What makes a good clinical question?

October 24, 2014

Ask-pico-11A good question is something that that someone asks when there is a clear need for information. Simple, blog done!

However, there are so many areas in clinical practice where there is a need for information that defining some of the parts that construct a good question is probably a skill worth acquiring. In clinical epidemiology those that ask and find answers to the right questions are those that make a difference to practice.

In 1995, Scott Richardson, was on sabbatical at the centre – when I first met him – and he wrote the following paper on The well-built clinical question: a key to evidence-based decisions.  In this excellent paper, published in the ACP journal, this is what he reports:

The question should be directly relevant to the problem at hand.

The question should be phrased to facilitate searching for a precise answer.

To achieve the above two aims the question must be focussed and well articulated for all 4 parts of its “anatomy.”

The idea of the anatomy of a question had appeared previously in the JAMA users guides in 1993: the medical literature how to get started – found an open source copy pdf here.

This articles starts off with, ‘it is now Friday morning and you have 2 hours to spend in the hospital library.” If only.

The 1993 JAMA article, though states some important principles:

‘The importance of such focused questions can be quickly assessed, and priority given to problems that are seen routinely and have practically important consequences. In general, those questions that are clearly related to a clinical decision about whether to use a therapeutic, preventive, or diagnostic intervention are the ones that warrant the most time. Focusing the question clarifies the target of the literature search and permits use of the appropriate guides for assessing validity in screening the titles and abstracts of the articles that are located.’

Similar to Richardson, the JAMA article clarifies the importance of relevant problems to practice that have significant consequences for patient care. Richardson article, however, is the first example of using PICO to formulate the question.

Using three key questions to focus should aid the formation of a good clinical question, these are:

  • What is the most important health issue for this patients?
  • Which issue should I address first?
  • Which question, when answered, will help the patient most?

Add in a degree of uncertainty or some difficulty, you are then on your way to building relevant clinical questions, which can improve patient care.

Carl Heneghan

About Carl Heneghan

Carl is Professor of EBM & Director of CEBM at the University of Oxford. He is also a GP and tweets @carlheneghan. He has an active interest in discovering the truth behind health research findings

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