Finding data by broadening your literature search

In week 1 we discussed how evidence-based medicine (EBM) has been the foundation of training for many doctors. However, we reflected that EBM doesn’t always meet the demands of 21st century primary care. Evidence can be a poor fit for complex patients with multimorbidity, whilst recommended interventions may only offer a marginal benefit for individuals.

Despite clinical evidence being vital to our jobs, we reflected how we also shouldn’t be afraid to question evidence and deviate from protocols when appropriate.

Clinicians are trained to find evidence from the literature to help them address questions they encounter in practice. For instance, in week 1, we introduced the case of Margaret, a patient with chronic back pain and pernicious anaemia.

During one of her clinic appointments, Margaret reports feeling that the beneficial effects of her B12 injections wear off before her next one is due, every 12 weeks. She consequently asks if she can have her B12 injections every 8 weeks instead. You check the guidelines, which unfortunately don’t contain any evidence on the utility and safety of reducing the interval between injections.

When we approach problems like this, we can perform a literature search and then critically appraise the evidence we find.

Even if you haven’t performed a literature search recently, you will likely recount visiting the pubmed or google scholar databases and formulating a search. If you need to refresh your knowledge on literature searching (databases, PICO questions, boolean operators, truncation symbols etc., the Open University library provides a useful summary. If you want to learn more about more detailed systematic reviews or wider research concepts, the WiseGP Learning page provides further links to a range of resources.

However, it’s important to think beyond biomedical evidence and consider how we can collect evidence from both sides of the gate…

Guidelines often omit wider social sciences literature, which can provide insight into the management of more complex cases. We’ll consider where there is more data in the coming steps.