He outlines four stages that physicians pass through on their way to solving clinical problems. This stage is highlighted by physicians being confronted with clinical problems or questions in their work or in many other situations including attending or teaching education sessions, taking self assessment tests, participating in clinical audits etc. Physicians must decide if the problem or question is relevant for their practice. For example, a psychiatrist might be confronted with some of the new Internet in Medicine journals that are being circulated to all physicians. She could then conclude that she has enough other available relevant educational resources at the present time and does not need the Internet resources.
Physicians tend to try to solve problems only if they know there is a solution to be found.
If the physician is going to take on the problem, there is evidence that this occurs if the resources are accessible, applicable, and familiar. Physicians will anticipate in advance what potential impact the change in their clinical practice might have, if they decide to solve a clinical problem. These clinical changes may be small, i.e. the prescribing of a different second line antidepressant or larger, i.e. deciding to learn how to conduct interpersonal psychotherapy. The latter decision could impact on the referral patterns from G.P.'s and the time the psychiatrist has available to conduct psychotherapy. Physicians will move to Stage 2- learning the skills and knowledge required to solve the clinical problem, if they decide that the problem is relevant, that it can be solved, that there are resources to solve it and if they can or want to adjust their practice accordingly.