Dear Neal
I absolutely agree - the number of questions depends on those 3 things,
and in particular on the method used. I could imagine dozens of
questions detected if I re-watched a video of my own consultations. But
many would be trivial and not important to clinical decisions. So among
the many studies (as in Martin's review), the data from Sackett's
evidence cart rounds is particularly relevant. They found 2 questions
per 3 patients (98 searches for 166 patients), and the searches changed
1 in 3 clinical decisions.
"Of the71 successful searches,37 (52%) confirmed their current or
tentative diagnostic ortreat-ment plans, 18 (25%) led to a new
diagnostic skill, an additional test, ora new management decision, and
16 (23%) corrected a previous clinical skill, diagnostictest selection,
or treatment decision."
Cheers
Paul Glasziou
Sackett DL, Straus SE. Finding and applying evidence during clinical
rounds: the "evidence cart". JAMA. 1998 Oct 21;280(15):1336-8. PMID
9794314
>>> Maskrey Neal 17/11/10 23:24 >>>
No Jeff, you're right. "The wide variation of average number of
questions generated by primary care physicians per consultation depended
upon the work setting, the definition of the question and the methods
used (self report, interview, observation)."
Coumou HCH, Meijman FJ. How do primary care physicians seek answers to
clinical questions? A literature review. Journal of the Medical Library
Association, 2006, 94(1), pp55-60.
Best wishes
Neal
Neal Maskrey. National Prescribing Centre, Liverpool, UK.
________________________________
From: Evidence based health (EBH)
[mailto:[log in to unmask]] On Behalf Of Jeff Harrison
Sent: 15 November 2010 22:22
To: [log in to unmask]
Subject: Re: Number of clinical questions per encounter
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:
* Abstract
Send to:
Ann Fam Med. 2007 Jul-Aug;5(4):345-52.
Information needs and information-seeking behavior of primary care
physicians.
González-González AI , Dawes M , Sánchez-Mateos J , Riesgo-Fuertes R
, Escortell-Mayor E , Sanz-Cuesta T , Hernández-Fernández T .
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 c
are 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
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On 2010-11-15, at 1:45 PM, "Farhad Shokraneh Naneh Karan" 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 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
