Purpose

I always hold the idea that the AIRS and a "transparent operation" put up by some extra-terrestrials would do no good but merely force us under the limelight for endless medical incidents.

(Two obvious examples were the use of outdated BCG by some obstetric nurses and the injection of syrup morphine to someone with terminal cancer. Yes, they're incidents. But do they worth so many press releases and all the hassles ?)

But I was too naive and completely missed the point. The open strategy, as I would call it, accomplishes at least three purposes:

1. With repeated press release on minor incidents, the media and general public lose their interest. It is now far much more easy to hide a major event. As Agatha Christie said (in The ABC Murders): What is the best place to hide a pin ? In a pincushion !
2. Because new incidents keep coming up, existing ones become outdated very quickly - so that no one would dwell on the follow up action (or the lack of follow up action) for those major incidents.
3. It is probably the most efficient way to reduce the case load of the public health care system.
   

Alas, they have the wisdom. As the old Chinese sayings: 大智若愚.

Appropriate

For those who are obsessive with terminology, medical errors are classified as follows:

1. mistakes, which could be: (i) knowledge based; or (ii) rule based (misapplying a rules, or fail to apply a rule)
2. skill based errors, which could be: (i) slip (e.g. writing "gm" for "mg"); or (ii) lapse (forget to write the treatment)

But, giving the correct opinion does not always mean that the patient would recover - and you wouldn't call that a medical incident if the patient dies despite appropriate treatment. With hindsight, of course, some of the appropriate treatment may not be all that appropriate. We can only make the best judgement from the information at hand. Otherwise we would have to go back and sue Issac Newton for not performing experiments accurate enough by the modern standard !

PS. I am more inclined to sue the in-charge physician of Alexander the Great for not measuring the blood pressure, not to say failed to perform blood culture and abdominal CT scan, for the great warrior.

For details, please see Oldach DW, et al. A mysterious death. N Engl J Med 1998; 338: 1764-1769.

Blame

After listening to KM's story, I said, "That could hardly be called a medical incident. If our colleague from that other department did not do the appropriate steps and missed the diagnosis, we should talk to his boss so that some relevant education (em ... in whatever sense you like to believe) could be given. But if he had done the things in an acceptable standard, there's nothing to blame."

"Quite true," my friend agreed, "We learn a lesson, of course, but there is no hard-and-fix rule under the sun saying that we could always make the correct diagnosis if we do everything appropriately. But what if their doings are not up to the international standard ? Say for example, you cannot make a diagnosis of heart attack in the emergency room because you work in one that has no ECG ?"

"In that case, one should blame the policy maker or whoever responsible for the problem - not to the poor clinician who has to see the patient without a ECG ..." I thought for another while and asked, "Is there a channel for some high authority to examine the case and decide crossing out the AIRS ?"

Listening to our discussion, CB added, "That high authority are actually nurses who migrated outside the solar system since the last millennium. All they do is to ask for reports from all parties !"

AIRS

On our way to meet an overseas visitor, KM asked if I had heard of the recent incident of AIRS.

I had not, and KM gave me the details. The story - keeping all parties anonymous - goes like this:

Our colleagues from another department did not make the correct diagnosis on a particular patient (who was under the care by us). Seriously they did nothing wrong - based on the data available to them at the moment, they have no reason to be suspicious. The correct diagnosis revealed itself a few days later - after some further investigations ordered by a meticulous physician.

The problem was: one of us report the "incident" to the AIRS.

For those who are not familiar with our system, AIRS stands for Adverse Incident Reporting System. It is a kind of mechanism so that we could report medical incidents (for example, wrong drug dosage being dispensed) that could adversely affect patients' well-being.

Of course our friends from the other department go mad - who wouldn't ?

Exposure

Lunch with FP and KK, my two medical officers. For sure our discussion touched on their training and rotation.

"Our sister hospital just can't recruit new trainees. They are too famous for the exceptional working environment." FP sighed.

"Is that the reason some of our trainees would have to do rotation in their hospital ?" I asked.

"No, not entirely. We would be sent to any hospital in this region because their trainees would have to come here for at least three months." KK explained.

"Why ?"

"Haven't you heard of the new regulation from the College ? All trainees need to spend at least three months in a hospital with obstetric service." KK added.

