You know that question that always comes up after a journal club/critical review of a paper session – “so where do we go from here?” and you also know the standard answer – “more research is needed”. Have you ever thought about why you use that answer? Well, firstly, its what we were taught from the moment we first started appraising papers, but, moving past that, could there be other reasons too?
Of course, in many cases, we may actually need to do more research but, in others maybe… just maybe… we don’t need more research. Maybe we say we want more research for other reasons.
Probably the possibly most common reason is that the research that we’re reading doesn’t seem to fit with our current thoughts about the issues or with our clinical practice. Our heads say “this can’t be right” so we say, “maybe we need to look at it again”. Have you noticed this is more likely to happen when we are set in our ways? We think we know the right way to do something so it’s a lot harder to accept that the research says we’ve got it wrong, like not putting a cannula into the dehydrated small person in front of us . And we’re not so sure about admitting that we’ve been doing it wrong for so long?
Or, even worse, the results might show something really quite scary, like we should be discharging a febrile neutropenic child to the care of their parents, where we can’t see them and they might get really really sick and they might die (even though the research shows that is exceptionally unlikely). Maybe then, we unconsciously use all that emotional energy, all that absolute fear of a very sick child, and we say “NO! I want to be more certain!” We ask for more evidence, more proof, more certainty because we’re scared. Asking for more research might result in a delay in the implementation of that scary change and so performs a role in relieving our current anxiety, allows further time to consider the options and gives us a chance to become more sure about the right course of action.
But the thing is – research is never certain, even when you ask for a lot more of it. So we have to start thinking about when enough research is present (see here) and sometimes we might have to take that first small scary step to doing things differently.