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. 2002 Mar 23;324(7339):710.
doi: 10.1136/bmj.324.7339.710.

Obstacles to answering doctors' questions about patient care with evidence: qualitative study

John W Ely  1 , Jerome A Osheroff, Mark H Ebell, M Lee Chambliss, Daniel C Vinson, James J Stevermer, Eric A Pifer
Affiliations

Obstacles to answering doctors' questions about patient care with evidence: qualitative study

John W Ely et al. BMJ. .

Abstract

Objective: To describe the obstacles encountered when attempting to answer doctors' questions with evidence.

Design: Qualitative study.

Setting: General practices in Iowa.

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

Main outcome measure: 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.

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