Are there studies where primary care clinicians (PCPs) report questions that arise clinically and are difficult to answer, requiring consultation with colleagues?

Clinical Questions in Primary Care: Evidence from Direct Studies

Yes, multiple studies have directly examined clinical questions that arise during primary care consultations, documenting both the questions clinicians struggle to answer and their reliance on colleagues for help. 1, 2, 3

Frequency and Nature of Clinical Questions

Primary care clinicians generate clinical questions frequently during patient encounters:

• Clinicians raise approximately 0.57 questions per patient encounter (ranging from 0.38-0.77 questions per patient), meaning roughly one question arises for every two patients seen 3
• Most clinicians encounter clinical questions at least a few times per week, with questions arising consistently across diverse practice settings 2
• In one prospective study, 21 primary care doctors submitted 78 clinical questions over 24 clinic days, representing 0.01 questions per patient encounter that they actually documented (though the true rate of questions arising was likely higher) 4

The Problem: Most Questions Go Unanswered

Clinicians pursue answers to only 51% (36%-66%) of the questions they raise, leaving roughly half of all clinical questions unaddressed 3:

• Of the questions clinicians do pursue, they find answers to 78% (67%-88%) 3
• Overall, only about 40% of clinical questions get answered in routine practice 4
• Even when clinicians find answers on their own, they are satisfied with only 67% of those answers 4

Types of Questions That Arise

Drug therapy questions dominate clinical uncertainty, representing the single largest category:

• 36% of all clinical questions concern drug treatment 3, 5
• 24% relate to diagnosis (determining potential causes of symptoms, physical findings, or test results) 3
• 13.5% concern epidemiology 5
• Questions about musculoskeletal, endocrine, skin, cardiac, and digestive systems are most common 5

Why Clinicians Don't Pursue Answers

Time is the single biggest barrier preventing clinicians from seeking answers to their clinical questions 2, 3:

• Clinicians doubt that useful answers exist for many questions 3
• Most clinicians (the majority of respondents) have no formal training in searching medical databases, limiting their ability to efficiently find information 2
• Clinicians are unaware of many available digital resources that could answer their questions 2

Reliance on Colleagues

Primary care physicians preferentially consult colleagues first when seeking answers, despite the availability of electronic resources 1:

• This pattern of consulting colleagues and paper sources has remained essentially unchanged from 1992 to 2005, and persists despite enormous increases in electronic information accessibility 1
• The preference for colleague consultation reflects practical barriers: formulating appropriate search questions, finding optimal search strategies, and interpreting evidence are all difficult for busy clinicians 1

Evidence That Questions Can Be Answered

When intensive searches are performed by trained information specialists, nearly all clinical questions can be answered:

• Investigators were able to provide answers for 95% of clinical questions that primary care doctors had raised 4
• Doctors rated these investigator-found answers as satisfactory in 86% of cases 4
• Answers found through intensive searches by specialists were significantly more satisfactory than those found by doctors' own searches (p = 0.002) 4

Solutions That Have Been Studied

Several approaches have been examined to help clinicians get answers:

• Clinical librarian services: Some studies examined embedded librarian support, where librarians answer questions in real-time (within 15 minutes) at the point of care 5
• Building question-and-answer databases for quick reference 1
• Consulting filtered information sources 1
• However, the effects of these interventions on physician behavior and patient outcomes have not been adequately studied 1

Critical Gap in Current Practice

This evidence reveals a persistent, substantial gap between the questions that arise and the answers clinicians obtain, with roughly half of all clinical questions never pursued and only about one-third ultimately answered satisfactorily 3, 4. This pattern has remained remarkably stable over decades despite technological advances, suggesting that solutions must address fundamental workflow and training issues rather than simply providing more information resources 1.