On the day after back from Aberdeen, I attended another gangsters' meeting.
There was, alas, nothing vigorous for discussion. Much of the time was spent on the plan of moving to the new block next year - and what the hospital (administration) planned to do with the original one.
Well, that's probably the major ball game our extra-terrestrial friends are playing at the moment.
**************************************
In the middle of the meeting, LS whispered at my ears, "Why is there so many elaborated plans for using the old block ? Was it not having some fatal flaw in construction to begin with, so that our noble Council members agreed to give money and built the new one ?"
It took me a while to recollect my memory and realized she was right.
"It doesn't matter. The Council per se had election twice since that decision; all of the present ones are new to this business and would not notice ..." I said to myself.
Wednesday, September 30, 2009
Tuesday, September 29, 2009
Tea
Spent an afternoon in Aberdeen - I was the invigilator of the Part I examination.
Alas, the examination consisted of two MCQ papers, each for three hours, with an hour of break in between. There were three invigilators: a consultant geriatrician, a representative from the British Council, and myself.
During the break, the secretaries from the College - whose office was upstairs - came and helped collecting the paper.
"Do you need to order some snack in the canteen ?" One of them suggested, "It would be lucky if we could leave before 7:30 PM."
I duly complied. Two hours later, I took a 15-minute break and went to the canteen.
No one was there.
Oh, there was one - a waitress. She recognized me immediately and gave me a bowel of noodle - that's my afternoon tea.
Hastily I finished with my break - there's a sense of uneasiness to eat alone in a huge canteen.
On my way back, I couldn't wave away that very question in my mind: How could this business survive ?
PS. After the examination, the lady from the British Council asked how senior those candidate doctors were.
"You know, a few of them asked me what did Surname and Initials mean ..." She pointed to me a small area of the answer sheet.
Alas, the examination consisted of two MCQ papers, each for three hours, with an hour of break in between. There were three invigilators: a consultant geriatrician, a representative from the British Council, and myself.
During the break, the secretaries from the College - whose office was upstairs - came and helped collecting the paper.
"Do you need to order some snack in the canteen ?" One of them suggested, "It would be lucky if we could leave before 7:30 PM."
I duly complied. Two hours later, I took a 15-minute break and went to the canteen.
No one was there.
Oh, there was one - a waitress. She recognized me immediately and gave me a bowel of noodle - that's my afternoon tea.
Hastily I finished with my break - there's a sense of uneasiness to eat alone in a huge canteen.
On my way back, I couldn't wave away that very question in my mind: How could this business survive ?
PS. After the examination, the lady from the British Council asked how senior those candidate doctors were.
"You know, a few of them asked me what did Surname and Initials mean ..." She pointed to me a small area of the answer sheet.
Monday, September 28, 2009
Letter
My recent bedtime reading is "分類尺牘大全" by 王天恨.
I found the sordid volume in the shelf of my father-in-law some months ago. In short, it is kind of a collection of sample letters - similar to those you expect if there exists a book Letter Writing for the Idiots - written in traditional Chinese (文言文).
And, therefore, I am the idiot.
It's an enjoyable experience, with interesting points here and there. For example, "逕啟者", the well known header in Chinese letter, was supposed to mean To the one who open this letter, I tell you directly and is not meant for politeness. Similarly, "XX尊前" was used originally as "XX樽前", implying the sender and receiver are sitting together with a bottle of wine and having some friendly discussion.
Alas, when did the modern Chinese become so superficial ?
PS. I agree the author has a romantic name. Too bad he was merely a poor educated Chinese brought up in the traditional way - too common a species (and therefore of little value) fifty years ago; unbelievably outdated nowadays, but also paradoxically highly precious.
I found the sordid volume in the shelf of my father-in-law some months ago. In short, it is kind of a collection of sample letters - similar to those you expect if there exists a book Letter Writing for the Idiots - written in traditional Chinese (文言文).
And, therefore, I am the idiot.
It's an enjoyable experience, with interesting points here and there. For example, "逕啟者", the well known header in Chinese letter, was supposed to mean To the one who open this letter, I tell you directly and is not meant for politeness. Similarly, "XX尊前" was used originally as "XX樽前", implying the sender and receiver are sitting together with a bottle of wine and having some friendly discussion.
Alas, when did the modern Chinese become so superficial ?
PS. I agree the author has a romantic name. Too bad he was merely a poor educated Chinese brought up in the traditional way - too common a species (and therefore of little value) fifty years ago; unbelievably outdated nowadays, but also paradoxically highly precious.
Sunday, September 27, 2009
Guadalcanal
My first lesson on the Pacific War was about the Battle of Guadalcanal - from a book of the same title.
(My father gave this small volume to me during a summer holiday of my primary school.)
I shall not describe the details of the campaign here. Suffice to say, as soon as the US army took the control of the airport at the very beginning, the fate of the Japanese soldiers were no different from what Dr. Sheppard heard from Hercule Poirot (in The Murder of Roger Ackroyd): There is only one way out - and that way does not lead to freedom.
Alas, that's the first time I came to realize most matters have a few determining factors; to excel in one crucial thing usually bears more fruit than to have a diffuse target and be all-rounded on everything.
Yes, that's the 20/80 rule - we all know so well nowadays.
(My father gave this small volume to me during a summer holiday of my primary school.)
I shall not describe the details of the campaign here. Suffice to say, as soon as the US army took the control of the airport at the very beginning, the fate of the Japanese soldiers were no different from what Dr. Sheppard heard from Hercule Poirot (in The Murder of Roger Ackroyd): There is only one way out - and that way does not lead to freedom.
Alas, that's the first time I came to realize most matters have a few determining factors; to excel in one crucial thing usually bears more fruit than to have a diffuse target and be all-rounded on everything.
Yes, that's the 20/80 rule - we all know so well nowadays.
Saturday, September 26, 2009
Hopping
The famous strategy that the US army used in the Pacific War was island hopping (跳島戰術), which is not without interest to meticulous students.
The idea was simple: The Allied army attacked only Pacific islands that were strategically important and poorly defended, while bypassing those heavily fortified by the Japanese soldiers.
This strategy worked. The Allies used submarine and air forces to isolate Japanese bases and limit their supply. As a result, troops on islands that had been bypassed became useless; they would either surrender or die of negligence.
PS. The strategy was generally regarded as devised by the US general Douglas McArthur. That's not entirely correct - a few of his colleagues played a crucial role in its development. Nonetheless, we almost always quote only the first author when referring to a paper, do we not ?
The idea was simple: The Allied army attacked only Pacific islands that were strategically important and poorly defended, while bypassing those heavily fortified by the Japanese soldiers.
