Things I Pretend to Know During Rounds (But Actually Don’t)

Rounds: the sacred daily ritual where you shuffle alongside a herd of white coats, gripping a clipboard, trying to look focused, confident, and—above all else—not clueless.
Rounds are where treatment plans evolve, medical reasoning is tested, and reputations are quietly shaped.

And if you’re a medical student, intern, or even a junior resident, rounds are also where you nod strategically, smile thoughtfully, and pretend to grasp concepts that fly straight over your exhausted head.

Because the truth is simple:
Medicine is a foreign language, a maze, and a culture—and fluency doesn’t happen in a semester.
So yes, we’ve all done it: nodded like we had it together, jotted down notes that made no sense, and turned to Google behind the nearest pillar.

This article is for every doctor-in-training who’s ever faked their way through the Krebs cycle, nodded at mentions of RTA types, or furrowed their brow at an ABG interpretation hoping no one noticed.

1. The Art of the Nod: Fake It 'Til You Learn It

You’ve perfected it over time.

The “Ah yes, makes sense” nod.
The “Slight frown and nod” to show critical thinking.
The “Let me just write something vaguely useful” escape maneuver.

Your facial expression screams, “I’m tracking with you.”
Your internal monologue whispers, “What language was that?”

But this isn’t just imposter syndrome—it’s a necessary defense mechanism.
This is clinical survival in motion.

2. Common Phrases That Trigger Panic

There are some phrases during rounds that will always spark a silent mental meltdown:

“Let’s walk through the Henderson-Hasselbalch equation.”
(Instant cardiac arrhythmia.)

“So what do you think is the underlying pathophysiology?”
(Adrenal glands activate.)

“How would you manage this differently?”
(I wouldn’t. Because I’m still figuring out what we’re doing now.)

“What’s your differential?”
(Does listing 20 random diseases count?)

“Do you remember the mechanism of action of that drug?”
(Only if you accept "sort of, but not really" as an answer.)

3. Topics We All Pretend to Understand But Secretly Google Later

Let’s make a collective confession.

Acid-base disorders
We get ABGs... in theory. But once you throw in mixed disturbances? Cue the panic.

Antibiotic selection
We say "broad-spectrum" like pros, but ask us to explain why cefepime instead of piperacillin-tazobactam? Excuse me while I search UpToDate.

Renal physiology
Especially when someone throws around the term “loop of Henle” like we all remember second-year nephron flow diagrams.

Chest X-ray interpretation
“There’s a subtle opacity in the lower lobe”—sure. Let me just zoom in, squint, and pretend I see what you see.

Anticoagulation bridging
Yes, we bridge with enoxaparin, but don’t ask us to recall the exact INR cutoffs, renal thresholds, and updated guidelines without a lifeline.

Obscure scoring systems
CHADS2-VASc? Sometimes.
MELD-Na? Kinda.
Ranson's criteria? Sounds like a food critic's scale.

4. The Pressure to Know Everything Is Real

Medical training quietly instills a deep fear of seeming incompetent.
We’re anxious about:

Being seen as the weak link
Disappointing the team
Losing the respect of peers
Proving our imposter syndrome true

So we do what seems safe: we pretend.
Not out of laziness or arrogance, but out of sheer pressure to survive.

We fear admitting we forgot that lecture material from last week.
We fear confessing that we barely grasped it when it was taught.

5. The Unspoken Skill: Bluffing with Elegance

Over time, you learn to master the clinical bluff.

You repeat buzzwords.
You rephrase what someone else said just enough to sound original.
You buy time with, “That’s a great question.”
You smile while mentally sprinting to organize your thoughts.

And when it works, you feel like a magician.

Until, of course, someone says:
“Can you elaborate?”
And your trick disappears in a puff of white-coat embarrassment.

6. When Pretending Becomes Problematic

There’s a delicate line between strategic nodding and harmful avoidance.

Faking it might help you through a tough round.
But over time, it can:

Build fragile confidence
Prevent real learning
Delay your clinical growth
Risk patient safety in the long run

Yes, pretending is part of the journey—but confronting the gaps is part of maturing into a safe, capable physician.

7. What We Should Say (But Rarely Do)

We’ve all wanted to say:

“I’m not totally confident in that, but I’ll read more.”
“I’m not sure off the top of my head, but I’ll look into it.”
“Would you mind explaining that again?”
“I’ve read it, but I’m still wrapping my head around it.”

These statements feel terrifying—like admissions of weakness.
But in reality? They open the door to genuine growth.

And when you say them in front of a kind attending or team, they lead to respect, not ridicule.

8. Attending Wisdom: We’ve All Been There

Here’s what you might not realize:
Most attendings see right through your nods.

Why?
Because they did the exact same thing once.

Many will tell you:

“I didn’t fully get acid-base until PGY-2.”
“I used to whisper nephron pathways to myself on the way to rounds.”
“We all learn medicine in spirals—you’ll circle back and understand more each time.”

These moments of honesty are everything.
They remind you that nobody truly masters everything in med school—and that’s okay.

9. How to Turn the Act Into Actual Knowledge

a. Keep a “Rounds Confusion List”
Jot down the terms or concepts you pretended to understand. No shame.

b. Tackle one per day
Spend five focused minutes reading or watching a video on just one topic. Daily micro-learning adds up.

c. Teach a peer
Explaining a concept—even briefly—can turn fog into clarity.

d. Ask questions unapologetically
Yes, it takes guts. But questions are proof you care about getting better, not worse.

10. Final Thoughts: You’re Allowed to Not Know Everything

Here’s the truth every trainee needs to tattoo on their soul:

You’re a med student—not a living encyclopedia.
You’re a resident—not a robotic AI.
You’re human—not a board prep book.

It’s okay to feel behind.
It’s okay to look things up.
It’s okay to learn on the fly.

What’s not okay is pretending forever—because medicine is built on lifelong learning.

So yes, if you have to, keep nodding on rounds.

But when the noise quiets down, take that moment to dig deeper, ask questions, open the books, and piece the puzzle together.

Because the real mark of a good doctor isn’t flawless recall.
It’s the courage to say, “I don’t know—but I want to.”