Fire

Another topic that TW and I discussed in length was cookery. After knowing her for some 18 years, I was absolutely surprised to know she began to prepare dinner for her husband.

And, I must admit I laughed up my sleeve when she asked questions like "How could I fry a piece of pork chop ?"

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

The next morning, I met AL. This is the first time after our man from Pluto moved his office.

My friend looked content as ever.

"You know, I just realize Queen Marie Antoinette may not be that malicious - he is just innocent."

"Oh, I think he's quite ambitious?" I knew what she meant.

"He may be," AL smiled, "but he's quite incapable of playing the game."

"How do you know?"

"From how he fired that piece of pork chop."

For a moment I had a déjà vu feeling of my conversion with TW yesterday.

"Oh, the problem is, he did not want to fire it from the very beginning - all he wanted to do was removing it from the top shelf of the freezer. But, he decided to turn on the gas and put the target on a pan for ages. By the time it was handed to me, the whole business was a piece of charcoal !"

I made a wicked smile, "Doesn't he know we could simply talk to a piece of meat, or, more simply, give it some hot potato in order to defrost it?"

My salute to Donald.

Property

On the next day after my mother's birthday gathering, I attended the annual meeting of the society of my specialty.

Met TW there. It has been quite some time since I last saw her, and we decided to excuse ourselves for a while in the middle of the meeting and lunch together.

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

We settled ourselves comfortably in a café nearby, and chatted on almost everything. Contrary to her usual never-care-less attitude, my friend was rather hot when she talked about R, a surgeon and (from what I gather) a distant acquaintance of her.

"I can't really understand why he doesn't buy a shop for his own office, or his own apartment to live." My friend sighed.

"Eh ...?"

"You know, R is paying some $30,000 each month to rent his office," TW continued, "and another $30,000 for his house - and he has been doing it for 5 or 6 years. That's quite enough to buy one!"

"Quite right." I agreed.

"And, one needs to retire sooner or later. When you have no income, how could you afford the rent? In fact, life could be very simple and you don't need a lot of money for the retired days - as long as you have a place to live."

I nodded; could not agree more.

PS. Frequent visitors of this site may recognize TW is one of the few who often gives comment to my blog. (And I love her blog very much, particularly her recent story on stress. See http://hk.myblog.yahoo.com/cal-culator/article?mid=413)

Duck

Had a small family gathering over the weekend; it was the 70th birthday of my mother.

The menu was specifically selected to suite her palate:

前菜: 叉燒，鵝肝腸

堂剪茶豬

杏汁白肺湯

一品煲

琵琶鴨

炆班翅

海鮮蒸乳酪

黑松露醬炒野菌

啫啫唐生菜

腊味煲仔飯

杏汁包

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

For the part-time gourmets, pipa duck (琵琶鴨) is the Nanjing version of Peking roast duck and a variant of the Canton fried duck, although the seasoning is slightly more complicated and the meat is much less greasy when served. Twenty or thirty years ago, it used to be a regular item available in many roasted meat stores. It is a pity this tasty treat has vanished in the market because it takes much preparation but you can't really make it more expensive than its competitor from Canton.

Alas, Darwin's law is followed even after the death of a duck.

Ponzi

My friend L was not very happy after reading my blog on our discussion about the medical insurance business. (See http://ccszeto.blogspot.com/2010/10/name.html and related ones.)

"You missed my point," he pointed out.

"Did I ?"

"Now, let's consider the problem again," my friend explained, "When the insurance scheme gets going for a while and many of the trustees are elderly, the claim rate would be very high. You agreed on this point. Didn't you ?"

"Yes ...?" I though we discussed that last time.

"Then, how could the business run? In other words, where comes the money to pay for the claim each year?" my friend was slightly excited.''

"You mean ...?"

"I mean, in a stable state, the yearly pay-off would be covered by the insurance premium collected that year." L went on, "When reputation builds up, more people would agree to join the scheme, and the business could prosper."

"Stop there. The story sounds familiar. Where did I hear of it?" I thought I was seeing light.

"Have you heard of the Ponzi scheme?" my friend suddenly put up a wicked smile.

"Yes ... no. What's it?" I vaguely remember the term but could not recollect what's that all about.

"That's the old term. After the financial tsunami, people called it the Madoff investment."

Absent

Met VW in the medical grand round.