This strategy worked. The Allies used submarine and air forces to isolate Japanese bases and limit their supply. As a result, troops on islands that had been bypassed became useless; they would either surrender or die of negligence.
PS. The strategy was generally regarded as devised by the US general Douglas McArthur. That's not entirely correct - a few of his colleagues played a crucial role in its development. Nonetheless, we almost always quote only the first author when referring to a paper, do we not ?
Friday, September 25, 2009
Midway
Although I said it was a bit of luck of Uncle Sam in the Midway Island, it is in fact difficult to tell whether it was sheer luck, or it was some fortunate happenings awarded to those who were well prepared.
The detailed sequence of the event on 4 June 1942 (what a date !) is well know. The Japanese carrier Akagi (赤城) sank for just one bomb, Soryu (蒼龍) for three, and Kaga (加賀) for merely a few more - lost with the carriers were the accompanying aircraft and experienced crews.
Why were these well-armed carriers so fragile ? It was luck: The American dive-bombers arrived at the perfect time to attack the Japanese carriers: armed Japanese strike aircraft filled the hangar decks, fuel hoses snaked across the decks as refueling operations were hastily completed, and bombs and torpedoes were stacked around the hangar, making the Japanese carriers extraordinarily vulnerable.
But, why were the US army so lucky ?
They did their homework. Oh, I mean they broke the code of electric communication between Japanese army some time before the battle, so that the Americans were well informed of the whereabouts of the naval force under Emperor Showa.
Alas, I shall not dwell on the story. Just that next time when you want to complain of having tough luck, make sure you've done your part well.
PS. I learn much about the happenings at the Midway island from a history teacher of mine in the secondary school, who apparently wrote his master thesis on this topic. I must thank (not him but) my headmaster for allowing such kind of irrelevant teaching in his school.
The detailed sequence of the event on 4 June 1942 (what a date !) is well know. The Japanese carrier Akagi (赤城) sank for just one bomb, Soryu (蒼龍) for three, and Kaga (加賀) for merely a few more - lost with the carriers were the accompanying aircraft and experienced crews.
Why were these well-armed carriers so fragile ? It was luck: The American dive-bombers arrived at the perfect time to attack the Japanese carriers: armed Japanese strike aircraft filled the hangar decks, fuel hoses snaked across the decks as refueling operations were hastily completed, and bombs and torpedoes were stacked around the hangar, making the Japanese carriers extraordinarily vulnerable.
But, why were the US army so lucky ?
They did their homework. Oh, I mean they broke the code of electric communication between Japanese army some time before the battle, so that the Americans were well informed of the whereabouts of the naval force under Emperor Showa.
Alas, I shall not dwell on the story. Just that next time when you want to complain of having tough luck, make sure you've done your part well.
PS. I learn much about the happenings at the Midway island from a history teacher of mine in the secondary school, who apparently wrote his master thesis on this topic. I must thank (not him but) my headmaster for allowing such kind of irrelevant teaching in his school.
Thursday, September 24, 2009
Hiroshima
A little friend used the atomic bombing of Hiroshima to describe my blog several days ago.
I beg to disagree - but there's really some truth in it.
You know what. Before 6th August 1945, the Japanese army was long on the verge of failure. Well, it was a little bit of luck of Uncle Sam at the Midway Island. But, by the summar of 1945, the naval force under Emperor Showa was essentially demolished; Iwo Jima and Okinawa were at the hands of the US army; Tokyo was paralyzed by repeated incendiary bombings.
Therefore, even if there was no Manhattan project, the result of the Pacific war would no doubt be the same - just that the failure of the Japanese army would be an enduring torture.
And, it may not be an entirely bad thing to see the collapse of the military government: Japanese people became more cohesive than ever, and they soon evolved to be a super-power of economy; Hiroshima is merely a small scar in their history.
PS. Don't worry. There is, as yet, no Nagasaki.
I beg to disagree - but there's really some truth in it.
You know what. Before 6th August 1945, the Japanese army was long on the verge of failure. Well, it was a little bit of luck of Uncle Sam at the Midway Island. But, by the summar of 1945, the naval force under Emperor Showa was essentially demolished; Iwo Jima and Okinawa were at the hands of the US army; Tokyo was paralyzed by repeated incendiary bombings.
Therefore, even if there was no Manhattan project, the result of the Pacific war would no doubt be the same - just that the failure of the Japanese army would be an enduring torture.
And, it may not be an entirely bad thing to see the collapse of the military government: Japanese people became more cohesive than ever, and they soon evolved to be a super-power of economy; Hiroshima is merely a small scar in their history.
PS. Don't worry. There is, as yet, no Nagasaki.
Wednesday, September 23, 2009
紅樓
The last regret in life, according to Eileen Chang, is: The Dream of the Red Chamber remains unfinished (紅樓未完).
But, isn't it exactly the reason that we still keep talking on the possible fate of Jia Baoyu (賈寶玉) and the Twelve Beauties of Ginling (金陵十二釵) ?
And, look, the very feature that makes this classic of Cao Xueqin (曹雪芹) immortal is not that the novel continues on and on without an end (like some local comics) - it has, but the story has not been completed.
That gives us everything for imagination.
For a similar reason, The Castle of Franz Kafka remains a classic - the novel is not only incomplete, it breaks off in the middle of a sentence.
If our German existentialist told you the whole mystery of Count Westwest, where should we use our power of imagination ?
As the old Chinese sayings: 朝聞道, 夕死可矣.
But, isn't it exactly the reason that we still keep talking on the possible fate of Jia Baoyu (賈寶玉) and the Twelve Beauties of Ginling (金陵十二釵) ?
And, look, the very feature that makes this classic of Cao Xueqin (曹雪芹) immortal is not that the novel continues on and on without an end (like some local comics) - it has, but the story has not been completed.
That gives us everything for imagination.
For a similar reason, The Castle of Franz Kafka remains a classic - the novel is not only incomplete, it breaks off in the middle of a sentence.
If our German existentialist told you the whole mystery of Count Westwest, where should we use our power of imagination ?
As the old Chinese sayings: 朝聞道, 夕死可矣.
Tuesday, September 22, 2009
海棠
According to Eileen Chang (張愛玲), the second regret of life is: Begonia has no smell (海棠無香).
Yes, the flower has an exceptional charm on the look; too bad it has no odor.
Is that a pity ?
I would say no.
We are attracted by her bright red flower because it gives us a sense of lust. Similarly, we are impressed by the smell of sandalwood (檀香), and the taste of sugarcane.
Do you see the point ? They catch our attention because each of them has a certain aspect being outstanding - not that they are all-rounded.
The same should also hold for selecting medical students: This boy is aggressive and has a pair of good hands, he would make a good surgeon; this girl is introverted but has sharp eyes, she would be an excellent pathologist; this man is autistic and keeps talking to plants, let's make him a malicious nephrologist ...
