Being Evidence Based – Dr. Scott Fisher, DC
A significant part of the language and culture at Ascent arises from our value in being evidence based (EB) or having an Evidence Informed Practice (EIP). What does this mean? Why is it important? What makes it true (i.e. nearly every clinic/practitioner will attest to being EB but, unfortunately, many are are either misinformed or, dare I say it, consciously lying to you… not sure what’s worse). Let’s look at what it means to be EB in practice and the things we do at Ascent to pursue this value to make sure we are continually becoming our best to help you move, feel and live your best.
Let me just preface this with a note that we do not profess to be perfect in this regard but we are striving towards optimal patient care and consider being evidenced based as a cornerstone of our practice. Equally as frustrating as practitioners providing poor quality and specificity of care are the practitioners who arrogantly state that they’ve got it all perfected. We recognize being an EB clinic is a fluid and dynamic process that requires both determination and humility.
What is Evidence Based Care?
There are three core components of EB care.
- Patient Expectation
The first is patient expectation or treatment preferences. This is a big one. Each patient enters every clinical encounter with an expectation of what their injury is, what treatment has worked for them in the past, what type of practitioner can help, how long it should take, etc. A key factor in the success of a treatment plan is aligning patient expectation with the plan of management, and vice versa. There is an art and value to this that at times can be difficult to balance but also cannot be overlooked. At Ascent we book approximately an hour (often longer with more complicated cases, i.e. concussions, running analysis, etc) for one-on-one time with our new patients. Our unhurried appointments are paramount to not only hearing the patient’s story and getting an accurate health history, but to also conduct a specific and thorough exam. (The same exam should not be done for every condition. If you come in with a sprained ankle and you get the same standardized assessment or ‘scan’ that a postural strain person receives you should probably find a new clinic). The first appointment also allows the practitioner to explain the diagnosis and treatment plan, give the patient an opportunity to ask questions and then once everyone is on the same page the treatment will begin. Yes, on the initial appointment you’ll receive a treatment (unless there is further investigation or referrals necessary before safely doing so). I’m always shocked when patients are surprised that they get treatment on the first visit. We’ve just figured out the problem… let’s get started so I can get you better quickly and get you back to doing the things you love. I recently spoke with a friend in another city. He said he was recommended a treatment plan of 40 visits to get his back pain better. What?!?! (If it doesn’t feel right, it’s probably not.) Wisely, he ran from that clinic and I referred him towards an EB practitioner in the city. Every situation is different, but often patients just need help getting through an injury and back out the door. It doesn’t need to be a lifetime commitment here folks.
“Our unhurried appointments are paramount to not only hearing the patient’s story and getting an accurate health history, but to also conducting a specific and thorough exam.”
- Practitioner Expertise
The second component is practitioner expertise. Sometimes this component gets relied on too heavily, but it is a vital part of the process. Having a depth of experience in a wide spectrum of conditions provides a foundation from which I offer a specific diagnosis and a specific treatment plan based on an individual’s case. Alternatively, if experience shows a condition does not respond well to my treatments then sometimes the best course of action is an immediate referral. This is where the value in working as part of an integrated team factors in. (Again, this is often an overused term, working under one roof does not imply working collaboratively for patient care). With a team of experts to collaborate within the clinic, and within a network of medical professionals in the city, I can rely on a collective expertise and experience to ask questions or make a referral when someone else is more suited to the task. In this day and age, one doctor/practitioner should not expect to be all things to all patients, and one type of treatment cannot be expected to be a reasonable method of treating whatever walks in the clinic door.
- Best Evidence
The third component is Best Evidence. This is the kicker. The terms ‘evidence’, ‘science’, ‘studies show’ etc have become pillaged of late and used too loosely. Check out this great clip:
Reading, understanding, critiquing and interpreting research is an arduous task that only a few do well. I’ll be the first to admit that I’m grateful that other people do it much better than myself and I can benefit from their labour. That being said, I consider myself very intentional and diligent with staying current and cutting edge. At Ascent there are several ways we pursue incorporating the best evidence into our clinical practice.
- We have amassed a huge collection of research that we often refer to. Currently on my desk is American Journal of Sports Medicine “Heavy Load Eccentric Calf Muscle Training for the Treatment of Chronic Achilles Tendinosis” by Hakan Alfredson et al. It’s a common practice to be finding, printing, sharing and discussing research around the halls of our clinic and finding research for our patients to ensure we’re giving the most optimal treatment possible.
- You’ll often see Anatomy textbooks and other materials around our offices. It is important to us that we never stop learning and never assume we’ve got it all mastered. We keep pushing forward. When I was in my practicum a brilliant clinician once told me, “I’m not smarter than you, I’ve just read more.”
- We utilize the invaluable service of Research Review Service. They hunt down sift through and interpret research on a weekly basis. They then have a database of clinically relevant reviews of almost any condition.
- Continuing Education – We Never Stop Learning:
- As an example, in the last two years alone our team has hosted researchers from Quebec that give a course called “New Trends in the Prevention of Running Injuries” from TheRunningClinic.ca, we have participated in various courses such as Functional Range Conditioning, Titleist Performance Institute, Shift Concussion Management, research symposiums and conferences and much more. We make the investment of our time and money to become better because we desire to be the best at what we do.
We recognize that it is often hard for you as a patient to know if you’re seeing a practitioner who has your best interest in mind and is actively becoming the best they can be and whose practice reflects best practice guidelines/evidence. We hope knowing the three components of EB care, trusting your gut, doing a little homework and asking questions of your health care providers will go a long way in ensuring you are getting the best care possible so you can feel, move and live your best.