Portal de Periódicos da CAPES

Awards Season Yin and Yang

2010; Elsevier BV; Volume: 63; Issue: 2 Linguagem: Inglês

10.1016/j.bjps.2009.07.016

1878-0539

M. Felix Freshwater,

Diversity and Career in Medicine

We Americans love awards. We have them in entertainment including the Academy Awards, Golden Globe Awards, Emmy Awards, Tony Awards, MTV Awards, Grammy Awards, Country Music Awards, in more cerebral spheres of the arts we have the Pulitzer Prizes that include journalism, fiction, poetry and plays and in medicine we have the Lasker Prizes for research. The only things that Americans love more than the awards are awards shows. Indeed, we have a new type of television shows called 'reality TV' in which people compete to win cash or prizes. Plastic surgeons are not immune to this mania. Every national meeting begins with an awards ceremony. Named awards exist for everything ranging from the 'Best Paper' published in a journal in the prior year to the 'Best Research' submitted to a contest. There is not yet an award for 'Best Plastic Surgery on One's Self' and I hope that no surgeon tries to win that award by conducting a double-blinded experiment in which both of his eyes are blindfolded. I expect the mania to devolve to the ultimate award namely the 'Best Award of Plastic Surgery Awards'. June is the most common month for graduation in the United States. This week I attended two awards ceremonies. Monday night was an awards ceremony in New York for my high school and Saturday night was graduation for our plastic surgery residents. Stuyvesant High School is a pure meritocracy because it selects its students solely on the basis of an admissions examination. Approximately 3% of examinees are selected. All Stuyvesant graduates attend college. Stuyvesant is purported to have produced more Ph.D.'s and more Nobel Prize winners than any other high school in the United States. There were two speakers at the awards ceremony; the first was Federal District Judge Denny Chin, who told us that in one week he would be sentencing Bernard Madoff and described what Stuyvesant's impact was on his career. 1Available at http://en.wikipedia.org/wiki/Denny_Chin1Available at http://en.wikipedia.org/wiki/Denny_Chin I was the second speaker and my topic is relevant to plastic surgery because of our plastic surgery organizations' propensity to produce awards. My speech was called 'The Retrospectoscope':"By profession, I am a hand doctor. Before I operate on a hand, I evaluate my patient. Evaluation consists of diagnosing and prognosticating - predicting outcomes. Based upon my prediction of a patient's future, I decide what treatment to recommend. To sharpen my prognosticating skills, I use an instrument called a retrospectoscope. It is also called "The coulda woulda shoulda machine". It is an instrument that is frequently used in medicine and other fields. It is similar to a subatomic particle in that nobody has seen it, but everybody knows that it exists. It is a unique instrument because it has 100% accuracy. With the retrospectoscope one can learn a lot about the past.Pack rat that I am, I still have a copy of my graduation program that stated that it was the 105th graduation ceremony. Forty-five years ago this month my class graduated from Stuyvesant. Because this is an awards ceremony, I thought that it would be interesting to examine my class' graduation program with my retrospectoscope to see how accurate the grantors of awards were in 1964 in prognosticating. Many members of my class have achieved distinction in their fields. Did the awards given in 1964 predict future success?The Creative Writing award went to a graduate who attended Yale. In the 1995 and 2005 Yale Alumni Directory he stated that he was a promotional writer for the New York Times. Yes, he is writing creatively, but not in the sense of what his award meant.At least two of my classmates have achieved fame as fiction writers. Neither won any award at graduation. The first, Eric Lustbader, has written a series of 16 action thrillers with his own characters and four novels in the continuation of Robert Ludlum's Jason Bourne series.The second classmate has, according to his website, written 11 works including six New York Times best sellers. They are:The New Prince, Bum Rap, Power Plays, Vote.com, Rewriting History, Because He Could, Condi vs. Hillary, Behind the Oval Office, Off with Their Heads, Outrage and his latest Catastrophe.The second fiction writer was listed in our yearbook as Richard Morris, but now he is a Dick.Using the retrospectoscope on math awards produces equally interesting results.The gold medal in math was won by my friend Harvey who captained the Math team and was first in New York and fifth of 225,000 in the US and Canada in the Math Association of America Interscholastic contest. Harvey