MENTORSHIP BRINGING A BETTER FUTURE
Silver Sands Veterinary
WALK-IN Emergency-Urgent Care
SilverSandsVeterinary.com
General Veterinary Care
A Family Centered Companion Animal Practice
ER-Urgent Walk-In Care Department
Department of Oral Surgery and Advanced Dentistry
DH DeForge, VMD Fellow
of the Academy of Veterinary Dentistry
17 Seemans Lane-Milford, CT 06460
Phone 203-877-3221
Fax 203-877-8301
Email DonDeForge100@gmail.com Email DoctorDeForge@yahoo.com
APP- Silver Sands Veterinary
Mentorship: The Canary in the Coal Mine
Mentorship: Bringing a Better Future
Avoiding the Wounds Caused By Moral Injury
Stress in the Work Environment
Donald H DeForge, VMD
Eliminating Stress in the Work Environment
In a recent literature
review, I read a very special Editor's Column by one of my favorite writers:
Thomas G Wilson Jr, DDS, Editor in Chief of Decisions In Dentistry.
Below are his thoughts on an article in the New York Times Magazine written
by Eyal Press.
Press opined that
"the corporation of American healthcare has changed how physicians
practice medicine, causing many of them to feel alienated from their
work. He goes on to say: "that many physicians confided they are
struggling with the stresses caused by their work environment."
The author feels many
physicians are convinced that the current healthcare system made it difficult
to properly care for their patients. They indicated they were under
constant scrutiny even to the point of having their productivity tracked on an
hourly basis. Many also complained that the demands of administrators, hospital
executives, and insurers forced them to stray from the ethical principles meant
to govern their profession. They said, “they were caught between the
Hippocratic Oath” and the realities of making a profit from people at their
sickest and most vulnerable periods."
Avoiding Moral Injury
Today, approximately 70%
of all physicians in the U.S. are paid by hospital system or corporate
entities. This has led to an increased depersonalization of healthcare
where personal interactions are reduced in favor of speed and efficiency. Press
found in a study that nearly 20% of ER department physicians stated they had
been threatened for raising quality of care concerns and pressured to make
decisions based on financial considerations that could be detrimental to their
patients. He goes on-that emergency department physicians are particularly at
risk for losing their jobs and many can be fired without due process.
Press concludes, that
these scenarios can lead to "moral injury" a term coined by the
psychiatrist Jonathan Shay, MD, PhD to describe the wound that forms when a
person's sense of what is right is betrayed by leaders in high stake
situations.
The Veterinary Oath and Five Freedoms
Confronting the pain of
Moral Injury is a strong reason for the need for strong mentorship from day one
of entering veterinary practice. As autonomy decreases and larger group
and corporate practices enter veterinary medicine, the new graduate needs a
guide while traveling through hoops of anxiety, worry, pain, and confrontation.
It is quite possible to
find wonderful mentoring in mega-practice veterinary healthcare. It is
just as easy to find all of the negativity as seen in human medicine.
As veterinarians, we
have committed ourselves to the Veterinary Oath.
"Being
admitted to the profession of veterinary medicine, I solemnly swear to use my
scientific knowledge and skills for the benefit of society through the
protection of animal health and welfare, the prevention and relief
of animal suffering, the conservation of animal resources, the promotion of
public health, and the advancement of medical knowledge."
As
veterinarians, we have been called upon to recognize and implement the Five
Freedoms of the Animal Kingdom
- Freedom from Hunger and Thirst: by ready access to fresh water and a diet to maintain
full health and vigor.
- Freedom from Discomfort: by providing an appropriate environment including
shelter and a comfortable resting area.
- Freedom from Pain, Injury or
Disease: by prevention or rapid
diagnosis and treatment
- Freedom to Express Normal
Behavior: by providing sufficient
space, proper facilities and company of the animal’s own kind.
- Freedom from Fear and Distress: by ensuring conditions and treatment which avoid
mental suffering.
Positive
Change removes the need for the Canary in the Coal Mine
When the young veterinary graduate leaves
veterinary school, the Veterinary Oath and the Five Freedoms of the Animal
Kingdom are their bible and belief system as Doctors of Veterinary Medicine.
In a few fleeting days; weeks; months they find
themselves in a quagmire with a moral dilemma facing them many times each
day. Wilson in his profession asks will the medical moral dilemma become
more prevalent as the corporate takeover of the American medical system
continues. Can this be the canary in the coal mine?
[For those unfamiliar with this phrase, “canary
in the col mine, we offer this explanation]-Following a deadly explosion in a Welsh coal
mine in 1896, an engineer called John Haldane invented a type of bird cage that
allowed canaries to accompany miners into the depths. The small songbirds are
much more sensitive than humans to the deadly carbon monoxide gas found
underground. This discovery saved thousands of lives from carbon monoxide
death.]
