13. Work roles (Medical Doctor) Tasks Characteristics of information needs Sources of information Awareness of information Outcomes feedback feedback Information Is sought (Case, 2007, 128)
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Editor's Notes
This user group has been very widely researched and studied, both in the U.S. and out, at least since the 1980s. In our research, we found that from that time to now, not much has changed in regards to Medical Doctors’ information needs. However, with the technologies that have emerged since the first studies were done, the way Medical Doctors access information has changed. That being said, we focused on current (2000-present) research and studies, with a concentration on first-world country-based studies (the UK, America, etc.).
U.S. Department of Labor - Bureau of Labor Statistics, Occupational Outlook Handbook 2010-2011 Edition
From our research, these were the most often-stated information needs that kept coming up time and time again. The most obvious need comes from problems and queries that patients present – in terms of diagnosis or management of symptoms. For example, if a doctor is examining a patient who has a certain combination of symptoms that said doctor has never seen before, he or she will have to acknowledge a certain information need. Because there are so many various sicknesses that could be the cause of these symptoms, no matter how well-trained a doctor could be, there is a high potential of running across something that is new or unknown to the physician. Another information need is to provide education materials to patients – for example, if a patient is diagnosed with breast cancer, a doctor needs to find good patient education papers, brochures, etc. or possibly even support groups. In addition, because the medical knowledge expands all the time and new discoveries are constantly being made, doctors also have a need for the latest research and new therapy or product information. Also, after diagnosing a patients problems, it’s important for a doctor to prescribe the right drug. For example, if a patient is allergic to the most common form of a drug (say, Penicillin), a physician would need to be able to find a proper substitute and the correct dosage.
These information needs were also summed up well by one article in particular (written by Karen Davies) in her review of the literature concerning the information-seeking behavior of medical doctors. She split these needs into four main subjects: diagnosis, drug therapy/information, epidemiology (study of factors affecting the health and illness of populations – essentially, keeping up with public health information, e.g. new flu strains, etc.), and treatment/therapy. As you can see from the table, she studied the importance of these needs for different types of doctors, such as primary care physicians, hospital clinicians, etc. – but these four categories were the major motivations for information seeking in doctors.
Also, there was one interesting theory that we thought was very important regarding the information needs specifically of doctors and this was the idea of foreground and background information needs. We’ve often come across time-related information needs and the impact that time can have on the urgency of a need and, therefore, the seeking behavior that is manifested. For doctors, these time-related needs are clearly split into two categories. The first, foreground needs, is the typical “crisis information need”. These are directly related to the patient and the need must be answered quickly. As listed here, these include a patient’s diagnosis, treatment, and prognosis. Because the need for fast information is great, physicians, similar to other groups we’ve discussed in class, are forced to consider only a certain amount of sources with the best ease of use. In comparison, background needs are those that are ever-present and not time-related. These needs are more general and extend throughout a physician’s career.
Time and time again, we saw that Medical Doctors’ top three modes of getting information are from internet search engines, colleagues, and from medical-specific resources. The study that Dorsey performed with 12 PCPs in Philadelphia, PA shows nothing different.
This slide shows the preferred sources of M.D.s Results based on a study performed on 12 PCP in Philadelphia, PA. “ Participants were asked to list the percentage of time used 14 options listed, each was selected at least once. However, the top three methods of information seeking used to give information to patients were the following: (1) use of an Internet search engine; (2) use of a specific software product, such as UpToDate; and (3) use of a colleague’s advice obtained via electronic mail, telephone, or in person. Figure 2 shows the range of results.” (Dorsey, 113) “ In this small sampling of physicians, the most common methods of gathering information for patient education appear to be the following: ( i) using an Internet search engine, ( ii) using professional resources such as UpToDate, and ( iii) consulting a colleague. ” (Dorsey, 114)
As a general understanding, the majority of this user group’s information seeking behaviors are purposive. One of the motivators for this purposive behavior (a quote from Bennett) states that “a doctor becomes aware of some lack in understanding a problem that stops or slows progress in addressing that problem. The awareness becomes sufficiently tangible to look for ways to address the gap between what a physician currently knows and what is needed to understand the problem.” This quote from Bennett illustrates why doctors are often motivated towards a fixed search and what sets their information-seeking behavior in motion. Another part of doctors information seeking behavior is unintentional information gathering. As with other user groups we’ve discussed in class, these are more passive behaviors – for example, this could be anything from information gleened at a casual lunch with a colleague, discussing things they’ve come across, notices about testing, etc. from a hospital bulletin board, and on and on.
