A while back, I was rounding on the ICU service with a new attending who had just come on service. On her first day, she said to us, "If you ever have a question on one of your patients...."
She paused. I waited for her to complete the sentence, assuming she was going to tell us something like, Feel free to bring it up on rounds so we can all learn from it.
"Don't ask me the question," she finished. "Look up the answer yourself."
The mantra of "look it up yourself" is pretty prevalent in medicine. I remember on another rotation, I had a question about the dosing of steroid in oral vs. IV form, and I did look it up, and still couldn't come up with the answer. I asked the attending on rounds, and he said, "This is why you need to look things up." I tried to explain that I still couldn't find the answer, but he didn't want to hear it.
Why is there this culture in medicine of refusing to answer questions that trainees have? I can't imagine saying something like that to a med student or resident. Isn't part of being in a teaching program to actually, you know, teach?
Agreed. There have been a number of times when I haven't been able to find a particular piece of information in a textbook/online, and it's been frustrating when the people who are paid to teach me have refused to do so. I don't understand why attendings think that my inexperienced searching through textbooks is always more valuable than learning directly from their years of study and clinical experience.ReplyDelete
I don't know.... but I can tell you the problem is even worse when your PI is a doctor and they expect you to "look up" how to run some complicated statistical model, and then complain when it takes you two weeks to figure out what you're doing.ReplyDelete
(Not that I'd know anything about that....)
I remember asking about something on rounds because I couldn't hear what someone had said, and the attending decided to punish me by making me do a presentation on it the next day. Moral of the story: If you miss what's going on because you can't hear, keep your mouth shut anyway.
It was much the same way for me in grad school. A prof told me to "look it up" after I asked what 9-BBN was when he wrote it in on the board. This was before internet and I had no idea where to look it up and his tone was such that I didn't want to ask that follow up. Not only that my classmates looked at me like "Yeah dumbass, look it up!"ReplyDelete
Today I mainly teach undergrads and I will say "look it up" when they ask for something like the melting point of benzoic acid. Part of the reason is that I usually don't have these numbers available at the top of my head. Even if I do know the number, I want to point out that these numbers are readily available in reference books and from easy google searches, and all of these sources are probably more reliable than my memory.
I think the idea is just to get students in the practice of being self-reliant and independent. I don't think it would kill them though to be less rude about it sometimes.
Yeah, I've basically accepted that I really shouldn't ask things of my adviser unless it's of the global, 'so where are we going with this in the future' question-which is a pain, because if he mentions something in group meeting, we'd all like to just ask for a quick clarification. I absolutely believe I should be able to look stuff up on my own, but dude, wouldn't it be fair to assume that if I'm asking a) it's a quick question or b) I've already sifted through Pubmed anyway?ReplyDelete
I am with you 100% here. It maes me so angry when doctors or anybody is like that...ReplyDelete
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Examples of the abdication of the responsibility of teaching are more easily found in med school education than examples of effective teaching. Med school at this point is basically a self study program which you pay ~ 45 grand a year so that the administration of you school can go through the motions of pretending to teach you stuff, collect your money and tell you to look it up.ReplyDelete
^ that's depressing, but I know it's true :(ReplyDelete
I understand and appreciate the benefits of "looking it up" but sometimes, textbooks don't even give a clear answer. They're lazy and missing the whole point that a good student would rather ask someone who knows rather than consult The Google.
welcome to every single one of my preceptors . . .ReplyDelete
I stopped asking questions on one particular rotation because the only answer I ever got was "go look it up." So much for trying to appear inquisitive and interested.ReplyDelete
Well, that definitely sounds like one of my ICU attendings. That same week they'd changed the format for ICU teaching. Previously, it had always been didactic noon teaching led by attending staff. Instead, we started at 7am, and "teaching" was to be case-based (requiring preparation and reading, of course) and led by the housestaff.ReplyDelete
I stopped asking questions a while ago because the answer was either 'look it up' or 'if you had read about this like you were supposed to, you would know the answer.'ReplyDelete
It's so true, but then if you dont ask any questions they think you're not interested. perfect no win situation.ReplyDelete
It's probably because they don't know the answer either, lol, and don't want to show their lack of knowledge in front of the whole group.ReplyDelete
It's the same with my nursing degree. And it is more than a pain in the arse when you spend hours looking up a specific topic, formulating an answer and then get told you were completely off track. Or can't find an answer at all. Argh!ReplyDelete
I do find I absorb information better when I go read about it myself, but if you can't find the answer and they still won't tell you? Unforgivable douchebaggery.ReplyDelete
I agree with Vivien on it occurring in nursing school, too. Personally, I love to answer questions and be helpful to everyone whom I come into contact. Not a lot of hospital staff are that way, though. I also think it's laziness on lots of nurse educators/attendings parts. Don't get me wrong, people need to be able to think for themselves, but *everyone* needs help once in a while. And if someone's openness about needing help is repeatedly squashed, it ends up hurting the patient more than anyone else; and that's a damn shame.ReplyDelete
There is a fine balance when you are teaching. I am a former residency director. I used to tell my residents that "you don't have to know everything, but you have to know where to find it." If it was material we had covered or that I knew was in their study material I expected them to look it up. However, if they didn't understand something or needed further guidance I was always happy to provide it. With that policy, I always found my team was better prepared and they were more confident in their ability to figure something out on their own.ReplyDelete
Teach? Nope. You have to be as frustrated as they are.ReplyDelete
And not answering the question after you've gone and looked it up implies that have not a fuckin' clue what the answer is.
Joy. Just share that joy, doc.