Answering Physicians' Clinical Questions: Obstacles and Potential Solutions
- Affiliations of the authors: Department of Family Medicine, University of Iowa Carver College of Medicine, Iowa City, IA (JWE, MER); Thomson MICROMEDEX, Greenwood Village, CO (JAO); Moses Cone Hospital, Greensboro, NC (MLC); Department of Family Practice, Michigan State University, East Lansing, MI (MHE)
- Correspondence and reprints: John W. Ely, MD, MSPH, Department of Family Medicine, University of Iowa College of Medicine, 200 Hawkins Drive, 01291-D PFP, Iowa City, IA 52242; e-mail: <john-ely{at}uiowa.edu>
- Received 15 April 2004
- Accepted 3 November 2004
Abstract
Objective To identify the most frequent obstacles preventing physicians from answering their patient-care questions and the most requested improvements to clinical information resources.
Design Qualitative analysis of questions asked by 48 randomly selected generalist physicians during ambulatory care.
Measurements Frequency of reported obstacles to answering patient-care questions and recommendations from physicians for improving clinical information resources.
Results The physicians asked 1,062 questions but pursued answers to only 585 (55%). The most commonly reported obstacle to the pursuit of an answer was the physician's doubt that an answer existed (52 questions, 11%). Among pursued questions, the most common obstacle was the failure of the selected resource to provide an answer (153 questions, 26%). During audiotaped interviews, physicians made 80 recommendations for improving clinical information resources. For example, they requested comprehensive resources that answer questions likely to occur in practice with emphasis on treatment and bottom-line advice. They asked for help in locating information quickly by using lists, tables, bolded subheadings, and algorithms and by avoiding lengthy, uninterrupted prose.
Conclusion Physicians do not seek answers to many of their questions, often suspecting a lack of usable information. When they do seek answers, they often cannot find the information they need. Clinical resource developers could use the recommendations made by practicing physicians to provide resources that are more useful for answering clinical questions.
Footnotes
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An abstract describing preliminary results of this study was published and presented at the Society of Teachers of Family Medicine Annual Spring Conference, Atlanta, GA, September 21, 2003.
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Supported by a grant from the National Library of Medicine (1R01LM07179-01).
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Dr. Osheroff is employed by Thomson MICROMEDEX, Greenwood Village, CO. This company disseminates decision support and reference information to health care providers and could benefit financially if it followed the recommendations described in this manuscript (as could its competitors). Similar considerations apply to his past consultation to Merck on their Merck Medicus project. Dr. Ebell is employed by Group for Organization Learning and Development, Athens, GA, and Michigan State University, East Lansing, MI. In addition, he is an editor at American Family Physician and has developed a computer application, “InfoRetriever,” which helps physicians answer their patient-care questions; he owns stock in the company that licenses this software. All these associations could benefit financially if they endorsed the recommendations made in this paper. However, the authors do not believe this represents a conflict of interest in the usual sense.
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The authors thank the 48 physicians who participated in this study.
