Toulmin’s Model in Medicine: A framework for clearer clinical reasoning

How philosophy and Toulmin’s argument model strengthen clinical judgement and communication

Clinical reasoning lies at the heart of good medicine. Whether deciding which diagnostic test to order, weighing treatment options, or discussing prognosis with a patient, doctors are constantly building arguments. These arguments are not combative; rather, they are structured ways of connecting evidence, reasoning, and recommendations. Yet many clinicians have never been explicitly taught how to present their reasoning clearly.

This is where Stephen Toulmin’s (1958) model of logic offers practical value. Originally developed in the field of philosophy, Toulmin’s framework provides a simple structure for organising arguments into clear components - claim, evidence, warrant, and rebuttal - providing a straightforward way to understand and evaluate claims. Applying this model in medicine can help clinicians clarify their own thought processes, explain decisions to patients, and communicate effectively with colleagues.

Why arguments matter in clinical practice

In healthcare, arguments are everywhere:

• Doctor-patient conversations: explaining why a test is (or isn’t) necessary.
• Team discussions: challenging and/or justifying treatment plans during ward rounds or patient handovers.
• Clinical writing: presenting cases in notes, referrals, or academic publications.

Strong arguments build trust, demonstrate transparency, and reduce misunderstandings. Weak arguments, by contrast, can lead to poor adherence, patient dissatisfaction, or even errors in care. Toulmin’s model provides a framework for clarity: breaking complex reasoning into manageable parts that can be easily followed by patients and professionals alike.

Core components of Toulmin’s Model

• Claim. The conclusion or recommendation. In medicine, this is the clinical decision: “I recommend you start this medication.”
• Evidence (Data). The facts supporting the claim: “Your blood pressure readings have been consistently high.”
• Warrant. The reasoning that links evidence to the claim, i.e., why the evidence supports the doctor’s recommendation: “Lowering blood pressure reduces your risk of stroke.”
• Rebuttal. Acknowledging counterarguments or exceptions: “Some patients experience fatigue, but if that happens, we can adjust the dose.”

These components form the skeleton of a medical argument. Together, they transform a decision from a vague directive into a transparent and persuasive explanation. Note, Toulmin’s model is actually comprised of six components (if we include the Backing and the Qualifier). The four components cited above offer a simplified approach to explaining Toulmin’s model, relevant to the discussion presented here.

Toulmin in action: A patient example

Imagine a 52-year-old patient with high blood pressure. The doctor recommends starting antihypertensive medication. Using Toulmin’s model, the reasoning might look like this:

• Claim: “I recommend starting you on a blood pressure tablet.”
• Evidence: “Your readings over the past three months are consistently above 150/95.”
• Warrant: “We know from large studies that reducing blood pressure lowers the risk of heart attack and stroke.”
• Rebuttal: “Some people worry about side effects like dizziness. If that happens, we can try a different medication.”

For the patient, this structured explanation is far easier to follow than a simple, unexplained directive. It shows the decision is evidence-based, transparent, and responsive to potential concerns. 

Toulmin for interprofessional communication

The framework is just as useful in discussions between healthcare professionals. Consider a junior doctor presenting a case on ward rounds:

• Claim: “I think this patient should be switched to oral antibiotics.”
• Evidence: “They have been afebrile for 48 hours and their blood cultures are now negative.”
• Warrant: “Guidelines suggest intravenous antibiotics are only needed until the infection is controlled, then oral therapy is safe.”
• Rebuttal: “If the patient deteriorates or new cultures are positive, we would reconsider IV therapy.”

This clear, structured argument signals that the recommendation is thoughtful, evidence-informed, and open to review—making it more persuasive to senior colleagues.

Benefits of using Toulmin’s Model in medicine

• Clarity for patients. Breaking down reasoning into claim, evidence, and warrant reduces confusion and helps patients make informed choices.
• Transparency in teams. Colleagues can follow the logic of a recommendation and identify any weak points.
• Stronger documentation. Clinical notes, referral letters, and medico-legal documents benefit from clear reasoning structures.
• Educational value. Teaching junior doctors to structure arguments improves their ability to present cases logically and confidently.

