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MODULE 25: YOUR FIRST 30 DAYS: STREET-SMART SURVIVAL PLAYBOOK
Section 25.3: Smart Questions vs. “Tell Me Everything”
The Art of Strategic Inquiry: How to Get the Answers You Need While Showcasing Your Competence.
SECTION 25.3
Smart Questions vs. “Tell Me Everything”
Learning how to ask questions that build credibility, demonstrate initiative, and accelerate your learning.
25.3.1 The “Why”: Questions as a Measure of Competence
During your orientation, questions are your single most important learning tool. Paradoxically, they are also the primary tool your preceptor and new colleagues will use to gauge your competence, your initiative, and your critical thinking skills. As an experienced pharmacist, you are accustomed to being the person who has the answers. In your new role, you will be defined, at first, not by the answers you give but by the questions you ask.
There are two fundamental types of questions an orientee can ask. The first is the “Tell Me Everything” question. This is a passive, open-ended query that places the entire cognitive burden on your preceptor. It signals that you have not attempted to find the answer yourself. Questions like “What’s the policy for heparin?” or “How do I verify this order?” fall into this category. While necessary in your first few days, a continued reliance on this type of question beyond Week One can quickly—and unfairly—create the impression that you lack initiative or resourcefulness.
The second type is the “Smart Question.” A smart question is an active, strategic inquiry. It demonstrates that you have already done some work: you have attempted to find the answer, you have a baseline understanding of the situation, and you are asking for clarification on a specific point of ambiguity or for confirmation of your own critical thought process. This section is a masterclass in transforming “Tell Me Everything” questions into Smart Questions. It is a skill that will dramatically accelerate how quickly your new team comes to trust your judgment and respect your expertise.
25.3.2 The Analogy: From Novice Reporter to Seasoned Lawyer
A Deep Dive into the Analogy
Imagine the difference between a novice reporter conducting their first interview and a seasoned trial lawyer conducting a cross-examination. Both are asking questions to get information, but their methods and the impression they create are worlds apart.
- The Novice Reporter arrives at the scene, opens their notebook, and asks a broad, open-ended question: “So, can you just tell me everything that happened?” This is a classic “Tell Me Everything” question. It’s lazy. It forces the witness to do all the work of structuring the narrative, recalling the details, and deciding what is important. The reporter is a passive receptacle of information.
- The Seasoned Lawyer enters the courtroom having already spent days, if not weeks, researching the case. They have read all the depositions, reviewed the evidence, and already know the story. Their questions are not open-ended; they are precise, surgical instruments designed to achieve a specific goal. They ask questions to confirm facts (“You were at the corner of Main and First at 3 PM, correct?”), to clarify ambiguity (“When you say the car was going ‘fast,’ what do you mean?”), or to propose a conclusion based on the evidence (“Given facts A and B, isn’t it true that C must have occurred?”). Each question demonstrates a deep, foundational knowledge of the case. The lawyer is an active driver of the conversation.
Your goal during orientation is to quickly transition from acting like the novice reporter to thinking like the seasoned lawyer. You must do your own “discovery”—by looking in the chart, searching the intranet, and consulting your drug info resources—before you ever approach your preceptor. Your questions should then be used to confirm your findings, probe the “why” behind a local practice, and validate your own clinical judgment.
Masterclass Part 1: The Anatomy of a “Smart Question”
A well-formulated Smart Question has a predictable, three-part structure. Mastering this structure will transform how you communicate with your preceptor. It turns a simple request for help into a demonstration of your thought process.
The Smart Question Formula: Foundation + Gap + Proposal (FGP)
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The Foundation (What I Know): Always start by briefly stating the work you have already done or the information you have already gathered. This immediately shows initiative and provides context for your question. It proves you aren’t being lazy.
Example Phrase: “I was reviewing the vancomycin dosing policy…”
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The Gap (The Specific Unknown): Clearly and concisely state the single piece of information you are missing or the specific point of confusion. This narrows the focus and makes it easy for your preceptor to provide a targeted, efficient answer.
Example Phrase: “…and I’m unclear on how our policy handles dosing in obese patients.”
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The Proposal (My Initial Thought): Whenever possible, conclude by proposing a potential answer or course of action. This is the most powerful part of the question. It shows that you are not just identifying problems, but you are actively trying to solve them. It demonstrates critical thinking, even if your proposal is wrong.
Example Phrase: “…My initial thought was to use an adjusted body weight for the calculation. Is that the standard practice here?”
Putting it all together: “I was reviewing the vancomycin dosing policy, and I’m unclear on how our policy handles dosing in obese patients. My initial thought was to use an adjusted body weight for the calculation. Is that the standard practice here?”
Masterclass Part 2: The Smart Question Matrix — Practical Application
Let’s apply the Foundation + Gap + Proposal (FGP) framework to a wide range of common scenarios you will encounter during your orientation. This matrix will be your guide for converting “Tell Me Everything” questions into powerful Smart Questions that build your credibility.
