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When you conduct any kind of research, whether that's scientific research or market research, there's always a bias somewhere. The trick is to know where it is. In fact, in some ways the job of a market researcher can only be said to manage bias, rather than to eliminate it. But it does help to know where the bias is. Here's an example:
In 2008 the RCVS conducted some market research on the provision of 24-7 emergency out-of-hours cover. As part of the research on a large number of practising vets, which was a big sample although not representative of all walks of veterinary practice, a series of questions was asked, of which here are just a few:
To set the scene....when asked the question in question 50 whether they felt that the obligation on them as vets to make provision for 24/7 emergency cover was inline with the obligations of other health care professionals, such as GPs, or did they think more was asked of them as a vet 85% felt that more was expected of them. That should not surprise anyone because it was true then, just as it is now.
But then later on respondents were asked a series of questions in sequence:
In question 66 respondents were asked whether if practices could opt out of making provision for 24/7 cover, did they feel that animal welfare would remain the same, get better or get worse? 72% said they thought it would get worse.
Then in question 67 respondents were asked if practices were able to out out of making provision for 24/7 emergency cover and the reasons why were explained to its clients, did they feel that public opinion of the veterinary profession would be affected 72% said it would be damaged.
In question 68 respondents were asked a conditional question whether if there were a risk of damaging the reputation of the profession by dropping the provision of 24/7 out of hours emergency cover, would they keep it 80% said they'd keep it.
And so we get to 69 where practices were given a very limited choice (three options) 66% of respondents said yes to the option "All practices have to provide 24/7 cover themselves, co-operate with other practices or use a dedicated out of hours service provider" [basically the status quo as it was then and the status quo as it is now]- and this was the first option of the three which is significant in the design of market research questionnaires.
What the questions above are collectively is a series of leading questions which would be expected to bias the response towards maintaining the status quo. Asking them in this way isn't wrong or right but it's helpful to know about the design of the study as it helps you to interpret the mindset of the people commissioning the research and the response of the respondents. The Royal College of Veterinary Surgeons always has been concerned about its reputation and its position as the regulator; the veterinary profession generally is naturally also concerned with its reputation so there is a common interest although it's certainly not proven that changing the arrangements for 24-7 out of hours emergency cover would damage the reputation of the profession. As to whether it might or might not affect animal welfare...that would depend upon how you changed them. And what do you mean by 24/7 cover? An obligation to your clients? Or an obligation to animal keepers generally?
What's interesting to me about this is that since this research was conducted I occasionally hear people from the College say thinks like 'the [veterinary] profession is in favour of maintaining the present arrangements for 24 hour cover'. In fact in my view you couldn't conclude that from this piece of research and this statement grates with me every time I hear it as I view it as misleading. The data weren't analysed in this way but if they were I doubt that the difference between the % who were in favour of maintaining the status quo and the % who were after some kind of change would be statistically significant.
In fact, I think that the most accurate thing you could say about this research is that even having been asked a series of leading questions that would be expected to bias the answer towards maintaing the status quo, the sample of vets surveyed (which was not a representative sample of each walk of practice life) was split on whether the present arrangements should be maintained. It would probably be just as accurate to say that vets were equivocal about maintaining the present arrangements for 24-7 OOH emergency cover, although in reality vets don't speak with one voice; that's because practising vets operate across a wider range of species and types of facility than human healthcare professionals in the UK, and the vast majority are in private businesses, in comparison to the human healthcare sector which in the UK is dominated by the NHS.
If you asked the questions in a different way you'd probably get a different response. I would confidently predict that if you asked vets if they'd surgically removed the reproductive organs of an animal, or done something requiring a clinical diagnosis like prescribe a POM(V), then the majority would say that they should either provide emergency OOH cover, or arrange an out of hours provider to do it for them.
However, if you first said to the majority of vets, this is what's normal in UK:
- if you want OOH emergency cover from your dentist, even a NHS dentist, you have to register
- if you want OOH emergency cover from your NHS GP you have to register
- if you want OOH cover from any kind of private business in the UK you have to register
- If you want to go abroad on holiday and get reciprocal health cover in the EU you have to register for the appropriate card.
- If you want private medical insurance you have to register.
Now consider this scenario. A member of the public calls your practice out of hours. Perhaps it's not a client of the practice. Or perhaps it's someone who was a client five years ago, but for the previous five years they've had their animal vaccinated at a vaccination clinic, bought their medicines online from an internet pharmacy, and not even visited the practice for a repeat prescription of a POM(V). As far as the practice is concerned they've disappeared off the face of the earth. Then out of the blue they call you on a saturday night in what they consider to be an emergency.
Should you be professionally obliged to provide these people with emergency care? By this we are being very specific and we do not mean whether you might choose to do it out of a sense of compassion for the animal but whether you should you be obliged to via your Code of Conduct?
Probably the result of your questions would be very different indeed....
In the intervening years between conducting this research there's been no significant change to practising vets' OOH obligations. There's been a bit of tinkering with the Guide to Professional Conduct, which turned into the Code of Conduct. On the way a phrase that most vets understood - 'animals under your care' - turned into 'animals committed to your care'; and the language of the Code changed from 'should' to 'must'. But in those intervening years the market for veterinary care changed dramatically.
The RCVS is presently consulting on 24/7 OOH arrangements and there's more on that here. If you respond, careful what you ask for...including asking for maintaining the status quo in a changing market.
As for the RCVS, the market research was probably carried out with good intentions because there's a good intention behind all actions. I hope if the RCVS does any more market research on 24-7 emergency cover they do a bit less with that bit of research and be a bit more focused. And I think I'd be looking at the question of registered versus unregistered clients.