Never say "I don't know"?

[DrDude]

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When I get asked a question I totally don't know the answer to I say "I don't know".

But I've heard from a student and now a resident that you should never utter the phrase "I don't know" to any question posed to you. Even if you have no clue you should still talk around it to show your thinking process (kind of like beating around the bush even if you don't actually answer the question).

I've seen this in action from some fellow students who refuse to say "I don't know" no matter how much the attending has them up against the wall. They will keep bringing up tangential facts related to the question even if they don't answer the actual question.

This apparently even applies to patients. Like if the attending asks me a question I forgot to ask while taking the history I say something like "Sorry I forgot to ask that/I don't know". Sometimes when you're taking a whole bunch of histories and physicals you sometimes forget to ask a specific question or elicit a specific sign on the physical that the attending then asks you about.

So what is your opinions? Should you never admit to not knowing and beat around the bush to at least show your thought process or is it OK to flat out admit you don't know if you don't?

 

[Isoprop]

rule #1: never lie about a patient to your intern/resident/attending/whatever even if that means saying "i don't know"

 

[Mayhem]

You'd be surprised how often I say "I don't know" to somebody each day and it's not a major issue. Maybe it's a personality thing but it's not in my nature to beat around the bush when I don't have a clue. Actually it annoys me to no end when classmates do that because all it does is waste a couple minutes. If you just said you don't know then the doctor could explain it and the ward round could move along faster. The problem is some of my classmates want the doctors to view them in a certain way, as if they were infallible. That's less important to me.

Of course, there are some situations where you don't want to actually say "I don't know." In those cases I use "I don't recall" because it implies that I knew it at some point but simply can't remember at the moment. Another choice is to say "I don't know but I'll find out." I use that one whenever I forget to ask something in a history. But really there's no crime in saying "I don't know" because sometimes you just don't.

 

[45408]

It's a lot easier for a resident/attending to continue bullying you if you weasel around it. Just say you don't know.

 

[nist7]

Aren't the attendings smart enough to be able to tell when a resident don't know something and instead of telling him/her straight up that they don't know....they are trying to BS their way around it?

On the other hand. if you think you have relevant and important "tangent facts/thinking" that contributes to the issue at hand...then by all means say it. But if you go by the philosophy to NEVER say "I don't know" I think you might be doing more bad than good.

 

[Flopotomist]

I am honest.. if I don't know, I don't know. I will then either volunteer to go find out (if it is a question I forgot to ask a patient) or sit quietly while somebody teaches me something that I didn't know (if it is a knowledge issue).

I figure it is better to keep my mouth shut and let somebody think that I might be an idiot than ramble around pretending to know an answer and PROVING that I am one.

 

[MSKalltheway]

Those who were giving that advice to never say "i dont know" are entitled to their opinion i suppose, but the way I see it, we are students. We arent supposed to know the answer every time. I mean, if you are saying I dont know more often than not, it may not be a good thing, but I would personally rather tell them that I didnt know, but I'll look it up the first chance I get. From what I hear, its more important to be enthusiastic enough to learn as opposed to knowing anything when youre on the floors. Most residents and attendings have told me they generally dont expect you to know much of anything early on.

 

[jbrice1639]

what if someone asks you for the specific cause of an idiopathic disease?
then the correct answer is "i don't know," but you can't say "i don't know" for fear of looking ignorant, but by not saying "i don't know" you are giving a wrong answer, also causing you to look ignorant.

so what am i trying to say here?

i don't know.

 

[enanareina]

I figure it is better to keep my mouth shut and let somebody think that I might be an idiot than ramble around pretending to know an answer and PROVING that I am one.

There are few things more painful than watching someone continue to argue the point when they clearly don't know the answer but refuse to admit it, especially when they come in contact with a vindictive pimper who keeps digging at them. Those are times you want to scream at them to just shut up, you don't know the answer!

As for the original question, I usually just say "I don't know" or "I don't remember" (if I knew at some point). If I'm with a patient, I usually tell them I'm not sure, but I'll look up the answer for them. I don't think saying "I don't know" reflects poorly on you in clinical rotations.

 

[notdeadyet]

There are few things more painful than watching someone continue to argue the point when they clearly don't know the answer but refuse to admit it, especially when they come in contact with a vindictive pimper who keeps digging at them. Those are times you want to scream at them to just shut up, you don't know the answer!

Agreed. Doctors-to-be that follow the maxim of never saying "I don't know" are where the reputation of doctors as arrogant comes from.