attended Columbia and got his Masters in Math at MIT. He switched coasts and became a healer of human conflict. He got his law degree from Berkley. Now he is a specialist in employment law.Two other classmates left graduation at Carnegie Hall with only their diplomas in hand. They had won no awards. They have a number of things in common. Both their last names begin with Z and although they went to different colleges both got their Ph.D.'s in math from Harvard in 1975, and both now live in Chicago.Sandy Zabell is a professor of statistics at Northwestern, who is probably best known to lay people for his work that established the statistical basis of DNA analysis in forensics.Bob Zimmer also lives in Chicago. He wrote two best selling math books "Essentials of Functional Analysis" and "Ergodic Theory and Semisimple Groups". Bob Zimmer, who never won an academic award at Stuyvesant, became a full professor and chairman of the math department at the University of Chicago and director of the Argonne National Laboratory. In 2002, Robert Zimmer, who did not attend an Ivy League undergraduate college, became the provost of Brown University and in 2006 he returned to Chicago as the 13th president of the University of Chicago.Were our principal and his staff poor prognosticators or is there some other explanation for the Retrospectoscope's results? To answer this question, let me tell you a story about a member of the class of 1963 . He had wanted to go to graduate school but because of the Vietnam War, he faced the prospect of being drafted, so instead he applied to and was accepted by a medical school. He describes his medical school education at Johns Hopkins and subsequent internship at Columbia. It would be polite to say that Hopkins and Columbia did not agree with him.He wrote:'I entered medical school by default. I was a terrible medical student, pained by constant exposure to the suffering of the ill and thwarted in my desire to do experiments. My clinical incompetence was immediately recognized by the faculty and deans. I could rarely, if ever, hear a heart murmur, never saw the retina, my glasses fell into an abdominal incision and finally, I sewed a surgeon's finger to a patient upon suturing an incision…. I was allowed to graduate medical school early with an M.D. if I promised never to practice medicine on live patients.As an intern in Pathology…. I kept this promise by performing autopsies. After a year in Pathology, I was asked by … the Chairman of Pathology, never to practice on dead patients.'You too can read this autobiography if you go to the link http://nobelprize.org/nobel_prizes/medicine/laureates/2004/axel-autobio.html and look for the autobiography of Richard Axel M.D., Stuyvesant Class of 1963, who won the Nobel Prize in Medicine in 2004.In the wonderful world of finance, one often hears the expression 'Past performance is no guarantee of future results'. Warren Buffet has said: 'If past history was all there was to the game, the richest people would be librarians.' The operative word is 'game'. It has to be approached as a game that is fun to do, something that you feel passionate about, not a job. That is the secret to success.Although I have not spoken to all the exemplars, my friend Harvey told me that math was no longer fun so he switched to law. Bob Zimmer has written that he started college as a physics major, but after spending 45 minutes trying to generate a sine wave on an oscilloscope, he switched to math. Last and certainly least, Dick Morris first had fun with election dirty tricks when he ran the Morris machine in the old Stuyvesant student government elections and he continues to consult for those seeking the highest office in the land, although the land no longer is the United States. 2According to his website http://www.dickmorris.com/blog/speaking-engagement/ Morris has "served as chief strategist for Mexico's reformer Vicente Fox in his upset victory in July, 2000 over the PRI after the party had ruled the nation for 71 years. He also was the chief strategist for the winning campaigns of Fernando de la Rua (Argentina), Jorge Battle (Uruguay), Chen (Taiwan) and, most recently, for Viktor Yushchenko, the Ukrainian presidential candidate who was poisoned during his campaign. He also handled the winning campaign for the new president of Mexico, Felipe Calderon."2According to his website http://www.dickmorris.com/blog/speaking-engagement/ Morris has "served as chief strategist for Mexico's reformer Vicente Fox in his upset victory in July, 2000 over the PRI after the party had ruled the nation for 71 years. He also was the chief strategist for the winning campaigns of Fernando de la Rua (Argentina), Jorge Battle (Uruguay), Chen (Taiwan) and, most recently, for Viktor Yushchenko, the Ukrainian presidential candidate who was poisoned