Analysis of questions asked by family doctors regarding patient care

BMJ 1999;319:358-361 ( 7 August )

Information in practice

Analysis of questions asked by family doctors regarding patient care

John W Ely, associate professor, ^a Jerome A Osheroff, deputy editor, integrated clinical information resources, ^b Mark H Ebell, associate professor, ^c George R Bergus, associate professor, ^a Barcey T Levy, associate professor, ^a M Lee Chambliss, clinical assistant professor, ^d Eric R Evans, staff physician. ^e

^a Department of Family Medicine, University of Iowa College of Medicine, 200 Hawkins Drive, 01291-D PFP, Iowa City, IA 52242, USA, ^b American College of Physicians- American Society of Internal Medicine, Philadelphia, PA, USA, ^c Department of Family Practice, Michigan State University, East Lansing, MI, USA, ^d Moses Cone Hospital Family Medicine Residency, Greensboro, NC, USA, ^e Student Health Service, University of Iowa, Iowa City

Correspondence to: J W Ely john-ely{at}uiowa.edu

Objectives: To characterise the information needs of familydoctors by collecting the questions they asked about patient careduring consultations and to classify these in ways that wouldbe useful to developers of knowledgebases.
Design: Observational study in which investigatorsvisited doctors for two half days and collected their questions.Taxonomies were developed to characterise the clinical topic andgeneric type of information sought for eachquestion.
Setting: EasternIowa.
Participants: Random sample of 103 familydoctors.
Main outcome measures: Number of questions posed, pursued, and answered;topic and generic type of information sought for each question;time spent pursuing answers; information resourcesused.
Results: Participants asked a total of 1101 questions.Questions about drug prescribing, obstetrics and gynaecology,and adult infectious disease were most common and comprised 36%of all questions. The taxonomy of generic questions included 69categories; the three most common types, comprising 24% of allquestions, were "What is the cause of symptom X?" "What is thedose of drug X?" and "How should I manage disease or finding X?"Answers to most questions (702, 64%) were not immediately pursued,but, of those pursued, most (318, 80%) were answered. Doctorsspent an average of less than 2 minutes pursuing an answer, andthey used readily available print and human resources. Only twoquestions led to a formal literaturesearch.
Conclusions: Family doctors in this study did not pursueanswers to most of their questions. Questions about patient carecan be organised into a limited number of generic types, whichcould help guide the efforts of knowledge basedevelopers.

Key messages

Questions that doctors have about the care of their patients could help guide the content of medical information sources and medical training
In this study of US family doctors, participants frequently had questions about patient care but did not pursue answers to most questions (64%)
On average, participants spent less than 2 minutes seeking an answer to a question
The most common resources used to answer questions included textbooks and colleagues; formal literature searches were rarely performed
The most common generic questions were "What is the cause of symptom X?" "What is the dose of drug X?" and "How should I manage disease or finding X?"

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Rapid Responses:

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More questions than a GP can answer.: Saroj K Mishra
bmj.com, 10 Aug 1999 [Full text]
Pattern of clinical question and doctors'' behavior is also similar in Japan: Manabu Yoshimura
bmj.com, 3 Sep 1999 [Full text]