Resign

On our way home from Wan Chai, I gathered from my Google Reader that King Solomon had resigned.

Of course it is news. It seems, in fact, an anti-climax when everyone on earth seems to be taken in by the accreditation business – which was obviously introduced by the King.

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I shall not discuss the goods and bads of the King. The more interesting topic is, of course, who would be the successor.

We need someone who could handle the lethal duet (I mean budget and media), but not having a conflict of interest and easily affected by individual parties.

How about Wen Jiabao (溫家寶) ?

PS. At this moment, there are two or three probable candidates, all currently senior administrators within the system – a phenomenon that speaks for itself how people think of getting someone overseas to take up the post.

Fair

After we watched Toy Story 3, Vivian and I brought Euterpe to buy her new school uniform.

It was a shop at Wan Chai. As soon as we got out of the MTR train, we were met with a sea of people hurrying to the Book Fair.

Oh, no. Most people are not interested in reading – or young models either. Some would go to the Fair for the sake of the Fair per se. It is a popular event; it seems trendy to join the crowd and be there – as the old English saying, to see and to be seen.

But, more commonly, people go there to buy books.

Alas, there is a fine line of difference between buying books and reading.

PS. I missed the Book Fair for seven or eight years. The last time I was there I bought Sophie’s World.

It’s a good book, but you could buy it any time at any book store, without the need to line up to pay.

Toy

While pondering about the sociological meanings of Pixar, I brought Euterpe and Vivian to watch Toy Story 3.

None of us had watched its previous parts, but my daughter could obviously follow the story. In fact, she broke into tears when Buzz and Woody were about to fall into the incinerator.

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Many friends of mine found the movie touching, not only because of seeing those toy friends again after they last appeared in the theatre nearly ten years ago, but also for our loss of ingenuity and ability to appreciate the world in the eyes of children.

Of course I am more uneasy for the very fact that we may, on occasions, be the toy, and our Andy could be our children, our country, or the one who created us.

Toys as we seem to be, we could think and make decisions by our own; the value of our life should not solely rely on our Andy – we should lead a meaningful life of our own.

PS. That’s why I am convinced Fan Li (范蠡) was such and admirable character.

Private

While I felt immensely interested with my private patient, our department amah caught me in the corridor and told me that our man from Pluto was not very happy.

As you know, our previous chairman moved to his higher position recently. Nonetheless, he continued to come back every weekend to see some private patients. What's more, he asked some of our final year medical students to sit in the clinic - with an intention to teach them.

The problem was, on that very morning, no student turned up.

I don't think I need to describe what happened next. (That's probably one of the rare occasions when our students would regret living in the era of advanced telecommunication technology.)

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That was, in fact, the first time I heard of our VC setting up a private teaching clinic, which appeared to be an exceptionally innovative and courageous idea. (The terms in italic are defined by Humphrey Appleby.)

After all, why should a patient pay and, at the same time, offer his time as the subject of the teaching? If he has some sensitive information, should he disclose that to the doctor he trust - in the presence of a gang of nondescript youngsters? And, should the doctor have some casual chat with his patient - which is an important component of the consultation (for establishing rapport, or even soliciting donations)?

I really don't know how much a student could learn by attaching a clinic of this kind (not to say whether that's an effective means of learning).

PS. Honestly I could not understand how a student could learn by any means. That's a problem of myself, I know.

Photo

Many of my friends know that my private clinic is a remarkable place. Although I don't make much money from it, there are a whole lot of interesting cases refer to me for curious reasons.

And I had an impressive new patient most recently.

To cut the long story short, as soon as he came into the consultation room and sat down, before he said anything, and while I was thumb through the referral letter, he showed me a photo of his - taken with Mr. Hu Jintao.

I hiccuped badly.

(For the physiology of hiccup, please refer to http://ccszeto.blogspot.com/2010/05/road.html)

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You may ask did I treat that patient differently ?

Of course not - well, yes, I gave him a fair treatment.

Oh, that's not because I did not give face to the leader our country. Just that by a common sense deduction, it seems exceedingly unlikely my patient is really in acquaintance with Mr. Hu.

I should have been less fair if it were a photo with, say, my chairman.

Manpower

(... cont'd)

Things went well until more recently, when they had the second industrial revolution as a result of computer and artificial intelligence.

Hollywood remained the dream maker, but Pixar required much fewer people to create Toy Story. Yes, a few highly skilled people remained to be needed to operate the complicated software, but the vast majority of those with an average intelligence, who used to fill in the colour or keep the pictures in order, lost their jobs. The quality of life does improve for those who could afford, but, for the rest of the society, their living standard actually deteriorates with the advance in technology - because they have no means to earn a living.

