Who

Met L on my way home. He seemed absorbed in his own thoughts.

“Hey, man. What’s up?” I tapped on his shoulder.

“Oh, nothing. I was just going through the advertising pamphlets of our coming CE Election Committee Subsector Election," my friend said, "Boring as they seem, there is an amazing thing between the lines - or should I say between the pictures?"

"Eh...?" I made an inviting grunt.

"Since you are so fond of psychology, look, there is something which should be there but is not." L smiled.

“What’s missing?” I scratched my head literally.

“None of the candidate says which side they’re going to vote!” My friend explained, “Very simply, is it the pig or the wolf?"

"Isn't it the whole purpose of democracy to elect some wise people so that they could make the decision for us in important matters?" I asked.

"Unfortunately, this time is the rare exception." L explained, "The only job of this Election Committee is to vote for the new CE. In other words, it is quite useless to advocate how good looking they are, or what policy they are for or against. Most of us have our own preference for the new CE, and we want our representatives to vote for the one we like – as simple as that. If someone come out and say it openly he stands for the side that I prefer, I shall vote for him; it doesn’t really matter if he was the root cause of the SARS outbreak or being literate only in four-letter words!”

Conscience

(The doctor continued with his explanation.)

"There are many subtle hints of declining well in advance. For example, the CEO of this #9413 sold his Porsche last week, the floor of its reception lobby is covered with an inch thick of dust, and its web page is still showing the information three years ago. Aren't all these sinister signs?"

"Well, ah ... yes," the stock broker was forced to agree, "But they are only proved indicative with hindsight. The problem is usually not we have insufficient information, but we have too much and could not distinguish genuine signal from environmental noise in a jungle of information."

"All the same," the doctor was not a trace more forgiving, "You are the professional. You are supposed to be the expert to extract valuable information and make the decision. What you are telling me is you do not only lower your standard of practice to the adherence of practice guidelines and standard procedures, but you also bring down your level of conscience so that you won't feel guilty as long as you have followed all those amulets written by extra-terrestrials!"

The stock broker was speechless. In a sense his client was right, but, on the other hand, he had no idea how he could pass his days if he were not to lower his level of conscience.

Maloccurrence

(The discussion between stock broker and his client continued.)

"I still believe it's your fault. You've not done everything that could prevent my losing money," the doctor insisted.

"No, we've done everything we should do from our side - and we are entirely satisfied with our performance," the stock broker remained calm and content, "True, you did lost money all the same. As you always say, this is a known complication of investment."

"I know what you mean," the doctor replied, "You've followed all practice guidelines and standard procedures. Every move was documented, conversation recorded, and consent signed. Yes, you have satisfied the administrator or whatever regulatory body there is, but, it is quite a different question to satisfy your own conscience - if you have any."

"What do you mean?"

"I mean, have you been staying alert to all trivial information and hints that would indicate the risk was going to materialize?" The doctor said.

(To be continued.)

Investment

(Discussion between a stock broker and his client.)

“Gentleman, I must say the situation is grim,” the broker began, “You've put your money on Neptune Opportunity, and, my goodness, the price crashed by 95% this morning.”

The client, a middle age physician, remained expressionless. Contrary to the common belief, he was barely literate, and could not comprehend any logical argument of more than twenty words. He had no idea what's the difference between, say, PE and PB ratios, or what kind of company Neptune Opportunity actually was – all he remembered was he was advised by the man sitting opposite to him to buy a stock with the code #9413.

Oh, there’s one thing he knew: He had lost money. Big money he earned by sweat and blood.

After another five minutes of dead silence, the doctor said, “It must be something you’ve done wrong, or information you've hide from me. It's a negligence or your side, or I should call it malpractice.”

"No," the stock broker remained calm and content, "This is not malpractice. This is maloccurrence."

Age

(A real story in my private patient clinic recently.)

"Doctor, you look really young. I never imagine a professor of medicine has no grey hair." The wife of my patient said before she left the consultation room.

"Oh, thanks for your compliment," I smiled, "But there are actually so many young professors of my medical school nowadays ..."

