I am honored to have the opportunity to discuss the special relationship between mentor, peer, and protégé—teacher, coworker, and student—which is as old as life itself but is unique in the profession of medicine and in the field of orthopaedic surgery.
At this time of monumental, fundamental, and draconian change in both the health-care industry and society itself, many of us are re-examining and questioning why we went into medicine in the first place. The Oath of Hippocrates personifies to me all that I feel is special and unique to the profession of medicine. Like many of you, I took the oath at graduation from medical school. A few of us consider the oath to be a covenant, a literal contractual obligation. Like most, I consider it to be a guideline for what our daily professional lives and our practice should be. It should be our creed and our goal. If the oath means nothing to you, then I suspect that you have low self-esteem, a poor self-image, and little self-respect because it would have been far easier to become a stockbroker, an administrator, a financial analyst, or even an attorney than to become an orthopaedic surgeon.
Let us look closely at this important and influential vow, which is steeped in the history and traditions of medicine. It begins, "I swear by Apollo, the physician, and Asclepius and Health and All-Heal ..." The third paragraph ("... I will give no deadly medicine to anyone if asked, nor suggest any such counsel; furthermore, I will not give to a woman an instrument to produce abortion.") has received considerable attention recently because of the issues that have been raised by Dr. Kevorkian, who provides assisted suicide or euthanasia, and because of the pro-life versus pro-choice debate. These are contentious, controversial issues that are at the forefront of today's headlines. This paragraph contains the oath of sanctity of life.
The fourth and fifth paragraphs are equally important. "... I ... will abstain from every voluntary act of mischief and corruption; and further from the seduction of females or males ..." is the oath of purity. "Whatever ... I may see or hear in the lives of men which ought not to be spoken abroad I will not divulge" is the oath of confidentiality.
In the course of dealing with these important issues, we as physicians have overlooked or forgotten one of the cardinal features—one of the hallmarks—of the oath: the second and longest paragraph. The Hippocratic Oath begins, "To reckon him who taught me this art equally dear to me as my parents, to share my substance with him and relieve his necessities if required; to regard his offspring as on the same footing with my own brothers, and to teach them this art if they should wish to learn it ... and ... impart a knowledge of the art to my own sons and those of my teachers, and to disciples ..." This is the oath of obligation to one's teachers and of obligation to fulfill one's role as a teacher of the art. I suggest to you that there is a reason why this is the first vow and the longest section of the Oath of Hippocrates. The obligation to teach and to honor one's instructor provides the foundation of the oath, which supports all of the other provisions.
The word mentor, like the word oath, comes from ancient Greece. Mentor was a character in Homer's classic poem, The Odyssey. When Odysseus went off to the Trojan War, Mentor was the friend to whom Odysseus entrusted his son. Mentor was not just the son's teacher, but he was his faithful friend, his trusted advisor, and his surrogate parent. The term mentor has come to mean more than just a teacher. It has come to mean someone who takes another person under his or her wing, who opens doors, who counsels and helps to advance that person's cause, and who becomes the person's sponsor.
This tradition crosses all fields and all cultures, past and present. Donatello and Leonardo da Vinci were mentors for Michelangelo. George Marshall was a mentor for Dwight Eisenhower, and J. William Fulbright was a mentor for Bill Clinton. In medicine, I think of Michael DeBakey as being very much the protégé of his mentor, Alton Ochsner. I have had so many influential mentors during my life and career that it is almost a sacrilege to mention one without mentioning all. The phenomenon of mentorship is a fulfillment of our Hippocratic obligation.
Peer is a term Americans usually use for a member of the same age-group, for a contemporary such as someone from the same class in school. The strict definition from the dictionary1 is "one that is of equal standing with another." The British usage of the word is slightly different, as in the peerage of nobility: "a member of one of the five ranks (as duke, marquess, earl, viscount, or baron) ..." Arthur Wellesley, the Duke of Wellington, was known as "The Peer" by his officers because he believed that they should be from the aristocracy. The ranks called him "Nosy" because of his hawk-like proboscis. As the fourth son of nobility, Wellington did not inherit his title, as many did. He earned it the hard way, as a soldier on the battlefield. Basically, our peers in orthopaedic surgery are closer to this British definition because we are something special. We have paid the price of a rigorous selection process and have struggled down the long hard road of training and retraining. In addition, we have to maintain a level of competence that is required by almost no other vocation in our society. We are the shamans, the samurai, the Jesuits of our civilization, and we should have both a mutual respect and an appreciation for our professional peers.
Times are changing and not necessarily for the better. Image, self-promotion, and self-reward seem to be replacing substance and selfless reward. The Golden Rule of the Bible, that one should do to others as he would have others do to him, has become the golden rule of mortgage lenders and third-party carriers—he who has the gold makes the rules. These difficult times should reaffirm the importance of our relationships with our professional peers. It should be one of mutual respect and appreciation. The favorite saying of one of my mentors was an old Native American proverb that said a man should not judge another man until he has walked a mile in his moccasins.
Protégé is "a person ... under the protection or kindly care of a friend or patron, especially of a person of superior position, influence, or skill."2 He or she is on the receiving end of the relationship with a mentor. There are very few things in life that are as satisfying as the ability to help and influence a younger person in a positive way. In many respects, you feel that you are paying back your own mentors. Our protégés reflect ourselves. As Bob Eilert would say, quoting the comic strip Pogo, "They are us!"
My group of mentors, which is called the Lamplighters, was started by Al Swanson back in the early 1950's. One of the supreme ironies in the mentor-protégé cycle is that we have found it hard to recruit new members because they are reluctant to get involved. I suspect that there are more potential mentors than willing protégés. If the younger members and guests of this organization fail to take advantage of the mentors here and at home, they are missing one of the great things of life and of the profession.
In the fall of my fiftieth year, I look back and reflect. I have been most fortunate to have had the benefit of mentors who have been helpful and influential, to have had relationships with my peers that have been more than satisfying, and to have had associations with protégés that have been fulfilling. These relationships, I feel, have been the most precious ones of my professional and personal life.
†Academy Orthopaedic Clinic, 8301 Spain, N.E., Albuquerque, New Mexico 87109.
I swear by Apollo, the physician, and Asclepius and Health and All-Heal and all the gods and goddesses that, according to my ability and judgment, I will keep this oath and stipulation:
To reckon him who taught me this art equally dear to me as my parents, to share my substance with him and relieve his necessities if required; to regard his offspring as on the same footing with my own brothers, and to teach them this art if they should wish to learn it, without fee or stipulation, and that by precept, lecture and every other mode of instruction, I will impart a knowledge of the art to my own sons and those of my teachers, and to disciples bound by a stipulation and oath, according to the law of medicine, but to none others.
I will follow that method of treatment which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to anyone if asked, nor suggest any such counsel; furthermore, I will not give to a woman an instrument to produce abortion.
With purity and with holiness I will pass my life and practice my art. I will not cut a person who is suffering from a stone, but will leave this to be done by practitioners of this work. Into whatever houses I enter I will go into them for the benefit of the sick and will abstain from every voluntary act of mischief and corruption; and further from the seduction of females or males, bond or free.
Whatever, in connection with my professional practice, or not in connection with it, I may see or hear in the lives of men which ought not to be spoken abroad I will not divulge, as reckoning that all such should be kept secret.
While I continue to keep this oath unviolated may it be granted to me to enjoy life and the practice of the art, respected by all men at all times but should I trespass and violate this oath, may the reverse be my lot.