And, in fact, I shall be highly suspicious if anything or anyone is all-rounded and outstanding in every aspect.
As Philo Vance said: Nothing perfect is natural or genuine.
Yes, the flower has an exceptional charm on the look; too bad it has no odor.
Is that a pity ?
I would say no.
We are attracted by her bright red flower because it gives us a sense of lust. Similarly, we are impressed by the smell of sandalwood (檀香), and the taste of sugarcane.
Do you see the point ? They catch our attention because each of them has a certain aspect being outstanding - not that they are all-rounded.
The same should also hold for selecting medical students: This boy is aggressive and has a pair of good hands, he would make a good surgeon; this girl is introverted but has sharp eyes, she would be an excellent pathologist; this man is autistic and keeps talking to plants, let's make him a malicious nephrologist ...
And, in fact, I shall be highly suspicious if anything or anyone is all-rounded and outstanding in every aspect.
As Philo Vance said: Nothing perfect is natural or genuine.
Monday, September 21, 2009
鰣魚
It used to be said that one of the three biggest regrets in life is having too many bones in Tenualosa reevesii (鰣魚有刺).
The same problem holds true for the lion-head fish. But, if there is none, would we still feel it precious and delicious ?
For fish, it used to be said that: 第一鯧，第二罔，第三馬鮫郎. Yes, they have big pieces of flesh and has certain degree of flavor. But, I've tried the first and third - they are way inferior to this Shanghai classic, not to say our little lion-head.
On a second thought, tasty fish usually have a lot of bones because we have to keep the flesh on our mouth longer and taste it better.
And, alas, if there is such kind of delicious fish without much bone, it would go extinct centuries ago - not only because of human beings, but also other predators in the sea.
PS. The only exception is probably fugu - for obvious reasons.
The same problem holds true for the lion-head fish. But, if there is none, would we still feel it precious and delicious ?
For fish, it used to be said that: 第一鯧，第二罔，第三馬鮫郎. Yes, they have big pieces of flesh and has certain degree of flavor. But, I've tried the first and third - they are way inferior to this Shanghai classic, not to say our little lion-head.
On a second thought, tasty fish usually have a lot of bones because we have to keep the flesh on our mouth longer and taste it better.
And, alas, if there is such kind of delicious fish without much bone, it would go extinct centuries ago - not only because of human beings, but also other predators in the sea.
PS. The only exception is probably fugu - for obvious reasons.
Sunday, September 20, 2009
獅頭魚
After a busy Saturday, I was back home in the evening. Vivian was on call, and I said casually to my mother, "Hey, what's there for dinner tonight ?"
"Something that you've long for..." She made a suspicious smile.
"And it is ... ?"
"It's lion-head fish (獅頭魚)."
My mother was absolutely correct. I did not have this dish for some 10 or 15 years.
For genuine fish lovers, this tiny little species definitely induce a mixture of feelings. The flesh is absolutely tender and full of flavor. On the other hand, the species is never more than 4 inches long and it is often a nightmare to dissect the meat from bone with chopsticks. No wonder in the old days it was mainly used for feeding cats, and only poor families would have the opportunity of coming up with the ingenious idea of making the feline feast human by steaming it with soy sauce.
"Something that you've long for..." She made a suspicious smile.
"And it is ... ?"
"It's lion-head fish (獅頭魚)."
My mother was absolutely correct. I did not have this dish for some 10 or 15 years.
For genuine fish lovers, this tiny little species definitely induce a mixture of feelings. The flesh is absolutely tender and full of flavor. On the other hand, the species is never more than 4 inches long and it is often a nightmare to dissect the meat from bone with chopsticks. No wonder in the old days it was mainly used for feeding cats, and only poor families would have the opportunity of coming up with the ingenious idea of making the feline feast human by steaming it with soy sauce.
Saturday, September 19, 2009
Demo
That Saturday proved exceptionally busy: It was the curriculum day in the morning; in the afternoon I had to attend the briefing session of MRCP examination.
It was at the Center for Health Protection.
The session was supposed to be kind of a live-demonstration, with real patients, for the new "integrated case" station. Many of us were therefor slightly disappointed when MN, our chief local examiner, explained that there would not be any patient for the demonstration.
"You know, this place is slightly sensitive," he explained, "There is always some suspicion that patients may get all sorts of funny infection by coming here."
After a while, he went on, "And, if anything does happen, we are not covered by insurance."
Alas, I badly need someone with wisdom to enlighten me on the purpose of a demonstration session when demonstration is not possible.
PS. Well, true, the talk of MN is clear and informative, and many of us - candidates and examiners alike - have difficulty in reading.
It was at the Center for Health Protection.
The session was supposed to be kind of a live-demonstration, with real patients, for the new "integrated case" station. Many of us were therefor slightly disappointed when MN, our chief local examiner, explained that there would not be any patient for the demonstration.
"You know, this place is slightly sensitive," he explained, "There is always some suspicion that patients may get all sorts of funny infection by coming here."
After a while, he went on, "And, if anything does happen, we are not covered by insurance."
Alas, I badly need someone with wisdom to enlighten me on the purpose of a demonstration session when demonstration is not possible.
PS. Well, true, the talk of MN is clear and informative, and many of us - candidates and examiners alike - have difficulty in reading.
Friday, September 18, 2009
Test
Another ingenious suggestion that received a hot discussion in the curriculum day was: Should we put up some kind of psychological test during admission, in order to screen for those candidates who are suitable of studying medicine ?
"An one-off screening test does not exclude the possibility of subsequent development of psychiatric disorders ..." LS was the first to come out and object.
"No, no ..." someone else explained, "We mean kind of a psychological test so that we could assure all candidates have a personality suitable of becoming a doctor."
TC raised his hand, "There's no evidence of such screening test. The Australian experience ..."
I could not recall the further detail of discussion. My mind was driven to something else -
I looked around and considered the character of each and everyone in the auditorium. (Fortunately or unfortunately, I know most of them.) Are they similar in any aspect ?
And I begin to imagine having surgeons, psychiatrists, and pathologists with a similar personality.
What a horror !
"An one-off screening test does not exclude the possibility of subsequent development of psychiatric disorders ..." LS was the first to come out and object.
"No, no ..." someone else explained, "We mean kind of a psychological test so that we could assure all candidates have a personality suitable of becoming a doctor."
TC raised his hand, "There's no evidence of such screening test. The Australian experience ..."
I could not recall the further detail of discussion. My mind was driven to something else -
I looked around and considered the character of each and everyone in the auditorium. (Fortunately or unfortunately, I know most of them.) Are they similar in any aspect ?
