A qualitative study of interphysician telephone consultations: Extending the opinion leader theory

Abstract

It has been suggested that the use of opinion leaders in the dissemination of information may be an effective method of changing clinical practice. Recent reviews on this topic, however, have found mixed results and have concluded that further research is needed to explore the circumstances that effectively utilize opinion leaders. We studied the interphysician telephone consultation, a situation in medical practice in which we see opinion leaders at work, to generate a grounded theory of opinion leader activity. Data were collected and triangulated among 3 sources: documentation of 129 telephone consultations received, 51 hours of field observations of consultants, and in-depth interviews of 12 callers and 12 consultants. Analysis was performed using grounded theory methods. A rich description of the context and mechanisms of opinion leader activity emerged. The results describe that opinion leader activity is effective in an informal context in which the practicing physician initiates the exchange. Valuable elements of opinion leader activity that emerged included the provision of a personal touch, reassurance, and advice that blends clinical experience with published evidence. Our results suggest that key to effective opinion leader activity is an informal practitioner-initiated context. Formal didactic sessions led by opinion leaders, therefore, may not be an effective format. In addition to evidence-based medicine, practicing physicians value "experience-based medicine" and the personal touch and reassurance that contact with an opinion leader can provide. Using opinion leaders as a means of balancing these 2 paradigms may be a useful model for continuing medical education in this domain.