Does the structure of clinical questions affect the outcome of curbside consultations with specialty colleagues?
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.
Bergus
G R
GR
Department of Family Medicine, University of Iowa College of Medicine, Iowa City, USA. george-bergus@uiowa.edu
Randall
C S
CS
Sinift
S D
SD
Rosenthal
D M
DM
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