What would happen with the consumption voucher (消費券) of $1000 ?
Does it help local business ? What an idea ! We all know people would pay with the voucher and save up the money.
For those who are not familiar with the history of Europe, there was a time when South America was newly discovered and gradually conquered by the Spanish people. There was no short of good silver mines in Peru and areas around. In fact, when Francisco Pizarro first defeated the Inca Emperor and took over the place, he was amazed to find local children have lots of silver toys and decorations. When tons of silvers were shipped back to his home country, however, the Spanish king did not grow richer. In fact, the whole Europe saw drastic inflation and a marked fall in the price of silver - a simple result of excessive supply.
Consumption voucher and other kinds of money in effect follow the same rule.
PS. For myself, I would try to support local economy and buy a new chair for myself in the office. The one that I'm sitting on is 13-year old and I inherited it from my predecessor.
Sunday, November 30, 2008
Saturday, November 29, 2008
Controversy
Appreciating a poster announcing the grand round of our sister department.
"Current controversies in the management of toe diseases."
To be given by Professor J, head of the division of scalp problem.
And therefore I know where the controversies are - it's all written on the poster.
Thank goodness this is not the memorial lecture of the King of the round table. I'm not sure how His Highness feels when he sees his knights fight with each other.
****************
Talking about the scalp, although I may not like the King very much, it is His Highness who taught me the meaning of a scalp doctor when I was the assistant intern of his team - and the intern who took the leave has become the chairman now !
"Current controversies in the management of toe diseases."
To be given by Professor J, head of the division of scalp problem.
And therefore I know where the controversies are - it's all written on the poster.
Thank goodness this is not the memorial lecture of the King of the round table. I'm not sure how His Highness feels when he sees his knights fight with each other.
****************
Talking about the scalp, although I may not like the King very much, it is His Highness who taught me the meaning of a scalp doctor when I was the assistant intern of his team - and the intern who took the leave has become the chairman now !
Friday, November 28, 2008
Fail
RT, one of our medical officers, failed in the recent MRCP examination - we are all worried.
No, we have very little doubt she would pass next time. After all, who hasn't failure of one kind or another in their life ? I always quote the example of LSF, one of our consultant and previous division head, passed the membership on the sixth attempt. So what ? (I suspect he is secretly quite proud of it.) He moved on in his career like rocket, and turned into a well-known hawk by the time he became the examiner !
(Our previous professor of child psychiatry told me this is called Dracula syndrome.)
But we are concerned when our little girl would leave the dark room she builds for herself, , when she would stand up a cheerful doctor again, and when she would stopped looking back the long dreadful night ...
when the dawn is one minute ahead.
PS. You know what: I failed English examination twice when I was in high school. That's not a reason to stop writing - that's the one to write more !
No, we have very little doubt she would pass next time. After all, who hasn't failure of one kind or another in their life ? I always quote the example of LSF, one of our consultant and previous division head, passed the membership on the sixth attempt. So what ? (I suspect he is secretly quite proud of it.) He moved on in his career like rocket, and turned into a well-known hawk by the time he became the examiner !
(Our previous professor of child psychiatry told me this is called Dracula syndrome.)
But we are concerned when our little girl would leave the dark room she builds for herself, , when she would stand up a cheerful doctor again, and when she would stopped looking back the long dreadful night ...
when the dawn is one minute ahead.
PS. You know what: I failed English examination twice when I was in high school. That's not a reason to stop writing - that's the one to write more !
Thursday, November 27, 2008
Kurukawa
Read a small book during the weekend. It was [讀書術] written by Yasumasa Kurukawa (黑川康正).
I read it at least a handful of times before. It is, in fact, one of the few books that I deliberately thumb through again every few years. Well, you may find the title somewhat explicit. It is written by a Japanese expert in public examination, and there is no commandment of life or other great topics in philosophy. All it has is a list of practical ways to gather and organize information for a profession.
But I consider that one of the most important capabilities to master.
PS. A poetic subject of our current medical students is Life Long Learning Skill, which largely focuses on gathering information from Internet and interpretation of medical literature. In reality the most important aspect of this subject, in its literal sense at least, is how to handle information overload.
I read it at least a handful of times before. It is, in fact, one of the few books that I deliberately thumb through again every few years. Well, you may find the title somewhat explicit. It is written by a Japanese expert in public examination, and there is no commandment of life or other great topics in philosophy. All it has is a list of practical ways to gather and organize information for a profession.
But I consider that one of the most important capabilities to master.
PS. A poetic subject of our current medical students is Life Long Learning Skill, which largely focuses on gathering information from Internet and interpretation of medical literature. In reality the most important aspect of this subject, in its literal sense at least, is how to handle information overload.
Wednesday, November 26, 2008
Thermos
Just finished with the licentiate examination.
The drama in itself was smooth. Nonetheless, in the middle of the morning session, a hospital amah appeared. She was pushing a trolley of thermos bottles - it was time to have some fresh hot water for the patients.
AL, our chairman's secretary, was taken aback, "Why are they so obsessive in changing the thermos bottles ?"
"That's the sign of a modern civilized society." My answer was as vague as the speech of Alan Greenspan.
You know what, before the mid 1970s, patients in a public hospital needed to give red-pocket money (利是) to hospital amahs in order to get some hot water. It was therefore a great step forward with the establishment of ICAC: thermos bottles are changed regularly and available to all patients - free of charge.
Despite all the hiccups, our society did advance a lot.
The drama in itself was smooth. Nonetheless, in the middle of the morning session, a hospital amah appeared. She was pushing a trolley of thermos bottles - it was time to have some fresh hot water for the patients.
AL, our chairman's secretary, was taken aback, "Why are they so obsessive in changing the thermos bottles ?"
"That's the sign of a modern civilized society." My answer was as vague as the speech of Alan Greenspan.
You know what, before the mid 1970s, patients in a public hospital needed to give red-pocket money (利是) to hospital amahs in order to get some hot water. It was therefore a great step forward with the establishment of ICAC: thermos bottles are changed regularly and available to all patients - free of charge.
Despite all the hiccups, our society did advance a lot.
Tuesday, November 25, 2008
Interest
Don't get me wrong. By no means I think by progressing from stage 1 to 4 that I described yesterday one would become a better physician.
In fact, quite the opposite. (At least it is not a "linear" relationship.)
Think. A doctor would remain interested in medical practice when he sees the real world and progresses from stage 1 to 3. Once he moves further and appreciates the similarity between patients, he does research and writes papers but he losses interest in (taking care of) individual subjects.
