title: Does the structure of clinical questions affect the outcome of curbside consultations with specialty colleagues?
abstract: BACKGROUND
  Clinical questions frequently arise during the practice of medicine, and primary care physicians frequently use curbside consultations with specialty physicians to answer these questions. It is hypothesized that well-formulated clinical questions are more likely to be answered and less likely to receive a recommendation for formal consultation.
  
  
  OBJECTIVE
  To assess the relationship between the structure of clinical questions asked by family physicians and the response of specialty physicians engaged in curbside consultations.
  
  
  METHODS
  A case series of clinical questions asked during informal consultations between 60 primary care and 33 specialty physicians using an e-mail service. Curbside consultation questions were sent, using e-mail, to academic specialty physicians by primary care physicians (faculty, residents, and community practitioners) in eastern Iowa.
  
  
  METHODS
  Questions were analyzed to determine the clinical task and to identify 3 components: an intervention, a comparison, and an outcome. Consultants' responses were analyzed to identify whether questions were answered and whether consultants recommended formal consultation.
  
  
  RESULTS
  There were 708 questions in this analysis: 278 (39.3%) were diagnosis questions, 334 (47.2%) were management questions, 57 (8.0%) were prognosis questions, and 39 (5.5%) were requests for direction. Clinical questions were less likely to go unanswered or receive a recommendation for formal consultation when the question identified the proposed intervention (odds ratio, 0.54; 95% confidence interval, 0.34-0.86; P = .006) and desired outcome (odds ratio, 0.46; 95% confidence interval, 0.29-0.69; P < .001). Only 271 (38.3%) of 708 curbside consult questions identified both of these components.
  
  
  CONCLUSIONS
  Medical specialists' responses to curbside consultation questions seem to be affected by the structure of these clinical questions.
authors.affiliation: Department of Family Medicine, University of Iowa College of Medicine, Iowa City, USA. george-bergus@uiowa.edu
authors.forename: G R
authors.initials: GR
authors.lastname: Bergus
authors.forename: C S
authors.initials: CS
authors.lastname: Randall
authors.forename: S D
authors.initials: SD
authors.lastname: Sinift
authors.forename: D M
authors.initials: DM
authors.lastname: Rosenthal
mesh_terms: D003195:Computer Communication Networks; D003937:Diagnosis, Differential; D005194:Family Practice; D006801:Humans; D007400:Interprofessional Relations; D007484:Iowa; D007802:Language; D008511:Medicine; D016017:Odds Ratio; D011320:Primary Health Care; D012017:Referral and Consultation / Q000592:standards*; D013038:Specialization; D013812:Therapeutics; D014481:United States