Evidence Based Practice – Chopping Down Trees To Save The Forest

By Pam Marshalla

Q: I have heard you say that you have a real problem with Evidence-Based Practice (EBP). Why would you be opposed to something that so clearly will help and protect our clients?

I am not against using EBP. I am for EBP.

However, I am concerned about several recent results of the EBP philosophy. I am especially opposed to three new ideas:

  1. I am against throwing out everything we have learned through a century of trial-and-error speech-language therapy just because we have no laboratory proof in the modern sense. As Dollaghan (2007) has pointed out, evidence comes from the lab, from the clinic, and from the client.
  2. I am against disposing of the SLP’s freedom to experiment in therapy in order to discover new ways to go about doing things. It is through this freedom that a profession grows. Without this freedom, a profession dies.
  3. I am against restricting our treatment to only certain methods when those methods might not be appropriate for the client. This harms clients and limits their potential.

Almost every textbook that I have ever read in our profession – and I have read hundreds – ends with a discussion about “what this all means” for the SLP. And in just about every one of these books there is a statement like the following: “SLP’s must use their common sense, their clinical judgment, and their personal clinical experienced to adjust and modify these methods to suit the needs of their clients.”

That’s it. That’s what Speech-Language Pathology is all about. SLP is the process of applying scientific ideas to concerns of a specific client. SLP is not a cookbook of procedures. We do not do step 1, followed by step 2, and so forth. We take science and apply it. Usually this means altering it to fit the immediate needs of our patients. We are professionals who design and implement programs. We are not technicians who follow procedures of someone else’s design.

And what about the trees? In the current zeal to make sure that everything we do has evidence behind it, there are those in the profession who seem willing to dismiss literally millions of hours of clinical evidence that have evolved out of the history of our profession. They think this will save the profession. In essence they are saying, “In order to save this forest, let’s cut down all the trees!”

Well I would prefer not to cut down the trees to save the forest. I would prefer to preserve every tree, to allow the trees to regenerate themselves naturally, and to allow new trees to be planted among them.


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