 

[Long Dong]

rule #1: never lie about a patient to your intern/resident/attending/whatever even if that means saying "i don't know"

Word, I say I don't know all the time.

 

[TerpMD]

I've had several professors tell me you should ALWAYS say you don't know if you don't. Imagine if they ask you if the patient has allergies- you forget to ask and say no. When they go in and ask, the patient is going to tell them they have allergies. Even if you "look bad" because you don't know, its better just to be honest. Being dishonest may seem like it's not a big deal (when they ask what causes a disease) but it is and could have serious impact on your patient in some cases.

 

[MeowMix]

With straight knowledge q's, I'll say I don't know but then say, "I would think that..." and then go on to demonstrate my incredible reasoning skills and superior logic.

With pt care, I ALWAYS am honest about what I do and don't know about the pt. One of the chief residents on my current rotation said it was great that I did that, because then he knew he could trust me completely with whatever I did say I'd done. He said, "You would be surprised how many students lie and say they've done something when they never did it, like a rectal exam. Then I have to do everything myself, because I don't know what they really did and what they didn't."

 

[45408]

On the other hand. if you think you have relevant and important "tangent facts/thinking" that contributes to the issue at hand...then by all means say it. But if you go by the philosophy to NEVER say "I don't know" I think you might be doing more bad than good.

This is true. If you get asked what the most common causes of <blank> are, and you have a few ideas rolling around, pick the most reasonable one, and you might be right. But if you have no clue, because you didn't do the reading, just say you don't know.

 

[mglavin]

Personally would you rather have a doctor that says to you "I don't know but I will find out"

or a doctor that beats around the bush and tells you some related facts about the disease you have that may or may not be relevant



Always watch out for the guy/girl who says or acts like they know everything

 

[mjl1717]

Personally would you rather have a doctor that says to you "I don't know but I will find out"

or a doctor that beats around the bush and tells you some related facts about the disease you have that may or may not be relevant



Always watch out for the guy/girl who says or acts like they know everything

This one of the best overall lresponses:

1)Id say first be honest.. (Its not Law or Law School.) To me this is what separates the two fields-[honesty and meticulous scrutiny versing dishonesty and brashness]

2)Since they say we only use 10% of the brain and we are not uncivilized animals.. I say ponder first, charge the neurons, and attempt an answer.. If you dont know say I dont know, or I can find out, or to show some integrity say I dont want to say anything that is wrong.. And find out!

3)Wasting even 40 seconds looking at the ceiling making believe you know the answer leans not only toward idiocracy but is POOR time management and the team will hate you!

4)Also dont say "I dont know" so much that it becomes reflexive or you are proud to say "I dont know"..Thats just bad for the field and you become about as good as a pile of hair..

 

[Law2Doc]

This one of the best overall lresponses:

1)Id say first be honest.. (Its not Law or Law School.) To me this is what separates the two fields-[honesty and meticulous scrutiny versing dishonesty and brashness]

Actually you have it a bit backwards -- the OP is an example of where med school and law school deviate in the opposite direction you suggest. Law students and lawyers know the consequences of giving wrong info and so don't do it. And the profession does a pretty significant job of self policing for ethical violations, something that medicine doesn't do well. The whole point of law school is to see where you can crash and burn and trouble shoot -- so if that means saying "I don't know" rather than risk giving wrong info, you ALWAYS will err on the side of not giving the info. Med students and doctors are a bit more arrogant, don't like admitting they don't know, and so, like the OP and his example resident, go astray. A lawyer would be less likely to not think through the ramifications of his words. So lying tends to be more frequent outside of the legal profession than in -- except on TV. There are crummy and crooked lawyers and there are crummy and crooked doctors. But I suspect the percentages aren't skewed in the way your post suggests.

At any rate, it's usually more tactful to add "but I'll look it up" to the end of any "I don't know". That's how most smart med students handle it.

 

[PRIMER]

This is somewhat absurd in my opinion. It's one thing to think you know that answer to a question, answer and be wrong, but its another to just skirt around the question. If you don't know you don't know. There will be plenty of other times to show what you do know. I can guarantee that all of us are about 50/50 for what we know and don't know. Sometimes this kind of stuff kills me. I mean, its a bad thing to say "I don't know" Personally, when I become an attending I would much rather deal with a person who does not mind not knowing (of course they can't "not know" too often), than someone who is so self conscience. I personally believe makes it harder to teach a person. Sorry this post was so long, but I just think we need not care about stuff like this. There are more important things to be concerned with, for example.....our patients

 

[diosa428]

This is interesting to me because I've recently had two very different experiences on rotations. With my first few attendings, if I said I didn't know, they'd simply explain the answer. With the attending I have now, I've found that if I say "I don't know" he just kind of stares at me like he expects me to say something further. With him, I've gotten into the habit of describing my thought process and giving some type of answer, because saying something (even if it's wrong) at leasts elicits the correct answer from him, rather than us staring at each other stupidly.

