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Rule 31: Review the world literature fortnightly

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In his book Kill as few patients as possible1 Oscar London suggests we review the world literature fortnightly. At an estimate rate of 10 RCTs added to Medline per day, there’s little chance of this happening.

Instead, it’s been widely suggested that doctors focus their reading on clinical questions which are relevant to their practice. But thousands of questions assault us at every turn, professionally and privately. They range from the ordinary (“What should I have for lunch?”) to the exceptional (“I wonder if β interferon will reduce relapses in this 7 year old with an aggressive demyelinating condition?”).

Questions can be divided into those which seek general, broad information and those which address a particular problem. (The former—background questions—are actually a combination of lots and lots of specific questions, but addressing each step is unfeasible.) The latter are known as “foreground questions” or “specific questions”.

One way of focusing the deluge of questions is by recording clinical questions as they arise, in the structured format2 we use in Archimedes.

We ask too many questions to answer them all in this way, so be sensible.3 Here are a few hints to make evidence based practice possible:

  • Use the evidence based process to answer questions which crop up time and time again; you’re more likely to find someone will have studied them, and you are more likely to be able to implement the answer you develop. Ignore questions which have limited applicability.

  • Work with colleagues to answer each other’s problems, perhaps by restructuring your journal club.4 In this way you can work with the individual strengths and all improve on your weaknesses.

  • Consider using the range of “pre-appraised” resources (like Archimedes, BestBets, and Clinical Evidence) to get to the answers quickly.

  • Give yourself a time limit—and if you haven’t found an answer, work with the best information you can.

Finally, if in your work your think your have a really interesting question and answer which other people should be able to read, submit it as an Archimedes topic (see for details).



  • Bob Phillips