"What's the point ? They would hardly be asked to see any consultation from the obstetric department." I was incredulous.

"The point is not what the point is," FP suddenly sounds like Humphrey Appleby, "The College just asks for doing rotation in a hospital with obstetric service, it doesn't specify what you do in that hospital or what exposure to obstetrics is required."

"You mean one can do rotation in the Emergency Department ?"

"ED is entirely relevant. In fact you can do geriatrics in a hospital with obstetric service, and the College counts that as exposure." FP said with a wicked smile.

"Geriatric obstetrics ... it sounds promising !" I couldn't help smiling back.

Site

In addition to a new computer monitor, I have also moved to a new personal web site lately.

Some of you may know I have an easy-to-remember site for some years. It is: http://www.ccszeto.com (Alas, it actually re-directs all visitors to a google web page. Who cares ?)

The purpose is naive. I put there lecture and seminar materials, together with some recommended readings, so that students and colleagues could download.

Although the name is attractive, site maintenance was slightly complicated (at least for some amateurish web-page holders like myself). And there's a bit of hassle for the visitors - there's an entrance page before you could get to the home page. One would easily lose his way and relevant material just doesn't pop up.

Google probably knows the problem even better. A new site system is set up, and existing users are encouraged to move.

And this is mine: http://sites.google.com/site/ccszetogroup/home

PS. Oh, no fancy stuff there. In fact most of the pages are monochrome. Before one could tell black and white, why confuse ourselves with so many colours ?

Monitor

On the very same morning that I visited the other side of the harbour, I had the computer monitor in my office changed.

The old one was the traditional CRT that was in use for 10 years (I bought it soon after I joined the university). In fact, I am apparently the last one in the department to use the old "fat" monitor. That's partly because of my psychological complex of using heavy instruments, but also for the simple reason that this time-honoured display is exceptionally durable and has a very good quality.

(I like it very much because it was just wide enough to show two A4 pages in parallel - so that I could easily do copy-and-paste from one document to another.)

But it has passed the prime of its life. In the recent months, the top bit of the monitor kept showing a twisted image. (Alas, anything and anyone that remained in the same position for too long would have their tops crooked. That's a rule of management.) I was forced to give it up; it is actually impossible now to get the necessary spare parts even if I want to have it repaired.

Photo

Although I am not one of them, the library brings back to me much memory.

The first time I was here was almost 12 years ago, when I was back from Bristol for the New Year holiday, and paid a visit to the man who still had a moustache, who showed me the place. (My old friends would know why I visited him.)

This is also the room where I had my nephrology exit examination (alas, those were the days when we had the oral exit examination at the room next to the office of the chief examiner - the man who used to have a moustache), and also where MRCP organizers (well, that's me) used to meet every year to bid for scenarios (a joyful but childish game that the College decided to give up a few years back).

*****************************

Soon after I tried to appreciate the internal decoration of the library, something caught my eyes.

On one of the walls hanged seven photos. They are the previous chairpersons of their department: AJM, DT, RY, TK, SK, WK, and my mentor - from left to right.

Yes, SK was there - despite he was subsequently being invited to drink some famous coffee and was forced to step down by the moustache man.

And so is the moustache man himself - even though he came down after failing in another political game.

A people who could stand straight and face their history would prosper, I am confident.

Library

After AL showed me that lovely piece of calligraphy in the morning, I went to the other side of the harbour in the afternoon - I was invited as the external examiner for one of their PhD students.

And this is the time for her oral defence.

There were six of us: the candidate, her supervisor (an eminent clinical professor), the chairman (a microbiologist assigned by the graduate school), two internal examiners (a biochemist and a pathologist), and myself. We met in their department library - named after their chairman in 1970s.

I was the first to ask questions and finished early - I could play dove if I wish to - but one of the internal examiners prepared three whole pages for this event, and, because of this happy accident, I have over an hour to sit there, taste the tea, and admire the library per se. Although I have been here for not less than a dozen incidents, I never had a chance to appreciate the internal decoration.

Stage

AL showed me a piece of calligraphy that was a gift to the man from Pluto. It titles [王國維 - 成大業之境].

