Point-of-care information that changes practice: it's closer than we think.

Providing care for our patients that is based on the best available evidence, and integrating that evidence with our patients’ values in the context of family and community, should be the goal of every family physician. In two studies in this issue of Family Medicine, Ramos et al and Schwartz et al study how we do (and too often do not) apply the best available evidence. Their work builds on that of Gorman et al, Covell et al, Ely et al, and others by studying how we answer questions at the point of care. Ramos et al directly observed an average of six patient visits per physician among the residents and faculty of a family practice training program. Not surprisingly, they found that residents ask more questions than their teachers do (1.5 versus .8) and that residents are more likely to attempt to immediately answer their questions (74% versus 39%) but that faculty place more value on the “left-over” questions that remain unanswered at the end of clinic. This makes sense—residents presumably had fewer patients per clinic and more time to answer questions and therefore had fewer important questions left at the end of the day. The traditional approach to evidence-based medicine (EBM), as described by Ramos et al, involves a laborious process of formulating a question; identifying, appraising, and synthesizing the best evidence in the primary literature or systematic reviews; and then applying the answer to patient care. In the Ramos et al study, less than 1% of questions were answered using the primary literature, which is consistent with work by Ely et al in a group of more than 100 Iowa family physicians, most of whom were in private practice.