That's the point: by then, patients become subjects.
That's why I always consider a professor of medicine who publishes widely is usually not a good clinician.
PS. Of course there are exceptions. After all there are schizophrenics within the "normal" population.
In fact, quite the opposite. (At least it is not a "linear" relationship.)
Think. A doctor would remain interested in medical practice when he sees the real world and progresses from stage 1 to 3. Once he moves further and appreciates the similarity between patients, he does research and writes papers but he losses interest in (taking care of) individual subjects.
That's the point: by then, patients become subjects.
That's why I always consider a professor of medicine who publishes widely is usually not a good clinician.
PS. Of course there are exceptions. After all there are schizophrenics within the "normal" population.
Monday, November 24, 2008
Simple
Contrary to what I said yesterday, it is not uncommon for amateurish medical practitioners to conclude things are often simple.
One favorite story told by WB, a friend and previous colleague of mine, is most illustrative. For a short while he was working with someone who "rotated" to the medical unit for certain months in order to fulfill the training of another specialty. After a week or so in medicine, the new comer made a casual remark to WB, "Internal medicine is not all that difficult - all you see are nothing but heart failure and chronic bronchitis and stroke and just a handful of conditions."
"Certainly," contrary to his usual self, my friend tried to be polite, "If you missed all other diagnoses !"
That's an extreme case of course. In fact most students are fascinated with all those rarities in medicine. I fancy there are several stages of maturation of a physician:
One favorite story told by WB, a friend and previous colleague of mine, is most illustrative. For a short while he was working with someone who "rotated" to the medical unit for certain months in order to fulfill the training of another specialty. After a week or so in medicine, the new comer made a casual remark to WB, "Internal medicine is not all that difficult - all you see are nothing but heart failure and chronic bronchitis and stroke and just a handful of conditions."
"Certainly," contrary to his usual self, my friend tried to be polite, "If you missed all other diagnoses !"
That's an extreme case of course. In fact most students are fascinated with all those rarities in medicine. I fancy there are several stages of maturation of a physician:
- Interested in rare things.
- Interested in picking up rare problems in common conditions.
- Interested in the difference between patients with the same common condition.
- Interested in the similarity between patients with the same common condition.
Sunday, November 23, 2008
Complexity
One hot topic amongst extra-terrestrials recently is the plan of change in the hospital funding system.
That sounds logical: for sure one should allocate the resource according not only to the number but also the complexity of the cases.
The problem is: how do we define complexity ? I shall not elaborate on the problem on the use of computer coding for diagnosis and procedure as the yardstick. The real fundamental problem is: The proposed system awards physical activity rather than the effect. Is a patient who had a whole body MRI (or other autopsy-equivalent investigation) and needs to stay in hospital for weeks more complex than another who is sent home by the consultant the next morning after admission ?
No, the two patients may well have the same problem - just that the latter one is cared by a capable and confident physician, who spots the problem right from the beginning and starts effective treatment.
(Oh, it is somewhat like Philo Vance in The Benson Murder Case. The whole of the New York Police Department had no clue on who the murderer was despite working like chickens of no head for several weeks - but the solution was crystal clear within half an hour after the great detective arrived at the scene. An auditor outside the solar system would conclude: You just solved a simple case !)
Well, with the new system, a capable but realistic physician would not need to think - even if he could spot right at the beginning what the problem is, he would go for all expensive and useless things to prove the case is difficult. (In reality he will actually screen for all occult comorbid conditions to make the case difficult.)
As Lao Zi (老子) said: 聖人不死,大盜不止.
That sounds logical: for sure one should allocate the resource according not only to the number but also the complexity of the cases.
The problem is: how do we define complexity ? I shall not elaborate on the problem on the use of computer coding for diagnosis and procedure as the yardstick. The real fundamental problem is: The proposed system awards physical activity rather than the effect. Is a patient who had a whole body MRI (or other autopsy-equivalent investigation) and needs to stay in hospital for weeks more complex than another who is sent home by the consultant the next morning after admission ?
No, the two patients may well have the same problem - just that the latter one is cared by a capable and confident physician, who spots the problem right from the beginning and starts effective treatment.
(Oh, it is somewhat like Philo Vance in The Benson Murder Case. The whole of the New York Police Department had no clue on who the murderer was despite working like chickens of no head for several weeks - but the solution was crystal clear within half an hour after the great detective arrived at the scene. An auditor outside the solar system would conclude: You just solved a simple case !)
Well, with the new system, a capable but realistic physician would not need to think - even if he could spot right at the beginning what the problem is, he would go for all expensive and useless things to prove the case is difficult. (In reality he will actually screen for all occult comorbid conditions to make the case difficult.)
As Lao Zi (老子) said: 聖人不死,大盜不止.
Saturday, November 22, 2008
唏噓
The news of lemming is: the classical periodic surge in the population of this lovely species has disappeared, and recent research showed that it is related to climatic change.
In short, lemming lives happily when warmth from the ground melts a small layer of snow above it, leaving a gap between ground and snow. This space provides warmth and food (i.e. moss on stones) and protects them from predators. With a warmer temperature, snow melts and refreezes, producing a sheet of ice that exposes them to foxes and prevents lemmings from feeding on the moss.
*************************
I cannot agree more with VW - the article is an enjoyable piece of intelligence. Here is the cover email that he sent me with the paper:
"When I was a little boy, I learnt from a scientific book that lemmings were genetically programmed to migrate through a certain path. After the change of landscape in Norway, the lemmings just jumped into the water and got drowned. I cannot express my complex emotion when I read this article last week. On one hand, I have been so wrong for more than 20 years. On the other hand, I was filled with overwhelming joy for finding out the truth. It would be a blessing if I can have many such encounters in medicine in the future.
I send you this because not many others think the story is interesting. I guess my daughter would, but I need to wait a few years."
I could understand his feeling.
In short, lemming lives happily when warmth from the ground melts a small layer of snow above it, leaving a gap between ground and snow. This space provides warmth and food (i.e. moss on stones) and protects them from predators. With a warmer temperature, snow melts and refreezes, producing a sheet of ice that exposes them to foxes and prevents lemmings from feeding on the moss.
*************************
I cannot agree more with VW - the article is an enjoyable piece of intelligence. Here is the cover email that he sent me with the paper:
"When I was a little boy, I learnt from a scientific book that lemmings were genetically programmed to migrate through a certain path. After the change of landscape in Norway, the lemmings just jumped into the water and got drowned. I cannot express my complex emotion when I read this article last week. On one hand, I have been so wrong for more than 20 years. On the other hand, I was filled with overwhelming joy for finding out the truth. It would be a blessing if I can have many such encounters in medicine in the future.
