Every once in awhile on the wards, one of the attending physicians will approach me and ask me to perform a literature review on a particular clinical question. It might be a question like “What does the evidence say about how long should Bactrim should be given for a UTI?” or “Which is more effective in the management of atrial fibrillation, rate control or rhythm control?” A chill usually runs down my spine, like that feeling one gets when a cop siren wails from behind while one is driving. But thankfully, summarizing what we know about a subject is actually a pretty formulaic exercise, involving a PubMed search followed by an evaluation of the various studies with consideration for generalizability, bias, and confounding.
A more interesting question, in my opinion, is to ask why we do not know what we do not know. To delve into is a question requires some understanding of how research is conducted, and it has implications for how clinicians make decisions with their patients. Below, I hope to provide some insights into the ways in which clinical research is limited. In doing so, I hope to illustrate why some topics we know less about, and why some questions are perhaps even unknowable.Continue reading…
