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'I have no idea'

Mark A. Hurt MD


I know you have experienced this. You have been in a conference or at the scope with colleagues when someone asks you a question or wants a diagnosis or perhaps your philosophy of how to make a particular diagnosis. Often, my answer is "I have no idea".

This has been a problem of mine since I began practicing in 1982. It is downright embarrassing at times, because if I have some time to think, I usually can propose a diagnosis or a differential diagnosis. It is particularly embarrassing, however, in conferences attended by numerous colleagues.

Why does this happen? I am no psychologist or psychiatrist, but my sense of it is that it is simply not like regular practice where I will sit back and think for a few minutes in the privacy of my mind -- without all the distractions. Almost always, when there is time for a few seconds to pass, a potential solution will occur.

I am curious to know whether others reading this blog experience similar problems and what they do to override or combat them. I can envision a few potential solutions, to wit:

1. Anticipate the question. This is not always easy to do at the scope, but it is possible in conferences where data is presented. Oftentimes there are a few minutes to prepare mentally.

2. Redirect the question with a question (to give you time to think), such as "Will you please clarify your question?"

3. Simply admit that you don't know, but will get back to the group at a later time (admittedly a difficult position to be in).

Please follow-up with me below. I am really curious to know your experiences.


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Dr. Phillip McKee


Hi Mark, I know exactly what you mean. It has happened to me many times over the years. If I truly have no idea, I just say so. To make a wild guess can be catastrophic. This is one reason why I don't do blind slide seminars when I visit Institutions. One's credability can be quickly ruined!! Mind you, I remember when I first moved from Belfast to London to work at St John's Hospital for diseases of the skin. On my first day at signout Professor Wilson Jones and Neil Smith greated me and said "Oh we have an interesting case for you to see. It's nothing difficult- just a classic example!!!" As you can imagine my heart sank as I instantly saw that I was being set up for a fall! I looked down the microscope and had no idea what the condition was but someone was looking after me. I blurted out that it looked like Orf (which I had never seen) and that is exactly what the correct diagnosis was. They never tried to catch me out again. I had another wonderful experience when I moved to St Thomas' Hospital. One evening I had been reading up on verruciform xanthoma which had only recently come to light. I went into sign-out the next afternoon and the first case in the slide box was an obviously warty lesion with a pale dermis. So before putting the slide onto the microscope I said "this looks like a verruciform xanthoma" and that's what it was! My reputation at St John's soared into the stratosphere.
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Mark A. Hurt MD


Hi Phillip,

Wow! Your good fortune is impressive. I can just see Edward and Neil setting you up for a fall - and, unlike Icarus, your wings didn't melt!

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Dr. Mona Abdel-Halim


Nice blog Dr Mark, it happens to me also. If I do not know the answer, I simply say: well I have no idea, let us read more about this and find the answer !!!!
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