AMA Journal of Ethics®

Illuminating the art of medicine

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AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. September 2002, Volume 4, Number 9.

From the Editor

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Reflections and Rantings of a Crazy Uncle

The journal editor compares the medical school experience to the structure and functioning of a family, with the behavior of one reflecting on the whole.

Audiey Kao, MD, PhD

It is that time of year again.

Millions of birds from thousands of species such as the black-throated green warbler and the dark-eyed junco are beginning their southern migration. No two species follow exactly the same path from beginning to end, but the ultimate objective of each member of the migratory bird family is the same—embarking on an arduous journey to its winter home. What triggers birds to begin their journey? How can they travel and endure such long distances? How do they know where to go? These questions have mystified people from the earliest times as seen in the writings of Homer and Aristotle. And while we have a better understanding of bird migration, there remain mysteries about this journey that maybe only the birds will ever know.

That ringing, that constant ringing, I can't get this incessant noise out of my head. Wow!!!!!! There go 4 birds in migratory formation. Oddly enough, as I am scratching out this story, birds of an unnatural variety are jetting outside my high-rise office window. It is that time of year again. Jets are buzzing the Chicago skyline—flying advertisements for the 2002 Chicago Air and Water Show. Did you know that the Chicago Air and Water Show is the oldest and largest free admission air and water exhibition of its kind in the United States? More than 2 million "birdwatchers" come out each year to see civilian and military craft perform their acrobatics on water and in the air.

It is that time of year again.

Thousands of members of a rare species, the green-chested medical student, are taking their initial steps towards becoming physician healers. What continues to motivate confident, yet inexperienced "young" people to embark on such an endeavor? How will they endure and persevere during this long journey? When confronted with hard choices, will they know which is the right path? These questions challenge, in part, the personal character and social support of each student. But, more importantly, as each new member is welcomed into the professional family of physicians, the answers to these and other questions often lie with the clan "elders" who have taken this journey before them. If you are a member of this species, seek out an elder in your school, and you will be the better for it. That incessant buzzing, I can't take it any more. Dang, today's young people show less respect for the experiential wisdom of their elders, and feel a greater sense of entitlement for everything. Oh get off your high horse, to get respect you have to show respect. Buzzzzzzzzzzzzzzz.

"Did you see Uncle Aud (pronounced "odd") with his plaid sport coat and lime green pants? Oh god, not another family picture."

A family is not genuine unless there is something dysfunctional about it—we all have a "crazy" uncle (or aunt or some eccentric or offbeat member) in our families. The expectations, roles, rituals, and idiosyncrasies of a professional family of physicians are much the same as those in a family related by blood. In a blood family, parents should know what is in their children's best interest. In the family of physicians, teachers must be responsible for properly educating and mentoring students on what it takes to be a good doctor. In a biological family, the conduct of 1 member reflects on the whole. In a professional family, the conduct of 1 member reflects on the whole. A family's teenagers rebel. Our profession's students and residents are increasingly more rebellious about issues ranging from student debt to residency work hours. Parents in a family need to know when to let their children make their own decisions. Medical faculty and administrators need to be responsive to the issues raised by students and residents, but they also must realize that medicine is a profession, and not an occupation. Uncle Aud, what about children who are adopted? Buzzzzzzzzzzz, that incessant buzzing, I can't stand it anymore. A family, related by blood or choice (adoption), doesn't hang out its dirty laundry for all to see. As a professional family, we, too, want the world to see only our good side. But in medicine, there are third parties—our patients—who can be harmed, and if we do not do an adequate job in self-regulation, then the public deserves to see our dirty linens. Remember young Skywalker, the action of 1 reflects on us all.

"Don't make me stop this car."

Remember those family trips you took as a kid. It is not hard to imagine what would happen when you combine 6 kids, 2 parents, 1 family station wagon during a long road excursion. When my parents took us on vacation, the calm and mature discourse in the family car—yeah, right—was a mix of Chinese and English. But nothing was said in the car that needed to be censored. Oh that (bleep) buzzing, I can't stand that (bleep) buzzing. As you start on your new and exciting road trip through medical school, remember to keep both arms inside the car, trust the driver, yell out when you need to stop for . . . anything, and be confident that you will eventually arrive at your destination.

I love you.

I don't know.

Are we there yet?

I hate you.

I am sorry.

I trust you.

Buzzzzzzzzzzzzzzz.



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