As I begin another term of teaching Evidence Based Practice at Glasgow University, I am struck by the sheet amount of information that is now available. Yes, a large amount of that is still behind paywalls (that is another discussion for another day), but with the sheer volume of case studies, cohort studies, controlled trials, systematic reviews, meta-analysis and also qualitative research, I find myself wondering why we still don’t always know the best way forward with a case.
Over the years evidence has been used to prove different points – chocolate and alcohol are good for you one day and bad for you the next. For many years, it was purported that smoking was good for you – we now know better. Evidence can be used in many different ways – hence the need for clinicians who rely on evidence being able to fully understand studies, evaluate the methodologies that have been applied and conclusions that have been reached.
As studies progress, evidence can become old and out of date. But what does that mean for the evidence that we are using today? It’s likely that in 5 or 10 years’ time, the evidence that we are using now to inform decisions, will be out of date and new evidence will possibly point us in a different direction. Does that mean that we are doing the wrong thing now? Perhaps. But what is the alternative? We have to make the best decision we can with the current evidence.
But decisions are not just clinical. There are so many other factors that need to be included in decision making around the owner and the animal. Rarely is a treatment decision purely made on clinical grounds alone. Owner attitudes, wishes, beliefs, finances, lifestyle and demands on time; animal temperament, multi-morbidities, species/breed and options that are available to them will all impact on a clinical decision. The art of veterinary medicine is to bring all of this together, communicate it well to all involved, and make the animal better.
So, whilst it’s lovely to have more and more evidence, we are at risk of being overloaded and not able to make a clear decision.
That leads me to another topic for a discussion……..
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