The modern idiom "canary
in the coal mine" is used to describe something or someone that warns
people of danger.
No one will know if Wilson is correct until
history is written over the next five decades. Whether the new veterinary
graduate decides to enter a mega-practice or seeks to work with greater
autonomy in a one or two doctor practice, the danger of moral injury and
burnout exists.
The
Mentor Challenges and Proposes a Plan to Eliminate Moral Injury
The mentor is essential in challenging Moral
Injury and preventing the resultant burnout. The mentor can open the eyes
of the new doctor so that they can handle all problems proactively rather than
retroactively.
Over and over in your head, the new graduate
may be thinking: I can’t do this anymore! My supervisors just ramble on
and on and never stop picking on me. I am exhausted and there is just not
enough time to get my work done! I stay late at night working on SOAP
Medical Records and the pile continues to grow. My senior peer clinicians are
so lazy and keep adding to my list of work to do as they leave early each
night. This leads to depression and low self-esteem and you begin to believe:
What’s the point, I’m not a good doctor and never will become an excellent veterinarian!
The
Toxic Work Place and Burnout
The Toxic Work Place [TWP] is the main
ingredient in the recipe of burnout. The work day begins to spin as the
new graduate is plagued by fear of retaliation if they speak out about
injustice
Your
Mentor and Coach
These early red flags are signs that cannot be
ignored. The mentor-coach can explain the difference between compromise
and accepting that which is just completely wrong. Most importantly, the mentor
takes and active role in showing their mentee the paths to change. This
does not always mean packing up the tent and moving on to the next veterinary
position. It always starts with open communication with management about
problem solving and developing team member mutual respect with focus on the
patient at all times.
The conundrum sits right in the middle of the
TWP. The practice owner and/or corporate management CMO may not believe
change is needed. They may not want to tip the cart and open up avenues
of change which may not benefit the bottom line.
An example is the CMO calling in all
professional personnel one at a time into their office during the buy-out
of a veterinary hospital. They have each doctor sit at a conference table
and ask them if they see the imaginary fish bowl at the center of the table and
all of the imaginary marbles sitting around the bowl. They say to the
doctor can you see the bowl and the marbles? They then state if you want
to stay at our hospital you must abide by our rules without compromise.
If they agree, one by one, each doctor places and imaginary marble into the
imaginary corporate fish bowl. If you do not see the red flag in this
scenario, your mentor will! This is beyond toxic! This is one person's
dignity and autonomy vanishing as the shackles of control are placed on the
wrists and ankles of the employee doctors.
Believe
in Yourself
As a mentor of 45+ years, I have told each
mentee that the only person that can stop you from reaching your goals and your
happiness in a very special role as a doctor of veterinary medicine is
yourself. Self-esteem is the key to growth. Finding a work place
that is open to suggestions and change allows you to grown and most importantly
locks in self-esteem.
Years
ago, as a rookie veterinarian, mentors were few and far between. New
grads were alone on an island and at times it was an impossible place to work
and live.
Today, a
mentor can be an advisor, coach, counselor, teacher, attending, or sponsor.
There may be a clearly defined goal to achieve, a skill to develop through the
relationship, or, more simply, an opportunity that encourages self-reflection.
I
tell all mentees that mentoring can continue for years or reach a speedy
conclusion in months depending on the circumstances and the individual. Some situations call for a change to another
mentor or creating an environment of multiple mentors looking at problems from
different perspectives.
Examples
would be a senior clinician and a past academic connection working in bi-mentor
roles for the same mentee. Two different mentors showing two different
ways to challenge and solve a problem can be a very positive creative plan.
Working together, they can transition into ongoing networking connections and
long-term friendships.
Ten Steps for Unlocking the Mentor-Mentee
Relationship
1] Set achievable
manageable goals for specific skill development
2] Measure achievement by
weekly meetings. Evaluating progress while improving confidence
3] One size does not fit
all-Regular goal adjustments based on needs of the mentee
4] Reflection on updating
mentees needs and aspirations
5] Accountability in skill
development
6] Evaluation of Medical
records and SOAP records
7] Discussion of progress in surgical
skills from rudimentary to complex
surgical techniques
8] Review of career adjustments and
advancements
9] Review
the Work-Life Balance and compare it to the Life-Work Balance-
The
mentee will find that they are not one and the same
10] Case
studies on Interpersonal Relationships as well as Client -
Doctor-Nurse-Relationships
Only utilizing all of the tools of the mentor-mentee connection can the challenge be completed to remove moral pain and negativity from the work place and replace it with the patient becoming paramount above all else. The conclusion is inner peace resulting in the long career your anticipated when you accepted your role as doctor of veterinary medicine at your graduation!
Contact Dr. DeForge at 203-877-3221 with questions or email
DonDeForge100@gmail.com
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