Although the writing was in the Small Seal Script (小篆), our chairman's secretary could read the last few sentences. The question in her throat was: Is it actually The New Year Eve (青玉案·元夕) by Xin Qiji (辛棄疾) ?

Yes and no. The paragraph actually goes like this:

昨夜西風凋碧樹，獨上高樓，望盡天涯路。
衣帶漸寬終不悔，為伊消得人憔悴。
眾裡尋他千百度，驀然回首，那人卻在，燈火闌珊處。

Alas, they are the three stages of doing academic study and being successful according to Wang Guowei (王國維). The sentences come from three different Song Ci (宋詞) - the last one being from Xin Qiji.

PS. I must confess I didn't learn this piece from the reading of Chinese poetry, but during my private study of astrology in secondary school !

Screen

An interesting recent demonstration of the logic "the condition is urgent, therefore the treatment is useful" is the proposal of screening for drug abuse in secondary school children.

(I am quite prepared to put it up as a counter-example of evidence-based medicine for our students. For those who are not familiar with the considerations on what condition worth screening, please read the WHO criteria described by Wilson and Junger in 1968 - or just search the item in Google.)

In fact, it is exceedingly impressive to see our senior government officials coming out and declare, "The problem of drug abuse is huge amongst school children. We cannot afford delaying this program."

But, it is even more horrifying when there seems no one - not even those die-hard opposers against screening - to point out the flaw in such a logic.

PS. I am not always against mass campaign of this kind, even if the intervention may not be effective. For example, during the period of SARS, it must have been a genius to suggest everyone cleansing their home with Clorox. Of course it doesn't help - the virus does not spread by fomite. But it does relieve anxiety to the public, which was actually a major problem.

Alas, few people know what they want to do, but even fewer know what they are actually doing.

Afford

The problem is, of course, even more patients value their own life but are not well off enough to pay that slightly more.

"The government should pay for those who could not afford," say the noble council members.

That sounds fair ? Quite wrong. If you have to pay for something because you have the money, but, if you don't, it would be available free, it is a discriminating system against people who have the money. Look, the item is something that has been decided - from the perspective of the general public - that it is not cost-effective to have it free for everyone. How could one twist the argument and say let's have it free only for those who could not afford !?

In the jargon of economy, we call it an indirect tax.

And the most interesting kind indirect tax indeed. If you think of it, most of these items have a fixed price. In other words, the rate of taxation is therefore very small for billionaires, but a considerable percentage for the middle class.

Life-saving

It doesn't take long for one to realize hardly any treatment is absolutely life-saving.

No, not even transfusion for severe trauma, surgery for cancer, or thrombolytics for heart attack. Not everyone survive after the treatment.

"You are trying to be picky," you may argue, "Of course all treatment with evidence-based efficacy and a reasonable price should be available to everyone."

By now, you may predict the question of someone who has studied Lee Tien Ming: How efficacious is acceptable, and what price is reasonable ?

But no, I would ask: Who is going to compare and decide on the price and efficacy (alas, cost and effectiveness) ?

Should it be our government or health care administrators ? Yes, they can decide from the society or public system point of view - and they should do so in order to determine which treatment should be freely available to all citizens.

But no. Neither the government nor administrators should decide for individuals. Some patients value their own life and are sufficiently well to do; they are willing to pay slightly more for a lower margin of benefit. They have the right to choose - and the right to know they have something to choose.

Who

You may recognize my description yesterday on health care administrators was not entirely correct. For specific treatment items, they usually hold a negative view: the government should not pay.

But we are not the Prince of Denmark; the question is actually not should or should not, but government or who else ?

And there comes the conflict. The general public and many of our noble council members would argue, "Of course it is the government. All men (and, for sure, all women) are equal. We need a fair society and everyone should have the right to receive medical care; government has the responsibility to provide it all."

They would often add, "At least for life-saving measures in emergency situations, the treatment should be free and available to all." (Sounds familiar, eh ? Remember the story of NovoSeven ?)

At this point, I must pretend to be Lee Tien Ming (李天命) for a moment and ask: What is life-saving ?

Alas, in theory, I should also ask what are the emergency situations, but that seems not a major problem. The common illusion, however, is: The situation is urgent (or critical), and therefore the treatment is life-saving.

