Tuesday, September 3, 2013

Why do clinical questions go unanswered?

- Kenny Lin, MD, MPH

What do you do when you have a clinical question that ideally requires an answer before the patient leaves your office? Do you flip through a textbook or a back issue of American Family Physician? Look up the topic in a online reference? Consult an smartphone app? Ask a colleague in the office or curbside a specialist by telephone?

Family physicians take many approaches to answering clinical questions, some more efficient and effective than others. For example, using AFP By Topic or the journal website search function is more likely to yield relevant results than hunting through a stack of print issues for that article on community-acquired pneumonia that you remembered reading at some point. Unfortunately, Deputy Editor Mark Ebell, MD, MS reported in a 2009 article that on average, 15-20 clinical questions come up each day, and most of these go unanswered.

A recent study published in JAMA Internal Medicine examined barriers to answering clinical questions at the point of care. Researchers affiliated with the Mayo Clinic conducted several focus groups with a total of 50 family and internal medicine physicians in academic medical center and community settings. Not surprisingly, the barrier most commonly mentioned by physicians was insufficient time. Some physicians with convenient access to computers and online references complained of not knowing which resource to search, and having doubts about whether the search was likely to yield an answer. Others were concerned that looking up information while in the examination room might diminish a patient's confidence in them. Finally, some physicians found that available resources simply did not contain the answers they needed.

The editors of AFP are interested in learning more about how you use our journal - in its print, online, and mobile versions - to answer your clinical questions. Are you able to find current, relevant answers at the point of care, or do you prefer to browse AFP at home and subsequently incorporate what you learn into practice? What could we do to improve your searching and reading experiences?

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