What clinical information do doctors need?

BMJ 1996;313:1062-1068 (26 October)

Information in practice

What clinical information do doctors need?

Richard Smith, editor 100336.3120@ compuserve.com ^a

^a BMJ, London WC1H 9JR

Summary points

Doctors use some two million pieces of information to manage patients, but little research has been done on the information needs that arise while treating patients
Textbooks, journals, and other existing information tools are not adequate for answering the questions that arise: textbooks are out of date, and "the signal to noise" ratio of journals is too low for them to be useful in daily practice
Computer systems that have been developed to help doctors are not widely used--perhaps because they have not been developed to meet doctors' information needs
When doctors see patients they usually generate at least one question; more questions arise than the doctors seem to recognise
Most of the questions concern treatment
Many of the questions are highly complex, simultaneously asking about individual patients and particular areas of medical knowledge
Often doctors are asking not simply for information but for support, guidance, affirmation, and feedback
Many of the questions go unanswered, but most could be answered; it is, however, time consuming and expensive to answer them
Doctors are most likely to seek answers to these questions from other doctors
The best information sources provide relevant, valid material that can be accessed quickly and with minimal effort
New information tools are needed: they are likely to be electronic, portable, fast, easy to use, connected to both a large valid database of medical knowledge and the patient record, and a servant of patients as well as doctors

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