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Posted: 9th October 2016

Is there a better way of doing this?
Dr Mark Holmes.
"Evidence-based medicine is simply a change in thinking and should not be used in a dogmatic fashion."

"Evidence-based medicine is simply a change in thinking and should be part of the overall approach to our patients," said Dr Mark Holmes speaking on the subject during a session on 'Professionalism' at the BVNA Congress.

He explained that good clinician bases the art of veterinary medicine on the evidence of science. And science is a methodical and systematic process to search for truth through hypothetico-deductive reasoning involving scepticism and a recognition of uncertainty, in an objective way.

Dr Holmes said he wanted to see a shift from 'eminence-based' medicine to evidence-based medicine that is underpinned by scientific tests. It is important to use tests to differentiate between belief and proven fact. Our senses can mislead our perception and interpretation and it is only through the use of statistics that randomness and subjectiveness can be eliminated.

"To buy one lottery ticket purchases hope; to buy more than one demonstrates the triumph of hope over expectation," he said.

There are two key factors when assessing statistics – How likely is it that my result is a 'lottery win'? and How representative is the result? When using statistics we acknowledge our doubt; although unless we are completely without imagination, we can always think of an alternative reason for an observation.

"Our patients may get better in spite of our treatments rather than because of them," said Dr Holmes. "Whenever we are asked about why we have made a particular clinical decision, we should always be able to explain and justify our action on the basis of our scientific training and experience in practice."

The two key factors in setting up a clinical trial are randomising of patients and blinding of the therapy; and the two key factors in assessing the results are the 'number needed to treat' and 'confidence intervals' provided by subsequent statistical analysis.  

"Be sceptical, look for the evidence, and use this approach for lifetime learning," said Dr Holmes. "Is there a better way of doing this? The application of science to patient care may not be the best way to cure our patients' but I believe that it is the least worst," he concluded.



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