Sunday, 18 September 2011

Be as impartial as you mean to be.


On Thursday and Friday, I attended a course on mentoring. The audience consisted mainly of GPs, with some hospital doctors, and interestingly, a couple of psychiatrists, who wanted to see whether mentoring approaches could be useful to them in their work with their patients.

As a self-selecting crowd, our attitudes to mentoring are probably not typical of the medical profession at large, and I assume that in general, we were more positive about the uses of mentoring than many. However, a few of the comments caught my attention; in particular, one GP who ambled in late commented that she had been mentoring for years, so thought she should see what it was all about. Hmmmm.

Having been mentored myself, I thought I was entering the course with a clear idea of the skills needed to become a good mentor, and also the belief that I had many of them already; the assumption being, that as a doctor, my professional life consists of talking to patients, eliciting the information needed to make a diagnosis, and then help them deal with the information and choices relevant to their problem.

Of course, this assumption betrays my ignorance. Many of us in the room struggled to leave behind our preconceptions about what mentoring is, and how it should work; in fact, I think that there are some people who still don’t get it. A theme throughout the course was a fixation of comparing mentoring practices with the kinds of tips and tricks that we use in medical interviewing, and the idea that the framework that we already use for eliciting information and forming conclusions is one that serves us well already, so surely should form the basis of this slightly different way of assisting people.

And yet therein lies the rub: mentoring isn’t so much about diagnosing the problem, and identifying the solutions, but rather about enabling individuals to steer their way through issues and challenges. Mentoring often seems to involve dealing with people who are bashing against a concrete block in their path, and the challenge is to help them realise that there is a clear track on either side.

It can be achingly frustrating to deal with someone who’s problem, in your eyes, have an easy fix. As a doctor, I have become accustomed to having the authority to say to people what the problem is, and what I think the solution is. In fact, such an approach is encouraged by the societal expectations of doctors, and the way we are trained. However, telling someone what the solution to their ails is is not the same as them solving it themselves.

Mentoring aims to help people reach higher by using the skills and abilities already within them. It is very  much about enabling them to tackle issues in their own style. Applied to patients, this represents a markedly different approach to practice than I am used to. I wonder how affective it will be, as I know that some of my patients think that when I ask them what they would like to do, it is because I do not know what should be done. In such situations, I have to play the traditional role of the doctor, but the manifestation of such expectations from my patients should not dissuade me from honing my skills further.

I find the techniques that mentoring requires to be a useful way of examining how I interact with my patients: if I’m honest, with virtually every patient, there is a course of action that I think is the ‘right’ one. This will be based on many factors, including my genuine assessment of what is in the patient’s best interests, but even this kind of conclusion involves significant value judgements, and it doesn’t matter how open I am, my preconceptions and biases are bound to influence the language I use with the patient, to steer them towards the decision that I think is the best one. I often wonder whether the anguish and dismay I feel when I think a patient makes the ‘wrong’choice is driven as much by the dismay that I have not been able to persuade them to agree with me, as it is by the concern about what will happen to them.

I therefore have to acknowledge that the prospect of learning how to support someone’s decision-making in a non-directive way opens up the possibility that I will become a more accomplished communicator and doctor. This is a tantalising prospect, as I have yet to confirm what the vision might be. All I know now is that it seems like a powerful idea to be able to learn how to help someone without my own vested interest and innate biases playing too big a role. I’ll let you know how I get on.

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