They are the excessive un-utilized productivity that Warren Buffett referred to.

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The very implication is, therefore, to keep the society in harmony, and to secure sufficient votes for the next election, the government has to think of enough silly things for ordinary people to do - so that they could earn their salt with dignity.

I shall not elaborate further.

Productivity

While I was pondering on the problem of minimal wage, it came to my attention that Warren Buffett pointed out the root of the problem to Barack Obama:

A high unemployment rate is the result of excessive un-utilized productivity in the society.

You don't see the relation? It goes like this:

A hundred a fifty years ago, there was a place called California. The land is fertile and very suitable for agriculture. Most of the people there earned their living as farmers, and the product of the land was sufficient to feed everyone.

A few decades later, the industrial revolution came. Much of the manual work in farming could be done by machine. The amount of crop produced remained the same and could meet the need of the whole population. (Actually it increased because of advances in technology.) However, only one-tenth of the citizens needed to be farmers.

How about the rest of them? They came together and drew pictures. The little place they settled was later known as the Hollywood, and they produced Snow White and the Seven Dwarfs. The artists earned their salt and bread and butter; the farmers (and everyone) enjoyed an excellent movie. The living standard improved for the whole mankind.

(To be continued.)

Double

On my morning paper, there is an eye-catching title stating that one of our noble council members - who is a die-hard supporter of the minimal wage ordinance - is hiring workers in a salary much lower than the minimum that he proposes for his own restaurant.

(Of course I'm not surprised.)

But, wouldn't it be reasonable to do something that you believe is correct, even though the law has not yet enforced such a practice ?

It sounds simple, doesn't it? However, if we follow the same logic, all politics practitioners (it's a term of my invention; I'm sure you know what I mean) who support elimination of the functional constituencies should not run elections of this kind.

And, by that argument, all of us who support such an elimination should leave our blotting sheet of that category blank.

Suddenly I feel sympathetic to that mad dog.

Chinese

While I was thinking of the prospect of Cantonese during my family dinner, Vivian made a curious remark on two of her colleagues.

"They graduated overseas, and they seem couldn't care less to improve their Chinese !"

"But why should they care? Chinese as a language is, seriously, putrefying. Look at our morning paper or what our country leaders say in the public. Our language is not stupid - it is possessed by a retarded ghost !" I said with a grin.

"Same for English if we follow your argument," my sister Jenny interjected, "The vast majority of Americans (and Anglo Saxons) could not speak or write sensible English."

"I do not agree - both for Chinese and English," my wife said, "Many of the ordinary citizens may not master the language well, but there remains a small group of well educated people with frequent exemplary demonstrations - in speech and books and newspaper columns. The prospect of these languages is not that gloomy."

"That may be true for English, because well educated people that could express themselves well would get to the top of their society," I sighed, "But, for ours, it's always something other than creme de la creme that rises to the top !"

Cantonese

A recent hot topic north to the Shenzhen river is the attempt to defend Cantonese as a local dialect.

You may not know the official (spoken) language of China was selected not by market economy, but an entirely democratic means. In 1912, a Commission on the Unification of Pronunciation was convened with delegates from the entire country, and Beijing dialect was selected - as a compromise of many participants for political considerations, or, in other words, the result of negotiation.

What you may not know is, the Beijing dialect actually won the champion with a narrow margin; Cantonese actually came as the first runner up - lost by only one vote.

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Nonetheless, I am not that worried of the preservation of our local dialect. If that's easily removed, Ying Zheng (嬴政) would have unified our spoken language over 2000 years ago.

Unless you believe our country has a stronger administration than that of our First Emperor.

Well, you may be right.

PS. As a traditional Cantonese, I certainly have a personal bias to preserve this very language. After all, no other dialect could do better when you want to express yourself by some colourful spicy vigorous explicit vocabulary.

Many of our honorable council members need them.

Opportunity

You may argue I am paranoid and have an unjustified bias against IPO. Many opportunities of making money would be missed.

That may be true. Nonetheless, let's ask ourselves: What is the principal criteria of selecting a stock or other investment product?

Right. It is perfectly acceptable to miss as many good opportunities as possible - there are thousands of them each day, and no one on earth could spot all (or even one-tenth). As Benjamin Graham said (in Security Analysis), the primary objective is to avoid trouble; we try our best to avoid issues that would lead us to deep water.

