The medical specialist: information gateway or gatekeeper for the family practitioner

The medical specialist emerged as a critical gatekeeper in a study of information sources used by family practitioners in New Zealand. Thirty-four practitioners in the Wellington region were interviewed and their responses examined to ascertain the extent to which five criteria influenced their choice of information sources for clinical decision-making. The criteria were availability, searchability, understandability, credibility, and applicability. Of three major information sources investigated (textbooks, colleagues, and medical specialists), textbooks were consulted most frequently but were rated less valuable than colleagues and specialists as a source of information. The medical specialist was identified as the information source that best meets the five criteria. Thus, specialists play an important role in disseminating information to family practitioners. However, female practitioners included in the study were less likely to approach specialists than were their male counterparts. Physicians made little use of medical libraries to support clinical decision-making. The apparent disadvantage of female practitioners in accessing specialists needs to be addressed by professional associations. Medical librarians seeking to improve the access of family practitioners to recent literature should consider the heavy use made of specialists as a source of information.