Delving into evidence-based medicine

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Evidence-based medicine is to clinical practice as the scientific method is to research, according to Dr. Stanley R. Robertson, an associate professor at Mississippi State University.

Dr. Robertson spoke July 18, during the AVMA Convention in Hawaii, about "Evidence-Based Medicine: Application in Veterinary Medicine." He said practitioners do base medical decisions on evidence—but the idea of evidence-based medicine is to follow a certain series of steps in making those decisions.

"In human medicine, it's something they've been doing in the past several years," Dr. Robertson said.

Some veterinarians have joined the movement to establish clinical medicine as a verifiable scientific activity. Technology has provided access to a wealth of information, and veterinarians looking at evidence specific to an individual case can also increase their general knowledge.

The traditional approach to individual cases is to rely less on research and more on an understanding of pathophysiology, extrapolations from other species, recommendations from experts, and personal experience. However, Dr. Robertson said, personal experience can be biased because veterinarians often remember either the best or worst outcomes.

He defined evidence-based medicine as a new approach to integrating the best research evidence with clinical expertise, patient values, and available resources.

"This still recognizes that clinical expertise as being important," Dr. Robertson said. "Evidence-based medicine is often a balancing act between research evidence and clinical expertise."

He described five steps to approaching a case through evidence-based medicine.

"The first step is asking answerable questions," Dr. Robertson said.

The components of an answerable question are the patient, population, or problem; the intervention or possible interventions; comparison of interventions; and the outcome. As veterinarians gain more clinical experience, they tend to ask fewer general background questions and more questions specific to the case.

"A lot of times, there are more questions than we have time to answer," Dr. Robertson said.

The second step is to find the best available evidence. Sources of information include Web search engines, online veterinary databases, and Web gateways that search multiple databases.

"It takes some practice to become effective at these searches, and also some persistence," Dr. Robertson said.

The third step is following rules of evidence to evaluate the information. The best evidence usually comes from systematic reviews of clinical trials.

The fourth step is applying the evidence to the case. The fifth and final step is to implement a treatment and examine the outcome.

Dr. Robertson said human medicine has made the process easier by creating brief analyses on a variety of subjects following the methodology of evidence-based medicine.

"We hope many of these analyses and tools developed for human medicine can be adapted to veterinary medicine," he said.

A group of veterinarians recently formed the Evidence-Based Veterinary Medicine Association, Dr. Robertson added. More information about evidence-based veterinary medicine and the new association is available at

"I see this as a bridge between academia and private practice," Dr. Robertson said.