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Open Access Debate

Clinical decision-making to facilitate appropriate patient management in chiropractic practice: 'the 3-questions model'

Lyndon G Amorin-Woods12* and Gregory F Parkin-Smith1

Author Affiliations

1 Murdoch University, School of Chiropractic and Sports Science, South Street, Murdoch, 6150 Perth, Western Australia

2 Murdoch University Chiropractic Clinic, Murdoch University, South Street, Murdoch, WA 6150 Perth, Australia

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Chiropractic & Manual Therapies 2012, 20:6  doi:10.1186/2045-709X-20-6

Published: 14 March 2012

Abstract

Background

A definitive diagnosis in chiropractic clinical practice is frequently elusive, yet decisions around management are still necessary. Often, a clinical impression is made after the exclusion of serious illness or injury, and care provided within the context of diagnostic uncertainty. Rather than focussing on labelling the condition, the clinician may choose to develop a defendable management plan since the response to treatment often clarifies the diagnosis.

Discussion

This paper explores the concept and elements of defensive problem-solving practice, with a view to developing a model of agile, pragmatic decision-making amenable to real-world application. A theoretical framework that reflects the elements of this approach will be offered in order to validate the potential of a so called '3-Questions Model';

Summary

Clinical decision-making is considered to be a key characteristic of any modern healthcare practitioner. It is, thus, prudent for chiropractors to re-visit the concept of defensible practice with a view to facilitate capable clinical decision-making and competent patient examination skills. In turn, the perception of competence and trustworthiness of chiropractors within the wider healthcare community helps integration of chiropractic services into broader healthcare settings.

Keywords:
Chiropractor; Clinical decision-making; Differential diagnosis; Red flags; 3-questions model