Those of you who know me or have got a feel for TRIP (via this blog or using the site) will know that our biggest motivation is allowing clinicians to get rapid answers to their clinical questions. The TRIP Database has been running for nearly 15 years and we’ve helped shape clinical search, spawning many similar search tools (perhaps the most recent being the eye-wateringly expensive (and soon to be rebranded) NHS Evidence). 
However, over the last few years my reservations about clinical search has grown.  To define that further, I mean clinical search for busy clinicians (as opposed to librarians, information specialists, academics etc).  Those that need a rapid answer to their clinical questions.

The current search paradigm is that users add 1-3 search terms, press ‘search’ and sift through the top 10-20 results to find the answer they’re looking for.  Below are a few problems with this (there are many more):

  • We know that clinicians are typically poor searchers, so there’s a handicap from the start.
  • The way clinician’s select which papers/documents to look at is problematic based on a number of factors.
  • From our experience of Q&A (answering over 10,000 clinical questions) we know the average number of references to answer a question is over two.  So, that suggests that clinicians will need to open 2+ documents and read them to find the information they need – highly inefficient, especially if the document is long.

Using the example of NHS Evidence, they have a vast resource (£700,000+ for marketing alone.  Their marketing budget is nearly 30 times higher than the entire TRIP Database budget!), a good brand, a competent implementation, part of the NHS ‘family’ yet have embarrassingly low search stats.  I believe one of the main reasons is that search is not something that works for most clinicians.  It’s a paradigm, defined by Google and people seem happy to settle for it.  Is it any wonder that clinician’s main source of answers to their questions is to ask a colleague?  One obvious reason that clinicians ask other clinicians  (but there are clearly others) is that they get an answer – not 10-20 links that may answer their question.

So, to me, any solution is to go back to first principles – in this case a clinician with a clinical question.  What do they want? An answer.  I’m hoping that’s not controversial – it seems obvious to me. 

To reiterate, imagine you’re a busy clinician and have a clinical question, what would you prefer:

  • A robust answer.
  • A list of 10-20 results, any number of which may contain all or part of your answer.

Is it only me that sees this as a ‘no brainer’?

If you’re one of the people that thinks the latter – please contact me ( as I’d love to understand your perspective better

Anyway, moving on to the notion of delivering an answer – this is where it gets complicated but also interesting.  I firmly believe that we shouldn’t shy away from a challenge, not one that’s so important as this.  With the experience gained in TRIP (with search and Q&A) I actually think that the issue is manageable.

Basically, I’m planning on building a system that will take a clinical question and deliver an answer. 

However, one thing for sure, it’s too big for TRIP to do it on it’s own.  So, we’ve started by getting together a small group of people representing organisations who have a vested interest in getting this right.  Those who share in the vision.  To me, the biggest challenge will be managing the disparate bodies – from the small to the very large.

If I can pull this off, we’ve got every chance of making an industry-wide change for the best.