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Tuesday Feb 18, 2014

It's OK to Ask for Help

Completing residency was one of the greatest accomplishments of my life. I had survived the grueling uncertainty of my pre-med years, finding any opportunity to make myself stand out among my peers. I had made it through medical school, with all its classroom endeavors and constant grilling from higher-ups. And now I had endured residency, with all its long hours, seemingly never-ending call and all the lessons those experiences entail.

I could no longer be viewed by others as a "pretend doctor." I now had a real job, and I had made it.

Along with this euphoric accomplishment came a certain confidence that I could do anything. Look what I had been through. I had mastered this, and now it was my turn to use my intelligence and training to heal, without a supervisor continuously looking over my shoulder.

Here I am listening to a patient. After 11 years of education and training, I still wondered if I knew everything I needed to know when I completed residency.

But it also came with the exact opposite feelings.

Did I really know enough to care for my patients?

Would they trust me?

Should they trust me?

What if I didn't know the answer to a diagnosis, what test to order or what treatment route to take? Eleven years was a lot of education and training, but was it enough? I wanted my new colleagues to be confident that they had hired the right person. I knew they didn't expect me to be perfect, but they did expect me to be competent.

In my final weeks of residency, an attending I had always admired offered some advice.

"Hey, I didn't feel fully comfortable with what I was doing until probably three or four years into practice," he said. "If you have any questions, you can always call me, even just for some reassurance. This is something we all go through, but it's not a weakness to ask for help."

I appreciated the sentiment. It came in handy with my patient Roger (not his real name). He was in his 50s and had some intellectual disabilities that would frequently impede our ability to properly communicate. Like many of the developmentally disabled patients I see, constipation was a significant issue for Roger. He had been hospitalized in the past for bowel obstructions, and he faced many social impediments due to this condition. I thought I could handle this problem with Roger and others. How hard could it be?

As it turns out, constipation can be fairly complicated. I tried a few things, stumbling around with treatment options, but I was not quite sure what I was doing. Despite feeling a bit silly for needing some help with this, I asked one of my colleagues who had more experience with this population. He gave me some pointers on which medications to try and how to use them effectively. Based on his advice, we were able to come up with a workable treatment plan for Roger that has kept him out of the hospital.

Not only has the experience not worsened the respect or relationship with my colleagues, it actually enhanced it. I was worried this might undermine my credibility, but it has done nothing of the sort. It seems that the more questions I ask or cases I run by my colleagues, the more they are willing to do the same. We have prevented many potential errors, and we have created better plans than what I otherwise would have come up with on my own.

No matter how many years of experience we have had in medicine, we have all seen different cases. I often ask residents about their experiences with certain cases, which has proven useful. None of us should feel self-conscious or hesitant asking for help, no matter how much or how little experience we have had.

I really appreciated that thought being shared with me as I began practice, and I've since found that it in no way tempers the accomplishment of my many years of medical training. In fact, it seems to more than justify it.

Kyle Jones, M.D., is a faculty member at the University of Utah Family Medicine Residency Program. He is the director of primary care at the Neurobehavior HOME Program, a patient-centered medical home for those with developmental disabilities. You can follow him on Twitter @kbjones11(Twitter.com).

Posted at 12:19PM Feb 18, 2014 by Kyle Jones, M.D.

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