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Discerning readers may notice my argument against buying IPO does not apply to all new stocks.

The best example is state-owned enterprise: It is to the interest of the government to sell out the business, and, for various political reasons, the price of the initial offer is usually attractive.

But, I remain skeptical.

IPO

During a casual conversation, Vivian asked for my opinion on a particular stock.

"It seems to be an excellent business, the dividend pay off is good, and is recommended by that famous analyst." My wife said.

"Maybe you're right," I replied, "But I'm an obsessive follower of Benjamin Graham and would not buy any stock that is on the market for less than two years."

"That's why you'd never care for any IPO?" My wife went on.

(For those who are not familiar with the stock market, IPO stands for Initial Public Offering.)

"Exactly," I said with a grin, "And, if the company is making a lot of money, who in his right mind would allow his own company listed in the stock market? Even if it has been listed, the owner should really privatize it!"

"But, there are good companies that need money for expansion." My wife pointed out.

"True, but it would often take a few years before an outsider - I mean small investor - to know exactly where had the money gone. I would rather wait for two or three years."

PS. In the jargon of game theorist, the situation is a classical example of trading with asymmetrical information.

Recipe

You may have heard of my friend L on several occasions in this blog. In fact, L is an excellent (though amateur) chef. Here is a story he told me recently:

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One day, L dinned alone at a newly opened Italian restaurant, and he ordered some spaghetti.

When the dish was served, my friend found that it was grossly over-cooked and exceedingly salty. In his own words, the whole thing was more a gastric diet for sodium replacement than pasta.

He summoned the manager of the bistro and demanded an explanation.

"Well, yes, that's not good ..." a man with a mask-face replied. My friend clearly noted that the two words so what were swallowed back into that man's throat.

"That's worse than no good; it's horrible! Any one who eats it all up would die of malignant hypertension the same night." My friend was slightly hot, "By the way, you should not be evasive with the quality of your food - I am a chef myself. I know how to prepare a dish of spaghetti !"

"Indeed ... In that case, in order to prevent further incidents, could you give me your protocol - recipe I mean - of preparing spaghetti so that we could follow in the future ?" The manager said.

My friend was taken aback. He had never thought of writing his own protocol of cooking spaghetti. After all, there are thousands of cookbooks on earth, and the only problem is you have to put up the effort to read before learning the technique.

There was a minute of silence before some light flash through his mind, "You do not sound like someone working in the service industry. Where are you from?"

"Oh, I was a consultant in a public hospital."

竽客

Another story from ancient China:

齊宣王使人吹竽，必三百人。南郭處士請為王吹竽，宣王說之。廩食以數百人等。宣王死，湣王立。好一一聽之，處士逃。

《韓非子·內儲說上》

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I suppose the story is well known enough and no translation is needed. What you may not know is what happened in the palace afterwards.

Yes, the King Min of Qi (齊湣王) summoned all royal musicians to have solo performance by each. One day, the King was surprised by a nondescript player, "Why! That's fantastic! I've heard your performance in the orchestra several times when my father was alive - and I never note that you're that outstanding."

"Of course not, Your Majesty," replied the musician, "I'd never tried to play well in a crowd of 300. It would be awkward to play differently; however well you do, it would not appear to be superior - but merely strange. Everyone else in the band hates you because you disturb their rhythm. In fact, an incapable player - like our friend who just escaped - would appear to perform better than someone who tries to outshine the others ..."

Negotiation

While you may think negotiation is a business of politicians who are committed to the hell, let me show you a story in the Three Kingdom period.

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As we all know, Guan Yu (關羽) is generally respected as the epitome of loyalty and righteousness. But his eventual failure was equally famous. For those who are not familiar with Chinese history, early after Liu Bei (劉備) took charge of Chengdu (成都), Guan was responsible for the defence of the Jing province (荊州).

It was a time of frequent battles. In 219 AD, Guan led most of his troop to Fancheng (樊城) - in a campaign against Wei (魏) - leaving Jing province to two of his subordinates. Lü Meng (呂蒙), the general of Wu (吳), took the opportunity and captured the whole province by the famous tactic subsequently known as crossing the river in civilian clothes (白衣渡江).

Hearing that Jing Province had fallen into Lü's control, Guan ordered a retreat from Fancheng and advanced southwards. What's not described in detail by Luo Guanzhong (羅貫中) - and even Chen Shou (陳壽) - is that Guan knew very well his troop was melting away (because of an excellent tactic of Lü, which we may discuss later) and could not possibly retake the Jing Province by force.