And I begin to imagine having surgeons, psychiatrists, and pathologists with a similar personality.
What a horror !
Thursday, September 17, 2009
Quit
While I was still digesting the email from KM, there came the curriculum day.
One hot topic that came up in the discussion was: How could we advised those students who are not suitable for medicine to quit ?
"We have to talk to them frankly." SF said.
"Yes, but, after seeing several dozens of students of this kind in the past 15 or 20 years, there was only one who agreed to quit." HK remarked.
"It is difficult," TC added, "Many students have too much pressure - their parents and friends have very high expectation for them. They have an obsessive idea that they could not just quit."
We all agreed in silence ...
A moment later, I whispered at the ears of JW, "Do they mean we should see the parents of those students who fail the final MB - as they have in the kindergarten and primary school ?"
One hot topic that came up in the discussion was: How could we advised those students who are not suitable for medicine to quit ?
"We have to talk to them frankly." SF said.
"Yes, but, after seeing several dozens of students of this kind in the past 15 or 20 years, there was only one who agreed to quit." HK remarked.
"It is difficult," TC added, "Many students have too much pressure - their parents and friends have very high expectation for them. They have an obsessive idea that they could not just quit."
We all agreed in silence ...
A moment later, I whispered at the ears of JW, "Do they mean we should see the parents of those students who fail the final MB - as they have in the kindergarten and primary school ?"
Wednesday, September 16, 2009
Arguments
On my way back from the consulate office, I received a remarkable email forwarded from KM.
Here it goes:
*******************************
Dear KM,
Thank you so much for teaching us these past few days during the ward round, clinics and other periods in the hospital... I am really grateful for it. But may I let you know something behind the scene and suggest some of my personal opinions?
You must have noticed that a lot of medical students like your teaching very much, no matter ward rounds, clinics, bedside teaching etc, there are always crowds of people around you. You would never mind it and welcome every student to join, but in fact, there have been so much arguments between classmates who are assigned to your wards and students assigned to other wards nearby. Everyone wants to have the chance being taught by you, so even they are not attaching to your ward, they also want to join your ward round or clinics, but those who have been assigned would be afraid that their chance to be deprived and so they would refuse other fellow classmates to come.
I myself was not attaching to your wards during my medical attachment, and as expected, the group of students who follow your round everyday at that time said I and my group-mates should not go to their wards and join because you do not like too many people...
The same problem also appear in extra bedside teaching... For those who are attaching to your wards, they can always have the first priority to approach you and asked for extra bedside during the week, while for others who may also hope to share the chance will always be disappointed. Therefore, a lot of arguments, misunderstanding and even relationship problems between classmates will arise from here.
I know you are such an enthusiastic teacher to medical students... but from my point of view, the problem of getting attached to popular doctors and sharing extra bedsides, etc. has become increasingly severe... I believe you would be the most suitable person to help in this difficult condition and prevent misunderstanding... may I suggest that from the next module, you can encourage those students who are assigned to attaching your ward to share good cases and clinic attachment with others attaching to nearby wards, and for the extra bedside, may I also suggest to avoid giving the teaching to the same group for many times but no chance leave for other groups?
Here it goes:
*******************************
Dear KM,
Thank you so much for teaching us these past few days during the ward round, clinics and other periods in the hospital... I am really grateful for it. But may I let you know something behind the scene and suggest some of my personal opinions?
You must have noticed that a lot of medical students like your teaching very much, no matter ward rounds, clinics, bedside teaching etc, there are always crowds of people around you. You would never mind it and welcome every student to join, but in fact, there have been so much arguments between classmates who are assigned to your wards and students assigned to other wards nearby. Everyone wants to have the chance being taught by you, so even they are not attaching to your ward, they also want to join your ward round or clinics, but those who have been assigned would be afraid that their chance to be deprived and so they would refuse other fellow classmates to come.
I myself was not attaching to your wards during my medical attachment, and as expected, the group of students who follow your round everyday at that time said I and my group-mates should not go to their wards and join because you do not like too many people...
The same problem also appear in extra bedside teaching... For those who are attaching to your wards, they can always have the first priority to approach you and asked for extra bedside during the week, while for others who may also hope to share the chance will always be disappointed. Therefore, a lot of arguments, misunderstanding and even relationship problems between classmates will arise from here.
I know you are such an enthusiastic teacher to medical students... but from my point of view, the problem of getting attached to popular doctors and sharing extra bedsides, etc. has become increasingly severe... I believe you would be the most suitable person to help in this difficult condition and prevent misunderstanding... may I suggest that from the next module, you can encourage those students who are assigned to attaching your ward to share good cases and clinic attachment with others attaching to nearby wards, and for the extra bedside, may I also suggest to avoid giving the teaching to the same group for many times but no chance leave for other groups?
Tuesday, September 15, 2009
Consul
Went to the USA Consulate Office to renew my visa - I will have a conference there in October and my original visa has expired.
It has been ten years since I was last here. While I had to line up at the Garden Road for an hour in the last millennium, I could (oh, in fact I have to) make an appointment on line in advance. There were a whole list of funny question on the web to fill in, and the only thing remained unchanged was the question on whether the applicant know how to make a bomb. (There seems no follow up question now if you reply yes; I hear that, ten years ago, the next question was: Do you know how to teach the others to make a bomb ?)
I was slightly early for my appointment, but the officers there were immensely efficient. The security check was impeccable as ever. I was thoroughly searched and had to hand in my mobile phone before I entered the building.
The whole process took merely 15 or 20 minutes. When I was back to the security gate and claimed the return of my mobile phone, they gave me a small souvenir in addition: my finger disc.
They sneaked it from my bag - without I noticing it - during the search !
PS. For those who are interested in the chemistry of explosives, go read Wolf SJ, et al. Lancet 2009; 374: 405-415.
It has been ten years since I was last here. While I had to line up at the Garden Road for an hour in the last millennium, I could (oh, in fact I have to) make an appointment on line in advance. There were a whole list of funny question on the web to fill in, and the only thing remained unchanged was the question on whether the applicant know how to make a bomb. (There seems no follow up question now if you reply yes; I hear that, ten years ago, the next question was: Do you know how to teach the others to make a bomb ?)
I was slightly early for my appointment, but the officers there were immensely efficient. The security check was impeccable as ever. I was thoroughly searched and had to hand in my mobile phone before I entered the building.
The whole process took merely 15 or 20 minutes. When I was back to the security gate and claimed the return of my mobile phone, they gave me a small souvenir in addition: my finger disc.
They sneaked it from my bag - without I noticing it - during the search !
PS. For those who are interested in the chemistry of explosives, go read Wolf SJ, et al. Lancet 2009; 374: 405-415.
