Ultimate Question of 3rd year: Keeping your mouth shut vs. asking questions

[Reborn07]

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I'm sure i'm not the first one to have my lack of knowledge exposed on rounds after asking a "dumb" question. It's really frustrating when you have a dying question but you're afraid that residents will view you as having "low medical knowledge" if you ask it. How do you guys handle this. I'm incredibly frustrated for not getting enough out of my rotation for not being able to ask what I want to know.

 

[DoctorFunk]

1st rule of Fight Club: Do not ask questions for which you are pretty sure you could look up the answers yourself.

 

[MSHell]

Ask a fellow student.

 

[Biscuit799]

I was gung ho "don't ever ask questions," however I then had a pediatrics attending who mistook my lack of questioning for utter disinterest in the field. He said I seemed completely uninterested and maybe a little stuck up. It was the furthest thing from the truth, and I eventually rectified the situation with him later. However I now am a proponent of asking about 1-2 well informed, inquisitive (re: NOT something you could look up in a book) questions per week. Everything else, ask a classmate or read about it later.

 

[Blade28]

That's a key lesson in med school, and bears repeating:

Not asking questions, and simply being "polite" and quiet = lack of interest, as viewed by most attendings. This is doubly true in fields where the residents/fellows/attendings tend to be more vocal and assertive, e.g. Surgery, OB/GYN.

 

[SocialistMD]

I echo Blade; anything at the med student level can be looked up in a book. Ask the questions that show you want to know the next step beyond what your recall or First Aid tells you. It continues on in residency and fellowship. Even junior attendings will ask their senior partners what they would do for a particular patient in a particular instance. Your residents/attendings are a wealth of knowledge that will save you time in looking things up. That said, asking too many questions is annoying and there is a baseline level you are expected to know (i.e. "Is that a normal potassium?" or "Can appendicitis manifest with RLQ pain?"). Some residents/faculty will take too-basic of questions to suggest a lack of knowledge, and there is no way to know what each resident/faculty's interpretation of what is basic will be. What will hurt you worse, though, is not asking questions, which, as mentioned before, implies disinterest.

 

[Tired]

I don't think that the "Never ask questions you could look up on your own" is a good rule, since really, every question can be looked up somewhere.

I think a better rule would be to make sure that you ask focused, rather than general questions. Don't ask, "How do you treat pneumonia?", ask "Why did you pick Zosyn instead of Levaquin?" Attendings want to teach (or most do, anyway), but they want to teach on specific points, not huge general areas.

 

[Blade28]

Agree with the above two posts.

 

[PoorMD]

i agree with the above posts.

ultimately though it depends on the attending/resident that you ask.
the one exception is in the OR.. The Law is totally different there. If you ask about a structure, or vessel, and you are so blatantly wrong that the residents are laughing, it could lead to some negative remarks on the eval. from personal experience, if the team is opening for an emergent cesarian, i would never point to a random lump of flesh and ask "is that the ureter?"

 

[Law2Doc]

I'm sure i'm not the first one to have my lack of knowledge exposed on rounds after asking a "dumb" question. It's really frustrating when you have a dying question but you're afraid that residents will view you as having "low medical knowledge" if you ask it. How do you guys handle this. I'm incredibly frustrated for not getting enough out of my rotation for not being able to ask what I want to know.

Part of the challenge is reading your attendings on this. There are some that expect questions, and will be annoyed if you stay mute, often turning to you at the end and asking in an accusatory tone "you don't have any questions?" Others will be equally annoyed if you ask a thing, and ruin their train of thought. It probably pays to err on the side of questions, because that shows your interest, but make them well thought out, and based on reading you have done. Save the really dumb or obvious questions to ask your classmates once the attendings are out of earshot.

 

[PeepshowJohnny]

Here are the questions I often ask my attendings:

"Hey Dr. Attending, how can I be as awesome as you?"

"Hey Dr. Attending, have you lost weight?"

"Hey Dr. Attending, did you know all the male/female)medical students voted you hottest doctor?"

Never gotten a bad review yet.

