The case for EBVM
Common concerns relating to evidence-based veterinary medicine (EBVM)
Isn’t implementing EBVM just a way to force people to read veterinary journals?
Is EBVM a way to place statistics in charge of patient care, instead of veterinary surgeons?
Don’t we have enough to do?
In the year of 2010 alone, around 18,000 veterinary papers were published in the world, across a myriad of different scientific journals.⊃1;
It is perhaps unrealistic to expect that a busy veterinary surgeon would have the resources (time and otherwise) to read every single publication in his field, critically appraise it and use it as a backdrop in decision making. In the human medicine field, in fact, it is estimated that it takes 10 to 15 years to translate research findings into clinical practice.2 However, when rigorous research underpins medical decisions patient outcomes are expected to be significantly better than when those decisions are steeped in tradition. The case for EBVM is therefore one for improving success rates of clinical decisions and better care.
Isn’t implementing EBVM just a way to force people to read veterinary journals?
According to one of the most eminent authors on the subject, evidence based medicine is much more than just reading papers. It is about reading the right papers at the right time and then altering behaviour (yours and other people’s) in the light of what you have found.3 This is obviously very challenging.
According to the Evidence Based Veterinary Medicine Association “The fundamental tenet of Evidence-based Veterinary Medicine is that the practice of medicine should be based on valid, clinically relevant research data, whenever available. This is in preference to the traditional method of medical training—still in sway—that is weighted more toward authoritative “experts,” espousing their best judgments, which are based on their experiences and their understandings of pathophysiology.” Evidence-based Veterinary Medicine is quite simply the incorporation of Evidence-based Medicine into the veterinary profession.4
Isn’t EBVM just a medical ‘fad’ created by young, highly numerate academics to belittle the performance of highly experienced clinicians?
Doctors and veterinary surgeons have always based their decisions on solid evidence – in fact, it would be illegal not to do so.
Indeed all doctors and veterinary surgeons make efforts to be aware of new research which has the potential of improving the outcomes of a given intervention. However, as scientists at heart, they can also recognise that they might be subject to a number of possible sources of bias.
Personal experience is certainly invaluable in the daily life-saving decisions that veterinary surgeons have to make. The “largest medical textbook of all”, however, is constituted by the accumulation of all the cases that are outside a veterinary surgeon’s personal experience. Even when literature is searched, care must me taken to distinguish what are objective facts and what constitutes subjective advice, even if it is consensual.
Despite the fact that health professionals are increasingly developing more effective ways to keep abreast of the literature, it was found that clinical decisions are often not based on the best available evidence. In fact, only 10 to 21% of decisions are made in this manner,5 with scientific uncertainty being encountered on average three times for every two patients seen by experienced teaching consultants.6 Although these numbers were found specifically for human medicine, they do raise interesting questions for veterinary surgeons, who have access to smaller numbers of systematic reviews and randomised control trial data.
Is EBVM a way to place statistics in charge of patient care, instead of veterinary surgeons?
Numbers will never replace the expertise and clinical judgement of a health professional. EBVM is a problem solving approach for veterinary surgeons, rather than a way to siphon away their clinical authority. By definition, evidence-based veterinary medicine is the use of best relevant evidence, in conjunction with clinical expertise, to make the best possible decision about a veterinary patient. In addition, the circumstances of each patient, and the circumstances and values of the owner/carer must also be considered when making an evidence-based decision.7
References
1. SCImago. SJR - SCImago Journal & Country Rank. [The SCImago Journal & Country Rank] [online] Available from http://www.scimagojr.com [Accessed 17 May 2012]
2. Balas, E.A. et al (eds) (2000) Information Technology Strategies from the United States and the European Union: Transferring Research to Practice for Health Care Improvement (Volume 76 Studies in Health Technology and Informatics) Amsterdam: IOS Press.
3. Greenhalgh, T (2001) How to read a paper: the basics of evidence based medicine, 2nd ed., London: BMJ Books,
4. Evidence Based Veterinary Medicine Association Frequently asked questions (FAQ) [Evidence Based Veterinary Medicine Association ][online] Available from http://www.ebvma.org/?q=content/frequently-asked-questions-faq [Accessed 17 May 2012]
5. Dubinsky, Michael and Ferguson, John H (1990) Analysis of The National Institutes of Health Medicare Coverage Assessment International Journal of Technology Assessment in Health Care Volume 6 (03) pp 480-488
6. Covell, DG et al (1985) Information needs in office practice: are they being met? Annals of Internal Medicine 103 (4) pp 596-599
7. Centre for Evidence-based Veterinary Medicine What is evidence-based veterinary medicine? [Centre for Evidence-based Veterinary Medicine] [online] Available from http://www.nottingham.ac.uk/cevm/whatisevidence-basedveterinarymedicine/whatisevidence-basedvetrinarymedicine.aspx [Accessed 17 May 2012]