"If you do not see the difference of the two, you do not see anything." said Hercule Poirot (in Murder on the Links).

PS. For a few times in the history, our country used the word government for situation, and revolution for treatment. I don't think I need to elaborate on the result.

Pay

My friend VW recently put up a nice description on some elementary principles of health economics (see: http://vwswong.blogspot.com/2009/08/expensive.html).

I shall not pretend to be an expert in this area. Nonetheless, the concept of incremental cost-effectiveness ratio (ICER) and the amount of money that people would agree to spend for one quality-adjusted life year (QALY) are actually some deep water that may skip your eyes.

It is dead simple to put it in layman terms: You need this amount of money to achieve that degree of additional benefit. Do you agree ?

The catch is, of course, who is going to pay.

To this very question, surprisingly, the answer of our noble council members, senior health care administrators, as well as many of our colleagues, (knowingly or unknowingly) often hold an unequivocal view: the government should pay - especially for life-saving treatment.

That, opens the Pandora Box.

PS. To have a global perspective, you can replace the word government by insurance companies.

Reminiscences

There was a talk given by Professor Sir David Todd at the Inauguration of the Medical History Interest Group. An abridged version of the talk appears in the Hong Kong Medical Journal, 2009 August, p. 315 - 319. Many of the quotes in this article prove illuminating. Interested readers should go to read the full text. I show you here a few:

"Those who live in the past are blind in one eye, but those who forget the past are blind in both eyes." (Therefore, please do not complain I write too much on history.)

"I do not wish to see your tonsils." (Professor AJS McFadzean's remark to a student who yawned in his tutorial.)

"Do you realize that while the diagnosis is the same, there can be major differences in the management of individuals depending on their previous health, coexisting disorders, genetic, family and social background ?"

"But by example, no medical school can teach a young person how to be understanding and caring. This can only come from the experience of life." (by Professor David Weatherall; I believe it was a remark on the teaching of medical ethics.)

"Example is not the main thing influencing others; it is the only thing."

PS. You think the last two citations contradict each other ? I follow example - please let me play god here.

Permanent

Seasoned audience would soon find the loophole of my story yesterday:

Our administrators do not have to protect privacy, they merely want to appear to be doing so - in the eyes of the media and our honorable council members. (You may consider there is actually no difference between the two. That's another story.)

At this point, let me tell you another series of communication between Neptune and a small group of people on earth:

**********************************

"Look. This is a new computer system that we put up to help your chronic management of XXX."

"It sounds brilliant. Em ... How do we key in the data if we treat XXX only temporarily ?"

"No, you cannot use the system in that case - it is only designated for the permanent care."

"Then how could this gadget help ? Actually we have to do more work and decide who and when should be included into the system."

"Oh, the system is not to help your work; we have it to reflect the workload."

"But much of our time is spent on this so-called temporary care ! How could the system reflect our workload ?"

"No, it does not reflect your workload - it reflects ours."

PS. What is temporary and what is permanent ? I shall leave this question of supreme importance some time later. According to the bible, only god is permanent.

Forward

I pulled your legs. God, and people who believe they are god, do not follow any logic.

The obvious question from we ordinary people is: What are the possible sensitive information in those mails ? Is it our duty list, reminders to wash our hands, or dates of those irrelevant seminars ? For professional hackers, I am sure they find tapping the lines of government officials or those teenage models more interesting.

(Well, of course, it is an eye opening experience for an outsider to see the jungle of emails on so many unimaginable matters - written by those supposedly senior administrators !)

Going back to the problem at hand, we said to those friendly IT specialists, "But it is exceedingly inconvenient for us to go to the ward and line up with the house officers to log on the computers there and read our message !"

"No problem," they replied, "We could arrange these messages in your intranet account to be automatically forwarded to your university system."

"Well, isn't that a circular argument and we are back to the same problem of privacy and sensitive information ?" We said to ourselves.

***********************************

Some days later, several of our colleagues found that they could not receive the forwarded message. They went to Neptune and asked; this very encounter, as they told me, turned out to be phenomenal:

The first reply was, "Your mail box is full."

"How could that be ? All messages were read and then deleted already !"

"No, you have to go to the ward, log on the HA system, and delete the message there - otherwise it would soon exceed the capacity."