As a result, Guan sent a handful of messengers to Lü for negotiation - with an aim to take back the control of part of the Jing province.

Of course Lü made good use of Guan's people but had no intention for an agreement - Guan didn't even have the ability to back up the negotiation.

I believe the lesson is obvious.

Pigeon

I was beginning to believe our friends in the Pigeon Party has learnt the primer of politics and started to achieve their objective by negotiation.

But I was wrong, from head to toe.

Who in his right mind would show all his cards in a poker game and disclose to the public all details of negotiation with the other side ? (The real question is, who in his right mind would negotiate again with this thick-headed lots, or who - in her right mind - would agree to be the middleman, or really, the middlewoman, next time ?)

Well, on one hand it proves that the Pigeons are not crooks.

But, I am more uneasy than ever to put my vote in the future on some complete idiots. (Well, yes, I never voted for them in the past anyway.)

PS. It is a romantic idea, or the result of reading too much Antony Jay and Jonathan Lynn indiscriminately, that people doing politics should record every discussion - be it formal or casual - on paper, so that it could be used as documentation later.

Humphrey Appleby in real life never does.

Blue

You may know the blood of octopus is blue in colour.

Scientifically, octopus blood contains hemocyanin, a copper-rich protein, for oxygen transport. Although less efficient than the iron-rich hemoglobin of vertebrates in terrestrial environment, hemocyanin oxygen transportation is more efficient than hemoglobin in cold conditions with low oxygen pressure.

Maybe that's the reason why in his classic novel The Man With Blue Blood (藍血人), Ni Kuang (倪匡) mentioned that these beings - although look exactly like human - come from Titan (the largest moon of Saturn).

Of course, blue blood has an entirely different meaning in modern English.

But, no wonder many who claim themselves blue blood are invertebrates.

PS. Unlike hemoglobin, hemocyanin dissolves in plasma and puts less workload to the heart (because the blood is less viscid). We need our hemoglobin confines within red cells because the molecule would bind to nitric oxide (chemically very similar to oxygen) - which is crucial for blood vessel dilatation.

Decentralize

While we all agree octopus is an intelligent creature, the structure of its central nervous system is remarkable.

I mean remarkably simple.

For those familiar with human anatomy, our brain has a good map of the whole body in terms of sensory and motor function. Cerebral cortex knows what's happening everywhere, and all complex movements - single synapse thinking by medical graduates excluded - are decided by supratentorial structures.

But octopus is different. It has no internal somatotopic map of its body, and most of the complex motor skills are not controlled by the central brain. In compensate, each arm of an octopus has an individual nerve cord, which has - in modern terms of business management - a high degree of autonomy in controlling the limb movement.

Alas, this design is, in itself, intelligent. To say the least, unlike dinosaurs, octopus does not decentralize its body control to a single place called asshole.

PS. For those who are not familiar with the neuroanatomy of dinosaur, please refer to http://ccszeto.blogspot.com/2009/10/stegosaurus.html

Octopus

Maybe it's a bit dull to talk about ginkgo nowadays. The hottest creature on earth at this moment is no doubt Paul the Octopus.

Of course everything mentioned in the sensational literature is superstitious. Nonetheless, octopus has a superb intelligence - it is one of the only three animals (and the only invertebrate) that could use tools and solve problems. For example, seeing some food in a glass jar, an octopus could unscrew it and extract the content inside - without being shown how to previously.

The other two creatures that could do so are chimpanzee and university graduates (I hope).

PS. Although the eyes of the octopus, like that of vertebrates, have retina, cornea, iris, lens, and a fluid-filled interior, their evolution is entirely different. Unlike human, objects are directly projected onto the retina of octopus - not upside down.

These similarities of structure, despite different origins, are a classic example of convergence evolution.

Gingko

Talking about plain congee, ginkgo is a more remarkable subject for discussion.

Oh, I'm not talking about its possible use in dementia or other brain problem. But, rather, the plant Ginkgo biloba is a curious species.

You know what. Ginkgo tree is a unique species with no close living relatives - it is classified in its own division; all related species have disappeared for over 2 million years.

The unexplainable point is, Ginkgo tree is tough. It adapts well to poor soil condition, and could tolerate much pollution. In fact, it grows fine in urban city, and is rarely attacked by insects or other diseases. Why should all its relatives got extincted ?

Well, maybe that's the same reason why Homo erectus and Neanderthals disappeared.

