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First published November 23, 2004 as JAMIA PrePrint; doi:10.1197/jamia.M1608
Journal of the American Medical Informatics Association 2005;12(2):217-224
© 2005 American Medical Informatics Association

A more recent version of this article appeared on March 1, 2005
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Submitted on April 15, 2004
Accepted on November 3, 2004

Answering Physicians' Clinical Questions: Obstacles and Potential Solutions

John W. Ely MD, MSPH1*, Jerome A. Osheroff MD2, M. Lee Chambliss MD, MSPH3, Mark H. Ebell MD, MS4, and Marcy E. Rosenbaum PhD1

Affiliation of the authors: 1 Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA; 2 Thomson MICROMEDEX, Greenwood Village, CO; 3 Moses Cone Hospital Family Medicine Residency, Greensboro, NC; 4 Department of Family Medicine, Michigan State University, East Lansing, MI

* To whom correspondence should be addressed.

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 1062 questions, but pursued answers to only 585 (55%). The most commonly reported obstacle to 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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