Asking medics questions

[DwayneEMTP]

I do think that happens...

Thank God...I thought maybe I had fallen into the Twilight Zone for a minute.

Every student in medicine, whether a freshman, an intern, or a resident, is involved in teaching... This produces practitioners who are forever in educational mode, both as a student and as a teacher. With this outlook, nobody is threatened by the questions of students, because they too still understand what it is like to be a student. That's why you get such positive response from physicians, but not with many medics...

That makes perfect sense! Thanks for that. Going in I often expected that Doctors would be the worst people to ask questions of, but it turns out the tougher the questions, be it ethical, anatomical, physiological, the better the answers and the more they seemed to demand of me as a student.

But a great many medic students seem to think that they don't have to make any effort to actually learn. They expect that everything they need will just be taught to them without them having to participate in the process. It's like, "I paid my money, so now make me a paramedic." And second, somehow these students are making it all the way to clinicals in medic school with their school still not having taught them that paramedic practice is about much, much more than just skills. Having read of your experiences, Dwayne, I know you know the kind of guys I am talking about and how common they are.

This was one of the many major let-downs for me in medic school. In my class of 12 (with 4 passing without having to retake anything next semester) there was only one other student that wanted to butt heads on grades and other objective achievements. There was very little drive in anyone.

One of my favorite moments in medic school, and also perhaps a valid example...

During my invasive cardiology clinical I was able to observe the Dr. trouble shooting a pacemaker with a bad atrial wire (one wire to each ventricle and one to the lft atria). We were watching the EKG on a huge screen set up nearby and he asked what I saw. Hell! I'm very weak in cardiology (though much stronger now than then) so I started sweating...and

I said “It looks like a normal EKG with a somewhat wide QRS complex”

He said “good...” and pulled a wire on the pacemaker!!!

He said “what do you see now?”

But I couldn't see any difference!!

I said “I'm not sure...”

He said “Answer the question or get your stuff together and go waste the girls' time at Starbucks!"

Man, my stomach was churning (even though I knew he wouldn't hurt the patient) and the sweat was running down my face...I so didn't want to humiliate myself and my cardiology instructor..

I said “I can't see what changed! It looks the same to me as before!”

He said “I hope so, that is the broken wire..that's why we're here.”

And then proceeded to pull each wire in turn.

“What now?”

“The QRS is huge!”

“Why”

(I don't know damn it! I don't know I tell you!)....Then...”wait..that must have been the lft vent wire...It's depolarizing more slowly through the muscle making the QRS wide!

“where in the left ventricle?”

Hell...”From the lateral side!"

He said “Exactly!”

“why can't it be the right vent?”, “What would happen if they were placed differently?”, “What would happen if X wires were firing but Y wasn't?” and on...and on...and on...until piece by piece the cardiology came together in my pea brain at a time I was certain it would have abandoned me.

What a gift.

Anyway...the point is, I couldn't wait to tell that story to my classmates...and without exception I got some version of “What a prick!”, or, “What was he trying to prove?!”

It just made me sad...

Good question! Certainly one that we all have to deal with at one point or another, on both sides of the fence.

Thanks a million for your response! Looking at it from this perspective will certainly change the way I approach questions and concerns in the future.

Have a great day all!

Dwayne

[fiznat]

What a gift.

Nicely put, Dwayne. Not many of us get the opportunity to be taught something like this in such a clear, effective manner. The fact that you recognized the opportunity for what it was makes it even better.

[cloe911]

This may be from an entirely different angle, but here goes.

During medic school and clinicals I "interviewed" 8 preceptors. My sole intent was to find a preceptor who would be an all-in-one medic and could teach me in a way I thought was fair. I ask questions...constantly.....and "why?" is the most common. While I know when to wait to ask, I can never seem to "get it right" without making a super patient preceptor go nuts. I agree that there are to many medics out there who are superior medics, but have no educating skills whatsoever. I have heard to many horror stories of interns being made to wash the preceptors car for asking a dumb question.

I have had several people tell me that I should just shut up and stop asking, and I've told them all the same thing; I want to make sure I have the right answer when my patient asks me questions.

[fiznat]

Well there are questions you should be asking your preceptor, and questions you should be answering on your own. If your question is something that deals with medical detail, pathophysiology, pharm, or something like that: you might be better off consulting your textbook or some other trusted academic source. If your question is about handling yourself on scene, the order in which things should get done for various kinds of patients, or how to better get histories from a patient interview, the preceptor is probably the person you should be asking.

Keep in mind though, that there are MANY different ways of doing things. Take the advice when you get it, pick up what you like, and prepare to create your own style once you are own your own. There is no clearly defined "right" way to do these kinds of things, only general guidelines that most medics follow. Pick up what gems your preceptor is willing to hand out, nod your head in agreement whenever possible, and understand that the ability to do this well comes with PRACTICE, not instruction.

[iMac]

I think questions have a time and place. As long as you don't ask questions at a really ridiculous time, you should be fine. It's very easy to make a question sound as tho you are trying to learn or understand something better. A good paramedic should always recognize that, but we do have a lot of "gifted" ones out there that will shut you down no matter what.

Good Luck.