Obstacles to answering doctors' questions about patient care with evidence: qualitative study.
OBJECTIVE
To describe the obstacles encountered when attempting to answer doctors' questions with evidence.


METHODS
Qualitative study.


METHODS
General practices in Iowa.


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


METHODS
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.
Ely
John W
JW
Department of Family Medicine, University of Iowa College of Medicine, Iowa City, IA 52242, USA. john-ely@uiowa.edu
Osheroff
Jerome A
JA
Ebell
Mark H
MH
Chambliss
M Lee
ML
Vinson
Daniel C
DC
Stevermer
James J
JJ
Pifer
Eric A
EA
D002983:Clinical Competence; D019317:Evidence-Based Medicine / Q000379:methods*; D005194:Family Practice / Q000592:standards*; D006801:Humans; D007255:Information Services / Q000592:standards*; D007484:Iowa; D005791:Patient Care / Q000592:standards*