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Primary Care

Obstacles to answering doctors' questions about patient care with evidence: qualitative study

BMJ 2002; 324 doi: (Published 23 March 2002) Cite this as: BMJ 2002;324:710
  1. John W Ely, associate professor (john-ely{at},
  2. Jerome A Osheroff, director of informaticsb,
  3. Mark H Ebell, associate professorc,
  4. M Lee Chambliss, assistant clinical professord,
  5. Daniel C Vinson, associate professore,
  6. James J Stevermer, assistant professore,
  7. Eric A Pifer, assistant professorf
  1. a Department of Family Medicine, University of Iowa College of Medicine, Iowa City, IA 52242, USA
  2. b Praxis Press, New York, NY 10010, USA
  3. c Department of Family Practice, Michigan State University, East Lansing, MI 48824, USA
  4. d Moses Cone Hospital Family Medicine Residency, Greensboro, NC 27401, USA
  5. e University of Missouri-Columbia School of Medicine, Columbia, MO 65212, USA
  6. f Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
  1. Correspondence to: J W Ely
  • Accepted 7 December 2001


Objective: To describe the obstacles encountered when attempting to answer doctors' questions with evidence.

Design: Qualitative study.

Setting: General practices in Iowa.

Participants: 9 academic generalist doctors, 14 family doctors, and 2 medical librarians.

Main outcome measure: A taxonomy of obstacles encountered while searching for evidence based answers to doctors' questions.

Results: 59 obstacles were encountered and organised according to the five steps in asking and answering questions: recognise a gap in knowledge, formulate a question, search for relevant information, formulate an answer, and use the answer to direct patient care. Six obstacles were considered particularly salient by the investigators and practising doctors: the excessive time required to find information; difficulty modifying the original question, which was often vague and open to interpretation; difficulty selecting an optimal strategy to search for information; failure of a seemingly appropriate resource to cover the topic; uncertainty about how to know when all the relevant evidence has been found so that the search can stop; and inadequate synthesis of multiple bits of evidence into a clinically useful statement.

Conclusions: Many obstacles are encountered when asking and answering questions about how to care for patients. Addressing these obstacles could lead to better patient care by improving clinically oriented information resources.

What is already known on this topic

What is already known on this topic Doctors are encouraged to search for evidence based answers to their questions about patient care but most go unanswered

Studies have not defined the obstacles to answering questions in a systematic manner

A comprehensive description of such obstacles has not been presented

What this study adds

What this study adds Fifty nine obstacles were found while attempting to answer clinical questions with evidence; six were particularly salient

The obstacles were comprehensively described and organised


  • Funding This study was supported by grants from the American Academy of Family Physicians Foundation (G9518) and the National Library of Medicine (1R01LM07179-01).

  • Competing interests JAO is an employee of Praxis Press, a company that produces evidence based clinical information resources for primary care doctors.

  • Accepted 7 December 2001
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