Seeing that I did not appear to be interested in the topic, the hepatologist asked, rather lightheartedly, "Have you heard of the story between GY and our third-year students?"

"Nop. What's up ?"

"The whole group of students, who were supposed to attach to the teaching clinic of GY last week, did not turn up, and the cardiology professor almost had a seizure," my friend said, "And this is not the first time. Just another day all the students did not turn up for the teaching clinic of GW, who had already selected suitable cases and arranged everything."

"Why's that?" I considered for a while, and added, "Oh, yes. They shall have their panel examination very soon."

My friend nodded.

"So, what's our cardiologist going to do?" I asked.

"He has asked all that group of students to come to see him next week..." VW said.

Knowing the usual GY, I chuckled for an inevitably long-dwelling meeting, and I said to myself, "That, in itself, is a penalty."

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

You may think I was not behaving properly and laughed at my colleague. In that case you are right, and I had retribution the next day.

I mean, when I lead the bedside teaching for my group of third year students, only half of them turned up.

Hope

Whatever the origin of my bedtime reading is, Huang's book remains an entertaining and educational one.

For example, this is actually the first time I realize the only thing that remained in Pandora's Box was hope. (Vivian was certainly surprised, and remarked that I should really brush up my general knowledge.)

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

Of course there is more than one explanation of finding hope locked in the Box. On one hand, you may think all tragedies of mankind root from the lack of hope. As Alexandre Dumas said (in The Count of Monte Cristo): All human wisdom is contained in these two words - wait and hope.

On the other, staying in the Box till the end may imply that (too much) hope is the worst disaster that we could ever see.

Yes, if you look around the stock and property market.

Myths

My recent bedtime reading is Myths of Greece and Rome (希臘羅馬神話故事) by Huang Chen Chun (黃晨淳).

The book is in Chinese. I bought it as a bargain item from a local book store. No, it's not a translation from an English one, but written by a Chinese author, who, according to what I could search from Google, publishes extensively in a diverse of areas, including Chinese mythology, philosophy, biography of famous people, and applied psychology.

In fact, there are at least three English books with the same title:

1. One written by Jane Ellen Harrison in 1927.
2. Another by Hélène Adeline Guerber in 1938.
3. A third by Thomas Bulfinch and Bryan Holme in 1981.

When I glimpse through their table of content, none is identical to Huang's one.

PS. A good portion of this book, notably in the account of the Trojan War, is obviously direct translations of Iliad and Odyssey of Homer.

Sometimes I have to accept history is contaminated by literature, or is written by the ones who survived till the end.

Reply

(My reply to Warren as follows.)

Dear Warren,

I shall be less elaborate. After all, I am more comfortable in assessing a company than giving opinion to the economy.

Yes, I agree there is too much money after the limited supply of commodity and stocks in the emerging market. I'm also inclined to believe if the interest rate turns around and begins to go up (presumably in mid-2011), there will be a crash in the bond bubble and more money would turn to the stock market. (According to Adam Smith, that would also be a sign of improving profit of commercial firms, and a rapid drop of PE in many companies would drive the stock price even higher.)

But that's for medium to long term. For the short term (one to three months), I have difficulty to find many stocks with a really attractive price - based on their record in the past three years. I regularly screen 120 to 150 local stocks and often use the number of stocks being under-priced as an indicator of the near future. My recent calculation did not show many bargain issues - not really a good sign for the coming three months. (One difficulty is, of course, balance sheet are more difficult to interpret nowadays because change in asset value is considered as profit or loss. I am still trying to figure out how to get around with this.)

By the way, I am slightly uneasy to see so often Wen Jiabao but very little Hu Jintao on the media.

Sincerely,

Warren

Recently I asked my friend Warren what he thought of the stock market. As always, he gave me an insightful response.

Here you go:

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

Dear Szeto,

As spoken, here are my humble views. I tend to believe that we are in 2004 rather than 2002.

