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

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7339.710 (Published 23 March 2002) Cite this as: BMJ 2002;324:710

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Overcoming obstacles to best evidence

I do part time (2 to 4 hours per week) consulting work for Stanford
SKOLAR MD, identifying interested groups in Canada. I initially starting
using SKOLAR in conjunction with COMPETE - an electronic medical record
study, run by The Centre for the Evaluation of Medicine at St. Joseph's
Hospital in Hamilton, Ontario. My main activity is full time family
practice.

It is an unfortunate reality, that in our present medical
environment, time is an overwhelming factor. This is a reflection of our
21st century lifestyle. Quality, comprehensive medical care, of which
evidence based medicine is a part, is time intensive. Fortunately
Information Technology can provide a solution. A well designed Web based
search technology is able to provide quick answers and allow the physician
to quickly choose the type and level of information required. For example,
I use SKOLAR MD, designed at Stanford University. By entering search
terms, which can be in a very simplified form, it simultaneously searches
across a range of information sources – textbooks, drug databases, medline
and Cochrane reviews and allows the user to bring up full text references
to review in order to answer their clinical question. There are still
obvious limitations to the state of medical evidence and literature at
this time, and sometimes there is not a good answer to the question.

Ideally, one has workstations in all areas of patient care and one
can find evidence based answers and apply them at the time of a patient
encounter. There are barriers to this scenario, the cost of establishing
such a clinic network being foremost. In Canada, some provinces are
looking at establishing Primary Care Networks. An important factor in
“PCN” is the recognition that IT plays an important role and as a result
subsidizing the cost of office systems. A convincing business model is
necessary to influence physicians to make this change in the way they
practice. A well designed system will result in many other efficiencies so
that more time can be spent in patient care and being able to seek the
best evidence for clinical questions.

Competing interests: No competing interests

27 March 2002
Michael J. Pray
active staff, department of Family Practice, Hamilton Health Sciences Corporation, Hamilton <ontario
605 James St. N., Hamilton, Ontario, Canada L8L 1A6

An underlying theory

I am struck by the similarities identified in this article that the
researcher faces, the nurse in clinical practice faces, the patient faces
when they try to gather health care infomation, and the list goes on....
There must be an underlying theory here that is relevant to not only to
the general practitioner. It is no wonder we find it hard to incorporate
evidence into clinical practice.

Competing interests: No competing interests

23 March 2002
Karen Kaiser
Clinical Practice Coordinator
University of Maryland Medical Center, Baltimore MD 21201
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