Questions and Answers, by Andrew Jacques ('05)

pimp (pimp) v. to ask a junior medical student unanswerable questions about medical history, obscure pharmacolgic facts, antiquated medical terms, or rare Caribbean diseases in rapid succession so that he or she will either immediately answer incorrectly or eventually buckle under the pressure of the attending physician’s line of questioning. (i.e. Dr. Smith pimped the medical student about the use of xanthine oxidase inhibitors in the preventative treatment of podagra.)

Until I came to medical school, I thought “pimping” involved the seedy side of lime-green, full-length furs and the world’s oldest profession. In a medical school or teaching hospital it means something completely different. Used well, pimping is an important teaching tool for junior students. Medical students are a strange breed. Being called upon in front of colleagues to answer a question, however difficult, burns a teaching point into your consciousness, and a medical student will never answer the same question incorrectly twice. Used aggressively, pimping can be the most miserable form of humiliation for a third-year medical student. It can destroy confidence and make a medical student feel worthless.

Pimping has certain rules as well. They are often unspoken, like some of baseball’s age-old regulations, but are upheld and respected all the same.

Pimping must always begin with the most junior member of the care team, most likely the third-year medical student. If he or she answers incorrectly, the next senior member of the team is given the opportunity to answer, and this process continues on to the senior resident.

No one may offer hints or clues to the third-year medical student, especially if he or she has no idea how to answer.

The attending physician has the right to pimp at any time, in any setting, and if a junior medical student answers an initial question correctly, an attending physician may rightfully choose to increase the intensity and frequency of questioning until the junior medical student answers incorrectly.

Through the years, medical students have employed methods to avoid pimping. For instance, diversion is a technique of distracting the team to another task just after being questioned. Sometimes talking as much and as fast as possible about another subject that you do understand is employed. This is affectionately called the tangent method. Also, a student may follow up a rather embarrassing missed question with a difficult clinical question about therapy or diagnosis in order to divert attention away from the embarrassment. This is termed the deflection approach. Finally, the mercy method utilizes a double edged sword of unintelligible sounds and grunts, as well as a terrified facial expression to communicate ignorance in the hopes that the attending physician will skip the medical student and move directly to an intern with the question.

As an illustration of pimping on the wards, the following is a partially factious exchange between medical student and attending physician. Included is the dialogue between the two, as well as the thought and emotions of one third-year medical student as he is “pimped.”

Attending: What is the emergency antidote to the important anticoagulant heparin?

MSIII thoughts: Finally one I can answer!

MS III: (confidently) Protamine sulfate.

Attending: Good, what is heparin made from?

MSIII thoughts: Ugh. What? How should I know? Can I remember, can I…

MSIII: (sigh) Uh. Uh. (hesitantly, stammering, with a pitiful look on his face) Well, heparin therapy

should be monitored by measuring the aPTT since it acts to activate anti-thrombin III. ATIII then binds to the…

Attending: Interesting, but are you going to answer my question?

MSIII thoughts: Ahhh! The tangent never works.

MSIII: (defeated, fishing for any answer, trying to remember a lecture from over a year ago) Maybe,

uh. Maybe leech saliva?

Attending: Well, lepirudin is isolated from leech saliva, but heparin was originally discovered in dog liver and is now manufactured from pig and cow gut, so you need to use caution in patients with porcine or beef allergies.

MSIII: (embarrassed) Of course! So when would you…

Pimping is a time-honored tradition amongst physicians and student doctors and can sometimes be an effective learning method. It can instill confidence or demolish a student’s will. Either way, being “pimped” will continue to frighten and challenge medical students for years to come.