Related to our user groups information needs, these are important specific aspects of doctors information seeking behavior. They need access to the information sources that Binwi discussed – through an office or medical library. Additionally, portable information seeking devices are becoming more popular, such as laptops or PDAs. As a personal example, my primary care physician now always has his laptop with him and he’s often looked up information while in my appointment with him. As for time issues that we discussed previously, this user group also needs very available access through working hours and even emergency times because they have very time-important foreground needs.
In addition, these two information seeking behavior factor greatly into our user group. The first is the Principle of Least Effort – this is essentially the easiest and fastest route to information. One real-life example of this for our user group could be when a patient is diagnosed with something that would require them to take penicillin, but, in their medical history, it’s noted that they are allergic to penicillin. So a doctor must find an appropriate substitute. Because of the ubiquity of penicillin and allergies and because this is a frequent problem, it is most likely, with the principle of least effort, that the doctor will go straight to a source that is easiest and fastest and may have been used many times before when solving this exact problem. This could be, for example, a well-used medical reference book on drugs and substitutions. Although there are probably MANY drugs that would be appropriate to substitute and lots of information out there on multiple different solutions, the principle of least effort influences this user group’s information seeking behavior greatly. In this case, it is the path of least resistance to simply go to a source which although it may not be the most updated or detailed, it renders a suitable answer in the shortest time possible. The other behavior important for our user group is the Cost Benefit Paradigm - Essentially, this information seeking behavior is the rationalization of weighing information and circumstances. As Case cites, this is when a doctor “considers whether they can render an immediate diagnosis based on the symptoms that are presented by the patient, or whether it is worth the time and money (assuming the patient must pay expenses) to run further laboratory tests before deciding on a treatment plan. The doctor must estimate the likely value of the information yielded by the tests versus the monetary cost and any potential dangers due to a delay in treatment.” One real-life example of this could be for a patient that comes in complaining of a occurrence of a rapidly beating heart and shortness of breath. Because there are no obvious causes, when the patient goes in to see a doctor about this issue, the doctor follows up with a non-invasive and over-arching electrocardiography test (or EKG). Nothing appears remiss with the results, the patient has no family history, and they haven’t had any reoccurrences of the problem. Putting these factors together along with the monetary cost to the patient and their health care provider (if they have one) and the time extra tests would take (for the doctor, nurses, additional staff), the doctor may choose not to pursue the matter any further and just be sure to check back in on the patient about this next time they’re in. It is this tradeoff consideration that marks this particular information seeking behavior in our user group.
The Leckie model suits our user group because, first and foremost, it is a work role-based model and we have a work role user base. Medical doctors as a group are motivated by their work role and the number of tasks they do day-to-day. It is a very linear model that reflects the basis of information seeking of doctors – patient presents with problem, problem prompts need, need prompts search, and search prompts answer. Leckie’s model also fits our user group because it makes allowances for individual demographics, which, in our case, often affects how doctors look for information. For example, the age of a doctor may affect their level of comfort regarding new information-seeking technologies, such as iPhones or PDAs. Additionally, because there are many specializations within medicine, this model gives a broader look at information-seeking behaviors that can apply across the map, no matter the specific field.
