How much answering are you allowed to do as a resident?

[Hemichordate]

When a patient asks you a detailed question about their treatment or diagnosis, should you as a resident give detailed answers, or is that something you normally let the attendings handle? And if you don't know the answer to something, how do you explain your lack of knowledge?

---

Members don't see this ad.

 

[Dermpath]

When a patient asks you a detailed question about their treatment or diagnosis, should you as a resident give detailed answers, or is that something you normally let the attendings handle? And if you don't know the answer to something, how do you explain your lack of knowledge?

Are you an intern or med student? If med student, let resident handle it. If intern, tell them if you have a decent idea, otherwise don't muddle the waters. If you don't know the answer, tell them, "I'm sorry, I don't know." You don't have to explain anything. But make sure you send someone who does know and can provide more info to the patient.

 

[Law2Doc]

When a patient asks you a detailed question about their treatment or diagnosis, should you as a resident give detailed answers, or is that something you normally let the attendings handle? And if you don't know the answer to something, how do you explain your lack of knowledge?

In residency you are pretty much their doctor and are expected to field all the questions you know the answer to. Many attendings don't want you to be the ones to break earth shattering news (ie you have metastatic cancer), but you may be the one the patient sees day to day regarding their condition, may be the only one advising them regarding post-hospital care and followup, and may be the one who tempers family members expectations for recovery before you ultimately have to break news of a poor prognosis. If you don't know the answer, you can say you don't know and will have the attending talk to them. But in general you are expected to know your patients so well that there is little you won't be able to answer.

 

[docB]

As you progress from student to resident and onward you become more comfortable explaining the medical aspects of things. "You have this and these are the problems and these are the possible therapies..." As a lower level member of the team the biggest thing is that you can't get boxed into a particular course of action if you don't know what will be happening. For example if you tell the patent they'll get a CT scan and then the attending decides to go another way the patient may be distressed that they are not getting the CT scan. It can take a lot of work to deal with those situations.

Most people develop a speech pattern that explains a lot but leaves a lot of open room on specifics about the plan. You have to learn this because you use it as an attending too. "I'm referring you to a surgeon. He may operate or watch and wait or get more tests."

 

[Top Gun]

As a resident, you are a physician, albeit one in training. You should be comfortable answering most questions from patients and family. Also, if you're doing night float or 24-hour call, family may be visiting the patient then, and there will be no attending around, so you will have to field as many questions as possible. You can do this by going through the chart and looking at the notes written by the primary team, so you have at least an idea of the treatment plan. You can suggest that they come back during the day if they want more details. For really major things, you may want the attending around, but you should be able to answer a reasonable number of questions. I also agree that sometimes you may want to keep the explanation open on details about the plan.

 

[Hemichordate]

Thanks for the answers folks.

 

[cpants]

Learn the phrase "That's a question for...(insert senior or specialist name here). Never make anything up, and know what you don't know. Pretty quick way to piss people off when they have to explain why what you said was wrong all the time. Encounter it all the time on surgery/surgical specialties. Something like "Dr. ER/Medicine said my gallbladder needs to come out and you are going to take care of it." Pretty annoying when the patient either A) isn't a surgical candidate or B) doesn't have anything wrong with their gallbladder. It's even worse when it's your own specialty and you tell them your plan when your attending/seniors have different thoughts. As a junior it's usually best to hedge until you've talked to someone more senior unless it's something you are super comfortable with

 

[Law2Doc]

Learn the phrase "That's a question for...(insert senior or specialist name here). Never make anything up, and know what you don't know. Pretty quick way to piss people off when they have to explain why what you said was wrong all the time. Encounter it all the time on surgery/surgical specialties. Something like "Dr. ER/Medicine said my gallbladder needs to come out and you are going to take care of it." Pretty annoying when the patient either A) isn't a surgical candidate or B) doesn't have anything wrong with their gallbladder. It's even worse when it's your own specialty and you tell them your plan when your attending/seniors have different thoughts. As a junior it's usually best to hedge until you've talked to someone more senior unless it's something you are super comfortable with

While this is good advice early on, and you absolutely can't ever box in the attendings with inaccurate statements or courses of action, the attendings/seniors aren't going to think highly of you after a while if they are brought in too frequently to discuss things with patients they think you ought to know the answer to. The best residents know the plan well enough allow the attendings to avoid long drawn out discussions with patients. Many attendings are happiest if they can round from the doorway and leave the sit down discussions and lengthy question and answer sessions to you. Don't make up stuff if you don't know the answer, but most of the time if you know your patient and were awake on rounds you are going to know the answer. It's not like being a med student where the plans may change while you are in lecture etc.

 

[45408]

You can answer a lot. That's one of the things I enjoy most about residency. You progress from knowing some of the treatment options for a disease to knowing most/all of the treatment options, and then you move on to knowing which treatment options apply in this situation, and which treatment you're going to offer, often before you've even talked to your attending.

Obviously, if you're in doubt about the specific option, you hedge, but there's plenty of times where I can see what we need to do and just tell the patient what they need. Gloss over the specifics if necessary, but it's cool to lay out the treatment plan right after you finish your H&P.

 

[badasshairday]

In the first two weeks of internship I've been expected to tell two different patients about diagnosis of malignancies with poor prognosis.

 

[nlax30]

You can answer a lot. That's one of the things I enjoy most about residency. You progress from knowing some of the treatment options for a disease to knowing most/all of the treatment options, and then you move on to knowing which treatment options apply in this situation, and which treatment you're going to offer, often before you've even talked to your attending.

Obviously, if you're in doubt about the specific option, you hedge, but there's plenty of times where I can see what we need to do and just tell the patient what they need. Gloss over the specifics if necessary, but it's cool to lay out the treatment plan right after you finish your H&P.

Definitely agree with this. Honestly as a resident you are probably going to be the main one interacting with the patient and family and filling in the details, "translating" for them after the attendings stop by and say their few cents.

Starting one if my first senior medicine months on ICU now and I find I'm usually the main contact or go between with the family and end up summarizing the daily plan from whatever specialists are on the case.

It can certainly be tricky at times and you'll quickly start to realize what you should and shouldn't say at certain times..... And it will definitely make you aware of what you don't know.