Not-sure-ness … a word sadly missing from the dictionary at the moment … is thick in the air at the moment, like sunseekers on a August beach or beer bottles the morning after a party* Not-sure-ness can come in many angles and shades, and if we can distinguish them we may be able to seek understanding more clearly.

For instance, we may be asking people to stay away from others for 10 days because they have a SARS-CoV2 positive test (source-isolation, to stop known infectivity), or 14 days because their household has someone with one (quarantine, to stop unknowing transmission), or for a few weeks while at highest risk of complications (protective-isolation, stopping catching stuff). If we somewhat lazily refer to all of this as “self-isolation” or “shielding” or “quarantine” we will end up introducing confusion – lack of clear knowing – by our ambiguous use of language.

It’s the same when we are doing evidence-based practice. We should be clear about what groups of patients we are referring to, for instance those who arrive at our doors with old-fashioned Kawasaki disease, the intervention we are evaluating, which might be high-dose corticosteroid, and the outcomes we are hoping to measure, such as fever resolution, heart function, and use of rescue therapies. By doing this, rather than conflating all patients with Kawasaki and Kawasaki-like conditions in every stage of treatment, and a mishmash of treatments and timings, we can then extract clean uncertainties, which show us the particular limits of our knowledge answering that particular question.

• Archi

*pre-pandemic references inserted for the Truly Old to experience nostalgia