title: Obstacles to answering doctors' questions about patient care with evidence: qualitative study.
abstract: 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.
authors.affiliation: Department of Family Medicine, University of Iowa College of Medicine, Iowa City, IA 52242, USA. john-ely@uiowa.edu
authors.forename: John W
authors.initials: JW
authors.lastname: Ely
authors.forename: Jerome A
authors.initials: JA
authors.lastname: Osheroff
authors.forename: Mark H
authors.initials: MH
authors.lastname: Ebell
authors.forename: M Lee
authors.initials: ML
authors.lastname: Chambliss
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Vinson
authors.forename: James J
authors.initials: JJ
authors.lastname: Stevermer
authors.forename: Eric A
authors.initials: EA
authors.lastname: Pifer
mesh_terms: 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*