What Do Clinicians Mean by “Good Clinical Judgment”: A Qualitative Study

Round 1

Reviewer 1 Report

This is an excellent thought-provoking paper, which I greatly enjoyed reading. Thank you for asking me to review it. It defined the pre-requisites of good clinical judgement as:

(1) strong baseline knowledge and breadth of clinical experience

(2) demonstration of curiosity, reflection, and wisdom, and

(3) an ability to attend to contextual factors and understand the ‘bigger picture’ when providing care to patients.

I have only one suggestion to make, which is that the authors should define what they mean by the word “clinical”. This is a word that has come to mean different things to different people, which currently can be divided into:

1. relating to the observation and treatment of actual patients rather than theoretical or laboratory studies

2. very efficient and without feeling; coldly detached "nothing was left to chance—everything was clinical"

How it ever acquired this second meaning is, from the medical profession’s perspective, concerning. Could it be that physicians are generally regarded as being detached, impersonal and dispassionate? If any physicians are like this, then I don’t think the authors of this paper, or myself, would consider they are likely to be capable of “good clinical judgement” since, as this paper points out, knowing the patient and their concerns and desires are essential to make good clinical judgements.

The word “clinical” comes from the Latin clinicus "a physician that visits patients in their beds," from Greek klinike (techne) "(practice) at the sickbed," from klinikos "of the bed," from kline "bed, couch, that on which one lies". Therefore, I suggest that the authors make it clear that they are using “clinical” in its original meaning or should simple change “good clinical judgement” to “good judgement at the bedside”.

Author Response

Reviewer: I have only one suggestion to make, which is that the authors should define what they mean by the word “clinical”. This is a word that has come to mean different things to different people, which currently can be divided into:

1. relating to the observation and treatment of actual patients rather than theoretical or laboratory studies
2. very efficient and without feeling; coldly detached "nothing was left to chance—everything was clinical"

How it ever acquired this second meaning is, from the medical profession’s perspective, concerning. Could it be that physicians are generally regarded as being detached, impersonal and dispassionate? If any physicians are like this, then I don’t think the authors of this paper, or myself, would consider they are likely to be capable of “good clinical judgement” since, as this paper points out, knowing the patient and their concerns and desires are essential to make good clinical judgements.

The word “clinical” comes from the Latin clinicus "a physician that visits patients in their beds," from Greek klinike (techne) "(practice) at the sickbed," from klinikos "of the bed," from kline "bed, couch, that on which one lies". Therefore, I suggest that the authors make it clear that they are using “clinical” in its original meaning or should simple change “good clinical judgement” to “good judgement at the bedside”.

Response: Thank you for reviewing our manuscript and for pointing out the lack of clarity around our use of the word clinical; we have clarified our intended meaning on Page 2, Line 28. 

Reviewer 2 Report

This is very challenging and high quality manuscript. This is very important work. Thank you for taking on such a challenging topic.

Author Response

Reviewer 2: This is very challenging and high quality manuscript. This is very important work. Thank you for taking on such a challenging topic.

Response: Thank you for your comments and for taking the time to review our manuscript.