I send you this because not many others think the story is interesting. I guess my daughter would, but I need to wait a few years."
I could understand his feeling.
Friday, November 21, 2008
Lemming
Met VW after lunch. He asked, rather suddenly, "Have you heard of the recent story about lemmings ?"
My face showed plainly that I did not.
He went on, "It's in Nature last week."
I considered for a while, but could not recall what he was talking about. Later the day he showed me an article by Tim Coulson and Aurelio Malo in the November 6, 2008 issue of Nature.
***********************
The story goes like this:
Norway lemmings live through winters beneath the snow and feed mostly on moss. The myth of lemming mass suicide is long-standing and has been widely advocated - generally in sensational literature.
In fact that's not the case. Lemmings have remarkable capability of reproduction. When the lemming population becomes too big and there is a lack of food, they will migrate in large groups. Since lemmings could swim, it is not uncommon to have large migrating groups trying to cross a body of water in search of a new habitat - and they die of exhaustion.
***********************
That sounds familiar, eh ? Why do so many amateurish investors commit mass suicide in a maniac stock market ?
They've never thought of dying !
And why do so many of our graduates jump to into the ice-cold water of certain specialties ?
"The word competition is not in my dictionary."
Your dictionary has very few words in order to suite your level, I know.
My face showed plainly that I did not.
He went on, "It's in Nature last week."
I considered for a while, but could not recall what he was talking about. Later the day he showed me an article by Tim Coulson and Aurelio Malo in the November 6, 2008 issue of Nature.
***********************
The story goes like this:
Norway lemmings live through winters beneath the snow and feed mostly on moss. The myth of lemming mass suicide is long-standing and has been widely advocated - generally in sensational literature.
In fact that's not the case. Lemmings have remarkable capability of reproduction. When the lemming population becomes too big and there is a lack of food, they will migrate in large groups. Since lemmings could swim, it is not uncommon to have large migrating groups trying to cross a body of water in search of a new habitat - and they die of exhaustion.
***********************
That sounds familiar, eh ? Why do so many amateurish investors commit mass suicide in a maniac stock market ?
They've never thought of dying !
And why do so many of our graduates jump to into the ice-cold water of certain specialties ?
"The word competition is not in my dictionary."
Your dictionary has very few words in order to suite your level, I know.
Thursday, November 20, 2008
Moai
The more I think of the upcoming infra-structure construction, the more I have a flash-back of the Easter Island.
The story was simple: This lovely place at the south of Pacific used to be occupied by a tribe of hard-working people. The place was fertile and, using the jargon of Adam Smith, the product of the land could sustain a considerable population - probably a few times more than the number of farmer that was needed.
And then the leader of the tribe got a grandiose habit to build gigantic Moai - the construction of which required much labour, chopping down woods or things alike that hurts the environment. When the forest was turned down, drought set in, and there was no material to build boats for fishing (or to fly). It was followed by famine and civil war and all possible tragedies.
Many authorities (for example, Jared Diamond) found it difficult to imagine why the leaders of the Easter Island allowed all these to happen: they should be sufficiently smart to foresee the inevitable disaster. (Even though they were not geologists and did not appreciate the relation between forest and water supply, the effect on fishing was immediately obvious.)
But we are wrong. More likely the leaders did not make such a decision - at least not deliberately. Since a (probably small) portion of the population could work as farmer and produce enough food for the whole tribe, the remaining people needed to find something to do to earn their living. In those days there was nothing called "industry" or "overseas trading".
Yes, it was a problem of unemployment.
And therefore they roared and insisted their leaders to build more Moai.
And the rest is history.
PS. You may ask why didn't those people find something fruitful to do. Well, there is an old saying: If the only tool you have is a hammer, every problem comes up needing a nail.
The story was simple: This lovely place at the south of Pacific used to be occupied by a tribe of hard-working people. The place was fertile and, using the jargon of Adam Smith, the product of the land could sustain a considerable population - probably a few times more than the number of farmer that was needed.
And then the leader of the tribe got a grandiose habit to build gigantic Moai - the construction of which required much labour, chopping down woods or things alike that hurts the environment. When the forest was turned down, drought set in, and there was no material to build boats for fishing (or to fly). It was followed by famine and civil war and all possible tragedies.
Many authorities (for example, Jared Diamond) found it difficult to imagine why the leaders of the Easter Island allowed all these to happen: they should be sufficiently smart to foresee the inevitable disaster. (Even though they were not geologists and did not appreciate the relation between forest and water supply, the effect on fishing was immediately obvious.)
But we are wrong. More likely the leaders did not make such a decision - at least not deliberately. Since a (probably small) portion of the population could work as farmer and produce enough food for the whole tribe, the remaining people needed to find something to do to earn their living. In those days there was nothing called "industry" or "overseas trading".
Yes, it was a problem of unemployment.
And therefore they roared and insisted their leaders to build more Moai.
And the rest is history.
PS. You may ask why didn't those people find something fruitful to do. Well, there is an old saying: If the only tool you have is a hammer, every problem comes up needing a nail.
Wednesday, November 19, 2008
Construction
One favorite strategy that our government - and many others - uses to tackle the recent tsunami is to put up more projects on infrastructure construction.
That sounds great: Expanding the government expenditure would give a kick to the gasping local economy; we could also bring down the unemployment. After all, it is of the public interest to build more roads, bridges, and culture centers alike.
But hold on. If there is such a real demand on those infrastructures, government does not have to make the lead; business people would - for the sake of profit.
For me, it is of course a nice thing to build a highway and connect my hut in the suburb to the downtown. It is, however, a waste of public resource if the government uses tax-payers' money to do such a thing.
And, more than that. When those infrastructures are neither cost-effective nor necessary, wouldn't it be an unworthy thread to the environment ?
Now, you see: John Keynes is the worst enemy of the fans of environment protection.
But, alas, many of these fans just disappear at a convenient time; others turn around and put their heads in some trivial matters.
That sounds great: Expanding the government expenditure would give a kick to the gasping local economy; we could also bring down the unemployment. After all, it is of the public interest to build more roads, bridges, and culture centers alike.
But hold on. If there is such a real demand on those infrastructures, government does not have to make the lead; business people would - for the sake of profit.
For me, it is of course a nice thing to build a highway and connect my hut in the suburb to the downtown. It is, however, a waste of public resource if the government uses tax-payers' money to do such a thing.
