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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 for publication: 04/15/04; accepted for publication: 11/03/04.

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.

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