Example quotations illustrating the themes
| Themes | Subthemes | Example quotation |
| Theme 6: Action/interaction encountering clinical questions | Type of action | Taking an action to engage in ISB: ‘…we're in the middle of an operation, and we notice a new case or some other issue in the diseased organ. I feel compelled to investigate the extent of the problem. What is the best way to solve the situation? …’ (perinatology, 11) Taking no action to engage in ISB: ‘… When my treatment is ineffective for the patient or there are concerns about the patient’s safety, I urge the patient to go to another centre or refer to other specialist…’ (neurosurgery, 22) |
| Action strategy | Explicit: ‘… At the point of care, in the operation room or the ward I look for the answer. It makes no difference where I am…’ (Section 16) Conservative: ‘… I'm afraid that if I admit I don't know anything right now and then go in front of others to find out what they're saying, I'll lose my credibility… Experienced physicians may be humiliated…’ (pediatric surgery, 11) Multiple: ‘… We had a patient with peculiar symptoms that I suspected it was Wegener’s disease, which had an underlying rheumatic immunodeficiency disease. The patient had evolved into a multisystemic and complex condition. We must search databases and books a lot, consult with colleagues… (ENT, 30) One time: ‘… the evidence-based resources make the necessary evaluations before, I trust them, and I perform the search once…’ (women health/preventive medicine, 17) Immediately: ‘… if the case is critical or involves medication, I will look into it right away…’ (ENT, 30) Postponed: ‘…but if it’s about inpatient that doesn't react to treatment in some spots, and at the same time, delay in treatment is not harmful, I'll look into it when the time comes…’ (ENT, 30) | |
| Action evaluation | Relevance: ‘… I have a set of questions in my mind; once we search, we compare the results… and then we decide whether or not this is a related diagnosis or treatment, is it relevant to our inquiry or not…’ (emergency medicine, 4) Credibility: ‘… I put my faith in the evidence-based sources to make these clinical judgements. But I undertake a critical assessment where this procedure is not replicated… How valid is it? How trustworthy is it, and who is the author? Which research institute do support? Has it a register code? These boost precision confidence. These are some general rules…’ (women health/preventive medicine, 17) Updated: ‘for treating the anticoagulants in 2014 Textbooks and earlier, such new drugs were not and the type of treatment was different, for example, it is the type of prothrombin concentrate for bleeding control, there was not such a thing at the time, the time of conducting the study is important, for example, the study was performed in 2012, but published in 2018…’ (emergency medicine, 8) | |
| Action feasibility | Diagnostic and therapeutic procedures' cost-effectiveness: ‘…treatment or diagnosis you intend to undertake must have a cost-effective. Give the patient the cheapest treatment and the simplest diagnostic possible. A treatment that is more effective while putting less strain on the health-care system…’ (pediatric nephrology, 23) Hospital equipment: ‘… I do some research and discover that this patient should be a PET, but we don't have a PET scan available, so we gave it up…’ (gastroenterology, 6) Patient preferences: ‘… I'd like to transfuse blood into the patient or give him medication. It’s good in my experience, and it’s good according to scientific resources. But my patient refuses, claiming that I am, for example, a sect that does not accept blood transfusions or that I do not utilize a particular country’s medicine…’ (emergency medicine, 8) Patient financial ability: ‘… We must consider the patient’s financial situation and a set of treatments, such as a very expensive therapy like a cochlear implant, which most of our people cannot afford…’ (ENT, 27) Not involving the physician in legal disputes: ‘… A very major issue that occurs is legal discussions, which means that besides everything done for the patient, a sequence of things can happen, and you must be responsive… therefore not every reference can be used to make a decision; it must be defended… ’ (emergency medicine, 10) | |
| Action selection | Information adequacy: ‘… does it rely on whether or not that information is sufficient for me? If I come across an article that has a low level of credibility but appears to be intriguing, I check to see if it has been covered elsewhere…’ (ENT, 27) Insufficient information: ‘… If the texts and guidelines don't yield results, I'll turn to the databases. In this case, you'll see that the points made in this authoritative article have been reiterated in several other articles…’ (endocrinology, 14) | |
| Clinical decision | Alone: ‘… If I’m looking for a simple answer to a query like a drug’s adverse effects, interaction, or dose, I’ll decide and utilize it myself…’ (ENT, 30) With consultation: ‘but if the matter gets extremely intricate, I will undoubtedly consult with my colleagues who are experts in that subject, seek their advice, and then make choices based on collective expertise…’ (ENT, 27) | |
| Action management | Save: ‘… Occasionally, if I find an article to be very valuable, I save it in my desktop or a flash or on Mendeley for future access…’ (general surgery, 7) Share: ‘… If I get a good outcome when looking for information, I usually share it with my colleagues…’ (emergency medicine, 10) | |
| Theme 7: CISB consequences | Patient related | Patient recuperation: ‘…The patient benefits most, your scientific knowledge increases as well, and the patient will get better. The side effects will be less…’ (Code 14). Patient Satisfaction: ‘… Aside from recovering faster, it lowers the patient’s budget, making your patient happier and more satisfied…’ (pediatric, 12) |
| Physician related | Personal development: ‘…The physician will be up-to-date, takes more practical action that is more appropriate. He is aware of his flaws and strengths and works to overcome them… ’ (women health/preventive medicine, 17) Be a professional: ‘… The main point is that you become more professional because of the information you uncover, and you also bridge the gaps that exist in that subject, leading to knowledge generation…’ (gastroenterology, 6) Self-actualization: ‘… the physician’s potential inner abilities and talents become active, he feels satisfied that the therapy he is providing is on time, and he is pleased with his patient’s recovery…’ (ENT, 30) | |
| Organisation related | Performance improvements: ‘…Both the physician’s medical errors and the additional expenditures are minimized accordingly. The patient isn't operated on very frequently. The end consequence will undoubtedly be an improvement in the organization…’ (general surgery, 7) Organization authority: ‘… Usually, when patients applaud their physician for their recovery, it generates a positive advertisement for the physician and the hospital, which gradually develops a brand…’ (internal medicine, 8) |
CISB, clinical information-seeking behaviour.