during his campaign. He also handled the winning campaign for the new president of Mexico, Felipe Calderon."At this awards ceremony I would like to congratulate the graduates who will win awards, but remind everyone that it is still early in the game of life. Although it may take decades to discover who are the true winners. The true winners are those who are passionate in pursuing their goals." On Saturday night, the University of Miami/Jackson Memorial plastic surgery residents awarded me a plaque in recognition of my contributions as a voluntary faculty member. My acceptance speech described the application of one of Gillies' earliest principles to the educational process:"We are all descended from Sir Harold Gillies. Because Ralph Millard was Gillies' student, Tony Wolfe, Buster Mullin and I can claim Gillies as our plastic surgical grandfather. Because Michael Lewin was Gillies' student, your program director can proudly claim Gillies as his plastic surgical grandfather. Thus, Gillies is your plastic surgical great-grandfather and Tony, Buster, your program director and I are kissing second cousins.Most people know that one of Sir Harold's favorite sayings was 'Boy, Plastic Surgery is not easy…. It's the constant battle between beauty and blood supply'. 3Millard DR. Plastic peregrinations. Plast Reconstr Surg 1950;5;26–53.3Millard DR. Plastic peregrinations. Plast Reconstr Surg 1950;5;26–53. However, most people do not know that in 1920 Gillies wrote that,'In planning the restoration, function is the first consideration, and it is indeed fortunate that the best cosmetic results are, as a rule, only to be obtained when function has been restored'.Thus, we find that long before Gillies worried about blood supply he was concerned about function. He said, 'function is the first consideration', or to put in other words, function precedes form or form follows function. 4The phrase "form follows function" is based in a different artistic endeavor than plastic surgery, namely architecture. It was a 19th century American architect Louis Sullivan who in an essay entitled "The Tall Office Building Artistically Considered" wrote: "It is the pervading law of all things organic and inorganic, of all things physical and metaphysical, of all things human and all things super-human, of all true manifestations of the head, of the heart, of the soul, that the life is recognizable in its expression, that form ever follows function. This is the law."4The phrase "form follows function" is based in a different artistic endeavor than plastic surgery, namely architecture. It was a 19th century American architect Louis Sullivan who in an essay entitled "The Tall Office Building Artistically Considered" wrote: "It is the pervading law of all things organic and inorganic, of all things physical and metaphysical, of all things human and all things super-human, of all true manifestations of the head, of the heart, of the soul, that the life is recognizable in its expression, that form ever follows function. This is the law."The graduating residents have learned that form follows function. How do I know this?Let me be very specific and talk about education, after all I just received this award. If you look at the forms that the division generates you would think that I have nothing to do with resident education let alone be praiseworthy of an award. Why do I make this claim?Examine the forms containing the names of mentors, residents' advisors for their grand rounds presentations, grand rounds lecturers or didactic session teachers for the past academic year and you will see that my name is missing from all the forms. All these forms are preserved for posterity ready to be retrieved for any inspector arriving to review the residency.Yet, despite my name being missing from the forms that are supposed to document the educational activities of this residency, our graduating residents have realized that there is little if any relationship between the appearance of a form and the function of graduate medical education. They have realized that it is more important that teaching function in reality than exist as words on a form. They have discovered that function precedes form.To the graduating residents I say that Gillies would be proud of you, his plastic surgical great-grandchildren, because you have learned his lesson well. I am proud to have earned your trust and respect and congratulate you.To the incoming first and second year residents, I say this. Your bodies belong to Jackson for 80 hours a week, but your brains belong to yourselves for all 168 hours of the week. Use your brains to discover the vast scope of educational opportunities available in Miami during the 88 hours a week that your bodies are free and you too will realize as these graduates have that function triumphs over form."