Obstacles to answering doctors' questions about patient care with evidence: qualitative study

Objective To describe the obstacles encountered when attempting to answer doctors' questions with evidence. Design Qualitative study. Setting General practices in Iowa. Participants 9 academic generalist doctors, 14 family doctors, and 2 medical librarians. Main outcome measure A taxonomy of obstacles encountered while searching for evidence based answers to doctors' questions. Results 59 obstacles were encountered and organised according to the five steps in asking and answering questions: recognise a gap in knowledge, formulate a question, search for relevant information, formulate an answer, and use the answer to direct patient care. Six obstacles were considered particularly salient by the investigators and practising doctors: the excessive time required to find information; difficulty modifying the original question, which was often vague and open to interpretation; difficulty selecting an optimal strategy to search for information; failure of a seemingly appropriate resource to cover die topic; uncertainty about how to know when all the relevant evidence has been found so that the search can stop; and inadequate synthesis of multiple bits of evidence into a clinically useful statement. Conclusions Many obstacles are encountered when asking and answering questions about how to care for patients. Addressing these obstacles could lead to better patient care by improving clinically oriented information resources.