It’s Okay to Not Know Everything

As a medical student, you are going to step foot onto a clinical rotation for the very first time armed with all the knowledge you gained throughout medical school. You meet the team and then within your very first hour, you may get “pimped”, or asked a difficult question. You immediately pause. Then you search through all the corners and crevices of your mind for the correct answer. And when you apologize for not being able to answer the question, the attending or senior resident may act astounded that you didn’t know the answer. And you may end up feeling utterly incompetent and defeated.

Well I, and everyone that has come before you, need to tell you—we have literally all been there.

I also want to let you know no matter what that it really is perfectly okay that you didn’t know the answer. This feeling of wanting to have knowledge of everything probably comes from our strenuous years of education, desire to become a great physician, and ambition. And it doesn’t help that on every medical show on TV, every single intern raises their hand eager to answer when an attending asks a question as if that scenario is actually true to life.

I was once on a gastrointestinal surgery rotation as a third year medical student and was asked by the attending what percentage of Americans die from lung adenocarcinoma each year. Yes, from a specific lung cancer. By a colon surgeon on the gastrointestinal surgery rotation. A friend of mine was berated for not bringing a packet of granulated sugar to help with a patient’s stoma prolapse on his first day—something he had never heard of before in his life. Unfortunately, this persists into residency. At the beginning of my very first musculoskeletal X-ray rotation, I was asked if I could see anything wrong with the bones on a comparison MRI. I really wasn’t sure what the normal signal of bone even was by that point or quite frankly, what normal versus abnormal bones looked like on any imaging modality.

I genuinely believe that most of the attendings or advanced residents don’t ever intentionally mean to make you feel bad. I have found that over my medical school and residency training sometimes attendings, especially ones that have been in the field for a while, can forget where they once were. Over time, they tend to assume all that knowledge in their arsenal is just basic information. They may not remember that they too once started out brand new on a new rotation and may not have known the answer either. There are a few exceptions of course, as some attendings (I’m sure you know a few!) have photographic memories or are just literal geniuses that actually did know the answer. And honestly, a few may be mean-spirited or having a bad day.

But it’s really okay that you didn’t read the entire 700-page textbook on that particular specialty in medicine before your very first day of the rotation. Or that you didn’t read the updates on that technique in the most recent New England Journal of Medicine article that literally just came out the day before. Even if I read the majority of a textbook before a rotation, I only retained at most 50% of that information anyway. I’m a type of person that needs to read things a few times to let it sink in and stay in my long term memory.

And this of course happens to anyone in any field. Imagine back to the time you had a job outside of medicine. Maybe it was as a receptionist at med-peds clinic, a sales associate at Macy’s, or an attendant for the Indiana Jones ride at Disneyland. It’s overwhelming. You barely know how to use the complicated phone system or the register, or your flashlight is running low on batteries and you don’t know where to get replacements. All of your motions seem excessively slow. By the time you are ready to take a break, you may not even know where the restrooms are!

In every situation in life when you are just starting out, it’s okay that you don’t know everything and don’t entirely grasp what you are doing yet. Over time, you became much more comfortable and became so much more efficient. The same thing is true with your medical knowledge—over time, with continued studying and clinical learning, you will ultimately be equipped with the information to succeed.

So if you find yourself not knowing everything early on, don’t ever feel inadequate. It is a common phenomenon that almost everyone has experienced. And when the time comes that you are the advanced one asking the questions, you will be supportive when the intern or medical student doesn’t know the answer yet. Because no matter how advanced you are, you understand because you were once there also.