1. QE +/- QE2 generate a huge wave of US dollar carry trade; hot money is flooding everywhere (like the role of Japanese Yen in 1990’s and 2000’s).
2. Investors gradually rebuild their confidence in stock markets when recent figures suggest low likelihood of double-dip recession in US though the recovery is stagnant.
3. The recovery of US economy is stagnant due to high unemployment rate, low mood of enterprise/individual financing and strong tendency of deflation with the fall in property price; hot money won’t stay in US and go to emerging markets and commodity nations.
4. Positive wealth effect has already occurred in the emerging economies because of blossom in property and stock markets; this drives economic growth and inflation and further attracts hot money.
5. Based on these 3 parameters: ratio of property price/annual income, ratio of monthly mortgage repayment/monthly income and gap between yield of 10-year US bond and rental return rate; the average HK property price is about 20% above its historical mean; of course this estimate is getting less representative owing to the polarization of property market; but smart money will probably choose to leave for stocks.
6. Opposite forces acting against each other in China: rising wages of blue-collar class and demand for goods and service; rising middle class and demand for better living environment / luxury goods; over/redundant investment of local infrastructure leading to overcapacity and bad debt; correction of overheated property market and possible negative wealth effect may occur in 1Q/2Q of 2011.

Therefore, my projection is:

1. Both property and stock (as well as commodity) markets will continue to rise, but the fundamental factors favor stock market in emerging markets rather than property market.
2. The whole world’s hot money rush to small emerging markets, this boosts a super bull market here. (Assuming that there is an interest rate increment by 2%, the calculated HSI by 2013 will be 40000-45000.)
3. The rise in stock market will only be limited to certain Chinese domestic consumption business sectors and commodities at least over the next 2 quarters till we can have a clearer picture of the correction of property markets in 1Q/2Q 2011.
4. There will be real surge of stock market in 3Q 2011 if there is no bubble-burst over-correction of Chinese property market early next year. Chinese banks and insurance sector will be the market leader by that time.

However, if there is really over-correction of property market, bad debts of the local government and major banks will rise substantially and the effect is quite unpredictable. I would love to hear your view too!

Sincerely, et cetera.

Infectious

While I was admiring the wonderful wardrobe of my colleagues' new office, Shirley - one of our pat-time nurses who helps taking care of our transplant patients - called me.

"We have a trouble with C," she sounded uneasy.

"Well ...?" I know C well; she is around 40 of age and is doing well after kidney transplant a few years back.

"She has herpes zoster over her shoulder; she visited her family doctor, who asked her to come back and seek our advise on treatment," Shirley continued. (For those not working in our field, herpes zoster is a viral infection that comes as multiple vesicles over a localized area of the skin.)

"That's easy. I shall see her." I see no problem there.

"But, the problem is, our infection control team would not allow us to see her in the clinic or in the ward - because she has an infectious disease. Otherwise she may spread the infection to other patients. If she ever appears in the clinic, the infection control team would need to trace the contact from each and everyone." My nurse immediately recognized I didn't realize the problem.

"Alas ..." Now I knew where she was getting at. Of course I remained puzzled because there are thousands of people out there with zoster or tuberculosis or influenze or what not.

After a moment of silence, I said, "Our wards are moving to the new block and some are empty. Thank goodness. I shall see her there."

"That's great! I shall ring her up." My nurse sounded relieved.

"But, following the argument of our infection control people," after considering the matter for a further while, I murmured, "How could C settle the payment in the shroff office, or get her medicine from our pharmacy? She will contact other people at those places." In fact, by the same logic, C should not come to the hospital by any public transport.

"That's not a problem," Shirley tried to reassure me, "They said that it would be safe if our patient wear a mask!"

"Jove, how could a face mask prevent the shedding of virus from vesicles over the shoulder?" I said to myself.

Maybe the strain of herpes virus is different outside the solar system.

Wardrobe

A hot topic recently amongst our colleagues is the furniture in their new office.

(For those who are not working in my hospital, we are moving to the new block, and most of our colleagues have their office relocated there as well.)

Oh, I mean the lack of furniture - there is no chair or desk or bookshelf or file cabinet.

But, there is a spacious wardrobe.

Many of us could not understand why people need such a voluminous space to put their coats and jackets.. Nonetheless, I believe the reason is obvious - the one who designed the office was obviously living in a planet with a surface temperature of 55-degree Kelvin, and always needs to put on a lot of clothes.

For example, the Pluto.

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

Just a little story come across my mind.

In 1935, when Albert Einstein first arrived at Princeton took up a position at the Institute for Advanced Study, the secretary asked what furniture he needed for his new place.

"Very few," he answered, "I need a small desk, a chair, and a gigantic rubbish bin - so that I could throw in all my mistakes."

Name

(My discussion with L continued.)

"But I'm confused," seeing that almost everyone is going to make a claim sooner or later, I asked, "That is not insurance."

