Sunday, April 19, 2009

Voices From the Past.
Reprinted from the Greater Kansas City Medical Bulletin, May 14, 1966.


There was a time when a physician need answer only to his God and his conscience. Whatever the shortcomings in his knowledge or training, yesterday’s doctor was Captain of the Medical Ship. His word was Law.

Those days are gone forever. The social and economic revolution of the past decade has had profound effects on medical practice. The most disturbing of these is the speed with which the control of medicine is passing from private to public hands.

Today’s doctor finds his practice supervised not only by the Local, State and Federal governments, but by a myriad of professional organizations as well. The AMA. The AHA, the ACP, the ACS, etc, etc, ad nauseum. All have their rules and regulations. There is no hospital worthy of the name with less than fifteen standing committees for the sole purpose of regulating the professional activities of its staff.

On July 1, 1966, a large segment of our population will come under federally regulated Medicare. If today’s trends are any indication of the future, tomorrow’s physicians will be practicing in an environment of even greater regulation and control. Furthermore, they will be subjected to regimentation of another type which may prove to be the greatest challenge of all. They will have to cope with the unyielding discipline of new knowledge and technology increasing at rates so fast that even computers can’t keep up.
As our society becomes more complex, we realize that a certain amount of regimentation is inescapable. Some may even be necessary. Unfortunately, much of it is simply the reflection of the bureaucratic thinking of our times.

Is there any hope for the future? In my opinion, there is and it lies in the simple fact that medicine will always be a private relationship between the doctor and the patient. Regardless of the system of medical practice, people will continue to seek doctors in search of relief from their physical and emotional ailments. They have the right to expect the physician to be a human being, sympathetic to their problems, and whose primary concern is for their welfare. Doctors would do well to remember this and not allow their anger and resentment of the system to interfere with their best medical judgement.

Until better criteria are developed, the patient can do worse than trust the doctor who answers to his God and his conscience.

Sherman M. Steinzeig, MD
Editorial Board Representative
Wyandotte County Medical Society

Friday, April 17, 2009


What is a mentor? According to Webster , he is "a faithful and trusted counselor or guide”. Then what is a "docent? It is defined as “ 1) teacher or lecturer and 2) a person who leads a guided tour”. In general, mentoring is usually considered to be a relationship of a minimum of 2 years. The docent concept as practiced at UMKC Medical School could therefore partially qualify as mentoring based on these definitions.

Being a good teacher does not automatically mean than one will be a good mentor. Teaching is the imparting of knowledge and the most successful teachers have occupational skills in their ability to present new knowledge with enthusiasm and flair.. Some of the techniques involved were covered in the Metro Med Bulletin. Chances are that the most revered teacher in your memory was both a good teacher and a good mentor paragraph

Mentoring in medical school and in post graduate training is considered adult mentoring and is distinctly separate from the techniques of the mentoring of children.. At present, the average medical teacher is most likely using the style one uses with children. Children are used to being told what to do, but this direct approach may not set well with advanced students and residents. The "drill sergent” approach at present could result in harassment charges against the teacher.

Resident learning is linked to what they need to know or do in order to fulfill their roles and responsibilities. They are striving for acceptance from peers and staff. They are anxious to prove that they "know something" and to show off their recently hard-gained knowledge. They are trying to shift from being subject-centered to being problem- centered.

The best way to help them become problem solvers is through questioning. When they ask for advice, the mentor should ask their opinion before responding. Some of the best mentors answer every question with a question. If the answer is fuzzy, they tell the student that he needs to "think more about it".

The areas of mentoring are. 1) education, 2) career, and 3) personal development. Educational mentoring involves inculcating the concept of being a perpetual student and the monitoring of knowledge by refresher courses, conferences and meetings. Career mentoring helps guide the student into a career for which he or she is most suited and , in residents, the necessary skills and competencies needed. Personal development mentoring guides decision-making and provides support during times of personal or social stress.

Simply stated, mentoring is the guiding of the development of the whole person. A basic grasp of the scope of mentoring is nicely presented by the work of Ned Herrmann and his “whole brain” concept. The Herrmann system classifies thinking processors into four distinct categories: A) logical, analytical and factual, B) structural, detailed, sequential C) empathetic, emotional and expressive D) conceptual, integrative, synthesizing. A good mentor would have a balanced distribution of the characteristics and use the competencies interchangeably. The scientific curriculum in medicine leans heavily on the A-B areas with emphasis on A characteristics, particularly in specialties.. Therefore, because of his lack of strength in the C and D areas, a typical specialist will have difficulty in truly mentoring a resident.

This makes specialties such as surgery, cardiovascular and gastroenterology. essentially apprenticeships, defined as "one bound by legal agreement to serve another for a certain time with a view toward learning an art or trade in consideration of instruction". Nowadays, the “apprentice” insists on a salary rather than trading his work for training and mentoring. Unfortunately, this causes consternation among those who give time to uncompensated teaching and mentoring.

Yet there are still those who love to teach and seem to have a calling. For them to feel fully rewarded, they should take a course in adult mentoring. It would improve the teacher, the student and the institution

Submitted 4/17/2009
C.Y. Thomas, MD