Medical Student Perspectives: Ask Good Questions.
I am reaching the end of medical school and one of the tips for success I have been offered by every clerkship director, every resident, every small-group facilitator and even a couple of books is, “Ask good questions.” Every time, I wanted to ask, “Could you please be more specific?”
What constitutes a good question? I am sure you have been told, “There is no such thing as a dumb question.” While that is almost true, you should not ask a question that is so simple that it makes it obvious you were not paying attention or you did not understand what was going on.
I recently returned from a global health rotation in Brazil where I learned about infectious diseases that affect Brazilians but do not occur (or are extremely rare) in the U.S. About 4 weeks into my 8-week rotation, I went to a dermatology clinic at the university hospital and worked with a new attending physician. Granted, I speak very little Portuguese but I should have been paying closer attention. While the residents and attending were talking, I picked up these words: Mycobacterium, dapsone, peripheral neuropathy, and Hansen’s, among others. I should have thought to myself, “What do these words have in common?” Instead, I blurted out, “What was wrong with that patient?” The resident looked at me a little confused and said, “Hansen’s disease. You know, leprosy. This is a leprosy clinic.” Now that was a dumb question! For those of you who will start your rotations on the wards in the upcoming months, much of what will be said may as well be in a foreign language. I suggest that you retain the words you know and look up the words you do not know and occasionally play the game, “What do these words have in common?” before you ask, “What is going on?”
Asking good questions requires four things: background knowledge, some interest in the topic, context and timing.
Background knowledge requires more than just having survived or even done well in your pre-clinical years. Background knowledge requires constant work. For instance, if you have a patient who is admitted with hyponatremia then you need to look up the causes and treatment for hyponatremia. You should be prepared to talk about hyponatremia for approximately 30 seconds during rounds and you need to be able to finish your 30-second talk with, “But what I didn’t understand from what I read is…” Make sure it is something you actually didn’t understand; doctors can always tell when you are asking a question to which you already know the answer. Please, don’t be that student. I know this sounds like a lot of work (and a little “gunnerish”), but there are many complex topics in medicine; your residents will probably appreciate a quick refresher before your attending starts asking them questions.
Demonstrating interest in a topic has a lot to do with being a good conversationalist. If you cannot express your thoughts on a particular topic you will never be able to convey your interest in it. While this can be difficult sometimes, there is always going to be something that you can take from your current rotation to use in the future. How do you get interested in a topic you find rather boring? Daydream. Yes, you read correctly: daydream. Think ahead to the days in the future when you are a real doctor. Imagine you are not a student sitting behind the radiologist in the dark trying to stay awake while she reads a head CT. Imagine you are in private practice and a patient comes to your clinic with mental status changes and you do not have a radiologist in-house. Now you have a question: “If I have a patient with mental status changes and I have to do a preliminary read on a head CT, what things should I be looking for?” Then, you can follow up with, “Which window would be best for me to see that?” The follow-up question is very important for demonstrating interest. If you have trouble with thinking of questions, try this: at your next family reunion, go to the person with whom you have the least in common and talk about that person’s hobbies for 10 minutes. It is great practice.
Before you ask the thoughtful question demonstrating your interest in a topic, consider the context. Those of you who are studying for your USMLE Step 1 have a lot of background knowledge, and you may even have an interest in the topic, but it is unlikely that your attending physician is going to be able to explain the biochemical mechanism behind doxorubicin-induced hemolysis in a patient with glucose-6-phosphate dehydrogenase (G6PD) deficiency in detail. A more appropriate question might be, “If a patient has G6PD deficiency, what would be a good alternative chemotherapy regimen?” (This question is best when asked to a hematologist.) Try to keep things as clinically relevant as possible. Also, try to avoid asking a question in such a way that it will put a physician in the position of knowingly contradicting the treatment decision of another physician. This is something that we, as professionals, should try to avoid. As professionals, we should respect our colleagues and the decisions they make, regardless of whether or not we agree with them.
Finally, consider the timing. This is probably the most important. There is, without a doubt, a right time and a wrong time to ask a question. For instance, during surgery try not to ask, “What are you doing now?” immediately after a major artery has been severed. In every clinical situation, you will be asked, “Do you have any questions?” Use the time before this question is asked, to think of a question and then save it for when the time is right. If you find that you have many questions, and you are not in a surgery, it is okay to write them down so you remember them. Writing your questions down is particularly important during a busy clinic. You can preface your question with the explanation, “I was curious about this when Mr. So-and-So was here, but I wanted to wait to ask you about it until we had time to discuss it a little more.” Saving the questions that are not vital to your understanding of the immediate situation will demonstrate to your attendings that you have respect for their time and their patients’ time.
To those of you who will start your clinical rotations this summer, good luck and ask good questions!
Council of Student Members Representative, Central Region
University of Iowa College of Medicine, 2007
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