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PubMedDate not supplied

Use of MEDLINE by physicians for clinical problem solving.

OBJECTIVE: To understand the ways in which computer-mediated searching of the biomedical literature affects patient care and other professional activities. Undertaken to determine the ways in which on-line access to the biomedical literature via the National Library of Medicine's MEDLINE database "makes a difference" in what physicians do when confronted with a medical problem requiring new or additional information. DESIGN: An adaptation of the Critical Incident Technique used to gather detailed reports of MEDLINE search results that were especially helpful (or not helpful) in carrying out the individual's professional activities. The individual physician was the source of the patient care incident reports. One thousand one hundred fifty-eight reports were systematically analyzed from three different perspectives: (1) why the information was sought; (2) the effect of having (or not having) the needed information on professional decisions and actions; and (3) the outcome of the search. PARTICIPANTS AND SETTING: Telephone interviews were carried out with a purposive sample of 552 physicians, scientists, and other professionals working in a variety of clinical care and other settings. Of these, 65% were direct users of MEDLINE throughout the United States, and 35% had MEDLINE searches conducted for them either at a major health sciences center or in community hospitals. RESULTS: Three comprehensive and detailed inventories that describe the motivation for the searches, how search results affected the actions and decisions of the individual who initiated the search, and how they affected the outcome of the situation that motivated the search. CONCLUSIONS: MEDLINE searches are being carried out by and for physicians to meet a wide diversity of clinical information needs. Physicians report that in situations involving individual patients, rapid access to the biomedical literature via MEDLINE is at times critical to sound patient care and favorably influences patient outcomes.

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PubMedDate not supplied

Bridging language and cultural barriers between physicians and patients.

OBJECTIVE: This study explored a group of primary care physicians' use of various methods to bridge language and cultural barriers between themselves and their patients and the physicians' perceptions of the availability and quality of these methods. METHODS: The authors mailed a questionnaire to 495 primary care physicians in the Greater Bay Area of northern California, an area chosen for its ethnically diverse population. Respondents were asked to estimate how many patients they saw per week, how many encounters they had per week with non-English-speaking patients, and how often they used each of six interpretation methods. They were also asked to assess the availability and quality of interpretation services. RESULTS: Physicians reported that, on average, 21% of visits were with non-English-speaking patients. Trained medical interpreters or the AT&T Language Line were used, on average, in fewer than 6% of these encounters, and no interpreters were used in 11%. In 27% of encounters with non-English-speaking patients, the physician could speak the patient's language, in 20% interpretation was done by a staff member who had no formal interpretation training, and in 36% a family member or companion of the patient interpreted. Physicians who had access to trained interpreters reported a significantly higher quality of patient-physician communication than physicians who used other methods (P < 0.0001). CONCLUSIONS: In an area of great ethnic diversity where physicians who had access to the services of trained interpreters reported a significantly higher quality of patient-physician communication, the low rates of use of trained interpreters suggest that factors other than quality, such as costs, preclude greater use of these services.

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