Global medical knowledge database is proposed

Editor—If every doctor who produced a critical appraisal in response to clinical uncertainty shared that learning globally then access to medical knowledge would be greatly enhanced.

What are the difficulties facing clinicians seeking knowledge?¹ The Cochrane Library, Best Evidence, Clinical Evidence, or guidelines in hard copy might be searched. If the answer does not seem to exist in a synthesised format the practitioners might do a Medline search. There is then the problem of getting the full text of the article.

The next step is appraising the article(s) for validity and to identify the results. The process that should be used when evaluating the different types of individual articles has been formalised and outlined in a series of articles in JAMA and described in an editorial in that journal.² This step is time consuming and requires skill and practice. Finally, the results should be presented in a format that is easily recognisable (critically appraised topic), such as that used by the Journal of Evidence Based Medicine, with a declarative title, message deriving from the results, and comments relating to real patients.

Realistically it is practical for a clinician to question, search, select, acquire the paper(s) and appraise them, and act only three or four times a year. Importantly, the knowledge acquired remains inaccessible to any other professional. If we could share these appraisals on a web based (and CD Rom) database we could avoid a massive duplication of effort. We could also make access to the knowledge much faster.

The global medical knowledge database will match each clinical query as closely as possible with both answered and unanswered questions. If there is an answer the software will display it automatically, in the form of a critically appraised topic. If the question is unanswered the doctor will be able to see whether someone is trying to answer it (and could offer to help). If the question is not on the database then the doctor will be prompted to post it.

Doctors offering to answer questions would search, appraise, and synthesise the evidence into a summary answer using free software available from the Centre for Evidence Based Medicine. The doctor would then post the answer, via a peer review process, to the database so that the next person would find it in the database and not repeat the work. The non-profit making database will have 24 hour access and be comprehensive, valid, up to date, and easy to search, providing answers to questions within seconds.