of quantitative methods, such as sensitivity, specificity, predictive values, and likelihood ratios, in clinical reasoning is not discussed. Stricter editing and shorter length would have been improvements.

Despite the abundance of redundant and irrelevant information in some chapters, this is an excellent book on a difficult subject that is critically important to the education and clinical efforts of all health care workers. At least half of the chapters are well worth reading at least once. The book is a useful introduction to clinical reasoning, its uses, methods of teaching it, and future research about it.