Ask

2. 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.

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.

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. (Johnson, 1946)

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. 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. The process of formulating these precise questions will focus your thoughts on the problem you are addressing, your clinical choices and outcome values.

TIP: 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?”