Much is written about bias in relation to EBM. The overwhelming focus is on methodological bias in creating primary or secondary reviews. However, little is written about a bias that is arguably as important – search bias.

What’s the point of spending huge amounts of money creating beautifully crafted pieces of research for them to be overlooked by a clinician looking for robust information to inform their decision making process?

The TRIP Database uses an algorithm which is a compromise and I would never claim it was perfect. The debacle with the NLH’s search 2.0 highlights further problems. Medline is a nightmare to use. In short there is no perfect clinical search engine.

So what does that mean for a practicing clinician? Do we want them to search multiple databases? I suppose, ideally, yes. But I’m far from convinced it is practical. There is an onus on clinical search engines to improve and meet the needs of the users. But the important message is that bias is not just about research methodology, it applies in equal measure to how clinicians access the research.