when an attending or resident asks u a q

[chef]

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and u have no clue what the ans is, is it better to admit that u dont know, or should u takea wild guess and give 1 word answer, or pretend u know the answer and give the "BS story" answer, trying to attempt to answer using some bs logic?


also if some1 has "10 commendments" or "survival guide" in M3/M4 yrs, pls post!

 

[KyGrlDr2B]

I have heard from several attendings that you should always say "I don't know." Then they will tell you and you had better know it if they ask you again.

 

[Amy]

I disagree. The best thing to do is make an educated guess, preferably explaining your thought process as you work your way to the answer. This way, you can show him what you DO know, even if you don't get the answer he was looking for. Just saying "I don't know" is a cop-out, and the doc will be annoyed that you put no effort into answering the question. The point of pimping is to teach... if attendings thought you knew everything, there'd be no point to asking anything.

A good general rule is that attendings want you to sound sure of yourself, even if you're wrong. It shows self-confidence, and the ability to think on your feet. But, as KYGrl mentioned, it's really poor form to get an answer wrong the SECOND time.

 

[Goofyone]

Probably depends on what the person asking you wants to hear.

 

[ckent]

I agree, an educated guess will get you more points. Most attendings don't like to hear "I don't know" even if they tell you that they prefer you to say "I don't know". An educated guess helps show off your thought process. It's part of the art of pimping, or responding to pimping. It can involve anything from re-directing the pimping question to a subject that you are more familiar with, responding to the question with a more complicated question, stating facts about the subject that don't answer the question to bluffing (guessing an answer to the question while speaking in a confident, authoritive tone). There was a wonderful article linked here on SDN on pimping that was written half-jokingly, but it really accurately described how students/residents should handle pimping IMO.

If the attending question is regarding patient information that the attending needs to know (ie the information needs to be accurate, like what a lab value was or what an x-ray showed), and I'm not entirely sure, I will usually make a guess based on what I think I know and preface it with "I'm not sure, but I think...". I have found that if an attending needs an exact answer right away, he or she will ask me to look it up. If not, and I look it up later and realize that I was incorrect, I will go back and correct the misinformation that I gave the attending. I do not advocate making "wild" or random guesses regarding patient information though (eg telling the attending that the potassium was normal and chest x-ray was clear when you never looked at either), as that can lead to medical mismanagement. If you vaguely recall seeing the information before but are not 100% sure about it, I think that it is acceptable to admit that you are not sure but relay what you vaguely recall in my opinion. What you vaguely recall can be useful in your team's management sometimes.

 

[gwyn779]

It depends on the person. Most have told they'd rather hear a guess, but a few have said they'd rather hear "I don't know."

 

[omores]

Depends on the type of question, and the circumstance in which it's being asked. For pimping questions, ask yourself the following:

Is it a "why" question -- one which, even though you don't know the answer, you could conceivably reason your way at least partway through? Example: why are beta blockers problematic in diabetics? Take a stab at it. Think out loud. "One of the risks for diabetics is low blood sugar, which can present itself as tachycardia. Beta blockers would suppress that. Beta blockers also have effects on insulin and glucose metabolism that are probably important, but I can't remember what they are...." If you're spouting nonsense, the person who asked you the question will cut you off before you dig yourself too deep a hole. Usually.

Is it a "what" question -- one which either you know or you don't? Example: what is the danger of overly rapid correction of hyponatremia? Either you've heard of central pontine myelinolysis or you haven't, and chance are good you've only heard of it if you've been pimped on it before. In my experience, this kind of kind of question is asked not because the doc really thinks you'll know the answer (although gold star if you do), but rather as a chance to show off his or her own knowledge. In a case like this, I'd always take a direct approach: "I don't have a clue. Enlighten me." And they will.

If you're being asked a patient care question such as whether the hematocrit dropped at the last blood draw or whether you heard femoral bruits on physical exam, you MUST be honest and admit you don't know. You can always phrase it like this: "That would have been a really good thing to check, but I didn't think to do so. I'll go find out now."

 

[DrQuinn]

I completely agree with omores...

with the students that work on my service, if htey dont' know, I'd rather they atleast say SOMETHING instead of standing there without saying a word. I'll give you five seconds and if you don't hazard a guess, atleast say I don't know so we cna move on.

Q, DO

 

[KyGrlDr2B]

I guess I was thinking of obscure little facts that they like to ask you. I was at an internal medicine meeting and the attending was talking about all of this crap no one had any idea of simply because we are still new at things. He told us not to make up the answer, but just say i dont know. If it's something you could think of a legitimate guess, then by all means do that.

 

[UCLAMAN]

I would give my educated guess then let them know that I didnt know for sure.

I don't understand why anyone would "BS" their way through an answer. If you don't know it, you don't know it. Consider it an opportunity to learn. Granted you don't want to make a habit of not knowing but if it happens infrequently enough then I don't see the harm in giving your best educated guess then letting the attending know that you don't really know.

Of course the attending knows more than you...he or she has been in the game longer and probably(hopefully) has more experience in their pinky than the medical student has total. So whats the problem with not knowing? (granted you aren't saying "i don't know" every single time you get asked a question)

 

[DOtobe]

Although I am still fairly early in the rotations process, I also vote for making an educated guess. I think the attending wants to see that you are thinking as well, and can put together some sort of thought process. If you try to reason out some type of answer you show you are understanding concepts, and didn't just memorize the "most common pimp questions" list.

But I don't think it's so bad if you have absolutely no clue what the attending is talking about to say "I don't know." I think you will look worse if you make a guess that is completely off base from what the attending is asking. It will definitely show that you were just pulling the answer out of thin air.

In terms of patient care, I think the thing to remember is DO NOT LIE TO THE ATTENDING. If you didn't check the labs, don't say, "Oh, they were normal" when you have no idea if they were or not. All the attending has to do is check the labs and find something abnormal, and you will be sunk. I agree with whoever (I believe ckent) said it would be better to say, "I didn't think to check, but I'll go check now."

I just hate that it seems like you have less control over your grade than you did the first two years. Now we have to worry about everything we say and everything we do, not just about studying hard for exams. It's really nerve-wracking.

 

[Kosmo]

I've found that, particularly for M3s, it's generally not that big a deal if you don't know the answer. Often they expect you not to know it and ask the question with the intent of making you think logically about the problem. So, especially when you get pimped during a surgery, I think it's ok to venture a guess to give the attendings/residents a chance to listen to your thought process. That way they can steer you in the right direction.

HOWEVER, I would not try to BS during rounds, especially if you get pimped on patients assigned to you. In that case it is best to know everything about the patient and their disease/treatment. If you do get stumped, just admit it and take the heat. And then know the **** cold for the next time they ask you.

 

[Mad Dog]

it really depends on the attending.

mostly though the attending is more concerned with how they look than how you look, so they WANT you to not get it right. then they can lord it over you and elevate themselves. the general best solution is to give them just enough to show that you're participating, and then act gleefully amazed when they spout their wisdom. just saying 'i don't know,' if in fact you really have no idea, can come across beautifully if you pull the second part off well. more often though i think they feel that you haven't played your part appropriately if you didn't at least hazard a guess.