The importance of starting with a good question

Questioning our current practice underpins the principles of EBVM – in order to practice EBVM, we must be prepared to question what we do and change accordingly.

Using a treatment protocol “because it’s the one you’ve always used” or “it’s the one you were taught at University” is not practising EBVM. Clinicians are constantly presented with new drugs, new surgical procedures and new evidence from clinical research; the progress of veterinary knowledge and research does not stop on the day of graduation from veterinary college. By questioning our practice in a critical way, we can move in a direction that keeps us up to date; also, by using the best possible evidence, we can offer our patients the best possible outcomes.

FACT

Well-formed questions underpin the very core of scientific methodology:
“One cannot get a clear answer to a vague question. The language of science is particularly distinguished by the fact it centres around well-stated questions.”
People in Quandaries, Wendell Johnson, 1946, Harper & Row.

One of the most common mistakes those new to EBVM might make is to start searching for answers with only a vague idea of what information is needed. In order to address complex or poorly defined clinical problems, you must first break these problems down into a series of more precise questions.  By framing your questions in this narrow, precise way, you increase your likelihood of finding evidence that specifically answers your question.

In equine medicine, rather than asking “What should I do about recurrent laryngeal neuropathy in horses I see in my practice?“, you could ask “In adult, racing thoroughbred horses presenting with recurrent laryngeal neuropathy, does ventriculectomy (‘Hobday’) with ventriculocordectomy, compared with prosthetic laryngoplasty (‘tie-back’), have a greater success rate for return to racing?

This question could also have many variations: for instance, you could change the outcome you want to measure, and ask “In adult, racing thoroughbred horses presenting with recurrent laryngeal neuropathy, does ventriculectomy (‘Hobday’) with ventriculocordectomy, compared with prosthetic laryngoplasty (‘tie-back’), have a greater reduction in air turbulence?

The University of Oxford have established the Centre for Evidence-Based Medicine (CEBM), focussing on issues surrounding the field of evidence in human medicine. They state that “One of the fundamental skills required for practising EBM is the asking of well-built clinical questions. To benefit patients and clinicians, such questions need to be both directly relevant to patients’ problems and phrased in ways that direct your search to relevant and precise answers.” Although this was written with human medicine in mind, the principle applies just as well for veterinary medicine and the practice of EBVM.