Culture kills the best strategies

In the line from the story of “Lewis Blackman,” one of the narrators mentions that there is a “perception” that it “is bad to call for help” in medical culture. There is no “perception.” It is a reality.

There are many expectations of providers that go without saying, to be upstanding professionals, compassionate, resistant to fatigue, empathetic, and un-jaded. These features, virtues essentially, are non-negotiable. They aren’t even talked about beyond medical school admissions, as residents we are simply expected to act this way at baseline. But there are two cardinal sins of residency, laziness and ignorance.

Often of the first things asked about a resident is are they “good:” a surrogate of the two measures, not lazy and not ignorant. A lazy resident is an involved problem, but an ignorant one causes a whole separate array of issues. They require additional oversite, their treatment decisions are in questions, and there is a fundamental breakdown in the trust between supervisor and supervisee. If an attending cannot trust their resident, the whole residency hierarchy breaks downs and workflow is impeded. Attendings have to question everything a resident reports, the resident is no longer a functional member of the team, and the resident is essentially demoted to a medical student.

On one hand, it may seem that as trainees we are expected to learn, and ignorance should be expected, but on the other hand, our proficiency as residents is measured by our proficiency and our ability to act independently. To ask for help is to say, “I am not ready to practice on my own.” Perhaps as trainees, we should feel comfortable asking for help, as we are trainees after all, but there is a catch. To ask for help, is to bring unwanted attention. Resident’s who ask questions are perceived as bad, weak, and indecisive. Perhaps the question was warranted, but residents who ask for help are tainted as “problems.” This is a stigma that lingers.

We certainly should call for help, but with medical education and the hierarchy as it is, asking questions comes at a cost.