(I was about to say the title professor deflated a lot in the recent years, but I refrained to say so in front of my patient.)

"You are too humble," she went on, "Let me see, you must be far from 60-year of age. Are you 53 or 54?"

I made a loud hiccup - the inevitable response when one tries to laugh and vomit at the same time.

Delay

(The discussion in the resuscitation room continued. Oh, yes, the blood pressure of the unfortunate young man continued to drop.)

"Damn, we are not against transfusion, but how could you be sure the blood is safe?" The grey hair man took over. He obviously was in the habit of using a colorful language.

"We always perform some necessary testings. Nothing is perfect, I agree. But the situation is urgent." The doctor explained.

"Stop that kind of bull shit. You ain't know anything of this testing business." The grey wolf roared, "In the old days, the standard way is to have the potential donor passing through six stages and fifteen tests before the blood is accepted. Now, you just check hepatitis and AIDS. That's not enough."

"That's picking bones from eggs," the doctor said to himself.

But, he did not say it aloud. He hesitated for a while, and then he continued, "All I could say is: Delay no more."

"What!?" Both the monkey-face and the grey wolf jumped.

"Alas, don't be paranoid. I am speaking English." The doctor was forced to say.

Bleeding

(The story in the resuscitation room continued.)

"Gentlemen, let's make it straight. The situation of your brother is critical. If he does not have some new blood in the coming hour or so, the chance is he would not make it." The doctor was grave.

"I don't think he needs any blood," the monkey-face said, half smiling, "I see that you are no short of water. Just give him more fluid to support the blood pressure."

"Let's face it. What he needs is new blood; the old blood won't do much better with more water." The doctor insisted.

"No, I don't think he is short of blood. All he needs is a better distribution of blood flow to each organ, so that some organs would not be deprived of blood while another gets too much." It now became clear that the smiling face was taking charge of the discussion.

"Alas, I agree there may be some organs better perfused than the others, but it does not mean that your brother has enough blood!"

"Well, even if he is hypovolemic, transfusion does not solve the root of the problem. You need to find ways to stop the bleeding." The monkey-face changed the topic.

"No, but transfusion is an important supportive treatment. If we do not give blood quickly, your brother may soon pass the point of no return, and he could not be revived even if we do stop the bleeding."

Shock

(In the resuscitation room of the Emergency Department.)

"Oh, this is horrible. He must have bled a lot. What is his blood pressure?" The doctor was examining an unconscious young patient just arrived and was obviously soaked in blood.

"Eighty over forty; pulse one-thirty." The nurse replied.

"Thank god we have a drip running. Let's give him some blood." The doctor ordered while looking for the site of bleeding.

"Hang on. We do not agree." An unexpected voice emerged behind the curtain. The doctor looked up. Two middle age man appeared besides the bed. One of them had a face like a monkey, and the other was full of grey hair.

"Who are you?" The doctor asked.

"We are his brothers." The monkey-face man said, pointing to the patient.

The doctor somehow hallucinated this man was smiling.

"Oh, my god - I mean oh, I see," the doctor tried to conceal his surprise, "Your younger brother has bleeding from somewhere. He must have lost one third, if not more, of all his blood. We need to give him transfusion, or he may die."

"Fxxk, we know - we are doctors ourselves," the man with much grey hair spoke with the voice of a wolf, "We've given him a shot of erythropoietin injection - his hemoglobin will increase a few months later."

(To be continued.)

Memory

While reading this horrifying story of George Orwell, as a middle-age man brought up by the colonial education, I could understand the worry and confusion faced by Winston Smith.

To begin with, there is always a vague memory of the old days and old system that we used to live with. Alas, now, we are not having a better system. In contrast, we are repeatedly being reassured that the things we are seeing are the same as the one we used to have, say, twenty or thirty years ago. (It is in its own a curious objective when a people refuse to improve, which always involve some difference, but insist to remain unchanged.) Each time, when a regulation is breached or a rule is modified, we are told that the rule is not new but has always been the same - although rather often we need to seek someone higher up to clarify the interpretation.

