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

Arch Fam Med. 2000 Jun;9(6):541-7. doi: 10.1001/archfami.9.6.541.


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 task 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 < .001). Only 271 (38.3%) of 708 curbside consult questions identified both of these components.

Conclusion: Medical specialists' responses to curbside consultation questions seem to be affected by the structure of these clinical questions.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Computer Communication Networks
  • Diagnosis, Differential
  • Family Practice
  • Humans
  • Interprofessional Relations*
  • Iowa
  • Language*
  • Medicine
  • Odds Ratio
  • Primary Health Care
  • Referral and Consultation / standards*
  • Specialization
  • Therapeutics
  • United States