Occupational physicians: what are their questions in daily practice? An observation study.
BACKGROUND
To enable occupational physicians (OPs) to make use of scientific information in the decision-making process, evidence-based occupational health practice is stimulated.


OBJECTIVE
To study the questions which arise in daily practice of OPs, and to evaluate the possible contribution of evidence-based medicine (EBM) strategies to answer these questions.


METHODS
Observation of 20 OPs during two consecutive half-day periods, followed by an interview to explore the topics that arose during the preceding period. The conscious or manifest and unconscious or latent questions by OPs were analysed, and the number of questions suitable for performing a search in scientific medical literature databases was assessed.


RESULTS
After 40 half-day periods, the OPs had asked 26 manifest questions and 348 latent questions; the latter were voiced during the interview. Of all the questions, 40% were clinical in nature and considered suitable for a literature search. The emphasis of these questions was on prognosis, susceptibility and diagnosis following individual consultations. A lack of time or 'no necessity to look for an answer' were the most important reasons for leaving the questions unanswered.


CONCLUSIONS
OPs spontaneously formulated less than one question per working day. However, after an observation of their daily practice followed by an interview, many latent questions were formulated. A substantial number of these questions could be answered by EBM strategies. If OPs were encouraged more to improve the quality of their decision making, they might formulate more answerable questions and feel more inclined to search for answers.
Academic Medical Center, University of Amsterdam-Coronel Institute for Occupational and Environmental Health, PO Box 22700, Amsterdam 1100 DE, The Netherlands. f.g.schaafsma@amc.uva.nl
Frederieke
F
Schaafsma
Carel
C
Hulshof
Angela
A
de Boer
Ralph
R
Hackmann
Nannette
N
Roest
Frank
F
van Dijk
D000328:Adult; D002983:Clinical Competence; D003657:Decision Making; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007255:Information Services; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D009426:Netherlands; D009787:Occupational Medicine / Q000592:standards*