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Dear Martin Thank you for posting this, it looks like an interesting paper. I hadn’t come across it before so my questions are, I accept, based on reading only the abstract (something an EBMer would never do). I’m somewhat surprised by how low the rate of questions per consultation is. I find it hard to believe only 1 in 5 consultations requires a question to be asked and a decision to be made – if so what is everyone doing in the other 4???? Should the finding in your study be interpreted as clinical questions the physician believed they didn’t know the answer to already? That is to say, something they had to look up or undertake further research before making a decision. Might this explain some of the difference between your study (0.18) and those previously cited? It appears to me that Phillipp’s question is about how often a question arises and your paper is about how often information is sought to answer the questions that have arisen. Then again, I may have mis-interpreted one or both of you. Jeff From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Dawes, Martin Sent: Monday, 15 November 2010 4:53 p.m. To: [log in to unmask] Subject: Re: Number of clinical questions per encounter We found fewer Martin Display Settings: <http://www.ncbi.nlm.nih.gov/pubmed/17664501> · Abstract <http://www.ncbi.nlm.nih.gov/pubmed/17664501> Send to: <http://www.ncbi.nlm.nih.gov/pubmed/17664501> Ann Fam Med. <javascript:AL_get(this,%20'jour',%20'Ann%20Fam%20Med.');> 2007 Jul-Aug;5(4):345-52. Information needs and information-seeking behavior of primary care physicians. González-González AI <http://www.ncbi.nlm.nih.gov/pubmed?term=%22Gonz%C3%A1lez-Gonz%C3%A1lez%20AI%22%5BAuthor%5D> , Dawes M <http://www.ncbi.nlm.nih.gov/pubmed?term=%22Dawes%20M%22%5BAuthor%5D> , Sánchez-Mateos J <http://www.ncbi.nlm.nih.gov/pubmed?term=%22S%C3%A1nchez-Mateos%20J%22%5BAuthor%5D> , Riesgo-Fuertes R <http://www.ncbi.nlm.nih.gov/pubmed?term=%22Riesgo-Fuertes%20R%22%5BAuthor%5D> , Escortell-Mayor E <http://www.ncbi.nlm.nih.gov/pubmed?term=%22Escortell-Mayor%20E%22%5BAuthor%5D> , Sanz-Cuesta T <http://www.ncbi.nlm.nih.gov/pubmed?term=%22Sanz-Cuesta%20T%22%5BAuthor%5D> , Hernández-Fernández T <http://www.ncbi.nlm.nih.gov/pubmed?term=%22Hern%C3%A1ndez-Fern%C3%A1ndez%20T%22%5BAuthor%5D> . Servicio Madrileño de la Salud, Madrid, Spain. [log in to unmask] Abstract PURPOSE: The aim of this study was to determine the information needs of primary care physicians in Spain and to describe their information-seeking patterns. METHODS: This observational study took place in primary care practices located in Madrid, Spain. Participants were a random stratified sample of 112 primary care physicians. Physicians' consultations were video recorded for 4 hours. Clinical questions arising during the patient visit and the sources of information used within the consultation to answer questions were identified. Physicians with unanswered questions were followed up by telephone 2 weeks later to determine whether their questions had since been answered and the sources of information used. Clinical questions were classified by topic and type of information. RESULTS: A total of 3,511 patient consultations (mean length, 7.8 minutes) were recorded, leading to 635 clinical questions (0.18 questions per consultation). The most frequent questions were related to diagnosis (53%) and treatment (26%). The most frequent generic type of questions was "What is the cause of symptom x?" (20.5%). Physicians searched for answers to 22.8% of the questions (9.6% during consultations). The time taken and the success rate in finding an answer during a consultation and afterward were 2 minutes (100%) and 32 minutes (75%), respectively. CONCLUSIONS: Primary care physicians working in settings where consultations are of short duration have time to answer only 1 in 5 of their questions. Better methods are needed to provide answers to questions that arise in office practice in settings where average consultation time is less than 10 minutes. PMID: 17664501 [PubMed - indexed for MEDLINE]PMCID: PMC1934982Free PMC Article Images from this publication.See all images (1) <http://www.ncbi.nlm.nih.gov/images?term=17664501%5bPMID%5d> Free text <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1934982/> <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1934982/figure/f1/> Publication Types, MeSH Terms <http://www.ncbi.nlm.nih.gov/pubmed/17664501> LinkOut - more resources <http://www.ncbi.nlm.nih.gov/pubmed/17664501> On 2010-11-15, at 1:45 PM, "Farhad Shokraneh Naneh Karan" <[log in to unmask]> wrote: Dear Philipp, I cited similar information in my master thesis using following book: Straus ES, Richardson WS, Glasziou P, Haynes RB. Evidence-based medicine: how to practice and teach EBM. 3rd ed. London: Elsevier Churchill Livingstone; 2005: Page 2, Paragraph 3... "our daily need for valid information about diagnosis, prognosis, therapy, and prevention (up to five times per inpatient (5) and twice for every three outpatients(6)". 5. Osheroff JA, Forsythe DE, Buchanan BG, Bankowitz RA, Blumenfeld BH, Miller RA. Physicians' information needs: analysis of questions posed during clinical teaching. Ann Intern Med 1991; 114: 576-81 6. Covell DG, Uman GC, Manning PR. Information needs in office practice: are they being met? Ann Intern Med 1985;103: 96-9 Best Wishes Farhad On Mon, Nov 15, 2010 at 10:53 PM, Dahm, Philipp <[log in to unmask]> wrote: I have people cite a paper that found that the average clinicians has 3 - 6 clinical questions per patient encounter. Can anyone provide the reference, please? Thanks Ph* -- Farhad Shokraneh, BSc, MS Medical Librarianship and Information Science Center for Gifted and Talented Students Iran University of Medical Sciences Tehran, Iran