Abstract
BackgroundA 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.DiscussionThis 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';SummaryClinical 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.
Highlights
A definitive diagnosis in chiropractic clinical practice is frequently elusive, yet decisions around management are still necessary
Development of the 3-questions model 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
The 3-questions model of clinical decision making for chiropractors 1
Summary
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, 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. The UK Code: S2.6 Clinical decision making When drawing up the working diagnosis or rationale for care, you must consider: a) Relevant information about the natural history and prognosis of any complaint the patient has b) The potential benefits and risks of care, including contraindications c) The likelihood of recurrence or need for long-term management [17]. If the cause of the presentation can be labelled (diagnosed), are there co-morbidities, and if so are they significant? The context of the clinical decision is “what are the ramifications of being incorrect?” Notwithstanding the traditional chiropractic emphasis on specificity, the reality is the implications for the patient are greater if the clinician ‘misses’ serious illness or injury compared to making an incorrect MSK diagnosis
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