Additionally, as this model doesn’t expressly address the more ELIS-applied beliefs and attitudes, Leckie’s model reflects our user group’s fact-based information seeking concentration. Although beliefs and attitudes can play into a doctor’s personality and therefore their information seeking behavior, the prevalence of information seeking needs for reputable facts best suits the Leckie model (in comparison to the Johnson model). Also, the variables that Leckie cites as being most significant in affecting information seeking (such as familiarity with the source, trustworthiness, packaging, timeliness, cost, quality, etc.) are all variables that greatly influence our user group.
So as you can see from the diagram of Leckie’s model, the work-based tasks prompt information needs and, again, this is certainly true of doctors.
Here are some local existing library services that we came across while researching. NLM – Open access online catalog and campus is on Rockville Pike, easy access for any patrons who need it. Welch – “Mother Ship” of all Johns Hopkins libraries. Suburban Hospital Medial Library – Bethesda, MD close to NLM and staff has privileges there. Johns Hopkins Libraries. http://webapps.jhu.edu/jhuniverse/libraries/
Here are the existing services that Suburban Hospital’s Medical Library has to offer. Verso = Virtual Electronic Reference Source The basic things that this existing library service has to have to be appropriate for our user group are text sources, online medical databases, and internet access. Suburban Hospital’s Medical Library has over 1,000 books and 100 journal subscriptions with searchable online catalogs, access to online medical databases, such as OVID and MDConsult, and plenty of internet access for doctors with other information needs. The location of the library is also important in itself. The Medical Library is located on the same hall with the Physician Lounge, Medical Staff Office (re-credentialing), and Medical Records. This location encourages staff to really make use of the services the library has to offer and also makes for a lot of foot traffic during the work day. It also can serve as a gathering place for doctors to exchange information and ideas. The librarian at this existing library service is also a powerful factor in the “successfulness” of the Medical Library as an information-seeking center. She is engaging in many aspects – she advertises the presence and helpfulness of the services that the staff and the collection can offer medical doctors. This, in turn, establishes her as a trusted source because of her experience and extensive medical knowledge – doctors can somewhat “speak their language” (using medical jargon, etc.) to her and she’ll understand and be able to process their information need. Additionally, her involvement in the goings-on at the hospital (such as attending patient rounds with doctors and serving on various committees at the hospital) give her more opportunities to connect with staff and make them more aware of her and the library as a trusted information source. Also, by doing these things, the librarian is able to keep abreast of current issues that may affect what information seeking people may be approaching her about in the near future.
During our research, we came across some barriers that Medical Doctors encounter in their work. Isolation (from medical libraries, conferences, and expert colleagues); stressful demands of the job, even budget and computer illiteracy. These barriers and others motivated us to think of some possible solutions. Hidden libraries – In the figure we showed earlier, “One of the least common methods of gathering information for patient education is consulting a librarian.” (Dorsey, 114) So we thought that making the library a regular part of the M.D.s orientation would be a worthwhile thing to try. Suburban Hospital is currently in the approval process for bedside consultations with the librarian. The librarian will be a tool the patients can use to get medical information while they are in the hospital. Doctors should be able to search by descriptors specifically related to the way something looks. Having a search tool that has features like color and texture would be helpful for doctors to use and diagnose diseases and conditions. Web-based Library Consult Service – “As an information system, it connects clinicians who have patient-oriented information needs with clinical librarians who have expertise in search and appraisal of the medical literature.” (Schwartz, 11) “The basic design of the LCS is intended to mirror and enhance the way that clinicians and clinical librarians naturally interact.” (Schwartz, 3) “ Provide full text evidence-based literature with critical appraisal in response to a clinical question asked by a physician who may be at a remote or rural site.” (Schwartz, 2) Customizable, depending on the demands and preferences of the user. Free/Open Source Software. May also serve as an effective platform for EBM education and research on evidence-based clinical practice.” (Schwartz, 11)
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