PS. Ginkgo evolved in an era before there was any flowering plants, but most of the Ginkgo trees are nowadays cultivated. Although physically durable, the species has very slow growth and late reproduction maturation, which predicts a losing battle in the game of evolution.

Congee

It was nearly lunch time after Vivian and I attended the antenatal clinic. My wife suggested to try a restaurant nearby.

The place is in the food court of a wet market and is renowned for its congee. Fortunately we arrived early and there weren't many customers around. Vivian ordered congee with grass carp slice and meat ball, mine with beef and grass carp belly.

Quite a perfect lunch in a hot summer.

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The best type of congee, in my opinion, is the "plain" one.

I put quotation marks around plain because white congee (白粥) by taste is, paradoxically, not plain in terms of cookery. To give the sensation of a pure rice and water mixture, you have to add a few ginkgo - alternatives are oatmeal, tofu skin, century egg, dried oyster, or dried scallop.

It has always been my puzzle in chemistry what's in common in all these seemingly different ingredients. All I could tell is they all serve to take away that trace of funny taste when plain rice is heated with boiling water.

But, the idea is universal. If something appears pure and flawless, it got to be artificial.

As Philo Vance said: Nothing perfect is natural or genuine.

Repel

(Overheard the discussion between two anesthetists.)

"There are so many young doctors who want to get our training post. I can't really make the head or tail of it." The senior consultant said.

"Why ! Our job is perfect. We seem to have a leisured life in the public hospital, and we could make quite some money when we come out as private practice. Haven't you heard of the ROAD to success ?" His SMO commented.

(Please refer to http://ccszeto.blogspot.com/2010/05/road.html for the "road".)

"But that's not true ! To say the least, life in the operating theatre could be quite stressed." The consultant replied.

"Who knows ? We have no house officers, and everyone applies because of their own romantic idea about us." The other said with a grin.

"Oh, you are right. Why don't we asked for some house officers - they could come once a week or so and see what we are actually doing. That would turn away 80% of the applicants that are not our cup of tea."

"But, my boss, we are slightly late. Our friends from Family Medicine have just started a similar program !"

PS. This story is, of course, fake. To say the least, it does not happen on earth - but only on another planet outside the solar system.

Art

My recent bedtime reading is The Art of Strategy by Avinash Dixit and Barry Nalebuff.

This is, in fact, a revised and expanded version of their previous book Thinking Strategically, which also read some years ago. Honestly, I would not have bought the new one if I knew it before hand - but I am happily wrong again this time. There are so many things new in this volume that you could consider it an entirely different work.

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In one of the early chapters, there is a section on the trick of guessing the answer for an MCQ that one does not know. The technique is, slightly to my surprise, exactly the same one that I learnt some thirty years ago from a Japanese expert of public examination.

As Ayn Rand said: The truth is universal; it finds the human mind only as a medium of expression.

PS. Medical students, however, should not be too excited. Most of the academic staff nowadays have not been "properly trained" in that sense - and questions are generally not set in that manner.

Hurdle

Maybe one little story of PT is illuminating:

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Shortly after our medical school was established, PT returned from England and took up an academic post in the Department of Anatomy.

That's a curious arrangement: PT was a cell biologist by training and could do embryology, but his major work in the department was to teach us gross anatomy - which he knew hardly anything.

How did he get around the problem ?

As Albert Einstein once said, in human activity, the longest distance between two points is often a straight line. Alas, he chose the most simple - but also the most difficult - way: He bought a volume of the good old Gray's Anatomy a few months before the term began, and finished reading (and reciting !) it during the summer holiday.

Every time when I wished to complaint there was not enough time and too many details to remember, his eyes seemed to say: I can do it; how about you ?

啟蒙

You may find my feeling to PT somewhat unexplainable - he was merely my anatomy tutor and not even a medical doctor.

Nonetheless, those were the very primitive days when I first entered this profession, and this early teacher of mine showed in a brilliant manner - with his knowledge and, more so, what he did - how we should face our life.

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While I was admiring my previous anatomy teacher, Vivian and I were preparing Euterpe for her last day in pre-nursery.

My daughter will move to another kindergarten to continue with her study.

Yes, you may think what big deal. There's nothing eternal on earth and we all move to the next stage of our life when the time comes. Nonetheless, Euterpe likes her pre-nursery class very much and I find it a pity to leave.

But, that's life.

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但願人長久，千里共嬋娟。

Gurudakshina

While thumbing through the pages of Nature, I found a familiar name.

