Our participants used two to three terms on average. Previous research found three terms [
15]; this difference may be because we did not count Boolean operators as terms, unlike the authors of [
15]. As all searches are connected to patient-related problems we expected the queries to contain more terms to describe the question more adequately. Another reason for expecting more terms in a query is that general questions are relatively easy to find in information sources containing aggregated data, such as evidence-based textbooks. Physicians are therefore advised to use reviews and studies as consecutive last steps in the search process when other sources cannot provide an answer [
16]. This makes it unlikely that the questions that were looked up in PubMed were general in nature. The more likely reason for lack of detail is that despite all recommendations for constructing proper queries in evidence-based medicine [
5,
6], physicians do not take the time to construct such queries. A study by Ely et al showed that physicians could not answer 41% of pursued questions. Analysis of unanswered questions showed that it was possible to answer a proportion of unanswered questions if queries were reformulated, better describing the question[
17,
18]. It has been shown that training courses in evidence-based practice improve search skills considerably [
19,
20]. Our results show that term count and number of retrieved articles in the query result have independent effects. If using more terms only reduced the number of irrelevant articles, then term count should not have an independent effect. Using more terms related to a question must therefore also increase the number of relevant articles. This is most likely to be related to a more precise description of the question. Although the percentage of queries yielding no articles rises slowly with the use of more terms, it does not have a negative effect on abstract selection up to at least 6 terms. Physicians should therefore be urged to use enough terms, describing the question accurately, and should not fear that this will yield too few articles. As our population is familiar with evidence-based searching, the question is why they do not use advanced search methods. One possible reason is that search tools are not on the main page of our portal and PubMed but require navigation to special search sections. As truly effective tools are likely to be used even when they are difficult to locate, this may not be a valid argument. Another reason might be that participants do not use the PubMed search tools effectively. Our participants selected fewer abstracts with search tools than with the use of four or five terms, and this might be related to improper use of the search tools. Tools that are effective in laboratory situations but are difficult to use properly during daily medical practice are inefficient for this type of search and should not be advocated for use initially. A final reason might be that other search engines do not require the use of advanced search methods and physicians try to search in the way most familiar to them. Examples of such search engines, delivering ranked results, are Google, Google Scholar and Relemed [
21]. Because these search engines perform relevance ranking they can be used effectively with natural language queries. The relative ease of Google searching has led to a publication advocating the use of Google to help solve patient-related diagnostic problems [
22]. The question is whether physicians should be taught to use these search engines or to use better search techniques in PubMed. One argument against Google is that there are several fundamental issues regarding the reliability of the information retrieved and the validity of the ranking method [
23]. More importantly, formulating accurate clinical questions and translating them into well formed queries, with or without the use of additional search tools, is likely to increase the accuracy of the search result regardless of the search engine used.