And, more than that. When those infrastructures are neither cost-effective nor necessary, wouldn't it be an unworthy thread to the environment ?
Now, you see: John Keynes is the worst enemy of the fans of environment protection.
But, alas, many of these fans just disappear at a convenient time; others turn around and put their heads in some trivial matters.
Tuesday, November 18, 2008
History
I was recently asked to write a chapter for a book on the history of dialysis.
Once started writing, I began to regret: It is not easy to find suitable reference from the Internet.
On a morning last week, the server of the university computer system was down. I looked at the half-finished manuscript and began to wonder what I could do. Naturally I went through the small library in my office - and a small paperback volume attracted my attention.
The title is: Peritoneal Dialysis - Summary from the Second European Meeting.
By thumbing through the pages I find a wealth of information on the development and change in our practice since the last millennium. In no time I understand how to finish with the rest of the chapter.
The trouble is: this book was given to me by the man who still had a moustache - when I first became his trainee some 15 years ago.
And it was meant to be an up-to-date review of the subject at that time !
Time flies.
How depressing.
Once started writing, I began to regret: It is not easy to find suitable reference from the Internet.
On a morning last week, the server of the university computer system was down. I looked at the half-finished manuscript and began to wonder what I could do. Naturally I went through the small library in my office - and a small paperback volume attracted my attention.
The title is: Peritoneal Dialysis - Summary from the Second European Meeting.
By thumbing through the pages I find a wealth of information on the development and change in our practice since the last millennium. In no time I understand how to finish with the rest of the chapter.
The trouble is: this book was given to me by the man who still had a moustache - when I first became his trainee some 15 years ago.
And it was meant to be an up-to-date review of the subject at that time !
Time flies.
How depressing.
Monday, November 17, 2008
Seizure
Another recent seizure attack of the local population is the scandal of Lehman minibond - our honourable members of the legislative council decide to set up a committee and investigate into the matter.
That's a bad sign.
I will not elaborate on the possible effect to the finanical system - that's all done by the few who voted against the proposal. It's more a worry of the delirium of the others on some fundamental principle of a government.
Yes, I agree genuine Trias Politica (三權分立) is often not feasible. Nonetheless it is usually a combination of legislature and executive powers while leaving the judicature independent - the last being the founding stone of a civilized society.
And, when a legislative council does not put its effort on improving the rule of the game but tries to become a judge outside the court, what's the difference between their members (and we !) and those barbarians who stone to death any (suspected) thief or prostitute that they arrest ?
Well, one glorious reason that was put up for this investigation outside the court was "正義得到彰顯". My goodness, one should always be skeptical when someone claims to be doing things for justice. After all, do we know what justice is ?
The Chongzhen Emperor (崇禎) quoted (almost) the same phrase when Yuan Chonghuan (袁崇煥) was cut into pieces by the epileptic Beijing citizens.
That's a bad sign.
I will not elaborate on the possible effect to the finanical system - that's all done by the few who voted against the proposal. It's more a worry of the delirium of the others on some fundamental principle of a government.
Yes, I agree genuine Trias Politica (三權分立) is often not feasible. Nonetheless it is usually a combination of legislature and executive powers while leaving the judicature independent - the last being the founding stone of a civilized society.
And, when a legislative council does not put its effort on improving the rule of the game but tries to become a judge outside the court, what's the difference between their members (and we !) and those barbarians who stone to death any (suspected) thief or prostitute that they arrest ?
Well, one glorious reason that was put up for this investigation outside the court was "正義得到彰顯". My goodness, one should always be skeptical when someone claims to be doing things for justice. After all, do we know what justice is ?
The Chongzhen Emperor (崇禎) quoted (almost) the same phrase when Yuan Chonghuan (袁崇煥) was cut into pieces by the epileptic Beijing citizens.
Sunday, November 16, 2008
Resonance
When the limbic system of a large number of people develops in-phase electric current and becomes resonant, it ends up in a political pressure.
Therefore it is so easy to gain support and have our names removed from all the places in the recent incident.
The same is true for the recent story on melamine. Do you know what is the most common and serious medical problem resulting from its contamination in our food ?
No, not kidney stone.
Not cancer either.
It is the delay in diagnosis of many other disease (for example, by ultrasound or other X-ray) - because the effort of many radiologists, together with the available machines, are diverted to the screening program for people who drink milk from China.
Well, if there were actually many cases of those plastic stones, I agree the resource is well spent. But if the program is largely for relieving the anxiety of many mothers and the general public, it may be more cost-effective to buy some alprazolam (or any other anxiolytic agent) and add it to their drinking water ...
... oh, and the coffee and red wine of our highly respected members of the legislative council.
Therefore it is so easy to gain support and have our names removed from all the places in the recent incident.
The same is true for the recent story on melamine. Do you know what is the most common and serious medical problem resulting from its contamination in our food ?
No, not kidney stone.
Not cancer either.
It is the delay in diagnosis of many other disease (for example, by ultrasound or other X-ray) - because the effort of many radiologists, together with the available machines, are diverted to the screening program for people who drink milk from China.
Well, if there were actually many cases of those plastic stones, I agree the resource is well spent. But if the program is largely for relieving the anxiety of many mothers and the general public, it may be more cost-effective to buy some alprazolam (or any other anxiolytic agent) and add it to their drinking water ...
... oh, and the coffee and red wine of our highly respected members of the legislative council.
Saturday, November 15, 2008
陰影
In response to my blog on doctor's name, EW - a friend of mine and a regular audience of this site - argued that with our limited resource, we shouldn't ask for too much.
He may be right, but one should try to make the best use of sow's ear and have a nice purse - albeit not a silk one.
**************************
But why does the limbic system of so many of us ring an alarm when our name is put down black-and-white by the others ?
I am not sure. One vivid scenario comes to my mind is (those usually naughty) kindergarten or primary school students have their names being jot down by their teacher. Alas, it is a symbol of doing something wrong - and having punishment not long later.
Sigmund Freud was right: It is a kind of psychological trauma from the experience in childhood.
PS. Psychoanalysis makes depression worse (and induces schizophrenia), I know.
He may be right, but one should try to make the best use of sow's ear and have a nice purse - albeit not a silk one.
**************************
But why does the limbic system of so many of us ring an alarm when our name is put down black-and-white by the others ?
I am not sure. One vivid scenario comes to my mind is (those usually naughty) kindergarten or primary school students have their names being jot down by their teacher. Alas, it is a symbol of doing something wrong - and having punishment not long later.
