Letters to the Editor

Physicians Should Use Resources to Find Clinical Answers



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Am Fam Physician. 2010 Feb 15;81(4):406.

Original Article: How to Find Answers to Clinical Questions

Issue Date: February 15, 2009

Available at: http://www.aafp.org/afp/2009/0215/p293.html

to the editor: As Dr. Ebell points out, it is well documented in the literature that questions arise from patient encounters and that most of these questions are not researched and are left unanswered. However, what he neglects to address is that when the questions are pursued, the literature provided answers to more than 80 percent of these questions.1,2

Dr. Ebell comments that PubMed should not be the first place to search for answers because “there is so much information it is like trying to drink from a firehose.” This phrase, coined by Clifford Stoll in an interview about his 1995 book Silicon Snake Oil,3 was made in reference to searching the World Wide Web—not for searching a well-constructed, refined database such as PubMed. Indisputably, PubMed is a large database; it contains more than 18 million citations and indexes about 5,200 journals. It may also be one of the most underappreciated and underused resources freely available to physicians and researchers.

Although time will always be a limiting factor or barrier for physicians in their pursuit of answers to clinical questions, a lack of searching skills should not stop them. As expert searchers, medical librarians are in a unique position to teach and demonstrate how to effectively navigate PubMed and other databases. Learning how to fine-tune literature searches takes practice and patience. Proper use of MeSH, Clinical Queries, My NCBI, and other tools can improve searching speed, success, and satisfaction.

In addition to using PubMed and Google to keep abreast of new studies and current trends, a subscription to a news reader is invaluable. A reader is a free online service that can be tailored to find blogs, RSS (Really Simple Syndication) feed subscriptions, journal tables of contents, clinical trials, health news, or virtually any topic of interest. These feeds can then be read from a single Web site. Medical librarians can offer advice and assistance in using the readers, managing subscriptions, and honing topics of interest.

Author disclosure: Nothing to disclose.

REFERENCES

1. Ely JW, Osheroff JA, Ebell MH, et al. Analysis of questions asked by family doctors regarding patient care BMJ. 1999;319(7206):358–361.

2. Green ML, Ciampi MA, Ellis PJ. Residents' medical information needs in clinic: are they being met? Am J Med. 2000;109(3):218–223.

3. Stoll C. Silicon Snake Oil: Second Thoughts on the Information Highway. New York, NY: Doubleday; 1995.

IN REPLY: I share Ms. O'Brien's appreciation for the depth and breadth of the PubMed database. However, it is important to note that a study found that it took physicians an average of 24 minutes to answer a question that remained unanswered at the end of a day of practice using PubMed.1 As I noted in my article, utilizing the Clinical Queries and Related Articles features on PubMed is much more useful for the busy physician. But, it should not be the first place we look for answers. Sources of pre-appraised, pre-filtered evidence are simply much more efficient, especially when they are regularly updated and incorporate calculators and interactive decision support tools.

I disagree that a steady diet of preconfigured PubMed searches for areas of interest, RSS feeds, and e-mailed tables of contents is a good medical information strategy for most practicing physicians. Those sources can tell us what is new, but they cannot tell us what is most important or useful. Because most physicians read no more than 30 to 60 minutes per week, it is critical that they focus on information that is relevant (reports patient-oriented outcomes) and valid (free of intentional and unintentional biases) in a way that takes as little time as possible.2,3 Although medical librarians can be important partners for researchers and for physicians when a search is particularly difficult or problematic, it is unrealistic to think that they have enough time to help physicians answer all or even many of their questions. The typical physician has about 10 questions per day, of which about one half go unanswered;46 that is more than 2 million unanswered questions per week by family physicians alone. Obviously, there is much work to be done by physicians, medical librarians, and informaticists to help us do a better job of answering more of these questions with the best available evidence.

Author disclosure: Dr. Ebell is a consulting editor for John Wiley and Sons, Inc., publisher of Essential Evidence Plus.

REFERENCES

1. Chambliss ML, Conley J. Answering clinical questions. J Fam Pract. 1996;43(2):140–144.

2. Shaughnessy AF, Slawson DC, Bennett JH. Becoming an information master: a guidebook to the medical information jungle. J Fam Pract. 1994;39(5):489–499.

3. Ebell MH, Barry HC, Slawson DC, Shaughnessy AF. Finding POEMs in the medical literature. J Fam Pract. 1999;48(5):350–355.

4. Ely JW, Osheroff JA, Ebell MH, et al. Analysis of questions asked by family doctors regarding patient care. BMJ. 1999;319(7206):358–361.

5. Ebell MH, White L. What is the best way to gather clinical questions from physicians? J Med Libr Assoc. 2003;91(3):364–366.

6. Ely JW, Osheroff JA, Gorman PN, et al. A taxonomy of generic clinical questions: classification study. BMJ. 2000;321(7258):429–432.

Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.

Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.

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