| Domain | “Tell Me Everything” Question (Avoid This) | “Smart Question” (Use This FGP Format) |
|---|---|---|
| Policy & Procedure | “What’s our heparin policy?” |
(F) “I’ve pulled up the hospital’s heparin protocol for DVT/PE.” (G) “I see the titration nomogram, but I’m having trouble finding the section on what to do for a subtherapeutic PTT on the first re-check after the initial bolus.” (P) “My assumption is that we would give a re-bolus and increase the rate per the nomogram. Can you confirm that’s correct?” |
| EHR Navigation | “How do I find old records?” |
(F) “I’m trying to find the discharge summary from this patient’s admission last month to see what antibiotic they received.” (G) “I’ve looked in the ‘Encounters’ tab and the ‘Notes’ tab for that date range, but I can’t seem to find it.” (P) “Is there a specific ‘Chart Archive’ or ‘Media’ tab I should be looking in for scanned documents from prior admissions?” |
| Clinical Decision-Making | “This patient’s potassium is low. What do I do?” |
(F) “I’m looking at Mr. Jones in room 405. His potassium this morning is 2.9, and he is asymptomatic.” (G) “I know we need to replete him, but I’m not sure what our standard institutional preference is between oral and IV for this level of hypokalemia.” (P) “Given that he is asymptomatic and can take PO, I was planning to recommend 40 mEq of K-Dur. Does that sound like a reasonable starting point here?” |
| Logistics & Workflow | “A nurse just called for a missing med. What do I do?” |
(F) “I have a nurse from 8-East on the line for a missing 09:00 dose of metoprolol for Jane Smith.” (G) “I have checked the MAR, and I see the order was verified. I also checked the ADC activity log, and it doesn’t show a dispense. I’ve confirmed it’s not in the tube station.” (P) “My next step would be to check the central pharmacy’s packing queue to see if it was missed. Is that the correct next step, or is there a specific technician I should contact for delivery issues?” |
| Formulary Management | “Is this drug on formulary?” |
(F) “I have a new order for olmesartan for the patient in 212.” (G) “I’ve searched our formulary on the intranet and it doesn’t appear to be a formulary agent.” (P) “The formulary does list valsartan and losartan as the preferred ARBs. I was planning to recommend switching to an equivalent dose of valsartan. Do you agree with that choice?” |
Masterclass Part 3: The Art of Timing and Delivery
Knowing how to formulate a smart question is only half the battle. Knowing *when* and *how* to ask it is just as important. Your preceptor is a busy clinician with their own workload. Respecting their time and workflow is crucial for building a positive relationship.
The Notebook Method: Your Secret Weapon
Get a small, pocket-sized notebook and carry it with you at all times. This notebook is your external brain. Throughout the day, as non-urgent questions, new acronyms, or points of confusion arise, do not interrupt your preceptor. Simply jot them down in your notebook. This simple act accomplishes three things:
- It avoids “Death by a Thousand Cuts”: It prevents you from constantly interrupting your preceptor’s train of thought for minor issues, which can be incredibly frustrating for them.
- It forces you to find your own answers: Often, by the time you go to ask the question you wrote down an hour ago, you will have already discovered the answer through observation or your own research.
- It allows for efficient “Bundling”: It enables you to save your non-urgent questions and ask them all at once during a dedicated, appropriate time.
Reading the Room and Bundling Your Questions
Your goal is to be a low-maintenance orientee. This means being acutely aware of your preceptor’s workload and choosing the right moment to engage them.
| Good Times to Ask Non-Urgent Questions | Bad Times to Ask Non-Urgent Questions |
|---|---|
| During designated check-in times (e.g., at the beginning or end of the shift). | When they are on the phone with a provider or nurse. |
| During lulls in the workflow (e.g., after the morning order verification rush is over). | When they are clearly in the middle of a complex clinical workup or calculation. |
| When you are walking with them to a unit or back from lunch. | When they are responding to a STAT page or a code. |
Word-for-Word Script: Initiating a “Bundled” Question Session
This script is polite, respectful of their time, and frames you as an organized, considerate learner.
“Hey [Preceptor’s Name], I know you’re busy, but when you get a free moment, I’ve jotted down 3-4 non-urgent questions from this morning. Is now a good time to quickly run through them, or should I catch you later this afternoon?”
Why it Works: It acknowledges their workload, signals that the questions are not urgent, quantifies the request (“3-4 questions”), and gives them an easy “out” to defer the conversation if they are in the middle of something. This is a hallmark of a professional who respects their colleague’s time.
Masterclass Part 4: The Critical Exception — When to Break All the Rules
We have spent this entire section teaching you how to be deliberate, prepared, and patient in your questioning. Now, we are going to give you the one, single rule that overrides everything else.
The Patient Safety Prime Directive
If you are uncertain about something that could cause immediate, significant harm to a patient, there is no such thing as a dumb question, a bad time, or an interruption. You must STOP and ASK IMMEDIATELY.
This prime directive applies to any situation where you feel a sense of unease or confusion about a high-risk medication or procedure. It doesn’t matter if your preceptor is on the phone, if the attending is in the middle of a sentence on rounds, or if the nurse seems incredibly busy. Your professional obligation is to prevent harm.
Scenarios That Mandate Immediate Interruption:
- You are about to verify a dose of an opioid, anticoagulant, or insulin that seems unusually high, and you cannot quickly confirm it is correct.
- A nurse is about to administer a medication, and you suddenly realize it might be the wrong patient or the wrong drug.
- You see a lab value that is life-threatening (e.g., critical potassium, sky-high INR) and you don’t know if the team is aware.
- You are in a code situation and are asked to prepare a medication you are unfamiliar with.
The “Safety Stop” Script:
“Excuse me, I’m sorry to interrupt, but I have an urgent patient safety question that I need to clarify right now.”
This phrase is your universal key. It is a professional and assertive way to stop the line. It signals to everyone that this is not a routine question; it is a critical safety check. No reasonable preceptor or colleague will ever fault you for interrupting to prevent patient harm. In fact, it will demonstrate that you have the most important quality of a great pharmacist: a relentless commitment to safety.