"You're right. If you put aside some money regularly and plan to use it some time later, we call that saving," my friend explained, "Of course you could argue the money to be used would be variable; everyone roughly pays the same amount, but some end up using little while other unfortunate ones may need a huge compensation - we call that indirect tax. In fact, by the very nature of human being, everyone would try to maximize his claim to get the most of the benefit - that's surely a way to increase the overall health expenditure in the society."

"Saving? Tax? But we are told it is an insurance !" I exclaimed.

"You read Shakespeare ?" my friend smiled.

"Yes ...?" I could not see his point.

"What's in a name? That which we called a rose. By any other name would smell as sweet." Suddenly my friend became Juliet.

"Look like the innocent flower, but be the serpent under 't!" I could not help but had to play Lady Macbeth.

Claim

That evening I met L again, and I told him my luncheon discussion. To my surprise, he looked horrified.

"Do you mean you think the government should propose a medical insurance to cover clinic visits and treatment of chronic diseases?" He gasped.

"Yes," I thought my idea was rather natural, and could not see why my friend was so excited, "What's wrong ?"

"It's all wrong," L smiled - rather wicked a one I thought - and he asked, "What is the claim rate for medical insurance of this kind?"

"It's around 40% according to our morning paper," I replied.

"That's the figure if you have a group of people start purchasing a medical insurance now and you review the claim a year later. But, let's say you follow the government proposal and everyone could renew the insurance irrespective to the age, how many of them would need to claim?"

"You mean...?" I began to see his point.

"I mean, except for that very few unfortunate - or really fortunate - ones who suddenly drop dead, close to 100% of the people would develop some chronic medical diseases or need a surgery before they decide to meet St. Peter - or our chairman Mao if you like."

Insurance

(Our luncheon discussion continued.)

While thinking of the manpower of the operating theatre, FY sighed, "You know, with the new proposal of medical insurance, the situation would be worse."

"Quite right, there would be even greater a demand for private surgeon," YH remarked.

"But not physician I suppose ?" I said, "The scheme seems to cover only surgery or some one-off treatment, but not for long term care of chronic medical diseases."

"You're right - and that screws up the whole thing," FY pointed out, "Good surgeons would go to the private market. But, for very complicated operations or high risk cases, private hospital would not take them up. On the other hand, there are fewer experts to handle these cases in the public sector."

"There would also be much problem in the training for new surgeons." YH pointed out.

"And, after all of the hassles, it doesn't help much to reduce the spending of the government hospital - the majority of which is for the care of people with chronic diseases." I added.

Selection

Met YH and FY, two of my friends from surgery, in the canteen.

The latter was not very happy.

"You know, the quality of our theatre nurse is hitting a new low every day." She sighed.

Without a personal experience, I looked at YH, who returned a curious smile.

"That's a process of natural selection," FY continued, "If they are competent, there's never short of attractive posts from private hospitals. The very fact that they are staying here means that they have some problem, in terms of either ability or personality."

I nodded and could not agree more. The same phenomenon may also applies to doctors.

"And they understand this point very well," she went on, "Since there is no way out, they turn their energy to small circles and politics - often disguised under the name administration!"

Subtly I reminded my friend that the problem does not only happen in the theatre.

Prize

When I mention my idea to my friend L and asked if he remembered which story in Zhuangzi (莊子) I was referring to, he gave me a curious smile.

"You like watching football, don't you?" he asked.

I knew he was referring to soccer, and I returned a nod.

"And do you know FIFA is giving out a Fair Play Award regularly?" my friend went on. (FIFA stands for Fédération Internationale de Football Association.)

"Yes ...?" I was at a lost.

"Don't you see the point? On the face of it, the award is given to a team or a player that achieves an exceptional standard of sportsmanship," L was slightly excited, "In reality, the award - and therefore FIFA themselves - is reminding the team or player that they are not achieving anything material, and they should try harder - probably by less fair a means."

"So, you mean, it's ironic that the Award - and therefore FIFA - is not promoting a fair play, but something else rather ?" I could not believe my own conclusion.

"That may not be what they intended to do, but that's what they are doing..." My friend looked hopefully into my eyes.

"And, same for some other international prize!?" I finished with the words that he put into my mouth.

L smiled. As Humphrey Appleby, he finally knew I knew what he knew.

盜跖

I was trying hard to recollect a story from Zhuangzi (莊子) about how to get along with malicious people and advise them to behave. Unfortunately, my memory fails me. Rather, an unrelated piece kept coming back to my mind.

