WRITER: AMY LILLARD
CONTACT: DAVE PEDERSEN
2130 Medical Laboratories
Iowa City IA 52242
(319) 335-8032; fax (319) 335-8034
Release: Sept. 28, 1999
UI study indicates physicians' questions are often
IOWA CITY, Iowa Family doctors routinely have
questions about patient conditions and procedures the doctors should take,
but most of the time the answers are not pursued, according to a University
of Iowa Health Care study.
John W. Ely, M.D., associate professor of family medicine
and lead author of the recently published paper, said doctors are often pressed
for time in finding answers to their own medical questions, but also perceive
the answers to their questions as too hard to find or non-existent.
"Doctors are constantly told we need to ask the right
questions before we can get the right answers," Ely said. "But maybe textbook
authors need to make the information they put in their books better fit the
questions that doctors do have."
Ely said the goal in researching what questions doctors
ask themselves, about their patients and the care they need, and how they
find the answers is ultimately to find better and faster ways of answering
those questions. He found that if doctors do attempt to research their queries,
they mostly consult textbooks that are often not helpful.
"Textbook authors often don't know what to put in
their books, so they just guess," Ely said. "This area is one that hasn't
been studied much, although asking questions is a frequent thing for doctors
to do. But nobody, especially the authors of books that doctors use to answer
common questions, really knows what kind of questions are asked, the amount,
and the time they take."
Ely and his colleagues studied 103 Eastern Iowa family
doctors, following each doctor at their practice for two half-days. The researchers
sought to have the doctors share any and all questions, even the "vague, fleeting
uncertainties that [doctors] would normally keep to [themselves]." After 21
months, Ely and his team tabulated 1,101 questions.
The researchers organized these questions into topics
and general types and determined some key trends. Doctors had the most questions
about drug prescriptions, obstetrics and gynecology, and adult infectious
diseases. The most common types of questions were the causes of symptoms they
observed, the correct dosages of drugs that were needed and the proper procedures
for managing a disease or condition.
In addition, the team found that 64 percent of the
questions asked were not pursued immediately. However, of those questions
that doctors followed up on, 80 percent were answered in an average of two
minutes using mostly readily available texts and colleagues. In an added discovery,
researchers found older doctors saw more patients, but asked the least number
Ely said the common question topics they found, such
as prescriptions, infectious diseases and obstetrics and gynecology, reflect
areas physicians are seeing a lot of but often do not know enough about. These
topics, and the types of questions asked regarding causes, dosages, and procedures,
are good indicators of what medical schools and texts should focus on.
"Texts, in particular, often need to focus more on
practical physician knowledge," Ely said. "They often get hung up on citing
clinical trials. For example, if a doctor has a question on whether to use
treatment A to treat a patient, a text focusing on experiments and trials
merely answers if treatment A works, not if it should be used. Meanwhile,
there may be a perfectly good reason not to use the treatment if it has side
effects, or it's expensive, or if there is a different treatment that would
work. So doctors often don't find the answers they need."
The occasional lack of relevance in texts that doctors
may use to pursue answers may dissuade the doctors from even trying, according
to the study. The finding of older doctors asking fewer questions may reflect
accumulated experience over the years and a knowledge of what questions can
be answered with existing resources.
In addition to being extremely busy, doctors may believe
that answers to their questions don't exist or they may not know where to
look. This problem has been a research interest of Ely's for several years
and is the impetus toward his future research and eventual goal.
"We need to find better ways of answering physicians'
questions," he said. "Ultimately, we'd like to have a huge database, maybe
on the web, where doctors' questions may be posted along with answers that
are continually updated. I've developed a personal database already, and it
has 1,600 questions. The need is there."
Ely's past research has involved similar topics, including
medical error, malpractice and the information needs and self-perceived errors
of physicians. He is already working on another study related to this, attempting
to find the proportion of doctors' questions that can be answered with existing
Ely's research team included Eric R. Evans, a staff
physician at the UI Student Health Service. The paper appeared in the Aug.
7 issue of the British Medical Journal.
NOTE TO EDITORS: A copy of this research article is available
online at www.bmj.com/cgi/content/full/319/7206/358.
To contact John Ely, call (319) 384-7533.
University of Iowa Health Care describes the partnership
between the UI College of Medicine and the UI Hospitals and Clinics and the
patient care, medical education and research programs and services they provide.