What are Murphy's three essential questions of diagnosis in Murphy's DBCD Rule?

• A. From where is the patient's pain arising?
• B. Is imaging necessary to diagnose the back pain?
• C. What has gone wrong with this person as a whole that would cause pain to develop and persist?
• D. Are there red flags?

Answer: (C)

The main idea is diagnosing back pain through a biopsychosocial, whole-person lens. Murphy’s rule asks for three essential questions, and the one about what has gone wrong with the person as a whole captures the heart of this approach. It pushes you to consider how biological factors interact with psychological and social factors—such as mood, stress, sleep, coping strategies, activity levels, and social context—to influence how pain develops and persists. This perspective explains why pain can continue even when a single tissue source isn’t clearly identified and guides management toward addressing those broader contributors, not just the local structure.

Other common evaluation questions—like pinpointing the anatomical source of pain or deciding whether imaging is necessary—are useful for guiding tests and treatment decisions, but they don’t embody this holistic focus as directly. Red flags matter for safety screening, but they’re not the central diagnostic questions emphasized in this rule.