Clinical decision-making to facilitate appropriate patient management in chiropractic practice: '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. 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';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."The exclusivity of medical knowledge and skill is being broken down. Inter-professional learning is now commonplace in medical education and seems likely to increase. Professional boundaries are being blurred as more and more things that were once the sole domain of doctors are being undertaken by other health care professionals. None of us works alone any longer, but in multidisciplinary teams in which we depend upon the expertise of others. This is not a diminution of medicine, but a strengthening of health care. We must acknowledge that, more than ever before, knowledge is available to patients and the public."Sir Graeme Catto, Past-President of the UK General Medical Council (2005) [1]Skills and competence in clinical decision-making are taught in various undergraduate healthcare programmes and cultivated through clinical experience. Many working diagnoses or clinical impressions, especially those for musculoskeletal (MSK) presentations, are developed through a process of exclusion, particularly when the context of diagnosis is uncertain. In other words, a definitive diagnosis may be elusive; however, a decision on management is still required.Therefor