Monday, September 14, 2009
Specialized
You may think there's nothing wrong with the doings of that well-to-do woman.
Well, there's nothing definitely wrong as such. (As a practising physician like myself, you would find the behaviour annoying. We shall take that aside for the time being.)
But my question is: Was this kind of blinded testing an advisable way to seek a second opinion or look for an appropriate doctor to take care of her ?
As the old sayings: To the hammer, every problem is a nail. Yes, she would find the best expert (at least in terms of book knowledge) of that rare disease. It is equally likely, however, that this expert knows very little outside his field, or he may not be very good at practical procedures. (I'm not implying that's my professor colleague. Don't be paranoid.)
I am sure that pretty client would enjoy a good time should she eventually be under the care of a real expert who do not know the normal dosage of panadol.
PS. As to those annoying patients, we clinicians would not have discrimination - we always give them a fair treatment.
By the way, similar to our approach to medical students, there are two modes we treat our patients: fair or nice.
Well, there's nothing definitely wrong as such. (As a practising physician like myself, you would find the behaviour annoying. We shall take that aside for the time being.)
But my question is: Was this kind of blinded testing an advisable way to seek a second opinion or look for an appropriate doctor to take care of her ?
As the old sayings: To the hammer, every problem is a nail. Yes, she would find the best expert (at least in terms of book knowledge) of that rare disease. It is equally likely, however, that this expert knows very little outside his field, or he may not be very good at practical procedures. (I'm not implying that's my professor colleague. Don't be paranoid.)
I am sure that pretty client would enjoy a good time should she eventually be under the care of a real expert who do not know the normal dosage of panadol.
PS. As to those annoying patients, we clinicians would not have discrimination - we always give them a fair treatment.
By the way, similar to our approach to medical students, there are two modes we treat our patients: fair or nice.
Sunday, September 13, 2009
Consult
Another story KM told me just recently:
A well-to-do young woman was admitted to a private hospital for some trivial problem. As you would expect, some sophisticated X-rays were done (with or without a good reason), and, fortunately or unfortunately, a rather uncommon disease was found.
The doctor there explained the problem to this woman. Alas, she put up an extraordinary effort and search the internet for anything and everything about this condition. Yes, she learned a lot - and then she decided to seek a second opinion.
She came and consulted one of our professors as a private case.
The catch was: She brought all her X-rays for the consultation, with no reports, nor any hint of what she learned from the web. (Of course she gradually revealed her hidden cards during that hour of discussion.)
My colleague passed the test - partly to his credit, partly because he recently saw another similar case and had done his homework !
PS. My amygdala flashes back a vivid comment of VY, our previous consultant endocrinologist: This is not a consult, but insult.
I shouldn't think like this, I know.
A well-to-do young woman was admitted to a private hospital for some trivial problem. As you would expect, some sophisticated X-rays were done (with or without a good reason), and, fortunately or unfortunately, a rather uncommon disease was found.
The doctor there explained the problem to this woman. Alas, she put up an extraordinary effort and search the internet for anything and everything about this condition. Yes, she learned a lot - and then she decided to seek a second opinion.
She came and consulted one of our professors as a private case.
The catch was: She brought all her X-rays for the consultation, with no reports, nor any hint of what she learned from the web. (Of course she gradually revealed her hidden cards during that hour of discussion.)
My colleague passed the test - partly to his credit, partly because he recently saw another similar case and had done his homework !
PS. My amygdala flashes back a vivid comment of VY, our previous consultant endocrinologist: This is not a consult, but insult.
I shouldn't think like this, I know.
Saturday, September 12, 2009
Fan
Irene, my secretary, was sick and stayed in the private ward. I visited her briefly on the weekend, and the two of us ended up having some casual talk that we hardly ever had in the past.
"I've got to get back work soon. There're piles of them !" She sighed.
"Don't be too stressed. What's there urgent ?"
"Lots of them. For example, the exhaust fan of the male toilet." My secretary hesitated.
"Now you come to this. I always puzzle why our toilet does not have an exhaust fan. One would never faint in our toilet because the air is full of the aroma of smelling salt !" I smiled.
"I know, KL asked me to go in once and experience - it's really an experience !"
"Then why does it take over 25 years to arrange for a fan ?" I pressed on.
"Oh, we applied for one long time ago, but, after some months of paper work, the reply was negative."
"Why ?"
"They said that an exhaust fan would affect the external appearance of the hospital, and, should there be a typhoon or anything that damage the fan, the responsibility of repairing it (by university or the hospital) was undefined ..."
"In order to facilitate the arrangement, should we invite a grant donor or external examiner to stay there for a while ?"
My secretary said nothing; she merely returned a humble smile.
PS. On a second thought, it may be more effective to ask a few of our delinquent medical students to stay there - their complaint is always taken more seriously than ours.
"I've got to get back work soon. There're piles of them !" She sighed.
"Don't be too stressed. What's there urgent ?"
"Lots of them. For example, the exhaust fan of the male toilet." My secretary hesitated.
"Now you come to this. I always puzzle why our toilet does not have an exhaust fan. One would never faint in our toilet because the air is full of the aroma of smelling salt !" I smiled.
"I know, KL asked me to go in once and experience - it's really an experience !"
"Then why does it take over 25 years to arrange for a fan ?" I pressed on.
"Oh, we applied for one long time ago, but, after some months of paper work, the reply was negative."
"Why ?"
"They said that an exhaust fan would affect the external appearance of the hospital, and, should there be a typhoon or anything that damage the fan, the responsibility of repairing it (by university or the hospital) was undefined ..."
"In order to facilitate the arrangement, should we invite a grant donor or external examiner to stay there for a while ?"
My secretary said nothing; she merely returned a humble smile.
PS. On a second thought, it may be more effective to ask a few of our delinquent medical students to stay there - their complaint is always taken more seriously than ours.
Friday, September 11, 2009
Storage
If you allow yourself to alter the view, polyethylene could be taken as some permanent storage of carbon dioxide, a compound that would keep the major greenhouse gas bound to the soil rather than being released to the atmosphere, which would be inevitably the case if it is degraded.
Now you see the beauty of plastic bags ?
You think that's crazy ? I'm not alone. People are beginning to consider long-term carbon dioxide storage by using the deep sea sediment as the reservoir. (Go read Goldberg DS, et al. Proc Natl Acad Sci USA 2008; 105: 9920-9925 and a few other related articles.)
You may argue, "Plastic bags are bad because they are unsightly and may harm some types wildlife if not disposed properly."
My salute to your excellent knowledge on the official reasons against plastic bags. But, your lips betrayed your mind - the problem is improper disposal of this excellent reservoir of greenhouse gas, not the thin films of plastics themselves.
