Trying to Look Smart While Having No Idea What the Consultant Just Said

If you’re a junior doctor, intern, or medical student, you already know the ritual: the ward round has started, and you're suddenly surrounded by a flurry of white coats, confident nods, and rapid-fire medical jargon. The consultant—the towering figure with an intimidating calm—has just spoken. Maybe it was a question, maybe it was a plan. Either way, everyone else seems to understand it. So, you nod too. Assuredly. Maybe even with a subtle “hmm.”
Except deep down, your brain is stuck in a loading loop.

Welcome to one of the most widely shared experiences in clinical training: looking sharp while internally unraveling. It's awkward, yes—but it’s also practically a rite of passage in medicine.

Let’s explore why this phenomenon exists, how doctors have mastered the art of pretending, and what this says about the unspoken truths in medical culture.

1. The Consultant Language Barrier: Fluent in Medical Ancient Greek

Consultants speak a version of English that seems to have passed through a filter of Latin, rapid delivery, and obscure references. It often includes:

• Diagnoses with ancient-sounding names you last heard in second-year lectures
  
  
• Syndromes so rare you didn’t know humans still got them
  
  
• Surgical techniques involving anatomical landmarks you've never even seen
  
  
• Drug names you’re sure aren’t stocked anywhere in your hospital
  
  
• Assumptions that you’ve somehow rotated through every subspecialty in the last month

They say it all so casually. You, on the other hand, are just trying to remember whether this is the same patient who came in with pneumonia—or was that Bed 3?

2. The Intern Reflex: Nod First, Panic Later

When your brain doesn’t catch up, your face must take the lead.

• Nod thoughtfully, as if you just had a profound realization
  
  
• Squint slightly, implying focused clinical reasoning
  
  
• Write random, scattered words in your notebook—“Pseudoxanthoma?? MRI?? Plan = ?? Check?”
  
  
• Maybe add a quiet “Right, of course,” to seal the act

This isn’t deception—it’s pure survival. Nobody wants to be the lone soul holding up the team by asking, “Wait… what was that again?”

3. Internal Monologue During the Consultant Speech

You’re not just standing there blankly. Your mind is racing with thoughts like:

• “Did he say ‘hyper-IgE syndrome’ or am I making that up?”
  
  
• “Why is no one else confused? Is it just me?”
  
  
• “I’ll look it up later. Or maybe during lunch. Or maybe never.”
  
  
• “Please, for the love of everything holy, do not ask me to summarize that.”

It’s not about intelligence. It’s about brain bandwidth—and yours is currently being chewed up by fatigue, stress, and four overlapping patient histories.

4. Why Do We Pretend? The Psychology of Medical Impostor Syndrome

This performance isn’t rooted in arrogance—it’s rooted in fear.

• Fear of looking unprepared
  
  
• Fear of being exposed in front of peers
  
  
• Fear of disappointing a supervisor
  
  
• Fear of slowing down an already hectic ward round

Pretending to understand becomes a learned reflex. You smile. You nod. You try to piece together clues like a detective in a badly dubbed movie. Meanwhile, you're planning to rewind the entire conversation in your mind later, hopefully with mental subtitles.

5. Classic Doctor Moves When They Don’t Understand

Over time, doctors develop a toolkit of subtle cues to mask confusion:

• The slow, sage-like nod. Extra points for murmuring “Interesting.”
  
  
• The frantic scribble, as though note-taking is synonymous with comprehension
  
  
• The concentrated squint—bonus if you’re gazing at a CT scan you’ve never seen before
  
  
• The diplomatic deflection: “That’s an excellent point; we could perhaps discuss with the senior again?”
  
  
• The post-round Hail Mary: “Just to clarify, when you said peritoneal signs, were we ruling out perforation?”

These techniques are universal. They're not only tolerated—they're almost expected.

6. Medicine’s Culture of Pretending

Why is this such a common phenomenon in healthcare?

Because we’ve been trained—often unconsciously—not to say “I don’t know.” From the moment medical school begins, confidence is prized. Admitting confusion can feel like breaking character in a high-stakes performance.

This can result in:

• Lost chances to learn in real time
  
  
• Increased reliance on post-shift Googling
  
  
• Poor communication among team members
  
  
• A heightened sense of isolation and imposter syndrome

And tragically, it perpetuates the cycle: the next generation watches, absorbs, and replicates.

7. Consultants Aren’t Always Blameless

To be fair, some consultants are excellent teachers. But others—well, not so much.

• They speed through explanations
  
  
• They throw around eponyms like they're testing you
  
  
• They forget that junior doctors haven’t spent 20 years in their subspecialty
  
  
• They ask, “What’s the next step?” in a tone that feels more like a courtroom than a classroom

This unintentionally creates a setting where it feels safer to pretend than to clarify.

8. How This Affects Patient Care

Beyond the comedic aspect, pretending to understand carries real consequences:

• Misunderstood instructions may lead to incorrect investigations
  
  
• Miscommunication can delay diagnoses
  
  
• Patients may receive conflicting information from the team
  
  
• Handover may be incomplete or incorrect

All of this stems from a moment where someone didn’t feel safe enough to say, “I’m not sure I understood that—could you repeat it?”

9. The Liberation of Saying “I Don’t Know”

There’s a kind of power in saying the scariest three words: I don’t know.

Try:

• “Could we go over that one more time?”
  
  
• “That’s new to me—may I clarify?”
  
  
• “I want to make sure I understood. Can I repeat the plan back to you?”

Far from being signs of weakness, these are marks of maturity. Consultants who truly value teaching appreciate honesty far more than pretend comprehension. They know the stakes are too high to reward silence.

10. What You Can Actually Do Instead of Pretending

Instead of defaulting to performance, here are constructive alternatives:

• Ask questions early—before they pile up and overwhelm you
  
  
• Repeat instructions back to check your understanding
  
  
• Debrief with colleagues post-round—chances are, they’re confused too
  
  
• Keep a log of terms or conditions you don’t recognize, and review them regularly
  
  
• Identify a mentor—a registrar or senior SHO—who’s approachable and non-judgmental

One well-timed clarification can save you hours of confusion later.

11. Remember: Even Consultants Once Faked It Too

Yes, even your sharpest, quickest consultant once stood exactly where you’re standing. Probably in the same corridor. Probably during a nephrology round. Probably nodding along to something about complement levels and renal biopsies without a clue.

They fumbled. They Googled. They feared asking questions too. What you’re experiencing isn’t failure—it’s just the process.

The key isn’t to eliminate those confused moments. It’s to reduce how long you stay stuck in them.

12. Final Thoughts: You’re Not Alone in the Performance

You’ve nodded when lost. You’ve smiled while mentally screaming. You’ve written notes you couldn’t decipher later. It happens to every doctor.

But here’s the shift: what you do next matters more than what you missed.

• Will you look it up?
  
  
• Will you ask your team?
  
  
• Will you admit it in a way that encourages others to do the same?

Behind every polished doctor is a past full of confusion, guesswork, and internal chaos. Embrace it, laugh about it, and never let it keep you from learning.

Because one day, you’ll be the consultant. And when a junior nods blankly at you—you’ll know exactly what that look means.