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August 2, 2010
Mentoring 101

I just got back from this year's Pediatric Hospital Medicine conference where mentorship was a constant topic of discussion. It came up time and time again, in sessions dealing with quality improvement, teaching and research. There were mentoring discussion groups and breakfast roundtables, and in the wrap-up session, several hospitalists highlighted the need for more mentoring opportunities.

Mentoring as a topic is not new to us. During our educational lifetimes, we've had one or more wise individuals with the right experience and perspective help guide our professional footsteps. Particularly in academic centers, the need for mentoring permeates the learning environment, and that's where many of us establish lifelong relationships with colleagues and teachers that can potentially affect our professional lives for years to come.

But how does a young hospitalist find a mentor?

Conferences like PHM are fertile ground for establishing these relationships. But sometimes, when you're fresh out of residency or you've started a new job, finding a person who shares your interests and has the time and inclination to help guide your career can be overwhelming and frustrating.

As I begin the second decade of my career as a hospitalist, I look back on the past 10 years with wonder and surprise. Ten years in which the field of hospital medicine has grown in leaps and bounds. Ten years in which my personal journey as a pediatric hospitalist has changed, grown, stagnated, reversed, evolved and flourished.

Yes, my 10 years as a hospitalist have been an amazing roller coaster ride. But it also makes me think that with more mentorship, my journey may have been less rocky. I wouldn't change it for the world because every individual is the sum of his or her experiences. But my lack of focus, especially early on in my career, probably delayed areas of professional development that I'm trying to overcome today.

So, being a grizzled 10-year veteran of hospital medicine, I offer the following five tips on how to find and maintain a mentor. Call it "mentoring for dummies" or "mentoring 101". Whatever you call it, I hope it helps:

1. Find a mentor. Of course! Simple, yet so complex. Finding a person who shares your interests and has the time and desire to fill that role can be a bit overwhelming, almost like finding the perfect mate.

But look around your workplace and try to identify an individual who shares your personality and interests, and just ask if you can be involved in projects or educational opportunities with him or her. If you have problems where you work, expand your search and look in other hospitals in the area.

But try not to go too far. Frequent communication or meetings are a good part of any mentoring relationship.

2. Find a niche. When you're just fresh out of residency, the last thing you think about is a niche. You're trying hard not to kill people, for goodness sakes! But find an area that tickles your fancy, raises your blood pressure in discussions with colleagues, makes you so excited to talk about that you make everyone else around you yawn except your mentor, of course. Focus on that area. Read about it, write about it, study it and present it.

3. Ask questions. Lots of them. Not only about the clinical cases in your everyday practice. Ask about billing, risk management, process improvement, ethics. Perri Klass, in her wonderful book "Treatment Kind and Fair: Letters to a Young Doctor," refers to the act of asking questions as "crossing borders". You might feel uncomfortable at first, and the answers may be unsatisfactory. But questioning leads to curiosity about the answers. And that is the essence of medicine, isn't it?

4. Go to meetings. Conferences not only increase your knowledge on medical topics, they are a great environment for camaraderie, networking and inspiration. Every time I return home from meetings like PHM, my head buzzes with ideas and possible projects.

But like any nice buzz, eventually it comes down. Don't worry. Be consistent, make a plan and start working. E-mail those people you met to see if they want to collaborate with you on a project. Read the pediatric hospital medicine and the SHM pediatric listserves, where now you can put a name to the face of those responding. Stay in touch with your colleagues.

5. Practice without fear. While I used to say this as a means to exorcize the possibility of lawsuits (so far it's worked), practicing without fear has become a mantra I preach to my students and residents. Practicing without fear means you walk into a patient's room willing to be a servant and to put your ego aside, focusing on words and gestures that truly involve the patient as the center of your endeavors. Sit down; be sympathetic, but not condescending. Admit you don't know everything. Smile. I know, it sounds a bit corny. But patients and their family members are experts at reading your attitude. And they can smell fear from a distance!

Then there's the five things you shouldn't do when seeking for a mentor. I'll discuss those in my next entry
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5 Comment(s)

Shawn Ralston wrote:
I really like this post, Ruben. It reminds me of the end of Atul Gawande's Better, which I like to read periodically to dispel the miasmas that creep into my little corner of academia on occasion.

I especially like your number 5. I might make it my personal motto for the year. Its two-pronged, as you've alluded to. Practice without fear of lawsuits, and practice without fear of sharing uncertainty with patients. Excellent advice. Thanks.
San Antonio, Texas | Tue, Aug 3 2010 09:05 AM

Jeff Grill wrote:
Insightful and inspiring, as always, Ruben!
Louisville, KY | Tue, Aug 3 2010 10:10 AM

Pratip Nag wrote:
Great 5 points. I totally agree with all that you say. Ruben. Special emphasis on finding a mentor who will guide you through and using tools like 5 year plans, which focus on balancing and fully realizing personal and work goals.

Also, love the point about being a human and a doctor who can smile and make patients laugh and say "I don't know, but we are on this journey together and we will try our best to figure it out". Loved the post!
Houston, TX | Thu, Aug 5 2010 09:58 AM

Diji Vaughan, MD wrote:
Remarkably true and concise.
Phoenix , Arizona | Fri, Aug 6 2010 09:21 AM

Ruben Nazario wrote:
Thanks for the comments! I think practicing without fear also alludes to the humility we should instill in the physician-patient relationship. Thanks again.
Fairfax, Va. | Fri, Aug 6 2010 09:25 AM

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About Ruben J. Nazario, MD
Ruben J. Nazario, MD, is now medical director at Inovalon, a health care data analytics company, and is medical editor for Elsevier's First Consult. A pediatric hospitalist, Dr. Nazario is a veteran of both community and academic pediatric hospitalist programs. All material represents his own views and does not reflect the views of his employer.
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