Does the structure of clinical questions affect the outcome of curbside consultations with specialty colleagues?

Abstract

Background: Clinical questions frequently arise during the practice of medicine, and primary care physicians frequently use curbside consultations with specialty physicians to answer these questions. It is hypothesized that well-formulated clinical questions are more likely to be answered and less likely to receive a recommendation for formal consultation. Objective: To assess the relationship between the structure of clinical questions asked by family physicians and the response of specialty physicians engaged in curbside consultations. Design and Participants: A case series of clinical questions asked during informal consultations between 60 primary care and 33 specialty physicians using an e-mail service. Curbside consultation questions were sent, using e-mail, to academic specialty physicians by primary care physicians (faculty, residents, and community practitioners) in eastern Iowa. Main Outcome Measures: Questions were analyzed to determine the clinical tasks and to identify 3 components: an intervention, a comparison, and an outcome. Consultants' responses were analyzed to identify whether questions were answered and whether consultants recommended formal consultation. Results: There were 708 questions in this analysis: 278 (39.3%) were diagnosis questions, 334 (47.2%) were management questions, 57 (8.0%) were prognosis questions, and 39 (5.5%) were requests for direction. Clinical questions were less likely to go unanswered or receive a recommendation for formal consultation when the question identified the proposed intervention (odds ratio, 0.54; 95% confidence interval, 0.34-0.86; P=.006) and desired outcome (odds ratio, 0.46; 95% confidence interval, 0.29-0.69; P