..the 180 respondents to the question rarely searched the 13 point-of-care databases listed in the survey for clinical or patient-care information. Over 90% stated that they never used 5 of the databases for clinical or patient care, and another 5 databases had between 75% and 90% of respondents never using them. For example, UpToDate was used daily by 4.8% of respondents but was never used by 64.1% of respondents for clinical or patient care purposes. MD Consult was the most used by all respondents, with 43.6% reporting using it at least a few times a year or more for clinical or patient care information.
There's a lot of scatter here but a few patterns are suggested. Filtered resources such as DynaMed and UpToDate, wildly popular among residents and private physicians, were hardly used at all by faculty, who tended to prefer repositories of books and journals such as MD Consult and Access Medicine. The filtered resources are more geared for focused clinical questions whereas the repositories are better suited for background reading and that may be more suitable for the teaching objectives of faculty.
Evidence based medicine (EBM) has evolved concerning information retrieval. Original teaching held that a Medline search and critical appraisal (a phrase coined for this use by the founders of EBM) should be done by the user at the point of care. That teaching has given way to a shift toward the use of filtered resources (secondary sources) which deliver information that has been searched and critically appraised by others. Proponents of filtered resources argue that primary searching and critical appraisal is too time consuming for clinicians. Purists decry this practice as capitulation to laziness. I discussed this trend in greater detail in a recent post on the history of EBM:
Dr. Brian Haynes was asked whether EBM was too much work for the busy clinician. When one considers the steps involved in searching, critical appraisal and application it does seem a daunting task. Certainly it would have been too time consuming before the era of computer searching. On line searching was available in the 1980s (you had to go to considerable trouble to set it up) but had not yet reached prime time even by the time EBM was announced to the world in 1992.
Haynes said that he and his colleagues were working from the beginning to make the process user friendly in everyday practice. They have been exploring ways to put best evidence into secondary sources, including even textbooks (some EBM purists decry the use of textbooks) so that doctors will not have to do primary literature searches and critical appraisal. Currently available secondary resources, said Haynes, may not be where they need to be yet but are improving.
As Guyatt pointed out the leaders realized early on that getting all clinicians to search and critically appraise the literature individually was an unattainable ideal. The best that could be done was to educate clinicians in the principles of EBM so they could then make more intelligent and effective use of secondary sources. Evidence derived from such sources has already been critically appraised and has been referred to as “pre-processed” evidence. Some EBM purists, taking a negative view of this approach, consider it an unfortunate compromise and have called it “evidence based capitulation.”