Do not over-interpret.

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

孔子與柳下季為友，柳下季之弟名曰盜跖。盜跖從卒九千人，橫行天下，侵暴諸侯，穴室樞戶，驅人牛馬，取人婦女，貪得忘親，不顧父母兄弟，不祭先祖。所過之邑，大國守城，小國入保，萬民苦之。

孔子謂柳下季曰：「夫為人父者，必能詔其子；為人兄者，必能教其弟。若父不能詔其子，兄不能教其弟，則无貴父子兄弟之親矣。今先生，世之才士也，弟為盜跖，為天下害，而弗能教也，丘竊為先生羞之。丘請為先生往說之。」

柳下季曰：「先生言為人父者必能詔其子，為人兄者必能教其弟，若子不聽父之詔，弟不受兄之教，雖今先生之辯，將柰之何哉？且跖之為人也，心如涌泉，意如飄風，強足以距敵，辯足以飾非，順其心則喜，逆其心則怒，易辱人以言。先生必无往。」

《雜篇第二十九·盜跖》

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

強足以距敵，辯足以飾非，順其心則喜，逆其心則怒，易辱人以言。

What a vivid description.

PS. I shall not provide a modern translation here. Interested readers could refer to http://www.tx5c.com/sxmd/zzbj/bhzz/

Division

I shall not elaborate on what came out from that Pandora Box. However, the more I think of it, the more I doubt my nostalgia.

For those who had read the article in the Annals, this is what I mean:

Yes, it is gratifying to do the sputum gram stain, examine the urine sediment, and go through the bone marrow smear for my own patient. Nonetheless, I have come to understand medicine, like the human society per se, has evolved to be an incomprehensibly complicated subject, and no one could do everything by himself. There is more than one bacterial stain we could do for a sputum specimen, the reliability of urine microscopy is very much lower if it is done by a doctor who only uses the microscope once a year, and it really needs an expert to determine what additional immunocytochemical studies are necessary after looking at the preliminary Wright-Giemsa stain of the bone marrow.

As a result, the improving technology means that an ordinary clinician could not take care of them all, and we have dedicated microbiologists to take care of the sputum, hematologist to orchestrate that set of bone marrow slides, and some autistic nephrologist to look at the urine. Each of us focus on a tiny part of an elephant while the very clinician who takes care of the patient as a whole could grasp on nothing. (More likely than not he is a sub-specialist of another area and is being a general clinician rather half-heartedly.)

In other words, the way to hell was paved by our own success.

PS. In that case, is there any one who could look at the whole picture ?

Maybe the dogs.

As Geoffrey Vickers said (in The Art of Judgement): Even the dogs may eat of the crumbs which fall from the rich man's table; and in these days, when the rich in knowledge eat such specialized food at such separate tables, only the dogs have a chance of a balanced diet.

Round

My friend KM shared with us an article from Annals of Internal Medicine (see http://www.annals.org/content/153/7/482.short), for which he further elaborated his view in his own site (see http://drkmchow.blogspot.com/2010/10/round.html).

The article is a simple one. It describes the experience of doing ward round in 1960s, when the author was a medical student, and then what becomes of a round nowadays, when he turns to a senior physician.

When KM first showed us the story, the few of us (for example, old-style physician like my friend CB) could not agree any more. Although we are not that old to experience a ward round in 1960s, we were brought up in the 1980s and trained in early 1990s - when medical students and junior doctors were given a free hand to do anything.

For example, as a third-year student, we were required (not merely allowed) to write down in the hospital record the findings of history and physical examination for that few patients assigned to us. Our documentation became part of the formal record, and, as students, we could hardly hide our pride when we found the medical officer referred to our notes when he presented the case to the consultant. In fact, that senior physician - whose formal title was Reader in Neurology - gave us no tutorial and taught us nothing directly; all he did was to appear in the ward at unpredictable hours and check if we were seeing our patients.

The sobering truth was, we were too green to appreciate this very method of self learning (although a few years later we realized the benefit was huge). We grumbled that we were not properly taught - and our voice was heard.

That opened the Pandora Box.

Game

During the weekend, I brought Euterpe to her singing class as usual.

Since parents are not allowed to join the class, I had to wait outside for an hour - a rare occasion when I could sit down and read some journal, without being disturbed.

