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Date of Report: 09/2003
Source: Pacific AETC, East Bay AETC
Author: Cynthia Carmichael, MD
Description: From The 4th Level, the Pacific AETC newsletter for clinical consultants.
In this article, questions asked by family practitioners to specialty physicians during e-mail curbside consults were analyzed. The hypothesis was that well-formulated clinical questions were more likely to be answered and less likely to receive a recommendation for formal consultation.
According to previous medical literature, well-formulated questions are those that identify:
 | An intervention of concern (eg, a treatment or a diagnostic test) |
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| The hoped-for outcome of the intervention |
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| A comparison intervention (if applicable) |
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Seven hundred and eight (708) curbside consultation questions were analyzed to identify the 3 above components and categorized according to requested task (ie: differential diagnosis; treatment, etc).
The results indicated that questions which identified a proposed intervention and the desired outcome were more likely to be answered and less likely to get a recommendation for formal consultation than questions which did not include the above. An example given in the article is helpful; "Will the addition of a beta blocker (intervention) lengthen the life (desired outcome) of a 58 year old woman with moderate congestive heart failure who is already taking an ACE-inhibitor?" Compare this question with, "What do I do for a 58 year old woman with moderate CHF who is already taking an ACE-inhibitor?"
The article found that primary care physicians in general do not ask well-formulated questions. Only 40% of the curbside consult questions clearly identified an intervention and desired outcome. "This finding suggests ... that even experienced physicians may benefit from training in structuring their clinical questions."
The take-home message for us as clinical consultants may be to listen for, and help ascertain the 'intervention of concern' and the 'hoped-for patient outcome' from those who call upon our expertise.
Bergas GR, Randall CS, Sinift SD, Rosenthal DM. Does the Structure of Clinical Questions Affect the Outcome of Curbside Consultations With Specialty Colleagues? Arch Fam Med 2000;9:541-547.
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