Attitudes to questioning in clinical practice may be changed

editor—Barrie and Ward suggest that a major barrier to the promotion of evidence based health care is the generation of questions by the doctor.1,2 The figure of only 2.4 questions asked per 10 patients should not astonish those who received a conventional medical education taught by authoritarian seniors in an atmosphere where questioning is not fostered. While running a course on evidence based child health at Leeds University we collected data that suggest that questioning behaviour may be changed. Some weeks before the course, and again at the end, the participants (community paediatricians and paediatricians in training) completed a statistical competence questionnaire. Two supplementary questions were included: “What percentage of your clinical work do you estimate is based on practice which has been proved to be clinically effective?” and “How many patients on average per month do you have questions about, or simply feel unsure about in terms of management?” (figure). Before the course participants reported that few questions arose during their clinical work, and the subgroup of Calman trainees were confident that a good proportion of their work was clinically effective. After the course the participants seemed to have developed a more questioning attitude in both paediatric practice and their management of patients' problems. Clearly, a well planned study is needed to ascertain whether a course in evidence based medicine can really change the questioning behaviour of doctors in the long term. The data, however, do suggest that courses such as ours may make it acceptable to admit to insecurities about patient management and may foster an openness to asking questions. One result of our course was that the community paediatricians, troubled by their lack of confidence in the effectiveness of their work, undertook and completed a study to ascertain the evidence base of community paediatrics similar to that carried out on a medical ward in Oxford.3 Barrie and Ward state that “evidence based medicine may make slow progress until doctors become more questioning in their routine practice.” Our data provide some evidence (and hope) that simple investment in courses provided during medical training can change the prevailing culture and encourage doctors to take a more inquiring attitude towards the care and management of patients.