Last week, I introduced the concept of mentoring and compared it to a traditional apprenticeship.  All professions have a period of apprenticeship, though they refer to it by different names.  In podiatry, some of the essential skills that we use to run a successful practice are learned primarily by working side by side with another podiatrist who has mastered these skills, in a practice setting. 

Here’s a short review of these skills.

Let’s start with patient communications.  From the moment we walk into a treatment room, we are being judged by the patient, and the result of that judgment is either trust, respect and cooperation, or distrust and failure to act on the part of the patient.  You can read all that is written about body language, touching the patient and “speaking in the patient’s language”, but unless you carefully observe all the subtle nuances that a great doctor puts into that patient encounter, you just can’t learn it.  When does the doctor smile, when is he serious ?  When does he listen, when does he speak ?  Based on what he learns about he character of the patient, what treatment does he recommend ?  How much information does he offer ?  Does he present choices to this patient, or simply give a recommendation ?  All of these communications skills are the subtle grist that distinguishes a good doctor from a great one.  Patients don’t know what your class rank was in podiatry school, nor what your board scores were.  But they will leave your office with an impression.  They’ll either leave with the confidence that following your recommendations is the right thing to do, or they’ll leave with doubt and more questions than they came in with.  Only a talented mentor can teach you these skills.  

Then there are diagnostic and treatment skills. First, there are the routine encounters that make up 90% of any practice.  A great doctor can handle those patients by instinct. Observing him or her will result in the development of good instinct on the part of the apprentice. Then there are the special cases, the unusual patient who presents with a particular demanding problem.  Yes, we can certainly blow them off and focus on the 90%, (and 90% of a good practice is still a pretty good practice) but the truly great doctor takes pride in those 10%, because those are the challenges that test his or her skills.  To effectively diagnose and treat the most routine and repetitive 90% of podiatry patients can be learned during a year with a talented podiatric mentor.  But as concerns the 10%, both the mentor and the apprentice will never stop learning.

The management and organization of a podiatry practice takes at least a year to learn and many years to master.  In the early month’s of building a practice, it matters little whether the office is efficiently organized and work flow is smooth and trackable, because time is on your side.  You can take a half hour to find a lost chart with keeping a patient on hold.   But once a practice grows to be busy and profitability is in sight, poor organization can block any further growth.  If charts are lost, if insurance claims don’t get filed, if there are frequent staff changes, if the doctor is perennially late…patient’s know.  More patients leave offices for screwed up billing practices than for doctors that they don’t like.  

Organizing the work flow in a practice requires creative skills that aren’t taught well in any school. Most of it is not invented de novo…it is learned from a mentor.  20 years later, I am still doing things the way my residency director Keith Kashuk, did things in his office.  In fact, there are a group of us here in South Florida who all have similar office procedures…because when questions come up, we call each other.  Networking between offices helps all involved.  Teams create better than individuals, when they work well together.

Then there is practice building.  Different techniques work better in different areas.  A Yellow Pages ad may be an effective use of your advertising dollar in a new community without a high managed care penetration, but in most areas of the country now, the managed care provider manual has all but replaced the Yellow Pages directory.  Conservative folks in the Northeast may frown at full page ads in the newspaper, while here in the South, it works for some practices.  It is harder to build relationships with other doctors in established areas unless a mentor makes introductions for you.  The mentor can pave the way for you into the medical hierarchy of the community and quickly make you an integral part of it.  Ultimately, though, your place in it will depend on your personality and how well you work with and are regarded by the other team members.  Your reputation in the community will make the difference between being a doctor who sends and receives referrals, and those who rely on an established patient base and advertising for a source of new patients.

We podiatrists today tend to think of our career training in discrete units, starting with pre-med, going on to podiatry school, and then residency training.  Following residency training, the last “formal” part of our training, the next step seems a vast void that we are cast into, where we must fend for ourselves, to learn to use the skills we’ve worked so hard to learn to become successful business people.  In fact, no one does this alone.  The system of mentorship is a long standing tradition in podiatry, and if fact, in all medical specialties.  We hate the word apprenticeship, because it conjures up images of going to work for a blacksmith in days of old.  But in fact, all professionals learn the intangible part of their profession in some form of one on one relationship with a veteran practitioner, and always will.  It’s perhaps the most satisfying part of your career training.  Find a mentor, or two, during or after your formal training.  It will complete you.

 
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