This week, however, there was some construction work going on at the place where I used to wait, and I had to go to another part of the building to find a seat.

And this little accident proved to be entertaining. Soon after I settled myself in a long wooden chair, an old man with a heavy cigarette smell and a husky voice came and sat next to me. With him there was a large square board, a little box, and a folding chair.

A few minutes later, a middle age man came and waved to the old one, who opened that folding chair and indicated the new comer to sit opposite to him.

The two then unfold the board - it became a table; from the little box they extracted some pieces of woods, for which they hurriedly arrange on the table. By now it became clear that they were playing Chinese chess.

And, for the rest of that hour, I enjoyed watching several rounds of this traditional game - a luxury that I missed for over 25 years.

PS. The players, seriously, were not all that outstanding. Nonetheless, the game was exceptionally enjoyable - exactly because the two sides used highly unconventional strategy. For example, in the first round, it was "三步虎對過宮炮", which is known only to some senile outdated bookworm who remains living in the previous millennium.

PPS. It is the traditional saying that it needs a real gentleman to remain silent while watching others' chess game (觀棋不語真君子). Alas, after doing bedside teaching for so many years, it is not all that difficult to be a gentleman.

Advance

The grand round was actually delivered by my friend KM and a few others. It was about the hot potato advance directive.

I must say I always find it difficult to understand why the extra-terrestrials put up so much interest in this topic - the effort is almost certain to no avail. When the talk was about to close, I told GY, who happened to be standing next to me, "What for? It's just like bringing a iPad to the African jungle and tell all those aboriginal that thin sheet of metal is fantastic and they should make good use of it. Yes, the gadget is superb, but they have no hope of understanding it - not to say using it regularly !"

My friend laughed, "You are getting more humorous with your age !"

I didn't tell him it's because I did not use my Listerine® recently.

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

If you think it's too cynical to compare jungle aboriginal to our local people, maybe a little story during the First Sino-Japanese War (甲午戰爭) would suit your palate.

For those not familiar with the history, the War was a sea battle between the Qing (清) empire and Japan, shortly after the establishment of the Beiyang Fleet (北洋艦隊) by the former. Yes, the Chinese battleships (mostly made in Britain) were superb, and the cannons represented the most advanced model. Nonetheless, the Qing side failed miserably - an outcome accurately predicted by Togo Heihachiro (東鄉平八郎), the fleet admiral of the Imperial Japanese Navy ...

... because the Qing soldiers used the cannon for hanging their underpants.

Saving

Another important topic in the gangsters' meeting was, of course, budget and saving.

I left the meeting early for the clinic, and did not hear what was discussed. That evening, during the grand round, I met WY and a few others who were in the meeting. Naturally I asked what was being discussed.

"Just the usual stuff," my friends said.

"You know, I note that quite a few items are removed from the hospital formulary recently. Of course most of them are taken away because the manufacturer is not making it any more. But, it does raise the suspicion that some of them vanish because of financial reasons." I said.

(Of course that's not true. For most of the expensive stuff, our system only makes it exceedingly complicated to get the approval of prescription. You can always give it if the patient really really really needs it - so was it said.)

"But, this afternoon, I suddenly realized we have to remove two items from our formulary and we could save a lot of money," I continued, "And they are not expensive new drugs so their omission would not attract attention of the media."

"Eh...?" WY looked puzzled.

"We should ban all prescription of frusemide and salbutamol. I'm sure the hospital expenditure would drop by half !" I put up a wicked smile.

PS. For those who are interested in economy, my suggestion is a variant of the Water and Diamond Paradox.

Go read Adam Smith.

Bat

A few days later, I attended another gangsters' meeting.

The major subject this time was would any of our trained fellow agree to take up the training of a second specialty, which is in urgent service need, so that he (or she, no discrimination here) may have a chance of promotion a year or two later when such a post appears.

Sitting next to me, LS whispered, "Who would? What happen if you ask him to have the trans-sexual operation and then you refuse to get marry with him - what could he do !?"

I laughed - as softly as I could so that I wouldn't catch the attention of the others. A little story from the Aesop's Fables came to my mind - with a bit of twist.

Here it goes:

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

To begin with, bat is an animal.

But, when it starts flying, all other beasts regard it as a bird.

And, even worse, when the bat meets other birds, they all think, "Yes, you could fly, but, although you appeared old enough, you are never as experienced or properly brought up for flying as us." In short, they do not think bat is one of them either.

