The art and science of asking questions is the source of all knowledge. —Thomas Berger
*Mr. Ketterman's Case
Mr. Ketterman presents us with many questions. Some might be:
How will the new diagnosis of congestive heart failure affect Mr. Ketterman's prognosis?
What side effects can I expect from the medications that have been prescribed for Mr. Ketterman?
Can I, as a physical therapist, identify interventions that can be used in the presence of these diseases to improve his function?
Can I alter the course of either disease with my interventions?
How can a busy clinician find answers to these questions that reflect the most up-to-date evidence? (See Appendix for Mr. Ketterman's health history.)
We have always had questions like these about patients like Mr. Ketterman. In the past, we have turned to a variety of sources for answers, including:
Tradition: This is the way it's always been done. Tradition has been handed to us by our academic and clinical teachers as well as by role models and mentors.
Authority: This is the way I'm told to do it. Again, our teachers sometimes tell us to do things in certain ways. We may also be told to do them in a certain way by our clinical supervisors or employers.
Trial and error: This seems to work before, let's see if it will work now. Sometimes we try to organize the responses to our trial and error to learn from them, but often trial and error just happens as we search for solutions in our practice. As we learned in Section I, our memories of what worked may not be very reliable.
None of these sources is very satisfactory as a way to really improve patient care. Instead, it would be much better to build decisions on the research that has been done about care. In the past, this task was quite daunting due to the vast amount of information and a lack of a framework for assessing the information. But the principles of evidence based practice provide an organized and systematic way to ask and answer these kinds of questions.
The very first step of evidence based practice is to convert clinical questions like the ones about Mr. Ketterman into questions whose answers can be sought in the literature. The first step in that process is to recognize that different kinds of questions will be answered in different ways. The first two questions, those about Mr. Ketterman's diagnosis, are what have been called background questions.
Background questions focus on learning more about the typical course or natural history of a pathology or trauma. Background questions also focus on the typical management of a patient problem and the typical responses to this management. Clinicians tend to ask background ...