Questioning behaviour in general practice: a pragmatic study

Abstract Objective: To study the extent to which general practitioners' questioning behaviour in routine practice is likely to encourage the adoption of evidence based medicine. Design: Self recording of questions by doctors during consultations immediately followed by semistructured interview. Setting: Urban Australian general practice. Subjects: Random sample of 27 general practitioners followed over a half day of consultations. Main outcome measures: Rate of recording of clinical questions about patients' care which doctors would like answered; frequency with which doctors found answers to their questions. Results: Doctors asked a total of 85 clinical questions, at a rate of 2.4 for every 10 patients seen. They found satisfactory answers to 67 (79%) of these questions. Doctors who worked in small practices (of one or two doctors) had a significantly lower rate of questioning than did those in larger practices (1.6 questions per 10 patients v 3.0 patients, P=0.049). No other factors were significantly related to rate of questioning. Conclusions: These results do not support the view that doctors routinely generate a large number of unanswered clinical questions. It may be necessary to promote questioning behaviour in routine practice if evidence based medicine and other forms of self directed learning are to be successfully introduced. Key messages Doctors' abilities to formulate questions about their need for medical information in routine practice has been little studied and may be poorly developed We found that general practitioners asked clinical questions at a rate of 2.4 questions every 10 consultations and that doctors in small practices (one or two doctors) asked fewer questions The doctors found answers to most of their questions using easily available sources of information If evidence based medicine and other forms of self directed learning are to make substantial contributions to health care, factors which affect doctors' questioning behaviour need to be identified and ameliorated

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