By the way, most of the industries are already charged for sewage disposal. As to the new Plastic Bag Tax, is it then a kind of double taxation ?
PS. My discussion in these two days are, of course, based on the assumption that greenhouse gas is bad because it is the direct cause of global warming. You may hold a different view. (Seriously, I do.) But that's another story.
Now you see the beauty of plastic bags ?
You think that's crazy ? I'm not alone. People are beginning to consider long-term carbon dioxide storage by using the deep sea sediment as the reservoir. (Go read Goldberg DS, et al. Proc Natl Acad Sci USA 2008; 105: 9920-9925 and a few other related articles.)
You may argue, "Plastic bags are bad because they are unsightly and may harm some types wildlife if not disposed properly."
My salute to your excellent knowledge on the official reasons against plastic bags. But, your lips betrayed your mind - the problem is improper disposal of this excellent reservoir of greenhouse gas, not the thin films of plastics themselves.
By the way, most of the industries are already charged for sewage disposal. As to the new Plastic Bag Tax, is it then a kind of double taxation ?
PS. My discussion in these two days are, of course, based on the assumption that greenhouse gas is bad because it is the direct cause of global warming. You may hold a different view. (Seriously, I do.) But that's another story.
Thursday, September 10, 2009
Degrade
I always find it difficult to justify the Plastic Bag Tax.
No, I should say I find it difficult to justify restricting the use of plastic bags - from the point of view of environment protection, we may actually encourage their usage.
Let's think of it: Why are people against using plastic bags ?
The answer is all too familiar, "Because it is not biodegradable and would therefore do harm to the environment !"
Alas, may I ask, "So, we accept paper bags or wooden box because they are biodegradable ?"
I could see you nod.
"How are papers and wood degrade, and what do they become ?"
Don't pretend you don't know the answers; they are plain obvious. Bacteria did the job, and those cellulose fibers become carbon dioxide.
Greenhouse gas !
(Meticulous earth science specialist would actually point out, depending on the exact species of bacteria and the condition of fermentation, the breakdown of cellulose fibers may be incomplete, resulting in the generation of carbon monoxide, methane, and a few other gaseous compounds that have a greater greenhouse effect than your good old carbon dioxide.)
Of course, you may argue the carbon dioxide could be re-cycled. There is re-uptake by plant for photosynthesis. But, look, the good is done by the plants but not paper bags. If we do not use paper and have the same amount of photosynthesis going around, we could actually reduce the amount of carbon dioxide in the atmosphere.
No, I should say I find it difficult to justify restricting the use of plastic bags - from the point of view of environment protection, we may actually encourage their usage.
Let's think of it: Why are people against using plastic bags ?
The answer is all too familiar, "Because it is not biodegradable and would therefore do harm to the environment !"
Alas, may I ask, "So, we accept paper bags or wooden box because they are biodegradable ?"
I could see you nod.
"How are papers and wood degrade, and what do they become ?"
Don't pretend you don't know the answers; they are plain obvious. Bacteria did the job, and those cellulose fibers become carbon dioxide.
Greenhouse gas !
(Meticulous earth science specialist would actually point out, depending on the exact species of bacteria and the condition of fermentation, the breakdown of cellulose fibers may be incomplete, resulting in the generation of carbon monoxide, methane, and a few other gaseous compounds that have a greater greenhouse effect than your good old carbon dioxide.)
Of course, you may argue the carbon dioxide could be re-cycled. There is re-uptake by plant for photosynthesis. But, look, the good is done by the plants but not paper bags. If we do not use paper and have the same amount of photosynthesis going around, we could actually reduce the amount of carbon dioxide in the atmosphere.
Wednesday, September 9, 2009
Wok
I decided to change a topic, "Talking about resignation, what do you think of the resignation of that 16 doctors ?"
"That's a good show - of both sides." The secretary was brief.
"What do you mean ?"
"Do you remember what happened ? One side threatened to terminate the contract of anyone who does not agree to cut the salary. All 16 of the other side resigned. The boss appeared and apologize sincerely - the threat was much too aggressive. Back came the gang of 16 - they felt satisfied with the apology and would therefore agree to the original proposal."
"Thanks for summarizing the case. But what's the point ?"
"The point is: The original proposal does get through without amendment, and that 16 doctors appeared to have done something to fulfill their role as representatives !"
"Oh ..." my mouth was wide open. "The tactic sounds familiar. Where did I hear of it ?"
"Couldn't you remember the Principle of Repairing a Broken Wok (補鑊法) ? Go and read Li Zong Wu (李宗吾) !"
PS. I have no idea whether the event was a careful planning of one side or both, or it was merely a convenient coincidence. As I emphasized again and again, it is usually difficult to distinguish an ingenious crook from a complete idiot.
"That's a good show - of both sides." The secretary was brief.
"What do you mean ?"
"Do you remember what happened ? One side threatened to terminate the contract of anyone who does not agree to cut the salary. All 16 of the other side resigned. The boss appeared and apologize sincerely - the threat was much too aggressive. Back came the gang of 16 - they felt satisfied with the apology and would therefore agree to the original proposal."
"Thanks for summarizing the case. But what's the point ?"
"The point is: The original proposal does get through without amendment, and that 16 doctors appeared to have done something to fulfill their role as representatives !"
"Oh ..." my mouth was wide open. "The tactic sounds familiar. Where did I hear of it ?"
"Couldn't you remember the Principle of Repairing a Broken Wok (補鑊法) ? Go and read Li Zong Wu (李宗吾) !"
PS. I have no idea whether the event was a careful planning of one side or both, or it was merely a convenient coincidence. As I emphasized again and again, it is usually difficult to distinguish an ingenious crook from a complete idiot.
Tuesday, September 8, 2009
Resign
(My little talk with Humphrey Appleby continued.)
"How about Andrew ? What do you think of his resignation ?" The permenant secretary was in the best of his mood.
"There must be a reason behind, but I just couldn't figure it out."
"I think that's plain enough ?"
"Come on. It's plain enough to you."
"Why? Let's be a moment of Sherlock Holmes and exclude the impossibles. Since it is close to the 60th ceremony and Donald is busy with putting out other fires, Andrew must have resigned by his own wish."
"I can understand that."
"Then, the problem is why. Let's advance ourselves and become Hercule Poirot: On the balance of probability, isn't it most likely that he does not want to see that basic thing being explained by the higher authority again ?"
"Well, yes. Let me see. Is there anything that needs further explanation ? Do you mean the judicial review on whether the Select Committee could summon witness ?" I hesitated.
"I didn't suggest anything." The permanent secretary of the cabinet put up a wicked smile.
"Em ... but the resignation does suggest what Andrew thought of the case !" Like Hastings, I was forced to the conclusion.