Sigmund Freud was right: It is a kind of psychological trauma from the experience in childhood.
PS. Psychoanalysis makes depression worse (and induces schizophrenia), I know.
Friday, November 14, 2008
Material
One obvious loophole of my discussion yesterday is: Why don't we make good use of the years in medical school to ensure the graduates to be capable of ordering sound investigations and prescribing effective treatment ?
Well, there are many practical and political difficulties (excuses). Nonetheless, on major question is: How could we ensure a student learn a particular thing ?
By putting it in the examination, of course. (Alas, that's what our educationalists call Outcome-Oriented Teaching.)
There comes the problem: How could we examine those practical aspects ?
No, don't be silly. It's not as easy as you imagine to test how a student order investigation and prescribe treatment in a real-life manner. "Which one of the following five treatment options would you choose ?" Have you ever seen a patient giving you options ?
With some grey hairs and wrinkles, we know very well whether a treatment order is reasonable or potentially lethal - but it is almost impossible to fit it in a (well-defined 10-point) marking scheme.
But we need to be fair ! We should therefore confine ourselves to reproducible scenarios and rigid marking schemes ...
... Things that could be counted, not those that count.
Well, there are many practical and political difficulties (excuses). Nonetheless, on major question is: How could we ensure a student learn a particular thing ?
By putting it in the examination, of course. (Alas, that's what our educationalists call Outcome-Oriented Teaching.)
There comes the problem: How could we examine those practical aspects ?
No, don't be silly. It's not as easy as you imagine to test how a student order investigation and prescribe treatment in a real-life manner. "Which one of the following five treatment options would you choose ?" Have you ever seen a patient giving you options ?
With some grey hairs and wrinkles, we know very well whether a treatment order is reasonable or potentially lethal - but it is almost impossible to fit it in a (well-defined 10-point) marking scheme.
But we need to be fair ! We should therefore confine ourselves to reproducible scenarios and rigid marking schemes ...
... Things that could be counted, not those that count.
Thursday, November 13, 2008
Wage
The major reason for a lengthy medical education is to maintain the wage of doctors.
I shall not elaborate here the major determinants of wage for any occupation - suffice to say it depends on the degree of dexterity, extend of physical (and mental) exertion, risk of fluctuation in income, and social position associated with the job.
You may say: That's the point ! Physicians need much mental (and probably physical nowadays) exertion, and we need to be very knowledgeable to achieve the task. The time of a doctor should be better spent in ordering tests, interpreting results, prescribing treatment, and performing procedures - not doing ECGs or typing discharge summaries.
Alas, don't be naive. Do you seriously think fresh graduates from medical school could order sound investigations and prescribe safe (let aside effective) treatment ? It takes some more years of training and experience. Moreover, do you think we need that many doctors if they only have to do the rosy tasks ?
And therefore we need people with five or six years of medical education to do ECG and other simple donkey job. "A long term of apprenticeship restrains (the competition in employment) more indirectly, but as effectually, by increasing the expense of education." (See Adam Smith, The Wealth of Nations, Book I, Chapter X.)
PS. In fact we are heading that direction. Over the years the wage of junior doctors come down a lot - much donkey work is delegated to nurses and paramedics; doctors are given less demanding a task but also a rapidly vanishing degree of freedom to practice independently, and specialty college replaces medical school as the barrier to minimize competition of practising medicine (which is the most effective means to keep the wage high).
But, look, with this argument, the wage is high for (senior) specialists only.
I shall not elaborate here the major determinants of wage for any occupation - suffice to say it depends on the degree of dexterity, extend of physical (and mental) exertion, risk of fluctuation in income, and social position associated with the job.
You may say: That's the point ! Physicians need much mental (and probably physical nowadays) exertion, and we need to be very knowledgeable to achieve the task. The time of a doctor should be better spent in ordering tests, interpreting results, prescribing treatment, and performing procedures - not doing ECGs or typing discharge summaries.
Alas, don't be naive. Do you seriously think fresh graduates from medical school could order sound investigations and prescribe safe (let aside effective) treatment ? It takes some more years of training and experience. Moreover, do you think we need that many doctors if they only have to do the rosy tasks ?
And therefore we need people with five or six years of medical education to do ECG and other simple donkey job. "A long term of apprenticeship restrains (the competition in employment) more indirectly, but as effectually, by increasing the expense of education." (See Adam Smith, The Wealth of Nations, Book I, Chapter X.)
PS. In fact we are heading that direction. Over the years the wage of junior doctors come down a lot - much donkey work is delegated to nurses and paramedics; doctors are given less demanding a task but also a rapidly vanishing degree of freedom to practice independently, and specialty college replaces medical school as the barrier to minimize competition of practising medicine (which is the most effective means to keep the wage high).
But, look, with this argument, the wage is high for (senior) specialists only.
Wednesday, November 12, 2008
Work
While waiting for some X-ray procedures of a patient, KT - one of our medical officers - sighed, "Why do we need a doctor to do ECG and all the clerical work ? You can train an assistant to do so in two months."
I gave a light-hearted reply, "Well, what proportion of our work really need the training of five years in a medical school ?"
In fact not much. Even for those often-considered precious elements of medical practice, such as physical examination, ordering of investigations, and drug prescription, you don't really need a full 5 or 6 years of medical education. In United States and many other countries, there are physician assistants who, after 2 years of medical education, could practice as primary care provider - and with satisfactory result. The appearance of "In-Store Clinics" in some states of America further shows that we could safely cover a substantial portion of primary care practice by minimally-trained people who follow well defined practice protocols (see Bohmer R. N Engl J Med 2007 February 22).
Then, what's the point of having such an elaborated medical education ?
I gave a light-hearted reply, "Well, what proportion of our work really need the training of five years in a medical school ?"
In fact not much. Even for those often-considered precious elements of medical practice, such as physical examination, ordering of investigations, and drug prescription, you don't really need a full 5 or 6 years of medical education. In United States and many other countries, there are physician assistants who, after 2 years of medical education, could practice as primary care provider - and with satisfactory result. The appearance of "In-Store Clinics" in some states of America further shows that we could safely cover a substantial portion of primary care practice by minimally-trained people who follow well defined practice protocols (see Bohmer R. N Engl J Med 2007 February 22).
Then, what's the point of having such an elaborated medical education ?
Tuesday, November 11, 2008
Lead
The same problem of choosing a topic also happens when we decide what to teach our medical students. Should we teach what they prefer, or should we decide what is important ?
You may think that's simple: Of course the faculty should decide - how could our younger generation know what is important in the future ?
