A “They Don’t Know What They Don’t Know” Problem in Medical Search Literacy
When 1005 Wasn’t One Thousand and Five
This happened just a few days back. Our domestic help—educated only till primary school but otherwise very intelligent—once wrote down an expense as ₹1005.
That surprised us. Whenever she spends money on our behalf and we later reimburse the same, it is usually a small amount, almost always under ₹300.
So we asked her, – “What did you spend one thousand and five rupees on?”
She immediately replied in Marathi,
“Nahin — ek she paanch.”
(No — one hundred and five.)
She believed she had written it right – she explained. “See this is 100-and-5″ !
What she didn’t realize was that writing 100 followed by 5 converts it into 1005. We’re now teaching her the idea of 10s, 100s, and 1000s—not numbers, but what numbers represent. That small incident stayed with me
Some Knowledge Is So Basic We Stop Seeing It
Once you understand place value, you stop thinking about it. You simply read numbers correctly. Without that foundation, even intelligent people make predictable mistakes.
The same thing happens every day with medical literature search.
Boolean operators, field tags, MeSH, truncation— these are not advanced tricks. They are foundational concepts, as basic as numerical literacy.
This is a classic case of “they don’t know what they don’t know” — and systems like PubMed amplify that gap rather than hide it.
Boolean Logic: AND Can Only Reduce Results
If you search PubMed for “Cough” and retrieve 500 articles, a search for “Cough AND Cold” will never retrieve more.It can only retrieve the same or fewer results. This is the first step to make PubMed feel like it is something unpredictable.
Field Tags Tell PubMed Where to Look
When you search – Diabetes[jour], you are not going to find articles about diabetes, just because the journal you are searching is “Diabetes”
You are retrieving articles published in the journal named Diabetes. And all articles in the journal need not be about Diabetes!
You are telling PubMed which field to search, not which concept you are interested in.
PubMed records contain multiple fields—title, abstract, journal name, authors, MeSH terms.
Field tags simply restrict the search to one of these.
Truncation Is About Characters, Not Words
Truncation in PubMed works on characters, not on words or concepts.
When you search – diabet* – PubMed retrieves records containing the words:
- diabetes
- diabetic
- diabetics
The asterisk simply tells PubMed to accept any characters that follow.
However if you want articles on diabetic neuropathy, you need not search – diabetic*. You will retrieve:
- diabetic
- diabetics
- diabeticus
The words that follow – —neuropathy, retinopathy, nephropathy— would follow anyway.
Truncation does not expand meaning.
It only expands spelling.
Numerical analogy:
Using truncation without understanding it is like adding zeros to a number without knowing what each zero does.
MeSH Is a Controlled Vocabulary
You cannot tag “stomach infections” with [MeSH].
Why?
Because the MeSH database does not contain this phrase!
MeSH is a predefined, structured vocabulary.
You can only use the terms that exist IN the database —nothing more, nothing less.
Just like numbers, structure determines meaning.
All This Is Not About Intelligence
My domestic help is not bad with numbers.
She simply missed one foundational concept early on.
In the same way, many highly competent doctors, administrators, and policy makers struggle with PubMed—not due to lack of ability, but due to missing conceptual training.
This Must Be Taught Early
Boolean logic, field tags, MeSH, truncation— this is foundational search literacy. It should not be picked up informally years later through trial and error. This belongs in undergraduate medical education, taught clearly, and early.
Because in modern medicine, what you retrieve shapes what you believe.
And mistakes here can have consequences far greater than writing 1005 instead of 105.
Common PubMed Mistakes (Seen Every Day)
- Using AND and expecting more results
- Using field tags without understanding what each tag stands for
- Tagging wrong terms with [MeSH]
- Using truncation to “add meaning” instead of characters
- Assuming PubMed “missed” papers when the query itself was flawed
An Urgent Appeal: Teach the Basics, Early
Medical search today is not a specialist activity.
It shapes clinical decisions, guidelines, policy documents, and funding priorities.
These concepts should be taught clearly, and early, during undergraduate medical training— before habits form, before incorrect mental models settle in, before frustration becomes normalization.
This is not about making everyone an expert searcher. It is about ensuring that every doctor knows what they are actually asking the system to do.
Because when users don’t know what they don’t know, systems like PubMed don’t compensate for that gap—they amplify it.
Teaching the basics is no longer a luxury. It is a responsibility.. I wrote so recently and I stress it all over again!
TheBasicsWeAreNeverTaught #SearchLiteracy #PubMedSkills #MedicalEducationReform #EvidenceMatters #HealthSystems #MedicalTraining #InformationBias
