Quote attributed to the Dean of Cornell Medical College*:

“Half of what we will teach you iswrong. The problem is, we don’tknow which half!”

* Joseph Bernstein, MD: Evidence Based Medicine; J Am Acad Orthop Surg 2004;12:80-88

1

2

3

Resolver problemas, mediante la creación, distribución o aplicación de información/conocimiento

Resolver problemas no operativos: aquellos para los que no existe una secuencia protocolizada de acciones que los resuelve

Tareas que precisan de una gran variedad de talentos y habilidades: para un profesional no es fácil dominarlas todas

About 10 years ago, if general internists wanted to keepabreast of the primary clinical literature, they would haveneeded to read 17 articles daily.Today, with more than 1000 articles indexed daily by MEDLINE,that figure is likely double.

CMAJ • APRIL 28, 2009 • 180(9)

PURPOSE The aim of this study was to determine the information needs of primary care physicians in Spain and to describe theirinformation-seeking patterns.METHODS This observational study took place in primary care practices located in Madrid, Spain. Participants were a random stratifiedsample of 112 primary care physicians. Physicians’ consultations were video recorded for 4 hours. Clinical questions arising during thepatient visit and the sources of information used within the consultation to answer questions were identified. Physicians withunanswered questions were followed up by telephone 2 weeks later to determine whether their questions had since been answeredand the sources of information used. Clinical questions were classified by topic and type of information.RESULTS A total of 3,511 patient consultations (mean length, 7.8 minutes) were recorded, leading to 635 clinical questions (0.18questions per consultation). The most frequent questions were related to diagnosis (53%) and treatment (26%). The most frequentgeneric type of questions was “What is the cause of symptom x?” (20.5%). Physicians searched for answers to 22.8% of the questions(9.6% during consultations). The time taken and the success rate in finding an answer during a consultation and afterward wereminutes (100%) and 32 minutes (75%), respectively.CONCLUSIONS Primary care physicians working in settings where consultations are of short duration have time to answer only 1 in 5of their questions. Better methods are needed to provide answers to questions that arise in ofice practicein settings where average consultation time is less than 10 minutes.

Paciente/problema Intervención/Comparador Desenlace de la intervención

Mujeres

embarazadas

Administración de

ISRS vs placebo

Malformaciones

cardíacas

¿Producen los fármacos ISRS malformaciones congénitas cuando son administrados a mujeres embarazadas?