Addressing weak arguments

Toulmin’s model also makes it easier to spot and correct weak reasoning.

• Missing evidence. A recommendation without data sounds paternalistic.
• Unclear warrant. If the link between data and decision isn’t explained, patients may not understand why action is necessary.
• Ignoring rebuttals. Skipping potential concerns can lead to mistrust or non-adherence.

By consciously checking each component, clinicians can strengthen their arguments and avoid gaps that undermine credibility.

Practical tips for clinicians

1. Start with the claim. State your recommendation clearly.
2. Select the most relevant evidence. Avoid overwhelming patients with unnecessary statistics.
3. Make the reasoning explicit.  Don’t assume the link is obvious.
4. Anticipate concerns. Proactively address side effects, costs, or alternatives.
5. Invite feedback. Ask, “Does this make sense to you?” to encourage dialogue.

Over time, this approach becomes natural and improves both communication and patient trust.

Conclusion

Medicine is full of complex decisions. Patients and colleagues alike deserve explanations that are clear, evidence-based, and respectful. Toulmin’s model of argumentation provides a practical framework for structuring those explanations. By explicitly stating claims, backing them with evidence, clarifying the reasoning link, and addressing potential objections, clinicians can transform clinical reasoning into transparent, persuasive communication.

The result is better understanding, stronger therapeutic relationships, and more confident decision-making in the everyday practice of medicine.

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Frequently Asked Questions (FAQs)

How philosophy and Toulmin’s model strengthen clinical communication

Q1: What is Toulmin’s model of argumentation?
A: Toulmin’s model (1958) provides a simple structure for organising arguments into clear components (claim, evidence, warrant, and rebuttal) providing a straightforward way to understand and evaluate claims. In medicine, it helps doctors explain their reasoning more clearly and transparently.

Q2: Wy is Toulmin’s model useful in medicine?
A: It provides a logical way to connect data, reasoning, and recommendations. This makes clinical decisions easier for both patients and colleagues to understand and evaluate.

Q3: How does it improve doctor-patient communication?
A: By breaking reasoning into clear parts, doctors can state their recommendation (claim), support it with facts (evidence), explain why it matters (warrant), and address concerns (rebuttal). This improves trust, clarity, and patient adherence.

Q4: Can Toulmin’s model be used in team discussions?
A: Yes. During ward rounds, handovers, or advisory boards, clinicians can present their recommendations in a structured way. This shows evidence-based thinking and makes decisions more persuasive.

Q5: What happens when arguments are poorly structured?
A: Weak arguments - such as missing evidence, unclear reasoning, or ignoring concerns - can lead to miscommunication, patient mistrust, poor adherence, and clinical errors.

Q6: How can clinicians apply Toulmin’s Model in everyday practice?
A: They can apply Toulmin's structured approach to strengthen their communication:

1. Start with a clear claim
2. Provide relevant evidence
3. Make the reasoning explicit
4. Anticipate counterarguments
5. Invite feedback

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References

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Gilbert K, Whyte G (2010). Using argumentation standards in the assessment of clinical competence: A focus on communication and reasoning in medicine. Proceedings of the 2010 Conference of the International Society for the Study of Argumentation (ISSA) in Rozenberg Quarterly The Magazine. https://rozenbergquarterly.com/issa-proceedings-2010-argumentation-standards-in-the-assessment-of-clinical-communication-competence/?print=print

Gilbert K, Whyte G. 2011. The uses of argument in medicine: A model of reasoning for enhancing clinical communication. MonashUniversity Linguistics Papers, 7(2), 29-46. https://search.informit.org/doi/abs/10.3316/INFORMIT.798306315544546

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Jenicek M, Hitchcock DL. 2005. Evidence-based practice: Logic and critical thinking in medicine. Chicago, Ill: American Medical Association Press. 

Sassoon I, Kökciyan N, Modgil S, Parsons S (2021). Argumentation schemes for clinical decision support. Argument & Computation, 12(3):329-355. doi:10.3233/AAC-200550

Toulmin SE (1958). The uses of argument. Cambridge: Cambridge University Press.