"How about Andrew ? What do you think of his resignation ?" The permenant secretary was in the best of his mood.
"There must be a reason behind, but I just couldn't figure it out."
"I think that's plain enough ?"
"Come on. It's plain enough to you."
"Why? Let's be a moment of Sherlock Holmes and exclude the impossibles. Since it is close to the 60th ceremony and Donald is busy with putting out other fires, Andrew must have resigned by his own wish."
"I can understand that."
"Then, the problem is why. Let's advance ourselves and become Hercule Poirot: On the balance of probability, isn't it most likely that he does not want to see that basic thing being explained by the higher authority again ?"
"Well, yes. Let me see. Is there anything that needs further explanation ? Do you mean the judicial review on whether the Select Committee could summon witness ?" I hesitated.
"I didn't suggest anything." The permanent secretary of the cabinet put up a wicked smile.
"Em ... but the resignation does suggest what Andrew thought of the case !" Like Hastings, I was forced to the conclusion.
Monday, September 7, 2009
Party
Humphrey Appleby visited the city recently. I was so happy and took the chance to be Bernard Woolley for a moment.
"Do you find the ex-colony interesting ?" I asked.
"Very. It's not the place, but the characters." He remarked.
"Such as ... ?"
"Let's see ... For example, what do you make out of CY ?"
"He's running for the next CE. So what ?"
"Oh, nothing. Just that he is too keen to deny being a member of the Communist Party."
"I suppose the reason is obvious enough ?" I was slightly incredulous.
"It is, but it doesn't mean that the reason - or tactic - is right. If he is a member, he should come out and say so; there's nothing to be ashamed of. The party is the one now ruling the biggest country in the world and it is a honor to be a member. In fact, if he does become the CE, the membership would give much convenience in the work."
"Yes, because he is one of them, and there's no need to guess if they agree to any particular policy - nor to look upon the face of some secondary administrative center in Sai Wan. But what if he is really not a member ?"
"Why ? He should come out and say it is a pity that he is not - but he would like to join !"
"Do you find the ex-colony interesting ?" I asked.
"Very. It's not the place, but the characters." He remarked.
"Such as ... ?"
"Let's see ... For example, what do you make out of CY ?"
"He's running for the next CE. So what ?"
"Oh, nothing. Just that he is too keen to deny being a member of the Communist Party."
"I suppose the reason is obvious enough ?" I was slightly incredulous.
"It is, but it doesn't mean that the reason - or tactic - is right. If he is a member, he should come out and say so; there's nothing to be ashamed of. The party is the one now ruling the biggest country in the world and it is a honor to be a member. In fact, if he does become the CE, the membership would give much convenience in the work."
"Yes, because he is one of them, and there's no need to guess if they agree to any particular policy - nor to look upon the face of some secondary administrative center in Sai Wan. But what if he is really not a member ?"
"Why ? He should come out and say it is a pity that he is not - but he would like to join !"
Sunday, September 6, 2009
Mooncake
Another thing that I did during the short holiday was paying a visit to the urn of my father.
Before we set off, my mother, Vivian and I discussed what to bring for the deceased. Besides a full set of traditional paper work for incineration, my mother had made ready of some rice, fruit, and some roasted duck - all favorites of my father.
"Shall we bring some mooncake ?" my wife suggested.
"Why ?" my mother exclaimed, "What an idea ! I have never thought of it !"
"So, did my half father like mookcake ?" Vivian
"He loved anything that is round and sweet ..." I could not stop smiling.
****************************
It was in fact a long time from the mid Autumn festival, but my wife managed to buy two good pieces of that special dessert from a small shop.
We arrived in a hot summer weekday afternoon, and the place was exceptionally quiet. In no time, the three of us displayed all the food on the table; I had a deja vu feeling of having a picnic - just that the place was a bit smoky.
While my mother took the chance to visit a few other urns nearby (alas, one would know at least a few by her age), my wife and I enjoyed a peaceful moment of burning the paper work.
On our way home, my mother remarked, "This is the first time in 20 years that he has some mooncake. He must be very happy."
"So are you too !" I said to myself.
Before we set off, my mother, Vivian and I discussed what to bring for the deceased. Besides a full set of traditional paper work for incineration, my mother had made ready of some rice, fruit, and some roasted duck - all favorites of my father.
"Shall we bring some mooncake ?" my wife suggested.
"Why ?" my mother exclaimed, "What an idea ! I have never thought of it !"
"So, did my half father like mookcake ?" Vivian
"He loved anything that is round and sweet ..." I could not stop smiling.
****************************
It was in fact a long time from the mid Autumn festival, but my wife managed to buy two good pieces of that special dessert from a small shop.
We arrived in a hot summer weekday afternoon, and the place was exceptionally quiet. In no time, the three of us displayed all the food on the table; I had a deja vu feeling of having a picnic - just that the place was a bit smoky.
While my mother took the chance to visit a few other urns nearby (alas, one would know at least a few by her age), my wife and I enjoyed a peaceful moment of burning the paper work.
On our way home, my mother remarked, "This is the first time in 20 years that he has some mooncake. He must be very happy."
"So are you too !" I said to myself.
Saturday, September 5, 2009
School
I took a few days off recently - Euterpe just began schooling.
Although I said began, my daughter attended some preparatory class for three weeks, so much so she could recognize two of the teachers and knew quite well the whereabouts of the classroom. However, it remained quite a chaos. The rooms and corridors were filled with struggling children and anxious parents, half of the latter trying to pacify their own kids, while the other half taking the chance to make photos and videos.
Our malicious nephrologist was neither. Euterpe was not completely well and kept sneezing, with occasional bursts of an annoying cough. Nonetheless, the morning was not entirely boring. Towards the end of it, the headmaster of the nursery made a speech. The father and the daughter had no choice but sat in the hall and listen. To our surprise, the speaker went on for 45 minutes and there was no sign of finishing.
The girl whispered at my ears, "Let's go home. I'm sleepy."
I tapped on her shoulders, and she just yawned.
Some ten minutes later, the speaker said, "Just one last point ..."
My daughter jumped up and shouted, "Good, go home !"
All of a sudden, no fewer than half of the parents and kids woke up and marched out of the hall. I had no idea if our headmaster could really finish with her last point; we left, and soon did the rest of the class.
And, of course, once outside the school, my princess was as energetic as ever.
Although I said began, my daughter attended some preparatory class for three weeks, so much so she could recognize two of the teachers and knew quite well the whereabouts of the classroom. However, it remained quite a chaos. The rooms and corridors were filled with struggling children and anxious parents, half of the latter trying to pacify their own kids, while the other half taking the chance to make photos and videos.