That's why bat would only appear at night - their existence could not stand any sunshine.

Leftover

That evening, while I was thumbing through my birthday present, a remarkable recipe drew my attention:

It was Leftover roast chicken salad.

Yes, it sounds plain enough. But, after reading no fewer than a dozen of cookbooks, it is one of the few recipes that described how to make use of leftovers.

But that's what many of the domestic chefs need ! Look, we do not hold a feast at home everyday (not even every week), and, if we do need one, most of us would prefer go to the restaurant and being served, rather than spending several hours in the kitchen so that our face is covered with sweat and grease. In contrast, we need a cookbook to show us the way to prepare the day-in-day-out stuff and how to make use of residual material. For example, how to revive a loaf of overnight bread when it becomes hard and dry, what to do for that piece of tasteless meat from the Chinese soup (老火湯), or what you could make up of from a few pieces of chicken you brought home from the wedding banquet last night ?

I am sure that does more good to our environment than boasting about global warming.

PS. I fancy I would write a book of this kind after my retirement. And, that night, I could already think of the name of the book.

Let's call it 《餘味無窮》.

Book

My birthday present from Vivian was Gordon Ramsay's Fast Food.

I don't think I need to explain why my wife give me this. Frequent visitors of this blog would know that I often perform private cookery experiments. When my wife asked me a few weeks ago what birthday present did I want, I showed her the title. She bought the book from Amazon. It was sold on discount and turned out to be cheaper than any local bookstore - mail expense included.

When I eagerly unwrapped my gift, my wife asked in a slightly incredulous manner, "This was published a few years. Why don't you go for more recent ones ?"

Vivian certainly did her search. Ramsay had five books published under his name after the Fast Food, including one in 2010, Ramsay's Best Menus.

"You know, as far as books are concerned, I never risk to read new ones," I explained to my wife, "I need something that has stood the test of time. Not only because I could see the comments of previous readers. But, more simply, since there are so many books appearing each year, if one could remain around a few years later, it is in itself a sign of excellence."

Attendance

That very weekend turned out to be a busy one. While I was accompanying Euterpe for her singing class examination, Vivian went to the Annual Scientific Meeting of the College of Surgeons.

Later in the afternoon, when we were all back home and preparing to set off for dinner, my wife showed me a little souvenir she got from the meeting.

It was a book with the title Healing with the Scalpel. In short, it outlines the history of surgery in Hong Kong.

While thumbing through the pages, an interesting photo came to my attention - it was the attendance sheet of the 1987 class of our medical school to an invited lecture.

Here it goes:

Time for nostalgia.

PS. Although the names on this sheet are four years more senior than me, I know nearly half of them - it was an era when we mentioned our name and everyone knew which year you graduated. It does bring along much memory to the good old days, when our medical school was very small.

And it is the law of physics: When the place is small, everyone becomes very close.

屎坑歌

Although I gave a little thought on the subject of minimum essential practical procedures and our marking scheme, I did not actually attended the curriculum retreat.

It was my birthday, and, more importantly, Euterpe was sitting for the first examination of her singing class and I had to leave the hospital on time to pick her up.

Before we set off for the examination, I asked my daughter, rather half-heartedly, "We're going to the singing class. You know the song Happy Birthday to You, don't you? Can you sing it for me now?"

My princess twisted her lips; she didn't reply.

And off we go.

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We arrived at the place slightly early. Foreseeing a whole-hour class, I asked my daughter, "Do you need to pee before going in?"

She nodded.

I brought her to the male lavatory. No one was there. I closed the door and put her on the toilet. In no time the deed was done.

While I was picking out some tissue paper for her cleansing, a familiar music appears, "Happy birthday to you, happy birthday to you, happy birthday to daddy ..."

It was my daughter singing that very song on the toilet !

I could not help but laughed as loud as I could. At last, I said to her, "Thank you, thank you. But, next year, please sing it at a better place."

"Shh ..." my princess whispered, "This place is quiet !"

Marking

My discussion yesterday largely referred to the macroscopic system of passing a student and conferring the medical degree. A related and more commonly encountered problem is how we score our students during the examination.

I suppose most of you know the old traditional time-honoured system is impression marking, which, unfortunately, does not sound very scientific. In the recent years, both the Royal College as well as our own medical school switched to use a structured marking scheme. In other words, if the student could answer a certain point in the written paper or accomplish a particular area in the clinical examination, he scores a point, and the overall mark is the sum of those from all areas.