But students are our customers ! (That sounds crazy, but many extra-terrestrials take it as the serious official view.) With their feedback years after years the university is slowly giving way. We put less emphasis on the teaching of basic science (i.e. anatomy and physiology), we introduce clinical skills early, and we take away many excellent - but with an arm-breaking weight, I agree - textbooks from their shelf.
"We should listen to them - they are on the spot and know what's important." Creatures living outside the solar system explain.
On that they are wrong. Students are not on the spot - practising doctors are. Go and ask any medical student what good is learning anatomy. None what-so-ever - until you become a surgeon or radiologist.
By then you would certainly become Franz Kafka (in The Trial) and say, "Since it is there and it's so important, why don't you tell me earlier ?"
You may think that's simple: Of course the faculty should decide - how could our younger generation know what is important in the future ?
But students are our customers ! (That sounds crazy, but many extra-terrestrials take it as the serious official view.) With their feedback years after years the university is slowly giving way. We put less emphasis on the teaching of basic science (i.e. anatomy and physiology), we introduce clinical skills early, and we take away many excellent - but with an arm-breaking weight, I agree - textbooks from their shelf.
"We should listen to them - they are on the spot and know what's important." Creatures living outside the solar system explain.
On that they are wrong. Students are not on the spot - practising doctors are. Go and ask any medical student what good is learning anatomy. None what-so-ever - until you become a surgeon or radiologist.
By then you would certainly become Franz Kafka (in The Trial) and say, "Since it is there and it's so important, why don't you tell me earlier ?"
Monday, November 10, 2008
Topic
"Didn't we have the same topic in this conference last year ? Why do we have it again ?" Our man from Pluto asked - in the middle of the conference organizing committee.
A few of us hurried to explain, "Em... Two drug companies wish to sponsor the symposium, and that's the topic that they specify."
Of course that's the case. There are new products in that area and our "business partners" are just too eager to push for the sales. After all, many participants of the meeting are sponsored by those companies.
A die-hard follower of market economy would not consider that a problem: Areas of new advances naturally attract more audience - that's exactly the purpose of having this kind of scientific conference. However, you may have a skeptical view and witness a professional meeting degrading to a extravagant pharmaceutical fair.
The problem is: Should be aim to provide a forum for our business partners to educate the audience, with the obvious benefit of revenue generation, or should we lead the way and choose topics that we believe important ? (Provided that we know the way. Do we ?)
"We should strike a balance between the two ..." You may say.
Alas, it's so much easier to be said than done.
By the way, BALANCE stands for By And Large A Naive Cockeyed Eunuch.
A few of us hurried to explain, "Em... Two drug companies wish to sponsor the symposium, and that's the topic that they specify."
Of course that's the case. There are new products in that area and our "business partners" are just too eager to push for the sales. After all, many participants of the meeting are sponsored by those companies.
A die-hard follower of market economy would not consider that a problem: Areas of new advances naturally attract more audience - that's exactly the purpose of having this kind of scientific conference. However, you may have a skeptical view and witness a professional meeting degrading to a extravagant pharmaceutical fair.
The problem is: Should be aim to provide a forum for our business partners to educate the audience, with the obvious benefit of revenue generation, or should we lead the way and choose topics that we believe important ? (Provided that we know the way. Do we ?)
"We should strike a balance between the two ..." You may say.
Alas, it's so much easier to be said than done.
By the way, BALANCE stands for By And Large A Naive Cockeyed Eunuch.
Sunday, November 9, 2008
Will
I must say I am thoroughly happy because I need not to have an opinion. That's a privilege of those living in Eden.
The argument put up by my friend was completely sound and logical. In fact, I could foresee if the series of communication was let known to some Patient Right Association, the hospital would be forced to resume the practice - and being asked why this policy was not effected earlier.
Nonetheless it is not always easy to act according to what logical arguments lead us to. As Arthur Schopenhauer pointed out, humans were motivated only by their own basic desires (Wille zum Leben, or "will-to-life"). More often than not we determine in no time the conclusion by our limbic system (which has a much higher speed of computation for evolutionary reasons), and for the rest of the time that we spend on so-called "thinking", we try to put up reasons and logic for what's been decided.
In other words, most of us use logic like a drunk uses a lamp post - for support, not illumination.
The argument put up by my friend was completely sound and logical. In fact, I could foresee if the series of communication was let known to some Patient Right Association, the hospital would be forced to resume the practice - and being asked why this policy was not effected earlier.
Nonetheless it is not always easy to act according to what logical arguments lead us to. As Arthur Schopenhauer pointed out, humans were motivated only by their own basic desires (Wille zum Leben, or "will-to-life"). More often than not we determine in no time the conclusion by our limbic system (which has a much higher speed of computation for evolutionary reasons), and for the rest of the time that we spend on so-called "thinking", we try to put up reasons and logic for what's been decided.
In other words, most of us use logic like a drunk uses a lamp post - for support, not illumination.
Saturday, November 8, 2008
Name
With the new admission system, it was somehow decided that the names of the in-charge medical officer and physician would be put black-and-white on a card next to the bed of the patient. Furthermore, all patients would receive - upon admission - a piece of paper with the names of those responsible doctors.
That created a major hiccup - so much so our man from Chaozhou hurried to take it away the next day after the policy took effect.
Is that appropriate ? I received this email the next day:
"To me, disclosing the name of doctor / physician is never an issue. Why should we hide from them? I remember very well when the name chop system was introduced in our hospital; this chop simply reminds me to write in a decent and responsible manner (under the name chop of XXX). Can't really see any down side of it."
My reply was all too slippery:
"I'm not sure whether I need an opinion. It seems a conflict between ethical and political considerations, or an argument between the neocortex and the limbic system."
That created a major hiccup - so much so our man from Chaozhou hurried to take it away the next day after the policy took effect.
Is that appropriate ? I received this email the next day:
"To me, disclosing the name of doctor / physician is never an issue. Why should we hide from them? I remember very well when the name chop system was introduced in our hospital; this chop simply reminds me to write in a decent and responsible manner (under the name chop of XXX). Can't really see any down side of it."
My reply was all too slippery:
"I'm not sure whether I need an opinion. It seems a conflict between ethical and political considerations, or an argument between the neocortex and the limbic system."
Friday, November 7, 2008
Tsukiji
After a night of complete bed rest we were more refreshed, and we found the streets more easy to recognize.
(Well, our IQ probably doubled once our blood was diverted from muscle back to the brain.)