If it comes to pt information, and I honestly don't know or didn't do it, I will say so.

 

[Agent Splat]

I had an attending a couple months ago that was pretty abrupt and liked to pimp quite a bit. I was presenting a new patient we admitted to him, and he says, "OK, tell me your diagnosis, then give me a differential diagnosis."

Now, I did have a differential diagnosis for the patient which was pretty weak, because the patient had really vague symptoms and I honestly had no clue what was going on with him.

If he had asked for a differential first, I would have given it to him, but since he asked for a DIAGNOSIS first, I was a bit thrown off and said "I don't know." Without giving me a chance to talk more about it or give him any differential, he launched into a 20 second rant about how if I was at this stage now in my medical education I had a long way to go.

I'm not sure if skirting around the issue here and just giving a differential instead of a single diagnosis first would have made a difference, or if I had randomly picked one diagnosis and said that, if that would have satisfied him. With this particular guy I really got chewed out a bit for saying it. But, this was sort of his personality. I have indeed said "I don't know" to many things in the past and never had a reaction like that from other doctors.

This was the same doctor that, to the whole team (senior resident, two interns, one M4 and 2 M3s) that the "fund of knowledge in this room is terrible!!!"

i think eventually you just get a feel for how the pimper wants you to respond...hopefully sooner than later in the rotation.

 

[mjl1717]

This is interesting to me because I've recently had two very different experiences on rotations. With my first few attendings, if I said I didn't know, they'd simply explain the answer. With the attending I have now, I've found that if I say "I don't know" he just kind of stares at me like he expects me to say something further. With him, I've gotten into the habit of describing my thought process and giving some type of answer, because saying something (even if it's wrong) at leasts elicits the correct answer from him, rather than us staring at each other stupidly.

If it comes to pt information, and I honestly don't know or didn't do it, I will say so.

Staring contest?? Now thats funny!!

 

[humuhumu]

If you don't know the answer to an attending's question, here's something you could say:

[YOUTUBE="CMNry4PE93Y"]Zombie Kid[/YOUTUBE]

 

[howelljolly]

Ive heard the opposite from a few attendings. We as doctors will not know everything. It is better to say that you dont know, and that you will look something up (right away), than to talk around the answer and try to sound good.

Why? Talking around the answer, making things up, and guessing, can put patents at risk. The attendings told me that they'd rather you get in the habit of looking things up, than get in the habit of being a BS artist (esp. a really good one that others cant call out).

Dont BS the attendings.

 

[CCLCMer]

Personally would you rather have a doctor that says to you "I don't know but I will find out"

or a doctor that beats around the bush and tells you some related facts about the disease you have that may or may not be relevant



Always watch out for the guy/girl who says or acts like they know everything

Good point. I agree that it's best to try your best to answer the questions you get asked, but at some point if you don't know, you have to just own up and admit it.

 

[osli]

I suggest the following response:

"Why are you asking me... aren't you supposed to already know?"

 

[A7madeus]

I suggest the following response:

"Why are you asking me... aren't you supposed to already know?"

You may use this trick if he/she doesnt know/use it because then the answer will be "no I am sorry, so I am asking a person whom I am sure he does know the answer😀"

 

[notdeadyet]

"Why are you asking me... aren't you supposed to already know?"

I prefer the dismissive wave of the hand accompanied by, "Pfffft!!!! Please! Challenge me!"

 

[PeepshowJohnny]

I've heard it both ways from attendings and I think both make a good point.

One argument for not saying "I don't know" is some atttendings like to have you make a stab at it so they can more easily educate you. For instance, if they ask what antibiotic you want to give, and you say a "wrong answer" he can explain why the antibiotic you wanted to use isn't ideal and compare it to the "correct answer" to show you why it's right.

Others have said they'd rather have you say "I don't know" because they want students to know their limits and be ready to admit when they don't know an answer and not be ashamed to admit it.

 

[dannylee718]

When I get asked a question I totally don't know the answer to I say "I don't know".

