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Fatima Ibrahim

Page history last edited by fatima ibrahim 10 years, 9 months ago

Fatima:

Respond with a 1 page paper describing how physicians can prepare questions, search for an answer, and the concept behind the format of a question. How can you focus your search for information?

Asking clinical questions is a dynamics process that is naturally expected to occur during and after a patient encounter. During the patient encounter, devising key questions to answer will greatly depend on the physicians ability to ask relevant questions and seemingly irrelevant questions. This will not only help focus the scope of the question but identify the etiology with more accuracy. Gathering any information from patients may be so important in many classes of diseases such as infectious diseases where symptoms may be very similar but therapies markedly different. Models have been devised to help physicians focus in on their “knowledge” gap, which is usually the most difficult task in the overall process. The PICO (Population, Intervention, Comparison and Outcome) is a good systematic approach, however will not add considerably to the mature stage of narrowing down a search in order to construct safe and efficacious decision.

Once a physician identifies the knowledge gap, the flow of action becomes easier and more rapid as there are resources that offer tips on wise searching through abundant resources. One issue worth special commentary is the extraction of useful information from epidemiological studies versus case investigations. While epidemiological study results may not apply to one’s patient, case investigations for a particular condition maybe discussed too specifically towards a certain demographic. That is why the dissection of information by the physician is an immeasurable skill. Abundant and rich resources should be used as a guide rather than just a handbook. Relevant data can be applied but differences need to be defactored. Also noteworthy in epidemiological studies is the study design and whether it was appropriate for the question asked. The golden standard of therapy presented in studies may not be applicable to the patient in question.  

Of great value is a systematic approach when identifying clinical questions. A great way to overcome the nonsystematic search which often wastes considerable time is presented in the Weinfield article. This is where physicians will develop a search strategy that will be associated with their mission statement. Once it is identified, maintaining competency can be accomplished by rerunning the search say once a month. That is not to say that they will be acquainted with all cases that they encounter in the hospital or clinic but they will be familiar with a variety of well thought out cases which they will be able to reference  to make sound decisions on slightly varying ones . It is also markedly important for clinicians to ask: what is it exactly that might baffle them, is the case clearly understood but the therapy unclear? There are many possibilities but sometimes an unidentified problem may propagate to too many. That is why focus is endlessly important to finding an answer at the pace of the therapy.

 In conclusion, as the abundance of information is expanding tremendously, physicians are ethically burdened to research the best possible standard of care. Answers from external resources need to be chosen surgically and applied with even more caution. Ensuring that the resources are exhausted becomes part of the responsibility of a physician as they decide a diagnosis or therapy. This may mean researching a great number of cases to be able to recognize a trend and associated exceptions to deduce a sound decision. This is mainly because certain case articles may be documented for a certain demographic but not another.  Defactoring circumstances from scenarios to reach a solution is a skill physicians need to develop that perhaps may not have been emphasized in remedial levels of education. The process of evaluating resources can be very intricate and tedious but the first step is outlining needs a formulating a focused and targeted question customized for the patient. The latter will pave the way for success at drawing clinical conclusions.

Comments (1)

Bev Wood said

at 6:10 am on Jul 30, 2010

Thank you for discussing the extremely important aspect of medical care, and one which is not addressed with any checklists, identifying what the patients' concerns are and speaking with the patient. This process is key to focusing your care and your interest. There are studies that indicate that physicians interrupt patients after they have spoken for about 13 seconds, but if they waited for 18 seconds the patient would have said all they have to say. This would reveal more information and would also make the patient feel more satisfied.
You are correct, that utilizing the PICO format provides much of the needed physician format and avoids time spent uselessly. If there is a knowledge or competence gap, it is important to identify and address this, and following systematic approach does this.
I also like the point you discuss of periodically revisiting the search to identify anything that may have been passed over or that is new. You refer to this issue at the end, indicating that evaluating a number of cases may identify a trend that would otherwise be overlooked. If changes are occurring, they may not be obvious and this will help, both for health (or illness) trends and for trends in the delivery of healthcare.
It there is a way to mine the data from questions asked, we can also discover ways we should be delivering learning to healthcare professionals.

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