AbstractPrevious research has found that improved search engine effectiveness—evaluated using a batch‐style approach—does not always translate to significant improvements in user task performance; however, these prior studies focused on simple recall and precision‐based search tasks. We investigated the same relationship, but for realistic, complex search tasks required in clinical decision making. One hundred and nine clinicians and final year medical students answered 16 clinical questions. Although the search engine did improve answer accuracy by 20 percentage points, there was no significant difference when participants used a more effective, state‐of‐the‐art search engine. We also found that the search engine effectiveness difference, identified in the lab, was diminished by around 70% when the search engines were used with real users. Despite the aid of the search engine, half of the clinical questions were answered incorrectly. We further identified the relative contribution of search engine effectiveness to the overall end task success. We found that the ability to interpret documents correctly was a much more important factor impacting task success. If these findings are representative, information retrieval research may need to reorient its emphasis towards helping users to better understand information, rather than just finding it for them.