WRITER: AMY LILLARD
CONTACT: DAVE PEDERSEN
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Iowa City IA 52242
(319) 335-8032; fax (319) 335-8034
e-mail: david-pedersen@uiowa.edu

Release:  Sept. 28, 1999

UI study indicates physicians' questions are often not pursued

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 of questions.

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 evidence.

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.

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