And, our memory is failing us. History study is ridiculed. Like the Department of Truth, our government is actively wiping off everything that triggers the memory of the colonial days. The portrait of the queen vanished and becomes the logo of bauhinia. Royal turned into People's. Nothing seemed to have happened in this fishing village for 100 years, and, according to the textbook of our children, the place suddenly became a metropolis and returned to its mother country in 1997. That's why by 2046, nothing would have changed, because no one would actually remember what this place was like fifty years ago.

As to the few who happen to believe they remember, their memory must be wrong.

They would be taken care of at room 101.

Orwell

My recent bedtime reading was Nineteen Eighty Four.

I bought the book last Christmas as a present for the winner of the grand round quiz. Nonetheless, I did not give it away and, as a general principle, I would not leave a book on my shelf unread. (See http://ccszeto.blogspot.com/2010/12/1984.html)

You may be surprised to find I did not go through this classic of George Orwell before, while I have read Animal Farm for at least three times - first as a secondary school student.

But, in retrospect, I find it an excellent arrangement. Big Brother is probably too much to be understood for someone below the age of 40.

Alas, maybe that's why Winston Smith had so much problem.

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

You may think this horrifying story of Big Brother is outdated after the fall of the iron curtain. But, I find it more real now than ever. Orwell had the wisdom of seeing the world ends up with three super-powers. You may call it USA, EU, and China.

Or, more likely, Google, Apple, and Microsoft.

Ross

Let me tell you a slightly irrelevant story.

In 1932, Barnaby Ross, whose name was never heard of before, wrote a book titled The Tragedy of X. It was a fiction about Drury Lane, a Shakespearean actor who had retired from the stage due to deafness and was consulted as an amateur detective.

The book proved a best seller, and, shortly afterwards, when his second novel, The Tragedy of Y, was published, Ross became the superstar of detective fiction. To add oil to the fire, Ross's novels were openly criticized by Ellery Queen, another famous crime novelist at the time. The two of them subsequently staged a series of public debates, pointing fingers at each other.

In order not to be recognized by the others, both of them wore masks when they appeared in front of the public.

The problem is, however, no one had ever seen Barnaby Ross - not even his publisher. Since his skill and plots appeared too sophisticated to be a new comer, it was suspected from the very first day that Barnaby Ross was the pseudonym of someone well known.

Alas, you could guess that much: Barnaby Ross and Ellery Queen were one and the same. I did not say one person because the two pseudonyms were used by two cousins, Frederic Dannay and Manford Lepofsky, who wrote novels in a combined effort. During the public debates, one took the role of Ross and the other Queen.

Lancashire

A recent hot topic amongst the cultural circle is a famous local author put up her own photo in her blog.

If you do not know who I am talking about, just visit the Lancashire Road. I must say I am quite far away from being cultural, but Vivian is a fan of this young lawyer. In fact, my wife was rather excited when she saw the picture of her favorite author.

"Oh, she really looks like a movie star!"

"Alas, that may be true, everything just sounds slightly unreal," I said.

"What do you mean?" As usual, my wife did not know where I was getting at.

"Oh, I don't mean that her face is a product of some plastic surgeon," I smiled, "But I have a gut feeling that the girl in the picture may not be her, or be the complete her."

"But, she said in her Facebook that many of her friends and aunties recognize her and ask why she suddenly comes out." My wife said.

"That's exactly the curious bit," I explained, "Nowadays the internet is so far reaching. If you put up the picture or video of anyone on to the web, in no time the face would be recognized. People appear from every corner and declare being the neighbour or classmate or friend. But, this time, they just write to her - or so it was said. We see nobody come out and say Hey, I know this woman; we belonged to the same hostel in the university."

PS. You may still be puzzled what I meant by the complete her. I shall explain tomorrow.

Match

You may think my worry was far-fetched because genuine bribery in election remains uncommon, and not all policies involve long term benefit.

But, unfortunately, the general idea remains - and is happening more often then you could imagine. There are innumerable topics of a society that people concerned are unable to grasp the whole picture to make a wise decision, while a small group who hold some critical information also have their own agenda.

