Andrew Jensen, MD, MBE | Elizabeth Dennis, MD | Cory Smith, MD
December 9, 2020
During your residency training, there will be times when you think that you might need help. These situations are most frequent during your first few months of intern year but continue to come up throughout your career.
At these times, you may feel pressure to appear independent by not reaching out. Resist this urge! Not only does this attitude put patient care at risk, it reflects a lack of self-awareness. You should never feel guilty about asking for help – on the contrary, asking for help demonstrates professionalism, integrity, and honesty. By showing that you know when you should ask for help, you demonstrate trustworthiness to your seniors. These instances are great opportunities for learning and professional growth. Avoid the archaic “asking for help is a sign of weakness!” – this is dangerous, ill-advised, and anachronistic.
Here are some of the common situations you will encounter during residency in which you may find yourself needing to ask for help:
1Taking Care of Inpatients
During the first few months of intern year, you will need to ask for help daily. Everything is new, and tasks that will eventually feel mundane require your full attention. It is healthy and appropriate to be asking for help during this time; in fact, if you are not frequently asking for help as an intern, something is wrong!
By the middle of intern year, the daily tasks become rote and you will find your groove. This can be a particularly dangerous time for some interns, however, as the familiarity tends to cause a lull in vigilance. If a new clinical situation arises that has you unsure, do not forget that you can and should still ask for help.
When you start seeing consults, either as an intern or a second year, you will not immediately have a good feel for what is normal. This is expected. For instance, you cannot know what is normal swelling versus compartment syndrome from reading a book – you must see it for yourself to know! There will also be times when you need assistance with a bedside procedure, such as an I&D or a closed reduction. Remember, it is now mandatory that appropriate time out is performed for ANY procedure – be it at bedside, ER or the OR (this means appropriate informed consent which includes communication with the patient, nursing, and families (for pediatric patients).
During the daytime, your seniors may be preoccupied with clinic or in the operating room. If the situation can wait, ask them for their advice or assistance between their patient encounters. However, if the situation is urgent, it is absolutely fine to walk into the clinic or OR and get their help sooner.
When taking overnight call, there is an extra layer of hesitancy because the people you would be asking for help are sleeping. Do not let this factor deter you from administering the appropriate patient care. Perhaps you are worried about a patient on the floor with worsening symptoms or are unsure if a new consult’s surgery can wait until the morning. It is much better to alert your seniors about an evolving situation overnight than the following morning when the damage may be irreversible.
As you progress through your training, there will be times when you find yourself operating independently. During these surgeries, you may begin to feel uncomfortable at certain parts of the case. To a degree, “safe struggle” is a healthy learning tool, but once things become unclear to you, it becomes dangerous for the patient. You must stop and ask for help. Perhaps you are lost and confused about distorted anatomy, or unsure about your fixation choice, or simply something just doesn’t feel quite right. Surgeons must possess the confidence in their skill but also the humility to know their boundaries.
Medical training can be taxing physically, mentally, and emotionally. The stress builds up over time and can manifest as anxiety, depression, or self-destructive behaviors. In these situations, we must use the same humility with ourselves that we do with our patients and ask for help. The specific type of help can look different for everyone – maybe it is a conversation with a mentor, maybe it is professional in nature – but it is critical to reach out.
Everyone will suffer emotionally at some point during medical training. Burnout is indiscriminate. Seeking help allows you to deal with the stressors in a healthy, sustainable way and get back on your feet.
In conclusion – whether you are taking care of patients or taking care of yourself, if ever you find yourself wondering if you should ask for help, the answer is always yes!
DISCLOSURES: Dr. Dennis This individual reported nothing to disclose Dr. Jensen AAOS: Board or committee member Dr. Smith This individual reported nothing to disclose.
Read the AAOS Code of Conduct for Discussion Group Terms, Conditions and Disclaimers HERE.
Copyright© 2020 by the American Academy of Orthopaedic Surgeons