Wrong Answer Syndrome
There is a sociological… idea (I’m not entirely sure whether to dignify it with the term “theory”) called Male Answer Syndrome. A person afflicted with this syndrome (usually a male) finds it very difficult to say “I don’t know,” regardless of the question. Instead, they will take a guess, state a generality, or evasively answer an entirely different question that they prefer.
A slight variation of Male Answer Syndrome seems to exist in academia, which I’ll call Single Answer Syndrome. This malady includes Male Answer Syndrome’s inability to admit ignorance but also causes otherwise very intelligent people to stubbornly look for a single cause behind a complex effect. Why do we grow old? Is Hamlet crazy? What causes cancer? Does lowering taxes boost the economy? Once academic experts, be they professors, politicians, or doctors, decide on the single answer to these various questions, all other possibilities are not only incorrect but are also dangerously ignorant.
Medical students suffer from yet a third related infirmity, Wrong Answer Syndrome. The whole exercise of medical school (from a fairly cynical viewpoint) can be reduced to trying to get the right answer on a long series of questions. More correct answers means better grades, better residencies, and better careers. (Also, presumably, better medical care provided to patients.) The first two years of questions come entirely from formalized pen-and-paper (and computer-and-mouse) exams, in which the correct answer to each question is hidden along with three counterfeit confederates, i.e., multiple choice. In this format, students strive to get, at bare minimum, 70% of the questions correct, and really hope for 90% or better.
Here in my third year, the format changes so suddenly that I suffered from a kind of psychic whiplash from July until November. No longer did I have the luxury of staring at a question and giving it (on average) 70 seconds of thought. No longer was the right answer provided, waiting to be ferreted out from the wrong-headed. The new paradigm consists of my attending physician (who gives me my grade) turning to me without warning and asking me a question. Examples range from the fill-in-the-blank (“What structure do I have here in my forceps?” or “What antibiotic should I prescribe?”) to the short-answer/essay (“What do you know about quetiapine?”) I then have maybe five seconds to flip through my brain and pluck forth the right answer. Now, instead of choosing the answer from four or five possibilities, I have to fish it out from the entirety of my knowledge. Instead of looking down at a question, re-reading it, and underlining pertinent details, I’m looking at a patient’s rash, or an organ through a small bleeding hole, or my attending’s dead-eyed stare.
I spent a couple of days keeping a tally of my right and wrong answers to “pimping” (Defined by Craig Miller in his The Making of a Surgeon as “a term with a specific meaning in medical education, a meaning that has no demonstrable origin—and no clear counterpart in common usage. It is the asking of a student or resident, by an attending, of some question within the broad field of medical knowledge. The implication is of repeated needling, a probing for pockets of ignorance; in fact, pimping is a sort of evil twin or mutant outgrowth of the Socratic method.”), depending on what service I was working on, I knew 20-40% of the right answers. The tumble from getting 70-100% correct to 20-40% is stressful, frustrating and humiliating. There is small comfort in knowing I’m not alone, all my classmates have the same hunted look- we’re all suffering from Wrong Answer Syndrome.
And perhaps Wrong Answer Syndrome is the precursor to Single Answer Syndrome. The pain of being wrong as a student is such, and the consequence of making a mistake within the sphere of health care is so dire, that physicians are driven to clinging to a single rationale that they can more easily understand: “Heart disease is caused by cholesterol, therefore I should give my patients statins to lower their cholesterol,” as opposed to, “There are numerous theories as to the cause of cholesterol including but not limited to chronic inflammation, auto-immunity, viral attack, neoplastic connective tissue, and cholesterol. All may contribute to the disease, but we don’t have a good handle on all the possibilities, let alone therapies to combat them.” They aggressively assert the former, ignore the latter, and, the worst outcome of Single Answer Syndrome, have difficulty recognizing and admitting when they’re wrong.
The physicians I work with are mostly very good, but very few of them consult with another colleague, a reference work, or the internet when they’re not sure of an answer. And why should they? When they were trained, doing any of those things was called cheating.