Email

You may consider my little story on protection of privacy weird (see http://ccszeto.blogspot.com/2009/08/ai-2.html). To my surprise, there is a similar recent happening to our email system.

The story goes like this: As a university staff, we all have an official email account. Since we have clinical duty, the Hospital Authority gives us another internal account for communication of (presumably) clinical affairs - we usually call it The Intranet.

The problem is: the two systems cannot easily communication with each other, and, many of us would have to go (from our office) to the ward and use a different computer to log on to the hospital system and read the message.

The result is obvious: many of our academic colleagues just ignore the system. After all, this clinical account is largely for distribution of (labelled as Highly Important) messages on some unrelated seminars or nanny reminders from some planets outside the solar system. In the old days, relevant materials (for example, our duty list) would be sent to our university account.

The recent change is: The Hospital Authority would only send message to our intranet account - and say sayonara to the university system.

You may ask: Why ?

We asked the same question, and the answer was for the protection of privacy and any sensitive information.

Let me give you 24 hours to digest their logic of this explanation.

Selection

In addition to handwriting, the other important characteristic with which officials of the Tang dynasty were favorably promoted was having an excellent book knowledge.

In that era of China, it meant knowledge in history, literature, and philosophy (of Confucius, and possibly Zhuangzi [莊子]).

This was, again, a tradition set up by Li Shimin (李世民).

Yes, you are entirely right. The system was not perfect. How could one ascertain translation of book knowledge to practical administration ? Nonetheless, isn't this system somewhat similar to the philosopher king proposed by Plato ? Similarly, most of the senior officials and political leaders of the British empire study history or philosophy in Oxford or similar places.

You may argue many of our senior officials do have a university degree. Well, yes, degree, but how many of our degree holders do have the corresponding education ? They are the same on a superficial look, but, as Liji (禮記) said: 鸚鵡能言，不離飛鳥.

PS. In the original Tang system, students who did well in the Imperial Examination (科舉) had to stay in Chang'an (長安) for a year or two to learn the political system of the empire and receive training on administrative skill before they could be sent to take up some junior posts of the government.

Handwriting

Students of Chinese calligraphy know very well that there are four great calligraphers of regular scripts (楷書四大家).

They are Yan Zhenqing (顏真卿), Liu Gongquan (柳公權), Ouyang Xun (歐陽詢), and Zhao Mengfu (趙孟頫).

In addition, there are (another) four great calligraphers of the early Tang dynasty (初唐四大家). They are Ouyang Xun (歐陽詢), Yu Shinan (虞世南), Xue Ji (薛稷), and Chu Suiliang (褚遂良).

One notable fact that may skip your eyes is, six of these seven people, except Zhao, were senior officials of the Tang empire.

The reason is simple. Li Shimin (李世民) was a fans of calligraphy, and he set up a culture that officials of excellent handwriting were favorably promoted.

You may consider that a biased system. Nonetheless, people who could write clearly generally mean that their mind is orderly and they know what they are doing.

As the old Chinese saying: 心正則筆正.

Calligraphy

Vivian became very much interested in calligraphy recently.

The question that she put up several time to me was: Which mentor should she have ?

Well, I had a brief period of learning calligraphy during secondary school but I'm no expert. Forced to give some solid answer, I said, "For woman, I recommend Zhao Mengfu (趙孟頫)."

My wife looked suspicious, "How about man - say for example, if you are going to pick up the habit again ?"

"Chu Suiliang (褚遂良) would be my cup of tea." I gave my well-prepared answer.

"How about Yan Zhenqing (顏真卿) ?" My wife obviously did her homework.

I made a discriminating remark, "Oh, no. Yan was a loyal courtier, but his writings were as thick as his head."

PS. Although my brain understands very well that we should not judge someone's artistic (or scientific) achievement by his political stand or moral standard, as a traditional Chinese, my heart still holds the idea that handwriting does reflect one's personality - and possibly the time that he is living.

EQ

It may skip your eyes that the very character to be successful that I alluded to yesterday is also called Emotional Intelligence.

You may ask, "Isn't EQ the calm quiet pleasant humble personality that could stand all sorts of verbal abuse ?"