The best example at hand is the public health policy, or, specifically, the recruitment of overseas medical graduates.

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

I shall not elaborate my opinion on that very last topic any further. Frequent visitors of this site would know just too well. Nonetheless, it really touched my nerve when Vivian told me our noble council representative said that manpower allocation was not even across all government hospitals and every department.

"That may be true, but I would be most enlightened if you could give me five examples that a department in a government hospital has a surplus of manpower. I can only name one - the headquarters."

"But, for the same specialty clinic, the waiting list is one week in a hospital, but 15 months in another," my wife tried to defend the surgeon.

"Does it mean that the hospital with a one-week waiting list has an over-supply of doctors, or their chief-of-service is an expert of torturing his staff?"

Mismatch

You may argue, based on the previous example of a benefit twenty years later, it is logical to ask only those who are potentially affected (i.e. those below 60-year of age) to vote.

But, I'm sure you see it plainly that's quite impossible, for obvious reasons:

1. Most importantly, the group most benefited (that is, those below the age of 20), is often quite incapable of making a logical and appropriate judgement.
2. It would be seen as a discrimination of age - a taboo that we don't want to get near to.
3. In real life, it is often difficult to tell how long it needs to wait for the benefit.
4. And, in reality, we do not vote for policies one by one (and we don't want to anyway - otherwise we would not need a representative in the council), we vote for persons, or, a choice of different bundles of policies.

Specific for point #1, you may now come to realize it is an inherent problem of democracy: There is often a mismatch between those eligible to vote and those who actually get the benefit, and the temptation is more than real for the former group to choose a policy (or, a candidate or political party) than would benefit themselves rather than the entire society. To put it simply, they balloon up their own purse by taking money from those who do not vote, or vote for the opposition.

Remarks

There are some remarks I have to make after the recent discussion.

First, genuine support to democracy does not mean voting for Party D. A well informed and calculated voter should vote whatever he prefers.

And, don't be too serious with my example of bribing voters by cash money - all elections are bribery of one form or another.

In most cases, however, the transaction is more subtle than the famous Four Great Inventions (蛇齋餅糉). Sometimes they fight for a better social welfare, rising our salary, cutting working hours, limiting competition from new immigrants - be they Filipino maid or British doctors. Yes, between statesmen or parties, politics is negotiation. But, between backbenchers and their constituents, politics is always benefit or bribery - depending on how you call it. For each candidate running for an election, they represent a mixture of policies and proposals sold in a bundle; even a wise voter could only choose a better candidate by balancing the gain and payoff.

It is, in short, the rule of the game.

Oligopoly

The problem is: Why should bribery of the election be so profitable?

Because the cost is very low for a selected group. (In our previous example, those over 60-year of age.)

But, if this group of voters do come to realize their true value, they would ask for a higher price. In reality, if there exists another malicious Party C2 and is willing to pay twice as high (i.e. $2), both Parties D and C would lose the election to the new comer. In a free market, by the law of economy, the final price to bribe these people would eventually be much higher - or, to put it in a more palatable language, the underprivileged group would enjoy more benefit.

However, politics does not often operate in the setting of a free market. In the jargon of business, the admission threshold (入場門檻) to form a Party is high, and, for us, since there is another invisible hand behind the scene, the choice is limited. In other words, it is a form of oligopoly (寡頭壟斷) - with the inevitable implication that the bargaining power of an ordinary citizen is very low.

Profit

I might be going too fast yesterday and the profitability of bribing an election may skip your eyes.

Let's suppose there are 6000 citizens in a country with a smooth distribution of age; voting for Party D would generate a total benefit of $600,000 to the society twenty years later. Equally shared by each and everyone, it means $100 per head. For simplicity, we assume the life expectancy is 80-year, and citizens could vote after the age of 20.

