Clinical Decision-making to Facilitate Appropriate Patient Management in Chiropractic Practice: ‘The 3-questions Model’

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SOURCE:   Chiropractic & Manual Therapies 2012 (Mar 14); 20: 6

Lyndon G Amorin-Woods and Gregory F Parkin-Smith

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

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.

From the FULL TEXT Article:

Development of the 3-questions Model

The chiropractic profession, particularly in Western countries, finds itself in a rapidly evolving healthcare landscape, with ‘modernisation’ being a consequence of escalating costs, an aging population, and an ever-diminishing relative resource base [9]. With a view to rationalising resources health system decision-makers are increasingly vigilant about the delivery of safe, evidence-based, cost-effective care, summarised as “the right care at the right time in the right place” [10, 11]. With this imperative in mind, the authors propose three straightforward questions that frame clinical decision-making within the context of diagnostic uncertainty.

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Question 1: What is the likelihood I will delay access to more appropriate care for this patient?

Contemporary chiropractic offers an array of conservative treatments, selected and delivered on the basis of research evidence, tradition, expertise, patient preference, or a combination of all these. Yet, before any treatment can be applied, the practitioner has a duty of care to ensure that the patient will receive the most appropriate care at the right time, which may in fact necessitate referral to another healthcare provider. In other words, the preferences, traditions, and care philosophy of the practitioner are secondary to the needs of the patient, supported by the maxim; ‘first do no harm’ [12, 13]. In short, the practitioner must consider what has gone wrong with the patient as a whole to bring them to this point, and what role the chiropractor may play in their management [12].

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