Mentoring, gatekeepers

There are few things in life as satisfying as finding one’s prejudice in print. It was, therefore, with great pleasure that I read (from cover to cover mind you) the September 2005 issue of the Journal (2005;47[7]:341-408). I particularly enjoyed Dr Timothy Rowe’s discussion of the relative places of technology and mentoring.

As a teenager I watched the movie Kings Row (in which, incidentally, Ronald Reagan has probably his finest role). Claude Rains plays a recluse physician who adopts Robert Cummings as his protégé. “What a wonderful way to learn,” I thought.

Some 15 years later, I found at the Winnipeg General Hospital an outstanding clinician and teacher—the late Dr Brian D. Best. For 2 years I clung to him like a barnacle and gained what I considered to be an excellent education. I agree wholeheartedly with Dr Rowe’s statement that “in the end trainees only become doctors under the guidance of physician mentors.”

I remain a technological ament (using the psychiatric not the botanical term). I was thrilled therefore, to read Dr Rowe’s comment that, “we must ensure that technology remains the servant and not the master of the clinician. To rely on technology rather than thought is the lazy way out.”

Unfortunately, “lazy ways out” are today’s best-sellers (instant mashed potatoes, oatmeal, custard pudding, etc.). Also, it seems that to become a walk-in clinician (“cream skimmer”) instead of a full-service family doctor is the “lazy way out.”

Which brings me to the pensive words from the “JAW” of editor James A. Wilson, “…who will become the gatekeepers of medicine if today’s family docs are no longer willing to fill that role. Will it be a new generation of young committed family docs … or some kind of computer-assisted licensed medical technician employee of the local medical authority…?” (BCMJ 2005;47[7]:344-350). I’m afraid, Jim, that I share your pessimism. We will have no greater success in holding back the tide than had King Canute 1000 years ago.

—Ashley M. Krisman, MD
Vancouver