Now come the critical moment: A malicious Party C would try to take all the benefit for their own ($0.6M twenty years later, or around $128,700 immediately - assuming a discount rate of 8%). To bribe a sufficient number of vote, and suppose everyone could be reliably bribed, the cost would be:

• First, we need to get all 2000 votes from citizens over the age of 60. We can pay $1 for each, and the cost is $2000.
• The present value of $100 in 20 years is $21.5. Since we need another 1000 votes to win the election, the cost is $21500.
• Therefore, the total cost to win is $22500, and the net profit, if cashed immediately, is $106,200.
• (In fact, if we take it as a present investment of $22500 and a return of $600,000 twenty years later, the yearly return is 17.8% - as good as the performance of Warren Buffett.)

In reality, the cost would actually be lower, because the turn up rate of voting is never 100%. A detailed mathematical model predicts that the money Party C needs to bribe a sufficient number of voter actually falls rapidly if the turn up rate comes down to 50%. Readers with an obsessive personality disorder can try to work out the numeric details yourself.

Here, a determining factor of this profitable business may not be immediately obvious. Let me tell you tomorrow.

Expectancy

You may disagree with my attempt to understand the phenomenon of bribery in election; I myself is slightly suspicious. To say the least, the traditional discounted cash flow method does not take into the account of the interaction between time and life expectancy.

It goes like this:

Let's suppose voting for Party D would generate a benefit of $100 twenty years later. Assuming a discount rate of 8% (the standard rate of return for a business with an average risk, as suggested by Benjamin Graham), the present value is $21.5. In other words, a calculated voter could be bribed by paying him $22.

But, in reality, you can do away with paying that much for many of the people in the community.

Why? If the expected life span of this country is 80 years, the future value of voting for Party D would be zero for anyone above the age of 60. In layman's term, they would not live that long to see the benefit - and, therefore, they could be bribed by an amazingly small sum.

Say, $1.

What's the conclusion? Alas, it means that bribery in election is a highly profitable business!

PS. In real life, many senior citizens do vote for the benefit of their children and grandchildren, and one could always join the dinner (or take whatever benefit that is offered) and vote for the other side. If you could think of all these, you would hardly be fooled by any politician. Unfortunately, most people are honest and do keep their promise.

Discount

You may think I am short-sighted and do not appreciate the long term benefit of supporting democracy. Well, let's analyze the problem from a business point of view:

First, please accept all long term gain could be converted for immediate cost-benefit analysis by the discounted cash flow (折讓現金流) method. The principle is simple. For example, in 1990, if Alan Greenspan promised to give you $100 ten years later. Given his creditability, we take 4% as the annual discount rate. It would imply the effect would be the same if our previous Chairman of the Federal Reserve gave you $67.6 in 1990 that and there. (Try it with your own calculator.)

But, if Ben Bernanke made the same promise to you in 2010, the financial environment (and, I am forced to say, the person) changed. The future is more risky, and the discount rate needs to be higher - let's say, 8%. In that case, you may prefer cashing away $46.3 from the chairman now, rather than having to wait until 2020.

The idea is, therefore, simple: The more uncertain and risky the future, the higher the discount rate, and, as a result, the lower the present value one would take as being equivalent. And, as pointed out by Albert Einstein, compound interest is the most powerful force in the universe. If we have to wait long for a huge wealth, we may as well get a tiny sum immediately. (For example, for 30 years and a discount rate of 12%, $100 becomes $3.3 only.)

Therefore, don't blame people who vote for the candidate that brings them to dinner; they have very little idea when democracy would bear fruit, and, since pursuing such an exceptional virtue has a very high risk, the discount rate should be huge.

Now

(The conversation between the old man and the pioneer of democracy continued.)

The politician then asked, "Why didn't you use your vote to support democracy?"

The old man said, "Why on earth?"

The politician scoffed, "Democracy is so important! With it, you can really reflect your opinion and affect government policy."

The old man asked, "But, how long will this all take?"

The politician replied, "Oh, 15 to 20 years - maybe slightly longer."

"But, even if we achieve eventually this ultimate aim of real democracy, what then?" asked the old man.

The politician laughed and said, "That's the best part. Old people like you can ask for more social welfare - for example, free flu vaccine or even free dinner party!"

"What do you think I am having in my hand?"