We set off to the place where Vivian is going to work - the National Cancer Center of Tokyo, which is some 20-minute walk from where my wife lives. Although we knew beforehand the Center is a luxurious building complex, Vivian and I remained stunned when the extravagant palace of oncology appeared - it seemed the diamond on the crown of the Ginza (銀座) area.
As a distinct contrast, on the opposite side of the road we saw the Tsukiji market (築地市場).
And, almost drowned in a crowd of tourists and local housewives, we suddenly realized why Shintaro Ishihara (石原慎太郎) proposed to move the market to somewhere else.
PS. Vivian and I took some time to navigate through the market to search for daily needs. Thinking of her new working place, my wife commented, "Japanese are so fond of salt and nitrosamine - that's why they have so many (cases of) cancer and high blood pressure."
I considered for a while, "That may be true, but after all they have the longest life expectancy."
(Well, our IQ probably doubled once our blood was diverted from muscle back to the brain.)
We set off to the place where Vivian is going to work - the National Cancer Center of Tokyo, which is some 20-minute walk from where my wife lives. Although we knew beforehand the Center is a luxurious building complex, Vivian and I remained stunned when the extravagant palace of oncology appeared - it seemed the diamond on the crown of the Ginza (銀座) area.
As a distinct contrast, on the opposite side of the road we saw the Tsukiji market (築地市場).
And, almost drowned in a crowd of tourists and local housewives, we suddenly realized why Shintaro Ishihara (石原慎太郎) proposed to move the market to somewhere else.
PS. Vivian and I took some time to navigate through the market to search for daily needs. Thinking of her new working place, my wife commented, "Japanese are so fond of salt and nitrosamine - that's why they have so many (cases of) cancer and high blood pressure."
I considered for a while, "That may be true, but after all they have the longest life expectancy."
Thursday, November 6, 2008
Destination
After struggling for nearly a whole hour, my wife decided to take a taxi.
The anti-climax was: the taxi driver didn't know the way either.
But he was certainly a traditional Japanese gentleman and was all too helpful. He drove us to somewhere (he believed) near our destination - which was probably a mile away - and stopped in front of a police station.
He went out and asked.
Another anti-climax: the police didn't know either. (The driver told me when he was back on the taxi.)
But our new friend seemed to have more confidence. He drove for another 200-m and dropped us - he pointed at a small road and told us that it should be somewhere inside.
We hesitated for a moment. Thank goodness we met another gentleman who spoke perfect English, and he gave us the same instruction.
It was, alas, already three hours after we left the Shinkansen (新幹線) station (enough for us to go back to Osaka). We put up the last drop of our courage (and strength) and went into that small road.
Around a corner there was a modern-looking building. At the door of which we found the (representative of the) housing agent.
He shouted aloud Ri Ha Min (my wife's name in Japanese translation) when he saw us.
Despite of the funny pronunciation, it was no doubt the most enjoyable circumstance when my wife hear someone yelling out her name.
PS. Some time later I found out why we went astray: We read the map up-side-down (or actually north-side-south).
And an old saying came to my mind: If the world appears all crooked, maybe you are just tilting your own neck.
The anti-climax was: the taxi driver didn't know the way either.
But he was certainly a traditional Japanese gentleman and was all too helpful. He drove us to somewhere (he believed) near our destination - which was probably a mile away - and stopped in front of a police station.
He went out and asked.
Another anti-climax: the police didn't know either. (The driver told me when he was back on the taxi.)
But our new friend seemed to have more confidence. He drove for another 200-m and dropped us - he pointed at a small road and told us that it should be somewhere inside.
We hesitated for a moment. Thank goodness we met another gentleman who spoke perfect English, and he gave us the same instruction.
It was, alas, already three hours after we left the Shinkansen (新幹線) station (enough for us to go back to Osaka). We put up the last drop of our courage (and strength) and went into that small road.
Around a corner there was a modern-looking building. At the door of which we found the (representative of the) housing agent.
He shouted aloud Ri Ha Min (my wife's name in Japanese translation) when he saw us.
Despite of the funny pronunciation, it was no doubt the most enjoyable circumstance when my wife hear someone yelling out her name.
PS. Some time later I found out why we went astray: We read the map up-side-down (or actually north-side-south).
And an old saying came to my mind: If the world appears all crooked, maybe you are just tilting your own neck.
Wednesday, November 5, 2008
Move
We left Takatsuki (高槻) on a Friday morning after saying sayonara to Professor O, Vivian's boss in Osaka.
The train service of Japan is superb. We took JR and arrived at Kyoto in 20 minutes. There was Shinkansen (新幹線) train to Tokyo nearly every 10 minutes; in two-and-a-half hours Vivian and I found ourselves in the most busy city on earth.
My wife reserved an apartment at Hatchobori (八丁堀), which is one station by JR from the Tokyo terminal. We got there all right (despite quite a bit of effort with all our luggage). The problem was: Where should we be going ?
I had a Google map of that area - printed before I came here. We checked again with the map in the train station. In no time local Japanese observed a foreign couple pushing and pulling tons of belongings on the streets of this metropolitan.
But the roads did not appear the same as what's on the map - and so were the buildings. Many of you may know Google map has a satellite view and I had a bird's eye idea on the place before we set off.
We walked further and found the streets even more unfamiliar. Vivian asked a couple of people, but none seemed to have heard of the place that we were heading ...
The train service of Japan is superb. We took JR and arrived at Kyoto in 20 minutes. There was Shinkansen (新幹線) train to Tokyo nearly every 10 minutes; in two-and-a-half hours Vivian and I found ourselves in the most busy city on earth.
My wife reserved an apartment at Hatchobori (八丁堀), which is one station by JR from the Tokyo terminal. We got there all right (despite quite a bit of effort with all our luggage). The problem was: Where should we be going ?
I had a Google map of that area - printed before I came here. We checked again with the map in the train station. In no time local Japanese observed a foreign couple pushing and pulling tons of belongings on the streets of this metropolitan.
But the roads did not appear the same as what's on the map - and so were the buildings. Many of you may know Google map has a satellite view and I had a bird's eye idea on the place before we set off.
We walked further and found the streets even more unfamiliar. Vivian asked a couple of people, but none seemed to have heard of the place that we were heading ...
Tuesday, November 4, 2008
嵐山
I went to Japan largely to help my wife to move to Tokyo. Before we leave Osaka, Vivian had a half-day off; we decided to pay a visit to Arashiyama (嵐山).
