It appears that a phrase, "evidence-based practice," is being
misinterpreted.  I would like to go on record regarding how this phrase
SHOULD be used.

We begin by identifying what is meant by "evidence."  In any profession,
the evidence of good care should be self-evident: a) the
patient/client/person being cared for was not harmed; b) the
patient/client/person being cared for was helped in some way that could be
identified.

Now, when we talk about practice that is based on evidence, we mean that as
practitioners, we have learned from our peers as well as our mentors and
are basing decisions on that knowledge.

In a new profession, some of that knowledge is, of necessity, learned by
trial and error (so also is research) as well as by carefully planned and
conducted  clinical observation and analysis.  It is out of these
observations and the sharing of same with others that science is developed.

It is important to keep in mind how all professions develop.  They begin by
gathering knowledge from many people who are observing similar phenomena.
Out of these observations develop a codification of that knowledge, which
is then passed on to "students" who may not have seen the phenomena that
serve as the structure and boundaries within which both theoretical
constructs (ways of thinking about the elements in question) and new
questions arise.

In an ideal world, evidence-based practice is derived ONLY from carefully
conducted scientific studies (both quantitative and qualitative) that have
been replicated by many different scientists in numerous settings, the
findings of which have been shared and discussed and analyzed, and whose
limitations are identified. Such discussion does NOT include the
denigration of the researcher or the ideas from which the study, its
design, implementation, analysis and conclusions are drawn, but rather how
the outcome of the research relates to other studies and whether what is
learned from the most recent efforts moves the understanding of the
phenomenon (scientifically-derived understanding) forward by adding to our
knowledge and perhaps offering us insights we did not have before.

None of us lives in an ideal world.  Currently the scientific basis for
lactation consulting is in its infancy. Theoretical constructs are few and
far between, and sometimes not even recognized as existing by others! On
what do we basis practice parameters in such a situation?  For the most
part, on the shared experiences of clinicians (this is one reason Current
Issues in CLinical Lactation was developed, by the way!), the study of
whose findings and ways of going about collecting the information and the
observations may lead to greater understanding, deeper insight, and YES,
even scientific studies that either support or refute prior understandings
previously accepted without challenge.

Here, too, however, it does us no good whatever to denigrate the clinician
who shares.  Rather, we need to consider--CAREFULLY and OBJECTIVELY--what
is shared and then see how closely it fits with our own observations.  If
it does not, we must ask ourselves WHY it does not and then seek to
understand what might be different about the two observers and their
observations that makes the outcomes and/or the understandings so
different.

Under no circumstances is it helpful to simply damn someone else's work by
demanding to know on what EVIDENCE it is based.  Perhaps no scientific
studies have yet been conducted.  Does that make those observations less
acute or insightful? I don't think so.  What remains is to convince those
in a position to, with the skills to, conduct scientific studies that the
questions each of us raisses as a result of our clinical observations, is a
question deserving of careful examination.

To share clinical experiences, including case reports, was one of the
PRIMARY reasons for starting LACTNET in 1995.  The profession has come a
long way in 5 years.  The numbers of persons who read LACTNET and are
subscribers (fulltime or occasional) has also grown in both numbers and
penetration around the world.  Let us not lose what is valuable about such
sharing by hiding behind a catch-phrase that is too often misused in the
absence of acceptance of the value of observations.

Think about it.
One LC observes Phenomenon A.  A second LC observes the same thing--in a
different country, with a different set of circumstances.  Multiply those
two observations by a thousand.  What do you have here?
When those observations are shared with colleagues, do we not have the
beginnings of evidence on which to base practice?  I would hope so.

After reading all that, are you tired? want to sleep? are you (perhaps)
already asleep?  OK.  THen think of it this way.

MIND YOUR MANNERS when reading the humble presentations of your peers (who
may be your mentors or your betters or maybe even your neighbors). Respond
as you would want to be responded to.  And remember to thank them for their
willingness to share.  That takes guts when the audience is more than 2,000
people around the world....

     mailto:[log in to unmask]

"We are all faced with a series of great opportunities brilliantly
disguised as impossible situations."
Kathleen G. Auerbach,PhD, IBCLC (Ferndale, WA USA) [log in to unmask]

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html