General Medicine Clinical Questions: Evidence-Based Approach
Direct Answer
The majority of clinical questions arising in general medicine practice (approximately 93%) can be answered using online evidence-based resources, with most answers found in clinical summaries within a median of 4 minutes 1.
Understanding Clinical Questions in General Medicine
Question Frequency and Pursuit Patterns
Clinicians raise clinical questions frequently during patient care:
- 0.57 questions per patient encounter on average 2
- Only 51% of questions are actively pursued by clinicians 2
- Of pursued questions, 78% are successfully answered 2
- This means approximately 40% of all clinical questions remain unanswered 2
The critical gap is not in finding answers, but in pursuing the questions in the first place.
Most Common Question Types
The taxonomy of clinical questions reveals clear patterns 3:
Top 3 question categories:
- "What is the drug of choice for condition X?" (11% of all questions)
- "What is the cause of symptom X?" (8% of all questions)
- "What test is indicated in situation X?" (8% of all questions)
By clinical domain 4:
- Treatment questions: 71%
- Diagnosis questions: 15%
- Epidemiology questions: 9%
By body system (using ICPC-2 classification) 4:
- Endocrine/metabolic and nutritional issues (most common)
- General and unspecified conditions
- Digestive system
- Musculoskeletal system
Why Questions Go Unanswered
Three question types account for 54% of unanswered questions 5:
- "Undiagnosed finding" questions - Management of abnormal clinical findings (symptoms, signs, test results)
- "Conditional" questions - Simple questions with qualifying conditions that complicate the answer (e.g., "What is the management of X, given Y?")
- "Compound" questions - Associations between two highly specific elements (e.g., "Can X cause Y?")
Barriers to Information Seeking
The main obstacles preventing clinicians from pursuing answers 2:
- Lack of time (most frequently cited)
- Doubt that a useful answer exists
- Uncertainty about where to search
- Complexity of rephrasing questions appropriately
Practical Strategies for Answering Clinical Questions
Optimal Search Approach
Start with clinical summaries - they answer 91% of questions successfully 1:
- BMJ Best Practice
- DynaMed
- UpToDate
Search hierarchy (following Haynes' pyramid):
- Clinical summaries (first line - highest yield)
- Systematic guidelines
- Systematic reviews
- Primary studies (only if above fail)
Question Reformulation Techniques
When initial searches fail 5:
For "undiagnosed finding" questions:
- Broaden the search from specific symptom to symptom category
- Search for differential diagnosis approaches rather than specific causes
For "conditional" questions:
- Remove the qualifying condition initially
- Search the simpler version first, then apply clinical judgment for the specific condition
For "compound" questions:
- Break into component parts
- Search each element separately, then synthesize
Knowledge Gaps Requiring Attention
70% of clinical questions relate to 4:
- Staying current with evolving evidence
- New tests or treatments
- Complementary and alternative therapies
This reveals a critical insight: Current guideline formats may not adequately address the dynamic information needs of general medicine practitioners.
The Role of General Medicine in Integrated Care
General medicine serves as the clinical bridge for patients with multimorbidity 6:
Core functions:
- Extended consultations for complex patients
- Relational continuity across conditions
- Individualized care plans
- Comprehensive medication review
- Self-management support
- Interdisciplinary coordination
- Cross-sector integration
Outcomes most improved:
- Patient-centered experience
- Care coordination
- Medication safety
- Health behaviors
Common Pitfalls and How to Avoid Them
Pitfall 1: Not Pursuing Questions
Solution: Track questions systematically during patient encounters, even if you cannot search immediately. Review and answer them during administrative time.
Pitfall 2: Searching Too Narrowly
Solution: When searches fail, broaden your question or rephrase it in more general terms before concluding no answer exists.
Pitfall 3: Using Wrong Resources
Solution: Avoid starting with primary literature or general search engines. Begin with clinical summaries designed for point-of-care use.
Pitfall 4: Assuming Guidelines Cover Everything
Solution: Recognize that guidelines often lag behind emerging evidence and may not address conditional or compound clinical scenarios 7.
Pitfall 5: Fragmented Approach to Multimorbidity
Solution: For patients with multiple conditions, prioritize whole-person assessment over disease-specific pathways 6.
Implementation in Clinical Practice
For individual clinicians:
- Allocate 4-5 minutes per clinical question for evidence searching
- Use clinical summaries as first-line resources
- Document questions that arise but cannot be immediately pursued
- Schedule dedicated time for answering accumulated questions
For healthcare systems:
- Integrate evidence-based resources into electronic health records
- Provide point-of-care access to clinical summaries
- Support maintenance of certification through question-tracking systems
- Recognize that general medicine expertise is essential for coordinating complex, multimorbid patients 6
The evidence strongly supports that most clinical questions in general medicine are answerable with existing resources—the challenge is creating workflows that enable clinicians to pursue and answer these questions efficiently 1, 2.