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

Do you think this old man is short-sighted and does not appreciate something more important in the long run? I would not go that far. After all, democracy should not be the goal - it is a means leading to a better life.

As Hercule Poirot emphasized (in Murder on the Links): If you do not see this point, you could not see anything.

PS. Exactly for this very reason, if democracy leads to a foreseeable adverse outcome, I would not support democracy.

Election

While I was considering to whom I put my vote in the medical council election, we have another one for the district council.

Like many others, I live in a place where there are two persons running this time: The original council member, who has done a lot of work on local affairs but has a suspicious party background, and a young man who, to keep my wordings modest, is more vigorous in pursuing democracy.

I shall not mention which side I support. In fact, an entirely different story of a fisherman came through my mind (see http://ccszeto.blogspot.com/2009/11/rich.html).

Let me modify it a bit:

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

A pioneer of democracy passed by the garden of a public housing estate, where he found an old man sitting there, with tickets to some dinner banquet and free influenza vaccine in one hand, and a voting paper in the other.

The politician complimented the old man on his support to the election, and asked which side he would vote for.

The old man replied, "The ally of Napoleon, of course."

(To be continued.)

Vote

During a casual chat, I suddenly realized many of our junior colleagues did not vote in our recent election of the medical council.

"Why! Rather hopeless for us to change anything," AC, my own registrar, said, "It's just a game for the insiders."

I was forced to agree. A sound economic principle actually lies here: If we consider our own personal benefit, we should never vote: There is no benefit because a single vote of us would not affect the result, but it does cost a trace amount of time.

Nonetheless I did vote. I took it as part of the duty of a doctor, and, if everyone believes we couldn't do anything, nothing would eventually be done.

Seriously, I have no favorite candidate.

I am just against one.

Modify

On a second thought, chopstick is a lingua franca of the Chinese culture.

Like everything else in life, it got modified slightly wherever it goes:

In Korea, chopsticks are generally made of metal (iron or silver); using wood or bamboo ones are considered as a sign of poverty.

In Japan, chopsticks have pointed tips (as compared to the blunted end of traditional Chinese chopsticks, which remains the standard design of disposable ones in Japan). For that seemingly trivial modification, there is, in fact, a substantial difference in the proper way of holding them.

On that last point, I shall not elaborate on the actual techniques. Suffice to say, a skilled user of the Chinese chopsticks could easily use his instrument to cut out a piece of flesh from, say, a whole fish – a task that is not meant to be done by the Japanese equivalent, however dexterous the user is. Of course, the explanation is obvious: We serve whole fish or other cuisine in big dishes, and there is often a need to dissect the object for sharing; in Japan, meals are generally served individually.

(Another contributing cause is that Japanese rice is slightly more sticky – or, in scientific terms, has a higher content of gelatin – for which it is less messy to use chopsticks with small pointed ends. Just try it yourself.)

PS. It is a common belief (and in fact quite scientifically proved) that chopsticks take part in the spreading of infections that could be transmitted via salive (notably Helicobacter, the cause of peptic ulcer). However, the blame is not entirely legitimate. A noble Chinese with an appropriate upbringing should finish with his dinner without soiling his chopsticks – each piece of food is diligently put into the mouth by a non-touch technique.

Chopstick

It was a Wednesday morning. When I received my lunch box after half way through our unit meeting, I found something important missing.

And I grumbled, "Gosh. I am a traditional Chinese, and I definitely need a pair of chopsticks for my lunch."

"So, did you bring your own pair when you went to England for study?" Someone asked.

I smiled, "That's really a story - I did not, or, I should say I forgot to do so. To make things worse I was in Bristol, not London, and I had no idea where to buy a new pair." (During that time, to be honest, I had either to dine in the hospital canteen - it is perfectly OK to eat fish-and-chips with knife and fork - or to use a spoon for everything if I decided to prepare my own dinner.)

"How did you get around the problem?"

"Alas, I rang up WY, who happened to need to be in London later that month for a meeting, and I asked her to bring me a new pair!" I smiled.

By the way, I am still keeping this very pair in my office - to remind me of the good old days.

