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Making evidence-based practice a reality.

Authors are with the Department of Family Medicine, University of Wisconsin  Madison. Doctor Potter is an assistant professor and also has a clinical practice at Wingra Clinic in Madison, Wis; Dr Rotert is a faculty development fellow and clinical instructor and also practices at Belleville Clinic in Belleville, Wis. Please address correspondence to Beth Potter, MD, 777 S Mills, Madison, WI 53715; phone 608.263.4550; fax 608.263.6663; e-mail bepotter@wisc. edu. INTRODUCTION Busy doctors need answers, and quickly. Ely and colleagues observed that primary care clinicians generate approximately 3 questions every 10 patient visits.1 Additionally, the body of medical literature is growing exponentially. To keep up with primary care literature, it would be necessary to review 7287 articles per month, which would take approximately 29 hours per day.2 In 1992, the Journal of the American Medical Association introduced a formula for applying evidencebased medicine (EBM) in User’s Guide to the Medical Literature. With this method, a physician develops a clinical question from a patient encounter, performs a literature search, selects relevant articles, and critically appraises them to find the answer. Although rigorous, this approach is too cumbersome to use during a busy clinical day. Instead of critically appraising primary literature, most physicians seek information that has been pre-appraised—critically analyzed and summarized by someone else.3 In the Ely study, physicians attempted to answer only 40% of the 1101 questions they generated, spent less than 2 minutes looking, and did formal literature searches for only 2 questions. Physicians need to have a method for finding answers at the point-ofcare.