Asking: Or Is It Pimping?

I was a third year med student before I found out what pimping was. No. Not that kind, the medical kind. See, the insider slang in medicine for a certain type of aggressive questioning is…well, pimping.

Doc Gurley Med Slang Dictionary: pimping; (def.) verb, as in to pimp; was pimped; got pimped; will be pimped. Used in a sentence “Dang. I can’t believe how badly I got pimped this morning on rounds.”

Being pimped means to be asked serial questions, kind of like being tortured by a 3 year-old who keeps saying “but why?” Except, unlike with the 3-year-old, the person doing the asking is your clinical supervisor. And the goal is to keep asking until you can’t answer. In other words, the goal is, basically, humiliation.

The justification for pimping is that it is a form of education. It is called a version of the Socratic method, although I doubt Socrates would approve. Socrates argued (har) that people learn better when they’re asked questions, rather than being lectured to all the time. Classically, extreme pimping is a surgical rounds event, optimally done to someone after maximum sleep deprivation while surrounded by a crowd of hostile observers. “You. In the back. Can you (smirk) tell us the three surgical approaches to the lesser sac?”

Woe be the person who can’t answer. Or, worse yet, dissolves into tears. It took the young Doc Gurley longer than it should have to realize that your first answer should be the most obvious answer. I would get asked something like “Can you tell us what this patient has?” and the only possible answer (to me), based on the patient’s two-week hospitalization that had baffled eight sub-specialty services and their nineteen invasive procedures, was “uh, no.” Unfortunately, the correct first answer was “This patient has a fever. It won’t go away. No one knows why.” The next correct answer was “A fever of unknown origin can be divided into two categories – true and false.” Sigh.

So what does pimping have to do with you? While it’s probably not the only reason, pimping may be one of the reasons why your doctor doesn’t ask you what you think. Pimping is such a hostile, aggressive part of medical training that many doctors become ask-averse. Well, except for the consummate pimpers, who believe they have the right to pimp anyone. If you get the feeling that you’re being mocked when your doctor asks what you think is going on with your body, there may be some truth to that. Perhaps you are, especially if the question is coming from a certain type of pimping doctor.

For doctors who (like me) despised the act of bullying pimping, I realized that one outcome of the experience is that I rarely asked patients, honestly and sincerely, what was going on – because I didn’t want to seem like I was pimping. One of my goals post-training has been to ask more often than I tell. It’s a shockingly positive thing to do – when done gently and considerately – and a wonderful form of post-pimping-rehab for those of us in recovery from the trauma of medical residency. When you ask someone what they think is going on, the answer can be really surprising. Everything from “I just want to know I’m not pregnant,” to “I’m pretty sure I’m dying” (when he is…). Learning goes both ways when you find out what’s going on inside someone’s thoughts before you launch into your spiel about tests/drugs/symptoms/disease. That‘s what Socrates was trying to teach.

Post-Pimping Tips for the Doctor-Patient Relationship:

1) If you’re a medical provider, pick a time period (one month? one week?) and genuinely ask each patient what they think is going on. You may be shocked by some of the responses. Help us all learn by posting what you learned in the comments section below.

2) If you’re getting medical help, try out saying this to your doctor: “You know, here’s what I’m thinking about these symptoms.” And then spit it out, even if you’re not asked. Don’t make the Doc Gurley mistake of believing the only answer is…well, the answer. Tell your provider what you think, starting with the most basic options. If you have a provider who asks you kind questions, trust them and open up – say things like “I’m worrying that it’s cancer,” or “I don’t care what it is, I just want to know it won’t kill me,” or whatever else you’re thinking. Help us medical providers learn by sharing your experiences in the comments section below.

3) If you get a provider who smacks of pimping, as in, “so what do you think is your diagnosis- can you share that with me and my staff? Did you find that on the Internet?” call him/her on it. And then get yourself another provider.

Socrates would approve.

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