Student Module 1 - Student Questions

Tips for Students - How to ask effective questions

  1. Use a positive, inquiring tone, not a negative, challenging one.

    Question: Why didn’t you do a serum porcelain test to rule out a zebranoma?

    Better Question: This seems like a tough diagnostic challenge. What are the possibilities that are most important to rule in and rule out? Would a serum porcelain test be appropriate to rule out a zebranoma?

  2. “What” questions are less threatening than “why” questions.

    Question: Why didn’t we refer this patient to a rheumatologist?

    Better Question: What are your criteria for when a paitent needs a rheumatology referral?

  3. Avoid “should” questions; they imply value judgments.

    Question: Shouldn’t we get a VQ scan on this patient with acute shortness of breath?

    Better Question: I know a VQ scan is important for ruling out a pulmonary embolus in patients with shortness of breath. Would that test be useful in this patient?

  4. Ask about what was done, rather than what was not done.

    Question: Don’t you send your diabetics for nutrition education when you first start them on an oral agent?

    Better Question: This is the first time I have seen a patient with newly-diagnoses diabetes. I understand the choice of the oral agent. Where does diabetes and nutrition education fit into the picture?

  5. Share your observation to introduce your question.

    Question: Why did you withhold antibiotics for this ear infection, after you gave amoxicillin to the kid with the earn infection this morning?

    Better Question: I noticed that you withheld the antibiotic for this child’s otitis media and spent quite a bit of time with the mother explaining your rationale for watchful waiting. This morning we gave amoxicillin to the child with a similar picture. Can you help me understand the difference between the two cases?

    Question: Shouldn’t we consider depression in this patient?

    Better Question: When she was taking about her fatigue, Mrs. Anderson mentioned problems with sleep. I felt that she seemed be a bit down. Is depression a consideration in this patient?

  6. Ask the doctor to explain her reasoning, not justify her decision.

    Question: Why didn’t you do a chlamydia test on this patient while she was here for her Pap smear?

    Better Question: Some guidelines recommend routine chlamydia tests for all young women who are sexually active. How do you decide which test to recommend to women in for their health maintenance exams at this age?

  7. Avoid criticism as part of the initial question.

    Question: You did not say anything to this patient about his smoking. Don’t the USPSTF guidelines call for counseling on tobacco use for every smoker?

    Better Question: You have quite a few patients who are smokers. How do you approach tobacco counseling and smoking cessation with your patients with so much to do in such a busy practice?

  8. Do not presume that there is only one good approach to taking care of patients.

    Question: On my medicine rotation at the VA, the attending always made us do Doppler exams on the feet of smokers over age 50. Won’t we miss vascular disease if we don’t do universal screening?

    Better Question: Mr. Smythe is a smoker and I am concerned about the possibility of asymptomatic peripheral vascular disease. What approach do you recommend to assess risk in patients like this?

  9. Provide a “scaffold” to help the teacher know where your question is coming from.

    Question: Why do you prescribe an antidepressant for a patient complaining of chest paint and palpitations?

    Better Question: This patient complains of chest paint and palpitations. We have ruled out MI and the Holter monitor test did not show and dangerous arrhythmias. So the problem may be panic attacks. I would think that an anti-anxiety drug would be used in this situation. I also worry that antidepressants can sometime make cardiac rhythm disturbances worse. What is your thinking behind your choice of antidepressant for this patient?