But I've heard from a student and now a resident that you should never utter the phrase "I don't know" to any question posed to you. Even if you have no clue you should still talk around it to show your thinking process (kind of like beating around the bush even if you don't actually answer the question).

I've seen this in action from some fellow students who refuse to say "I don't know" no matter how much the attending has them up against the wall. They will keep bringing up tangential facts related to the question even if they don't answer the actual question.

This apparently even applies to patients. Like if the attending asks me a question I forgot to ask while taking the history I say something like "Sorry I forgot to ask that/I don't know". Sometimes when you're taking a whole bunch of histories and physicals you sometimes forget to ask a specific question or elicit a specific sign on the physical that the attending then asks you about.

So what is your opinions? Should you never admit to not knowing and beat around the bush to at least show your thought process or is it OK to flat out admit you don't know if you don't?

What are my opinions? I don't know.

 

[Sean2tall]

On my first rotation, surgery, I was asked, "What is a Hartmann's procedure?" to which I replied, "I don't know". The chief resident said that it was an excellent answer. It is obvious and painful to watch people try to dance around and make things up in response to a clear-cut pimping question such as that.

However, if the question were, "What are the complications of hyperkalemia?" then "I don't know" would be a poor answer. At least going through your reasoning would be helpful to show that you are thinking. For example, "nerve conductivity would be impaired, so XYZ might happen."

With regards to answering questions for a patient, I often would say, "Well that depends on a number of things, let me check with the attending to see what he/she wants to do."

 

[mjl1717]

I suggest the following response:

"Why are you asking me... aren't you supposed to already know?"

From my experience atttempting to being a wise--- and dancing around sometimes easy questions.. (eg.-what is the mechanism of action of Sertraline or Selegiline).. puts one in even deeper mud!! [once again it aint law school nor the police test]

 

[Jesus DO]

When I get asked a question I totally don't know the answer to I say "I don't know".

But I've heard from a student and now a resident that you should never utter the phrase "I don't know" to any question posed to you. Even if you have no clue you should still talk around it to show your thinking process (kind of like beating around the bush even if you don't actually answer the question).

I've seen this in action from some fellow students who refuse to say "I don't know" no matter how much the attending has them up against the wall. They will keep bringing up tangential facts related to the question even if they don't answer the actual question.

This apparently even applies to patients. Like if the attending asks me a question I forgot to ask while taking the history I say something like "Sorry I forgot to ask that/I don't know". Sometimes when you're taking a whole bunch of histories and physicals you sometimes forget to ask a specific question or elicit a specific sign on the physical that the attending then asks you about.

So what is your opinions? Should you never admit to not knowing and beat around the bush to at least show your thought process or is it OK to flat out admit you don't know if you don't?

Interesting thread!

The dean of my school put it very simply like this:

"If you do not know the answer - then say 'I don't know, but I'll look it up' - but never ever give me or any of the hospital faculty bull shiet! If you don't know the answer, then don't bloody make things up. We know it when you give us bull shiet - cause your nose will look longer than like Pinnochio! So never BS."​

I kid you not, he said that infront of over 200+ student, faculty, staff - etc. I was a little bit in suprised with his choice of words - but needless to say he certaintly got his point across. It was a rather charismatic speech I must admit. Funny, mean, no hesitation, and just down right blunt to the point. I'm not sure... if he was sending a warning message to someone in the audience.

 

[Law2Doc]

One argument for not saying "I don't know" is some atttendings like to have you make a stab at it so they can more easily educate you. For instance, if they ask what antibiotic you want to give, and you say a "wrong answer" he can explain why the antibiotic you wanted to use isn't ideal and compare it to the "correct answer" to show you why it's right.

It's definitely good to take an educated stab at something you don't know, but you really ought to preface it with some wording that lets them know you aren't actually sure, and just taking a stab. Something like "I'm not sure but I would guess XYZ because..." tends to go over okay, even if it's wrong. Stating a wrong answer with certainty doesn't.

 

[mjl1717]

Interesting thread!

The dean of my school put it very simply like this:

"If you do not know the answer - then say 'I don't know, but I'll look it up' - but never ever give me or any of the hospital faculty bull shiet! If you don't know the answer, then don't bloody make things up. We know it when you give us bull shiet - cause your nose will look longer than like Pinnochio! So never BS."​

I kid you not, he said that infront of over 200+ student, faculty, staff - etc. I was a little bit in suprised with his choice of words - but needless to say he certaintly got his point across. It was a rather charismatic speech I must admit. Funny, mean, no hesitation, and just down right blunt to the point. I'm not sure... if he was sending a warning message to someone in the audience.