 

[Ypo.]

LOL. When I started third year I thought questions would be encouraged. I've since learned to keep my mouth shut and only ask one or two of the hundreds of questions that go through my mind each day. Then later, when I become chummy with the interns, I pick a "down time" to ask them. I've also picked up a strategy of watchful waiting for the first few days of a rotation to find out who the approachable residents are. My fellow students usually don't know the answer and/or I never see them.

I have learned to think a lot more about my questions before asking. Totally different from 1st and 2nd year where I did not hesitate to ask questions from my professors. The difference then was that my professors were there solely to teach (during that time period at least) whereas residents/attendings have clinical responsibilities and don't want you to waste their time. Seems pretty simple when you look at it, but it actually took awhile for this to sink in, especially since I am one of those people who loves to teach.

I've also since learned that if you shut up, don't complain, work hard, that most attendings notice that and then offer to teach a little (esp on rotations such as IM, OB, and I would bet surgery as well), and welcome a few (mind you only a few) pertinent questions. But first comes patient care, so you just have to shove your wants into low priority.

Another thing I struggled with was dealing with the one on one teaching/pimping. At first I didn't appreciate it at all, but eventually (after I realized how rare teaching is) I changed my attitude. Of course, sometimes a person teaches you something you already know (some people have a 'you listen, I talk' method of teaching). Then you just listen attentively, smile and say thank you and go about your way. Never show disinterest in a resident who is taking time out of their busy schedule to teach you. Sometimes I am embarassed at the way I must have appeared (unintentionally) in the beginning of the year. God, I remember in my first rotation getting upset at an attending for pimping me and then giving me a lecture which held me an hour later than I expected to go home that day (the attending was well intentioned, but the lecture really was extremely unhelpful).

 

[jocg27]

Benjamin Disraeli said that it is "better that they should wonder why you do not speak than wonder why you do."

Just saying...

 

[QofQuimica]

I'm sure i'm not the first one to have my lack of knowledge exposed on rounds after asking a "dumb" question. It's really frustrating when you have a dying question but you're afraid that residents will view you as having "low medical knowledge" if you ask it. How do you guys handle this. I'm incredibly frustrated for not getting enough out of my rotation for not being able to ask what I want to know.

I do have low medical knowledge, so I don't really worry about the residents or attendings finding out about it. The only time I feel the least bit competent is when I'm talking to one of the first years and they have a question about something they're learning. 😛

All joking aside, I think the general advice others have given is good. Do ask questions if you have them, but wait for an appropriate time. If people are trying to get through rounds quickly, maybe that's not the best time to be asking them your questions.

 

[Medarca]

There's nothing bad in asking for a help. Especially for students. To have a question is to be curious BUT NOT to be stupid! And maybe this right answer from a real specialist will help you to save somebody's life!

 

[fang]

Great advice above. From an intern perspective, I like it when students ask questions as long as I'm not hopelessly busy and the questions are reasonable. Here are some examples:

Lame question: "Which clotting factor has the shortest half life?"
-- You can look this us as well as I can. Although I THINK I might know the right answer (factor 7??), if I'm wrong and someone else knows and corrects me, it's embarassing.

Alternative: "Why do we overlap heparin and coumadin?"
-- I can answer this correctly without needing to remember specific facts I haven't thought about in 1 1/2 years.

Lame: "Which chemo regimen is best for adrenal carcinoma?"
--Remember, you're asking a medical intern... this question is better directed to an onc attending.

Alternative: "How do you manage someone with acute dyspnea?"
--This is more bread-and-butter for me, and I would be happy to share!!

Lame: "Why did you put this patient on antibiotic X when antibiotic Y is active against this organism and is much cheaper?"
--You can be sure I did it for a reason, like that's what sanfords or the johns hopkins guide recommends, or that's what the attending told me to do. The way this question is worded invokes a defensive response.

Alternative: "How did you decide on antibiotic X?"
--I can tell you how I arrived at the choice, and share what I know about why (broad gram negative coverage, good penetration, whatever).

hope this stuff helps!!