Mind the gaps

Future generations are likely to judge us as much by our management of what we do not know as of what we do. Trends towards increasing specialisation, guidelines, protocol and regulation, and devaluation of basic clinical skills of history taking and examination through over-reliance on clinical investigation, carry the risk that gaps in knowledge and services are overlooked and may be exacerbated. Unrecognised gaps are particularly hazardous. Professional practice and structures should give the best chance of eliminating blind spots, both to reduce scope for harm and to increase opportunity for progress, of which the uncharted territory should be a rich source. Safe practice should be as robust in addressing the implications of what we do not know as in applying knowledge prudently. The system itself needs to be evaluated as carefully as the practice it serves.