This was not the first time we came to this lovely town outside Kyoto, and we knew a bit the whereabouts. For that reason we deliberately avoided those well-known sight-seeing spots. After getting off the Hankyu Train (阪急電鉄) and passing the Cross Moon Bridge (渡月橋), we had a long walk to admire the red leaves.
After half an hour or so, we stopped at the Cool Temple (清凉寺) - Vivian was too excited to tell the story about the place with the same name in our own country, with a playful description in the all-time classic of Jin Yong (金庸) - The Deer and The Cauldron (鹿鼎記).
We found another small place nearby: the Garden of Two Buddhas (二尊院). There was, at the time, a small exhibition of some antiques, and we naturally took the advantage. Amongst all artistic work of Buddhism displayed, a piece of calligraphy caught my attention - it was not Japanese kanji (漢字), but genuine Chinese.
Vivian tried and read it, but was soon at a lost: like all traditional Chinese writings, there was no punctuation.
But I could understand it all right. The last sentence was all that attracted me. It said: 能言不能行,國之師也。
What a humorous twist of the traditional teaching by Xun Zi (荀子).
PS. The original saying was:
口能言之，身能行之，國寶也。
口不能言，身能行之，國器也。
口能言之，身不能行，國用也。
口言善，身行惡，國妖也。
This was not the first time we came to this lovely town outside Kyoto, and we knew a bit the whereabouts. For that reason we deliberately avoided those well-known sight-seeing spots. After getting off the Hankyu Train (阪急電鉄) and passing the Cross Moon Bridge (渡月橋), we had a long walk to admire the red leaves.
After half an hour or so, we stopped at the Cool Temple (清凉寺) - Vivian was too excited to tell the story about the place with the same name in our own country, with a playful description in the all-time classic of Jin Yong (金庸) - The Deer and The Cauldron (鹿鼎記).
We found another small place nearby: the Garden of Two Buddhas (二尊院). There was, at the time, a small exhibition of some antiques, and we naturally took the advantage. Amongst all artistic work of Buddhism displayed, a piece of calligraphy caught my attention - it was not Japanese kanji (漢字), but genuine Chinese.
Vivian tried and read it, but was soon at a lost: like all traditional Chinese writings, there was no punctuation.
But I could understand it all right. The last sentence was all that attracted me. It said: 能言不能行,國之師也。
What a humorous twist of the traditional teaching by Xun Zi (荀子).
PS. The original saying was:
口能言之，身能行之，國寶也。
口不能言，身能行之，國器也。
口能言之，身不能行，國用也。
口言善，身行惡，國妖也。
Monday, November 3, 2008
Neck
You may consider my blog two days ago somewhat ill informed: neither the Grand Council of Qing Empire nor the Standing Committee of PRC are the head administrating body of the country.
Yes, maybe you're right - but they are the ones who make the most important decisions.
They are not rubber stamp; they are the stamp pads.
And they are not the head, but the neck of the kingdom.
What is neck ? My friend MF had a vivid explanation: Neck is the structure that controls the head and determines whether it turns left or right.
By the way, MF is an eminent neurologist - who certainly has a more insightful view on the structure of the higher part of a body than infra-diaphragmatic physicians like myself.
After all, if you want to control any body, you grasp his neck, not the head.
Yes, maybe you're right - but they are the ones who make the most important decisions.
They are not rubber stamp; they are the stamp pads.
And they are not the head, but the neck of the kingdom.
What is neck ? My friend MF had a vivid explanation: Neck is the structure that controls the head and determines whether it turns left or right.
By the way, MF is an eminent neurologist - who certainly has a more insightful view on the structure of the higher part of a body than infra-diaphragmatic physicians like myself.
After all, if you want to control any body, you grasp his neck, not the head.
Sunday, November 2, 2008
Book
About to set off to Japan and visit Vivian.
As usual, I bring a book with me for the trip. In the past, I usually took a volume of Agatha Christie for that purpose: It is easy to read and almost always enjoyable.
But the thing is slightly different this time. In the coming few days, I would probably spend most of the time on travel and waiting. It seems an excellent opportunity to read something serious.
I decide to take the Wealth of Nations by Adam Smith.
Yes, I read it some time ago. In fact, I read it twice - once a modern Chinese translation, and once the English original. With the tsunami and increasing government control, this bible on free market seems untimely.
But, what could be better than visiting someone you admire when he is down and neglected by the public ?
PS. We know very well the book is called "國富論" in Chinese. The first Chinese translation, however, was by Yan Fu (嚴復), with a title "原富". The poetic nomenclature obviously roots from the all-time classic of political sociology by Huang Zongxi (黃宗羲): 明夷待訪錄.
As usual, I bring a book with me for the trip. In the past, I usually took a volume of Agatha Christie for that purpose: It is easy to read and almost always enjoyable.
But the thing is slightly different this time. In the coming few days, I would probably spend most of the time on travel and waiting. It seems an excellent opportunity to read something serious.
I decide to take the Wealth of Nations by Adam Smith.
Yes, I read it some time ago. In fact, I read it twice - once a modern Chinese translation, and once the English original. With the tsunami and increasing government control, this bible on free market seems untimely.
But, what could be better than visiting someone you admire when he is down and neglected by the public ?
PS. We know very well the book is called "國富論" in Chinese. The first Chinese translation, however, was by Yan Fu (嚴復), with a title "原富". The poetic nomenclature obviously roots from the all-time classic of political sociology by Huang Zongxi (黃宗羲): 明夷待訪錄.
Saturday, November 1, 2008
Committee
Most of my friends know just too well I am always skeptical with any meeting that needs more than a handful of people.
After all, if the whole Qing (清) Empire could be ruled by a committee of five or six (the Grand Council, 軍機處), and a country of over 1 billion people by a committee of nine (the Standing Committee of the Communist Party of China, 中央政治局常務委員會), why do you need a crowd of 50 for whatever matter at hand ?
In fact, for professional administrators, most would follow the teaching of Humphrey Appleby:
You wouldn't watch a drama without a script, would you ? (Not to say you are someone on the stage !)
After all, if the whole Qing (清) Empire could be ruled by a committee of five or six (the Grand Council, 軍機處), and a country of over 1 billion people by a committee of nine (the Standing Committee of the Communist Party of China, 中央政治局常務委員會), why do you need a crowd of 50 for whatever matter at hand ?
In fact, for professional administrators, most would follow the teaching of Humphrey Appleby:
- Do not go to a meeting without a (clear) agenda.
- Before calling a meeting, make sure you are able to prepare the minutes before the meeting actually takes place.
You wouldn't watch a drama without a script, would you ? (Not to say you are someone on the stage !)
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