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Practice Management
Mentoring—It Goes Both Ways!
Mark S. DeFrancesco, MD, MBA, FACOG
In the past few years, the concept of mentoring has emerged as more than just a civilized way of introducing a newly minted clinician into a practice. It ties directly with risk management and providing a high quality of care, and it can help build your practice and decrease your professional liability exposure.
The “original” Mentor was the friend of Odysseus who, during the latter’s long absence from home (first fighting and then circuitously returning from the Trojan War), watched over Odysseus’ son and estate.1 The name has since become both a noun (“a trusted, wise advisor”) and a verb (“to act as a trusted, wise advisor”).2
The concept of formal mentoring in medical practice is fairly new, but it has been around for a long time in other areas, including the legal world. In 1986 and again in 1996, the American Bar Association published studies on legal malpractice claims. One of their conclusions was that there were “some claims which could have been avoided with better mentoring.”3
In medicine we have been aware of the value of mentoring in academic settings, and generally most medical schools and residency programs have various systems of mentoring in place. Sometimes it may be called “advising,” but the purpose is the same: to provide a support system for “trainees.” In 1996, Gary L. Dunnington, MD, expressed concern over the “deterioration” in mentoring, despite an increase in academic faculty.4 Perhaps this plea was heard, or the ascension of Generation X has helped cure the problem, because there is much more interest in mentoring today in our academic venues.
In addition, mentoring has been included among the “core values” expressed in the newly revised strategic plans of both ACOG and its new related 501(c)6 entity, the American Congress of Obstetricians and Gynecologists. Both strategic plans may be found online at www.acog.org and clearly demonstrate the professional society’s recognition of the value of mentoring in overall professional development.
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TRADITIONAL MENTORING
In the interest of saving time and space, I will assume that most readers understand the nature of mentoring in the
traditional sense: seniors advising juniors. Whether it is the old saw of “see one, do one, teach one” or more formalized assignments of advisors and advisees, generations of medical students have learned from residents and attendings. Subsequently, junior residents learn from senior residents and attendings, and so on up the chain.
In ObGyn we have seen young people step up to the plate and make quantum leaps in improving the mentoring system. The Junior Fellows (ACOG members in residency and early years of practice) of District I formalized a system of brief lectures for medical students, each covering a specific, digestible topic. They made these available to other ObGyn residents throughout the country and have encouraged other Junior Fellows to contribute their own—essentially building a library of medical student talks for anyone to use in interactions with students.
The real problem seems to arise, however, when residents graduate and move into private practice. For many (especially a solo practice or a small group), bringing on a new associate means an improvement in the “quality of life” for the existing practitioners, at least being on call a bit less often. There is a natural human tendency to “sign out and sign off” for the night when the new associate is on call. In addition, some doctors take the arrival of a new associate as the opportunity to take that long-overdue vacation, leaving the new clinician to fend for himself/herself, not only around the intricacies of the office practice itself but also if a difficult or unusual clinical case presents.
This is where the connection to quality of care and risk management should be evident. Just as our legal friends have recognized the connection of lack of mentoring to increased incidence of legal malpractice, it doesn’t take a crystal ball to see that the relationship exists in our profession, with arguably higher stakes. I can still recall my first night as a new “private practice doctor” and deciding my first patient in labor needed a cesarean delivery for lack of progress. I was well trained and comfortable performing the surgery. However, before signing out for the evening, my senior partner made it clear I was not to hesitate to call him for anything at all. I was not to worry about waking him up. He came in and assisted me with the surgery, partly to assure his patient that he had not abandoned her to a new doctor whom she did not know well, and partly to reassure me that he was around if I needed him.
Over the early years of practice, I always felt comfortable calling him in to help if I had an unusual or difficult case, and he always obliged. Of course, as time went on, I needed him less and less. As we brought in clinicians after me, we did the same with them, and thus always tried to relay 2 messages: (1) Patient safety comes first, and it is not only acceptable but required that you call in someone senior if you are getting into deep water. (2) We would always be there to help, and it is not a failing to ask for it, in any sense of the word.
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BIDIRECTIONAL MENTORING
That said, mentoring can and should work both ways. There is a lot that we “gray-hairs” can learn from our new colleagues. Surgical techniques change continuously, as does the science upon which our practice is based. For instance, years ago we learned about relatively simple “triple screen” testing for early pregnancy anomalies, but now that has morphed beyond the “quad screen” to various algorithms for earlier screening involving new markers and the use of focused ultrasound measurements.
Electronic medical records (EMRs), e-prescribing, websites, and social networking are all rapidly becoming second nature to our young, new clinicians but may be intimidating to more senior partners. The best ways to interact with patients, transparency, “I’m sorry,” and other newer concepts are also something we may learn more from our newer associates.
We can and must learn from each other! During my early years of being a new attending at my community hospital, I showed my senior partner how to surgically treat an ectopic pregnancy using a laparoscope. If he were not receptive to my teaching him something new, he would have subjected that patient to a laparotomy and, in this case, not the best care.
Today, whether it’s putting your practice on Facebook or Twitter, looking for a good EMR, or developing a practice website, new associates should be of invaluable assistance—if we let them help!
Clinically, when your practice holds its regular meetings, the communication should go both ways. The roles of mentor and mentee actually should alternate from time to time, depending on the subject matter at hand. The more seasoned clinicians can often teach the younger ones much about office practice, best ways to treat some of the common things that somehow are rarely seen in a residency program, basic practice economics, and how to integrate into the local medical community.
On the other hand, the newer generation can help push the practice into the 21st century, adopting electronic tools and more efficient ways to communicate with patients. Also, the new practitioner can be a wellspring of up-to-date clinical information and the teacher of new techniques in the operating room.
The bottom line is we all have something
to contribute.
The author reports no actual or potential conflict of interest in relation to this article.
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Mark S. DeFrancesco, MD, MBA, FACOG, is Chief Medical Officer, Women’s Health Connecticut, Avon, CT.
References
- Homer. The Odyssey. New York, NY: Barnes and Noble Books; 2003.
- WordNet Search 3.0. Mentor. http://word netweb.princeton.edu/perl/webwn?s=mentor. Accessed January 15, 2010.
- Legal Malpractice Claims in the 1990’s. www.kvi-calbar.com/abaclaimdata.html. Accessed January 15, 2010.
- Dunnington GL. The art of mentoring. Am J Surg. 1996;
171(6):604-607.
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