Failure to use vertebral subluxation complex as a diagnostic term: a flaw of reductionistic diagnosis with resultant compromise of student and patient outcomes in chiropractic teaching clinics

OBJECTIVE - To determine and report the extent to which the term vertebral subluxation complex is applied as a working diagnosis by contemporary chiropractic students in a clinical education environment and the extent to which student interns diagnose and manage patients' health beyond simple mechanical joint dysfunction. METHODS - All 39 final year students in the RMIT chiropractic program self-selected then reviewed and summarised the health records of any 10 patients they had seen as a new patient within the University Chiropractic Teaching Clinics during the previous 6 months. The resulting 400 reports were then reviewed by the authors and the diagnostic categories identified and collapsed into themes. RESULTS - there were 355 patients with a spinal complaint for whom a working diagnosis of vertebral subluxation complex could have been appropriate, however this diagnostic term was used in only 13 cases. The more common diagnostic term was biomechanical joint dysfunction. In the vast majority of cases students diagnosed and managed patients attending the clinic with regard to mechanical joint pain and dysfunction only, and in the majority of cases did not address any health issues in patients beyond this clinical descriptor.