AMA Journal of Ethics®

Illuminating the art of medicine

Journal of Ethics Header

AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. May 2002, Volume 4, Number 5.

From the Editor

  • Print

Peking Duck Soup

The journal editor acknowledges the many skills that mothers have as caregivers and healers that are parallel to those needed to be a competent and compassionate physician.

Audiey Kao, MD, PhD

I know more than doctors," my mother confidently claimed. Despite practicing medicine for nearly 10 years, I still occasionally hear from my mom that my education and training as a physician do not compare to her years of experiential knowledge and expertise as a caregiver. In some ways, my mom cannot be serious—she is not licensed by the state to practice medicine, nor can she sort through a grocery list of differential diagnoses to determine the appropriate course of action. But in other ways, she and other mothers like her, armed with the healing powers of chicken soup, can teach their physician-children a thing or two about caring and common sense.

According to the World Health Organization's Action Programme on Essential Drugs [1], a drug is considered essential if it is "as relevant today as it was 20 years ago," and satisfies 4 criteria. It must be (1) evidence-based, (2) efficient, (3) flexible, and (4) forward looking. To many, the chicken soup that our mothers made for us when we were sick can be classified as an essential drug [2]. But maybe more importantly, these criteria also characterize our mothers' abilities in their roles as caregivers that are as applicable and relevant for medical professionals today as they were more than 20 times 20 years ago.

A special food was "the chicken of Rabbi Abba." Concerning its preparation, there is a divergence of opinion in the commentaries. It was assumed that it was prepared in such a way that after it was cooked, it was soaked in warm water for a long time until it completely dissolved. Rabbi Abba is said to have consumed this fowl as a remedy [3].

As far as possible, the meat should be that of hens or roosters and their broth should also be taken, because this sort of fowl has virtue in rectifying corrupted humours, whatever the corruption may be, and especially the black humours, so much so that the physicians have mentioned that chicken broth is beneficial in leprosy [4].

Chicken soup that is boiled neutralizes [body] constitution. This is [both] an excellent food, as well as a medication for the beginning of leprosy, and fattens the [body] substance of the emaciated and those convalescing from illness. Pigeon sucklings and all soups made therefrom have the special property of producing migraine headaches. . . . The partridge, if boiled, causes constipation. If it is boiled in its skin, it loosens the stool. The hen and the rooster have [even] more powerful stool-loosening action [5].

While there has never been a randomized control trial on the therapeutic efficacy of chicken soup, mothers have long used observational, anecdotal, and intuitive evidence in their roles as caregivers and healers. In an era of increased understanding about the biology and pathophysiology of disease, the emergence of scientifically driven, evidence-based medicine is critical to the advancement of medical care. But, as physicians, we should never loose sight that other information and evidence, oftentimes gleaned from careful observation, remains an important part of the therapeutic relationship.

Efficiency

Mothers are famous for their ability to juggle a seemingly infinite number of tasks in any given day. Time management, prioritization, and peer support are skills and resources that mothers draw on and that physicians increasingly need in the hectic environment of contemporary medical practice. Unfortunately, while these "efficiency" skills seem innate to mothers, they seem lacking in, and are not taught to, medical students, residents, and new physicians during their education and training. For example, physicians should to take advantage of the competencies of other professionals such as nurses, social workers, and chaplains in providing efficient care to their patients. While it is true that physicians need to manage their time better, it must also be noted that physicians do not have as much control over the conditions of their work environment as mothers, and thus true efforts towards efficiency, must address the "hassle factor" that distracts physicians from caring for patients.

Flexibility

There is no "basic" formula for the preparation of chicken soup. Some mothers add carrots, others may not; there seem to be an infinite number of variations. The fowl of preference in Chinese culture may be duck (of the Peking variety) rather than chicken—but, frankly, both birds will probably be equal in therapeutic value.

"Flexibility" also describes the different ways mothers relate to their children whom they love equally. Some mother-children relationships are easy while others are more difficult. One child will almost always obey, another will need closer observation and more coaxing. From the physician's perspective, the ability to interact differently with patients who have exactly the same illness is critical to establishing a therapeutic relationship. Thus physicians, no less than mothers, must be flexible and treat each person they care for as an individual.

Forward looking

Mothers are, by their nature, forward looking, devoted to and constantly protecting their children's futures. This longitudinal perspective that mothers have in the care of their children is a worthy of reminder for physicians. Physicians, too, look out for their patient's best interest, but sometimes our view gets myopic. Frequently physicians get swept up by the intensity of managing and treating an acute illness, and can lose sight of patients' long term well-being. There are few relationships outside those of the blood variety that are as important and intimate as the patient-physician relationship. Therefore, in many ways, our mothers remind us as physicians to balance our desire to cure at all costs and the need to care for our patients.

In the month of May when mothers are honored and motherhood celebrated, I want to say, "Mom, thanks for all of your support through the years. Love, your son.



References

  1. Action programme on essential drugs. Action for equity. Geneva: World Health Organization; 1988, DAP 92.5:5.
  2. Ohry A, Tsafrir J. Is chicken soup an essential drug? CMAJ. 1999;161:1532-1533.
  3. The Babylonian Talmud (2nd century BC 3rd Century AD). Seder Moed, Shabbath. 145b.
  4. A Treatise on the Canon of Medicine of Avicenna [Book I translated by Gruner OC]. London: Luzac; 1930;407.
  5. The twentieth treatise. Vol 2. The Medical Aphorisms of Moses Maimonides. Translated and edited by Rosner F, Muntner S. New York: Yeshiva University Press;1971:77.

The viewpoints expressed on this site are those of the authors and do not necessarily reflect the views and policies of the AMA.