It sounds robust, eh ? The difficulty is, however, under this system, for example, a student could pass even if he says he would give cyanide infusion for his patient, or beats up the surrogate during the short case - provided that he answers and does everything stated on the marking scheme right.

(In reality, of course, it never happens. Many of us use impression marking to give the total score, and we work backward to make up all those sub-categories.)

PS. There are ways to get around with this problem. A commonly used one is the inverse marking scheme: A candidate score full marks at the beginning, and scores are deduced along the way whenever he commits a mistake - and the among of deduction depends on how bad the mistake is. One major error (for example, potentially life-threatening omission) would lead to failure.

You think this scheme innovative ? Not at all. The Olympic Games use it to score gymnastics for many decades. It is, as a matter of fact, the orthodox method to assess performance of practical procedures.

Practical

You may think my argument yesterday was using the extreme of the case, and, for the majority of our graduates, we should expect them to be proficient in a certain number of essential practical procedures.

Alas, using the jargon of logic, you are committing the red-herring fallacy. But I shall let you through this time.

Nonetheless, my answer remains NO.

The reason is simple: Why do I need to master, for example, a procedure of internal medicine if I determine to be an orthopedic surgeon ? In fact, if a student is determined to be a pathologist, he does not really have to master any procedure (and, seriously, know how to examine the patient alive) - all he needs is some basic book knowledge in clinical medicine, and hopefully a better-than-average understanding of pathology-related subjects. Yes, his choice of further career would be very much limited, but that's his own decision, presumably after assessing his own strength and weakness. If the medical school does not give him the degree, the society may really lose a talented pathologist.

You see where we are getting at ? We do not need a system of ensuring our graduate to be proficient in certain practical procedures for all clinical areas. A student should get his (or her, no discrimination here) medical degree if he knows very basic medical knowledge (for example, in physiology, the heart is responsible for controlling blood supply to other organs), and is proficient in at least one particular subject - which allows him to pursue his career; of course if a student is good at many areas, he could have a wider choice of job.

Essential

I must say I had an impulse to tell KL the Hospital Authority had a little publication "Handbook of Internal Medicine", in which a chapter lists all procedures to be covered.

But I didn't. On a second thought I was not sure what procedures were essential - in its very literal meaning. After all, our extra-terrestrial friends always emphasis that internship is part of the training; house officers should not be considered independent, and all procedures should be performed under supervision. Although it is the good intention of our educationalists that we should aim to have graduates becoming competent house officers, in reality, the receiving end neither expect nor require such a quality.

And, sitting through the examiners' meeting of our final examination for all these years, I could name a few dozens of candidates who were deficient in many aspects of the basic knowledge and capable of no procedure - but they passed, by the skin of their teeth, because of a very prerequisite: They should be advised not to take up a clinical job.

In other words, all those essential things are not that essential if you decide to get the name of MBChB (or MBBS) and not practising.

Minimum

While I was discussing what are allowed and prohibited for our house officers, KL - one of our star professors and an excellent teacher - sent me an email.

Here it goes:

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Hi Szeto,

I was asked to give a 5-min talk on "What are the minimum essential practical procedures our students should be competent in and how do we ensure they are trained?" in the curriculum retreat tomorrow. Frankly, I feel uneasy about this question and therefore I borrowed your wisdom in my ppt presentation. I hope this does not constitute plagerism.

Best, et cetera.

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My friend was referring to two of my blogs in August (see http://ccszeto.blogspot.com/2010/08/parents.html and http://ccszeto.blogspot.com/2010/08/spoiled.html).

In return, let me play plagerism and show you a few slides of his, which explains why he was uneasy:

• Why do we need to ask this question?
• Are our students overwhelmed with practical procedures?
• If our students are incompetent, will setting a “minimum” improve outcome?
• If the procedures are essential, should there be a minimum?
• If a student fails to meet the minimum, will there be a “minimum” of the minimum?
• What kind of message or philosophy are we trying to deliver to our students?

• Our core curriculum: a bare bone - Aren’t we offering the minimum already?

• Our core curriculum: Still too much? (Is the bone too big or the doggy too small?)

• “minimum” + “essential” + “practical”: Isn’t it common (clinical) sense?
• If we agree this is common sense, are we undermining our students’ intelligence?
• Or… !?