On that, you are wrong. The original idea of emotional intelligence, and the suggestion that EQ is related to the chance of being successful (using outcome measures such as the result in open examinations), both in the classical text of Daniel Goleman, is that ""goal-directed self-imposed delay of gratification".

In fact, in the original Emotional Intelligence: Why It Can Matter More Than IQ, the concept of EQ actually encompasses Adversity Quotient, Social Quotient, and a number of other Qs that are proposed by those clumsy imitators. As the old proverb says, the first one who use flower to describe a woman was a genius ...

PS. If EQ is merely the ability to stand insults by the others, Neville Chamberlain would probably be the most intelligent (in the emotional aspect) person in human history - but it was Winston Churchill who could tolerate all the hard times (from the German army as well as the Parliament) and defeated Hitler.

Character

Regular audience of my blog would argue I am contradicting myself. Some months ago I declared that most of the jobs did not really ask for talent to become successful (see http://ccszeto.blogspot.com/2009/03/achievement.html), but just now I seemed to say that wit is another necessary condition for a high-flyer.

But no. We do not really need a genius to make a good hockey player, university professor, or a brain surgeon. We need some special character - but that's not a body of Wayne Gretzky, a brain of Albert Einstein, or the hands of Arthur Rubinstein.

The character is a trait of obsessiveness, a personality of enduring boredom and tough training, an acceptance of tolerating temporary suffering in order to achieve the ultimate goal, or a mindset to motivate oneself in the face of adversity.

In the classic Marshmallow experiment designed by Walter Mischel, this very capability is called "goal-directed self-imposed delay of gratification".

True, a lengthy term. Whatever we call it, this is probably the most important character we need to cultivate in our next generation - children and students alike.

Intelligence

Just finished reading How to Multiply Your Baby's Intelligence by Glenn Doman. It is the sister book How to Teach Your Baby to Read that finished some days ago.

You could well imagine what's there. Encouragement, reassurance, you baby is a genius, and so forth. Well, it does give some solid advice on the way to teach young kids reading, mathematics, and general knowledge, but these are side-dishes. The book is a best seller because parents love to be reassured that their children would do well - if not brilliantly.

And the same for the book Outliers, which my friend VW recently talked about (see http://vwswong.blogspot.com/2009/07/outliers.html).

Yes, it is a rosy picture. They think they are able, and so they are able. I have a deja vu feeling of reading Publius Vergilius Maro.

But that's not true. What Malcolm Gladwell’s study actually showed was one would be successful if, and only if, they have the wit and are being encouraged. In the language of logic, all those extra training and encouragement are necessary condition - but not sufficient condition - for becoming successful.

Alas, as a father myself, I am not spared - sometimes I choose to forget about logic.

PS. Of course, if our primary objective is (for us and for our children) having an enjoyable process, the chance of being successful doesn't really matter.

AI-2

(The story continued.)

The old woman saw the worrying face of that doctor-in-training, and tried to be helpful, "I had an X-ray done when I was in the Emergency room. You can go see the film - they said that there's something hazy in my lung."

"Good idea !" The AI cheered.

But, in no time he became depressed again. "No, that doesn't help. There is no X-ray film as such in this hospital - all as digital image in the computer, which I do not have the access."

The old woman's face turned black, but out from her mouth came a gush of colourful language. (I can tell you verbatim when we have the chance.) Finally, the woman asked, "Well, well, I have enough. Can you just fix up those regular blood tests for me ? You can take blood, eh ?"

"Em ... I can take blood ..." the young man hesitated, "but we've got to wait for the house officer because I cannot print out the specimen form ... also in the computer ..."

A few more colourful sentences filled up the air, "Are you really supposed to take care of me ? Why don't they allow you to log on to the system and see my information ?"

"They said it is for the protection of your privacy ..." The final year student murmured.

(Author's note: I deliberately removed the colour from the language.) "Privacy of what ? You young man is allowed to ask me all sorts of embarrassing questions, feel my breasts, examine my private parts, and now you tell me you are not allowed to see my medical information in order to protect my privacy!?"

And the two were both speechless - doctor and patient alike.

AI

Many of you were fascinated with the happenings on 2nd July 2011 that I described some days ago (see http://ccszeto.blogspot.com/2009/07/graduate.html). In fact, on that very morning, there was another little story in the same ward.

