I recently attended a conference presentation on workplace challenges from a young cardiologist's perspective, and I was reminded of a family medicine intern whom I will call Jack. "Smart but lazy" was my assessment of his performance during a 4-week rotation on my cardiology service. Unknowingly, I had a front-row seat to a slowly unfolding tragedy. I learned more about Jack from that presentation than I had ever known about him in life, and that's a shame.
I learned that since Jack was a millennial, he was probably in a hurry for success but needed a sense of purpose. He likely knew of my high expectations, and that made it difficult for him to have the time to network with friends and family who could provide support. My desire for him to stick with it during long days and nights probably didn't balance well with the millennial "preference for a flexible and liberal workplace policy." That presentation by another young doctor, summarizing typical characteristics of millennials, gave me a glimpse not only of who Jack was but also what he probably did not wish to be.
Leaving 'Early' Equals Lazy
I remember one particular evening, around 5 pm, when Jack and I finished rounding on the telemetry unit. While we walked the long hallway back to the cardiology department, we bemoaned our particularly grueling day. At least 2 more hours of echocardiograms, stress exams, and Holter interpretations awaited. There were still a few consults left in the emergency department, and an intensive care unit nurse paged us that a patient's wife had finally arrived and was in the waiting room. As I resigned myself to the work ahead, Jack thrust his arm forward to uncuff his watch from the sleeve of his short white coat. "I'm sorry," he said, " But I really gotta go. I have ball practice tonight."
I rolled my eyes and grunted, "Unbelievable," under my breath, deciding that this latest annoyance would have to go on his evaluation. Just 1 week prior, he left early because it was his birthday. Before that, it was something else. Back when I was an intern, if I'd asked to leave early during any of my rotations, I'd have been figuratively drawn, quartered, and flunked.
If I hadn't been so busy myself, I probably would have sat Jack down for a long chat, but I didn't. I let it go. I chalked it up to laziness and reasoned that if he hadn't learned responsibility at this point in his training, there was probably nothing I could say or do to change that.
Jack was bright, articulate, and quite entertaining with quips and jokes that left me chuckling a day later. After his cardiology rotation, I saw him from time to time and wondered if he knew about my lukewarm assessment of his performance. Did he even care? He was friendly enough when I would run into him, so I was never sure. After residency, he went into private practice and I never saw him again. A few years later, a physician friend mentioned casually in a phone conversation that the intern we'd shared on rotation, Jack "Somebody" was dead of liver failure, a result of years of hard closet drinking. I was stunned and immediately wondered if there was anything I could or should have done to change his lethal trajectory in life.
The conference presentation by Harri Silvola from Finland, a self-professed millennial physician, also covered what young doctors need from older mentors. This part haunted me. Maybe instead of reporting his bad performance I should have tried to get to the bottom of why Jack needed to leave early. I question now if his performance was really all that bad. He presented well and seemed to put together a reasonable assessment and plan for the standard H and P. Patients liked him. Heck, I liked him, but I did not really respect him. He left when there were still work to do and more learning opportunities available. He wasn't my definition of "dedicated," but maybe I need to change my definition.
Silvola said that as mentors, we older physicians need to practice "soft skills," which includes showing appreciation and giving straightforward feedback. We should provide our millennial mentees flexibility and harness their commitments. We should empower them, he advised.
Did I practice "soft skills" with Jack? I don't think so. Although many students asked to shadow me and interns and residents enjoyed rotating with me, I was never known for my "soft skills."
Rethinking Old Standards
Maybe the old way of teaching does not meet the needs of a generation who weren't brought up with the rough edges we thought were required to make a good physician. In my early days of training, the tough got tougher and the "weak" got out. Because of that hard-nosed approach, we olders brag about surviving the "glory days"—but do we really want that for future physicians and trainees?
Do we want them to suffer a grueling schedule in addition to what has been thrust upon medicine in the last decade? To be tethered to a computer, to spend endless hours obtaining prior authorizations? Shouldn't we try everything in our power to disrupt a system that has produced the greatest crisis of burnout, depression, and suicide in the history of medicine?
I know that alcoholism is what killed Jack, but perhaps the essence of who he was could never mesh with what it was we wanted him to be. Physicians should never be forced to choose between having a life or practicing medicine. I owe it to the memory of the lost millennial Jack to better help future trainees find a way to have both.
Melissa Walton-Shirley is a native Kentuckian who retired from full-time invasive cardiology. She enjoys locums work in Montana and is a champion of physician rights and patient safety. In addition to opinion writing, she enjoys spending time with her husband, daughters and parents, and sidelines as a backing vocalist for local rock bands.
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Cite this: Melissa Walton-Shirley. Millennial Mentoring: Is it Time to Soften Our Rough Edges? - Medscape - Oct 22, 2019.