Our malicious nephrologist was neither. Euterpe was not completely well and kept sneezing, with occasional bursts of an annoying cough. Nonetheless, the morning was not entirely boring. Towards the end of it, the headmaster of the nursery made a speech. The father and the daughter had no choice but sat in the hall and listen. To our surprise, the speaker went on for 45 minutes and there was no sign of finishing.
The girl whispered at my ears, "Let's go home. I'm sleepy."
I tapped on her shoulders, and she just yawned.
Some ten minutes later, the speaker said, "Just one last point ..."
My daughter jumped up and shouted, "Good, go home !"
All of a sudden, no fewer than half of the parents and kids woke up and marched out of the hall. I had no idea if our headmaster could really finish with her last point; we left, and soon did the rest of the class.
And, of course, once outside the school, my princess was as energetic as ever.
Friday, September 4, 2009
Cook
I am recently reading What Einstein Told His Cook by Robert Wolke as my bedtime reading.
It is a present from my friend KM, who obviously knows my interest just too well. The book is an eye-opening experience for those with interest in both cookery and natural science, with the connection between the two beautifully demonstrated.
Of course, the book is far from perfect - at least in the eye of a critical reader with special interest in biological science. Wolke is a chemist by training, and he is certainly highly meticulous in the topics of sugar, salt, heat, and microwave, but his weakness in discerning individual food material is equally obvious. There's even no discrimination between beef and pork, not to say various species of fish.
(In fact, I am also slightly disappointed for the lack of a detailed discussion on vinegar and wine, as well as the reaction between the two, which generate the fruity smell of ethyl acetate.)
Alas, I enjoy thumbing through the pages in many lovely evening and really shouldn't complain that much.
It is a present from my friend KM, who obviously knows my interest just too well. The book is an eye-opening experience for those with interest in both cookery and natural science, with the connection between the two beautifully demonstrated.
Of course, the book is far from perfect - at least in the eye of a critical reader with special interest in biological science. Wolke is a chemist by training, and he is certainly highly meticulous in the topics of sugar, salt, heat, and microwave, but his weakness in discerning individual food material is equally obvious. There's even no discrimination between beef and pork, not to say various species of fish.
(In fact, I am also slightly disappointed for the lack of a detailed discussion on vinegar and wine, as well as the reaction between the two, which generate the fruity smell of ethyl acetate.)
Alas, I enjoy thumbing through the pages in many lovely evening and really shouldn't complain that much.
Thursday, September 3, 2009
End
Now, you may come to appreciate the art of a medical decision, or the fine balance between asking for more evidence, or being satisfied with the available ones and make a decision.
(Of course, many a time we make a tentative decision and start treating a patient - while we continue to look for further evidence.)
However, our task is not as easy as Plato's picking the best ear of wheat - because very often we do not know when would the journey end.
You think there is still time to do another investigation ? Thanatos secretly comes that night.
Well, true, we play Sisyphos just too often.
But, for this very reason, we are sentenced to the eternity of frustration in Tartaros.
(Of course, many a time we make a tentative decision and start treating a patient - while we continue to look for further evidence.)
However, our task is not as easy as Plato's picking the best ear of wheat - because very often we do not know when would the journey end.
You think there is still time to do another investigation ? Thanatos secretly comes that night.
Well, true, we play Sisyphos just too often.
But, for this very reason, we are sentenced to the eternity of frustration in Tartaros.
Wednesday, September 2, 2009
Decision
Many of you may have heard of the following story:
One day, Plato asked Socrates what love was.
Socrates said, “Go across this field, and pick the biggest and best ear of wheat. Remember one thing. You cannot go back and have only one chance.”
After a long time, Plato came back with nothing. Socrates asked what happened.
“I once saw some big and nice wheat, but wondered if better ones were yet to come. So I just passed by, but the later ones were not better than before. Thus I had nothing at last.”
Socrates said this was love.
(If you wish to know the second half of the story, read this: http://vwswong.blogspot.com/2009/06/happiness.html)
********************************
No, I'm not going to write anything romantic.
Just that the same considerations apply when we make clinical decisions. If you keep going to look for better evidence to prove a diagnosis (or to exclude alternative possibilities), you may well miss the opportunity to treat the patient.
One day, Plato asked Socrates what love was.
Socrates said, “Go across this field, and pick the biggest and best ear of wheat. Remember one thing. You cannot go back and have only one chance.”
After a long time, Plato came back with nothing. Socrates asked what happened.
“I once saw some big and nice wheat, but wondered if better ones were yet to come. So I just passed by, but the later ones were not better than before. Thus I had nothing at last.”
Socrates said this was love.
(If you wish to know the second half of the story, read this: http://vwswong.blogspot.com/2009/06/happiness.html)
********************************
No, I'm not going to write anything romantic.
Just that the same considerations apply when we make clinical decisions. If you keep going to look for better evidence to prove a diagnosis (or to exclude alternative possibilities), you may well miss the opportunity to treat the patient.
Tuesday, September 1, 2009
Exclude
You may argue it does no harm to ask our colleagues to acquire better equipments and do a better service.
On that, you are wrong.
As Robert Merton stated: Any purposeful action will produce some unanticipated or unintended consequences.
But this time the consequence is quite anticipated. From now on, when you ask the colleague from that another department for an opinion, they would always suggest doing something more sophisticated because XXX and YYY could not be excluded.
Of course, how often could we say with absolute confidence that everything else has been excluded ? Even if a test is 100 percent reliable, you still run the risk of mixing up with the result from another patient.
And our life - as well as our patients' - would be wasted in the endless list of further investigation.
Alas, on that final certificate, the cause of death would be put down as paranoid psychosis.
PS. One real story I remember vividly from my days of being a trainee: A patient had prolonged fever of unknown cause. A senior microbiologist came and offered a possible explanation. He went on and wrote in the case notes: This patient needs a post-mortem examination to confirm the diagnosis.
On that, you are wrong.
As Robert Merton stated: Any purposeful action will produce some unanticipated or unintended consequences.
But this time the consequence is quite anticipated. From now on, when you ask the colleague from that another department for an opinion, they would always suggest doing something more sophisticated because XXX and YYY could not be excluded.
Of course, how often could we say with absolute confidence that everything else has been excluded ? Even if a test is 100 percent reliable, you still run the risk of mixing up with the result from another patient.
And our life - as well as our patients' - would be wasted in the endless list of further investigation.
Alas, on that final certificate, the cause of death would be put down as paranoid psychosis.
PS. One real story I remember vividly from my days of being a trainee: A patient had prolonged fever of unknown cause. A senior microbiologist came and offered a possible explanation. He went on and wrote in the case notes: This patient needs a post-mortem examination to confirm the diagnosis.
Subscribe to:
Posts (Atom)