Here it goes.

**********************************

"Madam, I'm the doctor-in-training of this ward. What's your problem ?" The assistant intern was talking to a woman just admitted from the Emergency department.

"I have so many problems that I couldn't even finish in one sentence ..." The patient was breathing fast, "and my memory is no good. Even if I try to tell you everything, I would probably miss out some crucial details. Why don't you look up in the computer ? I have been followed in this hospital for decades."

"Em ..." The final year student hesitated, "I am not allowed to log on to the system and check your detail. Let's make it simple, what drugs are you taking ?"

"Do you seriously think I could tell you those names ?" The old woman tried to squeeze out the last bit of air from her lung, "Well, here they are ..." Out from the pocket she threw a dozen kind of tablets - all without a label.

"God, how could I know ?" The poor AI said to himself. He knew just too well there was a complete list of medication in the computer record. But that information was not within his reach.

(to be continued ...)

Worry

I must say the continuous assessment form for our final year students doesn't worry me at all.

Let me show you a recent email from other parts of the solar system; it is (one of) my real worry.

************************

(The extra-terrestrial assessors) would like to see a more systematic way of giving feedback to students on all exams. They appreciate that we do not want to show students the actual MCQ questions but they suggest several ways of doing it :

1. De-briefing sessions to the whole class (some panels are already doing this); OR
2. Some comments about common errors / misconceptions to be posted to the students by web or email (some exams are doing that already) AND
3. Students are allowed, within a designated period after the exams, to look at the scripts with textual answers (e.g. SAQs) and that if they wish, to have a discussion with the teacher concerned.

************************

Well, while we always comment that our students put too much emphasis on examination rather than focus on acquiring skills to become a competent doctor, are we encouraging them to behave that way ?

Assessment

While I was crawling along the corridor with my backache, GC waved at me with a wicked smile.

"Do you have a few minutes ? We got to discuss on the business of continuous assessment."

"Well ... ?" I foresaw my backache would move up to the head.

In no time we found ourselves hiding in GC's office. The issue was simple: the hematologist was asked to revise the continuous assessment form (alas, marking scheme) for our final year students, and our man from Pluto subtly suggested him to involved me in the discussion.

But my friend had his own idea; all he needed was some encouragement and reassurance, and the thing was fixed in 2 minutes.

(Maybe also fortunate for him, I had very little idea of my own. I always believe amendments of this kind could serve no purpose except putting up an impression that we appear to be doing something.)

PS. To the credit of my autistic friend, he did not write an exhaustive proposal in an email, or call for a meeting of ten people. In the analogy of immunology (see ccszeto.blogspot.com/2008/01/lymphocytes.html and ccszeto.blogspot.com/2008/01/granuloma.html), GC is neither B nor T lymphocyte - but a polymorph; he sees a problem and tackles himself.

The sobering truth is, unfortunately, polymorphs generally have a short live-span.

Backache

Sprained my back a few days ago.

It got better after resting (alas, doing mostly computer work) for a day - but it came back all of a sudden after a big sneeze.

And I found myself exceedingly careful with a lot of ordinary activities. Well, I could still do all of them: turning around to reply to the phone, getting up from my office chair, doing my shoelace, or putting back some books to the top of the shelf.

Just that it sores and I couldn't do them in a swift manner I used to be.

And I have to walk slowly - observing things around in a bit more detail.

PS. By coincidence I was doing a short case of ankylosing spondylitis with my students this morning.

Education

Some of you may wonder: how could people have no choice and are forced to do evil things ?

Alas, there are several possibilities. In the case of Malfoy, the fate was chosen by his parents.

But that's not a common happening. More often than not, the situation is similar to our falling stone analogy, and people appear to be making their own decision, but in fact they are under undue influence of extrinsic forces.

Oh, no. I'm not talking about something supernatural.

I mean education.

Or, brainwashing with some sugar coating.

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Ironically, do you know the favourite subject that our next generation is now being brainwashed (oh, sorry, educated) ?

It is to be critical.

For example, they challenge the reliability of the Polaris (which, I agree, is not without problem).

And they soon lost their way in an uncharted sea.