CONTACT: BECKY SOGLIN
2130 Medical Laboratories
Iowa City IA 52242
(319) 335-6660; fax (319) 335-8034
Release: July 24, 2000
Note to editors: The Archives of Family Medicine article
cited can be accessed at http://archfami.ama-assn.org/issues/v9n6/full/foc0017.html
Outcome of physicians' e-mail consults depends on questions
IOWA CITY, Iowa -- When primary care physicians have
questions about how to care for a patient, they often use "curbside" consultation
-- informal discussion typically in person or by phone with a specialist --
to get advice. These informal consultations can save a patient from having
to visit a specialist for a formal consultation, saving the patient time and
money. However, it has not been clear how primary care physicians can make
the best use of this important medical resource.
A recent University of Iowa Health Care study sheds
light on the informal consultation process and reveals ways primary care physicians
might make better use of these consults. Based on the UI Hospital and Clinics'
innovative E-mail Consultation Service, the study specifically found a link
between how primary care doctors structured their questions in e-mails and
whether specialist consultants answered the questions without requesting a
formal consultation. The findings were published in the June issue of the
Archives of Family Medicine.
The researchers found that well-structured questions
were those that clearly identified the treatment the primary doctor was proposing
to use and the desired outcomes they hoped their patient would experience,
said George Bergus, M.D., UI associate professor of family medicine and the
study's lead investigator and primary author.
"When both components were present, primary care doctors
had successful outcomes from their curbside consultations 90 percent of the
time," Bergus said. "However, when neither component was included in the e-mailed
question, only 70 percent of consultations were successful."
The observational study analyzed nearly 700 e-mail
queries from, and responses to, 60 primary care physicians in eastern Iowa,
including UI faculty, residents and community practitioners. The 33 specialty
physicians and other health professionals who responded to the queries were
all within the UI Hospitals and Clinics.
Bergus said that only 38 percent of the queries examined
contained both components (proposed treatment and desired outcome) that made
up a well-defined question. Neither the clinical experience
of the primary physician nor the clinical area involved in the patient's care
seemed to be related to how well the queries were constructed.
Primary care physicians' questions were categorized
by how well defined they were, whether they identified both the treatment
and desired outcome, and other components. Consulting specialists' responses
were analyzed for whether they answered the questions and recommended formal
consultation. The study did not assess the thoroughness or accuracy of the
answers or whether requests for formal consultation were appropriate.
Bergus said the findings reflect what is known about
problem solving, and they also suggest that primary care physicians might
make better use of e-mail curbside consultation by carefully constructing
questions they want answered.
An example of a clearly stated question more likely
to elicit the answers needed to help a patient would be: "Will the addition
of a beta-blocker lengthen the life of a 58-year-old woman with moderate congestive
heart failure who is already taking an angiotensin-converting enzyme inhibitor?"
In contrast, a less clearly stated question would
be: "What should I do for a 58-year-old woman with moderate heart failure
who is already taking an angiotensin-converting enzyme inhibitor?"
"While e-mail consults are on the rise, phone curbside
consults remain the most common form of consults for primary care physicians,"
Bergus said. He added that curbside consults of any type fill about one-third
of the information needs of primary care physicians, with the remaining needs
being met by consulting textbooks and journals, and other methods.
Bergus cautioned that specialists must respond differently
to e-mail consults than they do to telephone or in-person consults. He said
that studying the structure of clinical questions asked over the phone or
in face-to-face exchanges also merits study.
Curbside consultations represent any exchange between
physicians about a patient where there is no legal relationship between the
consultant-physician and the patient. The consulting physician gives advice
only to the treating physician and does not examine or communicate directly
with the patient, does not review the patient's record and charges no fee
for the consulting services.
In addition, to Bergus, UI investigators involved
in the study were Christina S. Randall, Ph.D., research assistant in family
medicine; Suzanne D. Sinift, project assistant for the E-Mail Consult Service;
and David M. Rosenthal, Ph.D., UI associate professor of family medicine.
Staff in the UI College of Medicine Informational Systems also provided technical
The study was supported in part by a grant for graduate
training from the Human Resources and Services Administration in the federal
Department of Health and Human Services.
The UI offers a physician tutorial on formulating clinical
questions at: http://fpinfo.medicine.uiowa.edu/tutorial/intro_questions.htm
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.