Thank You!!

 

[MastahRiz]

I think it's all relative. I've seen some really great docs tell their patients straight out, sorry, I don't know. The thing is though, that as long as they seem really knowledgable about everything else, no one seems to notice, nor do they seem any elss credible.

If you do end up saying I don't know, I doubt it makes a lasting impression, unless you're saying it left and right.

Then again, even "nervous guy" from scrubs never said I don't know-- he always had a guess.

 

[collegefootball]

Here is my .02 from an outsider.
There are always times that are appropritate to say you don’t know. It is never wise to always say you don’t know something. There are certain types of questions where a person can say they don’t know and you are better off saying you don’t know then trying to give a guess. Studies have shown that when you say you don’t know something to the right questions, you build respect from your peers. When you try to give a guess at every question even though you know you don’t know something, you build distrust from your peers.
When a physican asks, what are the five symptoms of “so and so disease?” It is always wise to at least say a couple of the symptoms that you do know and just achknowledge that you don’t know all of the symptoms but will look it up immediately and will remember all of the symptoms next time asked.
You do not want to say, “but I guess.” You are better off saying, I think…………. If you use the word I guess, then it sounds like you are just throwing words out of your mouth. If you say I think, it shows that are you trying to think of the answer.
I remember my speech professor saying it’s important to use the words “correct me if I’m wrong” in a professional setting.

 

[rgarrig]

When I get asked a question I totally don't know the answer to I say "I don't know".

But I've heard from a student and now a resident that you should never utter the phrase "I don't know" to any question posed to you. Even if you have no clue you should still talk around it to show your thinking process (kind of like beating around the bush even if you don't actually answer the question).

I've seen this in action from some fellow students who refuse to say "I don't know" no matter how much the attending has them up against the wall. They will keep bringing up tangential facts related to the question even if they don't answer the actual question.

This apparently even applies to patients. Like if the attending asks me a question I forgot to ask while taking the history I say something like "Sorry I forgot to ask that/I don't know". Sometimes when you're taking a whole bunch of histories and physicals you sometimes forget to ask a specific question or elicit a specific sign on the physical that the attending then asks you about.

So what is your opinions? Should you never admit to not knowing and beat around the bush to at least show your thought process or is it OK to flat out admit you don't know if you don't?

lol - one of the first points they drilled into us at medical school was the following...

What are the three most important words a doctor can say?

I don't know.

And no, they didn't mean that no one knows the three most important words ;-)

Be honest; that works.

 

[Cancer Man]

I once had a professor who told us the following:

It's not wrong to be ignorant, It's not. But to discover you are ignorant and to choose to remain so, is wrong.

That being said, I don't think that it is wrong to use the "I don't know" response, but it should be followed up with some sort of "I'll find out and let you know" type phrase. Then research should be done to find out. This shows initiative and drive.

 

[Law2Doc]

Then again, even "nervous guy" from scrubs never said I don't know-- he always had a guess.

Many things you see on TV would get you sued into oblivion in real life. Not being able to give an answer is almost ALWAYS preferable than giving a wrong answer (and this mantra will often keep you out of court).

 

[Law2Doc]

You do not want to say, "but I guess." You are better off saying, I think&#8230;&#8230;&#8230;&#8230;. If you use the word I guess, then it sounds like you are just throwing words out of your mouth. If you say I think, it shows that are you trying to think of the answer. I remember my speech professor saying it's important to use the words "correct me if I'm wrong" in a professional setting.

I actually don't think saying you are "taking a guess" is so bad, and have seen very smart people (in two professions) follow that with educated guesses and do quite well with it. I suppose "taking a stab", "give it a shot", "I would think" have less of the taint you are concerned with. Saying "I think" rather than "I would think" is semantically troubling because the former comes off as more of a statement of knowledge, rather than an impromtu attempt to reason it out. It's always dangerous to suggest you have knowledge you don't.

 

[mjl1717]

I actually don't think saying you are "taking a guess" is so bad, and have seen very smart people (in two professions) follow that with educated guesses and do quite well with it. I suppose "taking a stab", "give it a shot", "I would think" have less of the taint you are concerned with. Saying "I think" rather than "I would think" is semantically troubling because the former comes off as more of a statement of knowledge, rather than an impromtu attempt to reason it out. It's always dangerous to suggest you have knowledge you don't.

I hate to say it, but I usually concur with L2D.😕