Practice means “to do repeatedly in order to learn or acquire proficiency.”1 The instrument on which a pianist practices is the piano; the instrument on which a physician practices is patients. A great pianist, Walter Gieseking, believed that practice had to be done meticulously, slowly, and under observant supervision. The teacher helps the student understand what he or she does not know and, more importantly, cannot see, because no one is able to see him- or herself completely. Learning correctly under the guidance of a good mentor is essential. Learning incorrectly is a serious problem, because such mistakes are hard to unlearn.

A LONG-LASTING NEED

Being a good physician requires more than learning skills and information; it also demands knowing how to use those skills and that information in a way that is best for patients, society, and the physician him- or herself. Great music teachers spend most of their time educating experienced musicians about interpretation—how to get the audience to hear the magic in the music. Every one of us needs teachers, and our need for them never disappears. Great golfers, singers, and physicians require mentors for as long as they are trying to be great golfers, singers, or physicians.

LEARNING CURVE

The learning curves of artists and physicians are remarkably similar. They are asymptotic, with a rapid rise at the start, followed by a gradual slowing and then a marked flattening. Becoming an adequate physician takes work but can be accomplished by any B student quite easily. Moving from adequate to good takes more work, even for the gifted. Advancing from good to excellent is far more challenging than progressing from adequate to good. To become a truly great physician requires not only the ability to know volumes and have excellent skills— plus thousands of hours of practice—but also the capacity to become wise. This is easier for some than others, but it cannot be accomplished without mentors.

WHO IS A MENTOR?

Many so-called mentors are really drill sergeants. They believe there is one way to do things right, their way. They turn out people like them, unfortunately.

Yes, great physicians are excellent role models for the person wanting to become a great physician, but those great physicians may not be excellent mentors. Being a good mentor requires being a skilled teacher—that is, being able to recognize and nourish what is great in another person. High-quality mentors do not turn out clones.

Because diversity, complexity, and uncertainty are at the heart of existence, methodologies that stress standardization, rigidity, and adherence to one's principles are guaranteed to produce physicians who are standardized, rigid, and adherent to their principles. They may be very good physicians, but they are never great. Greatness demands recognizing the beautiful, mysterious complexity of existence.

Patients can often be good mentors for physicians—as well as friends, spouses, and colleagues—all who are willing and able to speak to their doctors critically, not for the purpose of tearing down but rather helping them do better.

EVOLUTION

There is a point in the evolving mentor-mentee relationship when the latter recognizes that he or she is now teaching the former. Great mentors welcome and facilitate the reversal. The next step in the relationship is when the mentee recognizes the shortcomings of the mentor, because he or she is always flawed. Thereafter, the mentor and mentee develop a relationship in which they both have a realistic assessment of each other, the mentor's bringing out the best in the mentee and vice versa (Figure). That is thrilling!

THE GOAL

Truly great physician mentors are not satisfied with helping develop excellent physicians. A mentor's primary interest, and indeed chief responsibility, is to help his or her students become great people, which is more important than being great physicians. Superimposed on that great person are the skills and knowledge that allow him or her to become an excellent physician.

CONCLUSION

Many of our genes are asleep at any one time. They express themselves or remain dormant depending upon the environment that surrounds them, and so it is with each person. All of us have strengths and weaknesses. Sometimes, we react nobly and other times like Bernard Madoff. What great mentors do is awaken within us what is great, noble, and generous and suppress that which is mean, petty, self-indulgent, destructive, and exploitative. It is a rare person who can resist something truly seductive. Caring, effective, great mentors help their disciples learn who they are and what they are really about; they help their disciples fall passionately in love with the opportunity to become great people and not be seduced by lesser goals.

George L. Spaeth, MD, is the Esposito research professor and the emeritus director of the William and Anna Goldberg Glaucoma Service and Research Laboratories at the Wills Eye Institute in Philadelphia. Dr. Spaeth may be reached at (215) 928-3960; gspaeth@willseye.org.

  1. Webster's New World College Dictionary. 4th ed. Hoboken, NJ: Wiley; 2001;1129.