The Missing Step in the Scientific Method

By Andrea Brown
March 21, 2026 | VOLUME 4, ISSUE 1

When research isn’t enough

Initially, his solution was what many researchers would consider standard: Publish the findings and share them with the medical community. But as he reflected on the broader implications, it became clear that publication alone was insufficient.

“We can publish these papers that are incredibly important—matters of life and death—and still not see a change in practice,” he said.

That realization was reinforced by his own experience at the bedside. Looking back, Dr. Valley recalled caring for patients who said they felt short of breath or unwell, even when their pulse oximeter readings appeared normal.

In those moments, he trusted the data. “I hear you, but everything looks good,” he would tell them—only later questioning whether those numbers had been misleading.

That gap between evidence and implementation highlighted a deeper issue within the health care system and revealed a new role for clinicians.

“I started to recognize that research by itself is limited,” Dr. Valley said. “There is a need for researchers to also be advocates.”

Is there a better way?

Dr. Valley said he believes that clinicians are uniquely positioned to drive meaningful change because they experience problems in real time.

“We have this opportunity that most people don’t—to see the problems at the bedside and feel those problems ourselves,” he said.

Yet, in the fast-paced clinical environment, those obstacles are often managed in the moment rather than addressed in a more encompassing manner.

“A lot of times, we try to work around [these problems],” he said. “We figure out how to get through them to take care of our patients rather than asking how to remove them entirely.”

Advocacy begins by resisting that instinct, Dr. Valley said. It starts when you pause to examine recurring frustrations and ask a simple but powerful question: Is there a better way?

That shift—from working around problems to interrogating them—was not automatic. It required stepping back and recognizing patterns in everyday frustrations rather than dismissing them as part of the job.

Many of his research efforts, including his work on pulse oximetry, stem from exactly that mindset: identifying pain points in patient care and pursuing solutions that extend beyond individual encounters.

Learning on the job

Despite its importance, advocacy is not something most clinicians are formally prepared for.

“We spend a lot of time learning how to practice medicine and how to be researchers,” Dr. Valley said, “but [we spend] very little time learning how to advocate.” As a result, many clinicians interested in advocacy must navigate unfamiliar territory, often without a clear road map.

“There’s no great training that says, ‘These are the steps you should take,’” he said. “It’s very much learning on the job.”

Mentorship can play a critical role, but systemic barriers remain. Without structured pathways or dedicated time, advocacy work can be difficult to prioritize alongside clinical and research responsibilities.

Dr. Valley credits mentors who were strong advocates themselves with helping shape his approach, even as he navigated the space largely without formal training. At the same time, he stressed that many clinicians who could make meaningful contributions in this space may never do so, not because of a lack of interest but because they lack the time, structure, or guidance to get started.

Still, Dr. Valley emphasized that the stakes are too high to ignore.

“Change can be slow,” he said. “But I don’t think that’s a good enough response when patients’ lives are at risk.”

Why accurate pulse oximetry matters

For the pulmonary, critical care, and sleep medicine community, pulse oximeter inaccuracy is more than a technical concern; it is a patient safety issue with implications for health equity.

Clinicians rely on these devices to make critical decisions, from hospital admissions to oxygen therapy. When those readings are misleading, the consequences can be severe.

Dr. Valley recalled moments in his own practice that now feel unsettling in hindsight—times when patients reported symptoms that didn’t align with their readings.

“I remember patients saying they felt short of breath, and I’d say, ‘I hear you, but everything looks good,’” he said. “Now I think about where those numbers came from and whether they were misleading me.”

The experience underscores a broader lesson: Even widely trusted tools have limitations, and clinicians must remain critical and curious in their use.

Scaling advocacy beyond the bedside

For clinicians interested in advocacy, Dr. Valley offers a reassuring perspective: The foundation already exists.

“We are natural advocates,” he said. “That’s what we do at the bedside.”

The challenge—and the opportunity—is to extend that mindset beyond individual patients.

“Instead of just fixing a problem for one patient at a time, we should ask: Are there opportunities to scale this? Can we work together to create change at a larger level?”

In the case of pulse oximetry, that has meant engaging with regulatory agencies, raising awareness across the medical community, and pushing for improved device standards.

Dr. Valley and his colleagues began by publishing their findings and bringing attention to the issue, then they worked to ensure the data reached the right audiences. Their efforts have contributed to increased awareness and have helped prompt engagement from organizations such as the US Food and Drug Administration, though progress has been uneven.

“We’ve had varying degrees of success,” he said, noting that while some institutions have responded, discernible change at a systemwide level takes time.

There is growing recognition of the problem and momentum toward better standards, but reliable solutions are not yet fully in place. Clinicians are left navigating this uncertainty in real time, balancing the benefits of pulse oximetry with a clearer understanding of its limitations.

“I’m still taking care of patients in the ICU, and I still don’t really know what to do about pulse oximeters,” he admitted.

The problems worth solving

If there is one takeaway from Dr. Valley’s journey, it is that advocacy does not look the same for everyone. It begins with attention—paying close enough attention to recognize when something isn’t working—and the willingness to act.

“The key is to think about the things that bug you when you’re taking care of patients,” he said. “Those are often the problems worth solving.”

From there, the path to advocacy may not be straightforward. But as Dr. Valley’s work demonstrates, it is essential.