That's PT.

(For our relation, see http://ccszeto.blogspot.com/2010/02/prosector.html)

My feeling is difficult to describe. What a happy surprise to find your previous teacher - and a highly respected one - to be in good health, excel in his field, and be invited to write a review article for that very journal ! It has been over 20 years since I last saw him, and he has moved from London to another corner of the globe - pursuing the same topic of research, and in a much more sophisticated manner. (I look up in the PubMed and found many brilliant articles of his team, in almost every good journal, you name it.)

Maybe I could express what I wish to do with a word that I newly learnt: Gurudakshina.

OTM

Although I usually buy medical books on-line, it remains a pleasure to walk through a jungle of medical books in a traditional book store.

The problem of searching what you want in Amazon or places alike is you must have some idea what to look for. Depending on how you choose the key word, it is very easy to miss an entire topic or group of books. (Not to say very often we have little idea what we want - until that very volume flashes across your visual field.) That's the beauty of going somewhere flesh-and-blood: Everything available is there. Using the jargon of Bernard Woolley, you are shown with every details of the unknown unknown.

(The same argument also holds for our digital PDA: The amount of data stored is huge, but they would only appear when you look for them. With a Moleskine, I could see everything any time I flip through the pages - whether I like it or not.)

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This time, I find the new edition of Oxford Textbook of Medicine.

I still remember in his preface to the first edition of the Textbook, Sir David Weatherall tried to convince his readers that textbook of medicine would not become a dinosaur.

“Certainly, the basic and clinical sciences are moving so fast that no textbook of medicine can hope to be absolutely up to date. However, relatively few of the advances in these fields lead to major changes in patient-care, and those that do require several years of critical evaluation before they become an integral part of routine clinical practice.”

I shall leave it to you to decide whether OTM has become a dinosaur.

Bookstore

It was raining like hell on Saturday and Vivian was on-call. I bought some hamburgers and french fries from our favourite restaurant in Hung Hum and we ended up having lunch together in her office.

The weather was less horrible when I left Vivian's hospital, and, almost guided by my basic instinct, I went to that nearby medical bookstore at Jordan - it was at least one year since I was here last time.

The place has changed very little since I first set my feet here 25 years ago, when it was first open. Alas, that was also the time when I entered the medical school.

(Before it was opened, there was actually only one small medical bookstore around the whole colony - at another corner of Jordan. This little place is still there, just next to that renown diary company.)

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The only book I bought was the new 59th edition of British National Formulary. The original one on my shelf was the 38th edition, published in September 1999 - soon after I joined the university. The world has changed so much; things become more chaotic (as predicted by the law of thermodynamics) - the book has expanded from 750 pages to over 1000.

The cover has changed from green to purple, but the content remains very much the same - although a bit more complicated.

Rather symbolic, I believe.

Readings

(Two more emails that follow.)

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Thank you very much Professor... Oh by the way, since our CUHK accounts will be expired very soon and I will not be able to read most medical journals online later (well, honestly, I stick to BMJ and NEJM only..). I know we can assess many free texts with eKG. Do you recommend me to have a personal account of the journals mentioned?

Best regards,

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It seems advisable to first test if you could handle the information load. You may sign up for the table of content by email or Google reader (both are free), and download the full text from eKG if you find any particular piece interesting. You may then decide on formal subscription a few months later.

Sincerely,

Communication

(Some recent communications with a young colleague. I suppose it is timely to put them on my blog.)

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... I find that even I have recited the houseman handbook for MB and still retained some of the content, I have difficulty in real life application. I wonder how and what I can do to improve as soon as possible? ...

Best regards,

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... Seriously I have no concrete answer. My advise on tactic is, after seeing each patient, to ask yourself to state your conclusion in the case notes before writing down treatment order. That would usually clear up your mind and avoid many illogical doings.

From a strategic point of view, it would be useful to remind yourself: If this is something I have to do a year later as a junior MO, I shall make sure I could do it now...

Szeto

Predictable

Do you see where we are getting at ?

Right, we treat our enemy by doing things at random (or, using the mixed-strategy according to the game theorist), but we use a clear pattern of behaviour to our ally.

Or, if we turn the table around, our friends have a predictable response, while foes often caught us by surprise.

To go one step further, our evolution has brought us to use the information and make the decision subconsciously: Things or people that have a recognizable pattern of behaviour are friends; those that are not that predictable, enemies.

That's why we find such a comfort in science, or are so disappointed when we read the Book of Job.

I shall not elaborate further.