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February 12, 1992

Distorter Vows to Veto Cute Cracks

Author Affiliations

The Johns Hopkins University School of Medicine Baltimore, Md

JAMA. 1992;267(6):807-808. doi:10.1001/jama.1992.03480060053027

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In Reply.  —Make no mistake: satire is risky business. These letters illustrate just how risky it can be. Drs McLean and Stein worry that my essay will do for medical training what Andre Agassi has done for American tennis or what Michael Milken has done for Wall Street. In a warmly collegial fashion, Dr Pierach reprimands me for my flippant attitude toward urinary solutes and reminds me that investigative diligence is required to diagnose uncommon disorders such as porphyria.Okay, I'll play it straight. I couldn't agree more. Medical training should foster honesty, thoroughness, selflessness, and dedication; the bottom line should be "substance above style." In truth, I intended the essay to satirize the "me" attitude of the 1980s. Under the psychological and financial stress of training, even the most dedicated residents may become cynical about medicine as a vocation and lapse into a self-centered careerism. I worry that we