The pattern starts early. On my very first night of Orthopedic call as an intern, my upper-level resident told me to call him for anything, but “...remember, it’s a sign of weakness”.  Ah, the mixed (or not so mixed) messages of training. Do it perfectly every time and don’t require any help.

Truthfully, I was already a do-it-yourselfer going way back to first grade as a latchkey kid and soon babysitter for my little brother when he started first grade three years later. I learned to care for myself, entertain myself (no TV allowed during this time), do my homework (never checked by my parents), turn in my homework, and study for tests. I learned early how to do this, with largely positive results. (We only locked ourselves out of the house once in all those years, and used the bathroom window to solve that particular problem.)

These are necessary skills. And yet there are times when you require help and some type of backup is needed, as a doctor and a human. 

I was coaching a client recently about calling in backup. The group he is in had recently agreed to add a second hospital to the one they were already covering. They had discussed concerns about what to do if emergencies occurred concurrently at both hospitals and devised a plan to have someone on backup call. 

But they hadn’t yet delineated when it would be necessary or appropriate in a specific way.  When would it be clear to everyone that backup was needed? 

He was concerned about how it would function and be perceived. How would they manage the learning process during the transition, and how would they distinguish what qualifies as a "real" emergency? Essentially, he wanted to know when calling in backup would not diminish his standing in others' eyes. Or even his own eyes. 

No doctor likes dragging another person in for help unless it’s necessary. Training and practice don’t teach you this skill or even to think about the question. In medical culture (in part because, as it was explained to me so clearly and succinctly the first night of call), it’s considered a sign of weakness. You are supposed to be self-sufficient. At all times. Forever.

The need for backup is valid the moment you recognize it. There's no requirement to demonstrate personal hardship or compromised patient care. Your judgment is sufficient.

Being willing to call in backup is a sign of healthy self-confidence and an awareness of your limitations, which are critical attributes for physicians.

When I was getting ready to retire from medicine, I had someone on backup for the entire last month when I was on call or had tough cases. I knew the arthritis symptoms in my hands and wrists were worsening, and I wouldn’t allow patient care to be at risk.  

So I arranged for help to be available. One time on call I did need it, as the patient had a complex and unusual problem that would require close and extended follow-up.  So it was ideal to have someone with me, not only for decision-making and potentially muscle at the time, but also to manage any future problems. 

I needed some help with the fence in my yard a couple of years ago, so I called my brother for backup. I’m calling him again this year for some things around the house that require more strength and an extra set of hands. 

I’ve had some health struggles this year, and I’ve had to call in backup to my medical team. During this time I’ve also contacted friends for more emotional support. I’m attempting to rehome a dog with challenging behavior issues, so I’ve called in backup by getting a trainer. 

Once upon a time, I would have managed all these things alone, because of self-sufficiency and “rugged individualism”.  But that’s no longer the life I want to live. I no longer buy into the idea that asking for help is “a sign of weakness” or that I should be able to handle everything. I don’t even desire to handle everything on my own anymore. 

Because traveling the path of life is simply better with company and assistance. 

Asking for help isn’t a weakness. It’s a strength. It’s acknowledging your limitations and asking to have them augmented by another. It’s being vulnerable and open to receiving, skills that we independent and giving types benefit from cultivating. 

The first time you call for backup it may feel uncomfortable, even wrong. But each time you practice, it becomes easier and easier. 

Oh, and that upper-level resident my first night on call? I got a call from the ER about a distal radius fracture that needed to be sedated, set, and splinted, which I had not done before. He talked me through the whole procedure of sedation, closed reduction, and sugar tong splinting. 

I nodded and said, “Well since it’s my first one, why don’t you help me.” And he did. Without grumbling (at least to me).

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