Conversion

You may ask: How do I find my Kindle?

Not bad. To say the least, the screen is soothing and there's no flash light. (Good for someone with migraine, like me.) I tried the Wifi connection and bought a novel from the Amazon site. Everything was plain sailing. Nonetheless, to save the battery power, I turn off the wireless most of the time, and, if I need to buy new books, I could do it on my desktop computer and move it to the device via a USB cable.

The major difficulty, however, came when I tried to read journal articles. To begin with, it could only open HTML or DOC files after conversion - not convenient. If you download a paper in PDF and pass it to the device, the file could be opened, but, since the paper size is usually A4 or standard letter, you need to zoom in and it is rather complicated to move around a page. The next thing I tried was to open a paper as full text and then print it to PDF after adjusting the paper size to A5. Alas, it comes up perfectly well on the Kindle screen - just that the files are amazingly big (often 15 to 20 MB for each article).

PS. You can also open a full text, save it as HTML only file (rather than a full web page), and then print that file to PDF as A5 pages. The file size becomes much more manageable (generally 300 to 500K). But the process is slightly complicated.

PPS. Which book did I buy to test my new toy?

Why! For sure it was The Murder of Roger Ackroyd.

Kindle

My recent new toy is Kindle.

I bought it on-line as a bargain item. Although I am slightly uneasy with virtual bookstore and a paperless system (for example, see http://ccszeto.blogspot.com/2011/10/choice.html), there is an objective need for me to have an electronic reader. It goes like this:

Since our wards moved to the new hospital block last year, it becomes quite a nuisance to people like me who have our office staying in the old block. (The root of the problem is, of course, when the new block was designed by some extra-terrestrials, no office space was planned for academic staff.) Although it takes no more than 5 or 7 minutes to walk from our own office to the ward, it becomes neither here nor there when we have, say, 15 minutes of spare time in the ward (for example, after the morning round but before a bedside teaching).

For that reason, many of us bought iPad in the past one year. Well, after reading Tim Ferriss, I am not fond of checking emails all the time, but it seems a good idea to have some documents or journal articles at hand.

PS. Another brilliant design of the new hospital block is that the largest blind spot for mobile phone connection is the lift lobby - exactly the place where you need a mobile.

Manpower

(The gangsters' meeting continued.)

"We need more doctors."

"Don't be silly. We won't have more graduates until 2014. But, by 2017, we would have loads of them, and the pendulum would be back to the worry of having unemployed medical graduates!"

"Shall we hire some from overseas?"

"Alas, the problem is more complicated than what you think."

"Well, yes, our friends in the medical council are all against the idea - and for obvious reasons. They always say we should hire more part-time doctors. What a suggestion!"

"Some of them do pretend to apply to help for the out-patient clinic, but that's quite beyond the point. What we need are doctors to do the ward round and on-call duties."

"But, going back to the plan of employing overseas doctors, it's not only our friends in the medical council blocking us; our lovely extra-terrestrials are putting hurdles just as much."

"What hurdle?"

"Quite simple. Let's say an overseas applicant has some training in internal medicine and wish to apply for a post in our department. For sure we are eager to accept. However, aliens outside the solar system come to the conclusion that our emergency department is more in need of manpower, and insist that new employees must spend their first 6 months in the A&E. That's quite enough to put off the applicant."

"In that case we should never try to improve our service - we should actually make it worse, so that we would be regarded as in need and get more resource!"

PS. For those who were also in the gangsters' meeting, you may not be able to recall some of the conversations I outlined above. That's entirely expected.

I dozed off in the middle of the meeting and had a nice dream.

Well, maybe not such a nice one.

Diffuse

Shortly after the two jokes, I attended another gangsters' meeting.

The focus of discussion was, of course, the manpower problem.

Let me show you some bits and pieces.

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"Is it possible to cut down the admission?"

"But there are so many patients need to be admitted."

"In that case, can we confine the overflow cases to a few wards so that we don't have to see one or two cases in each ward. It is really leg-breaking to conduct a ward round for all overflow cases."

"No, the hospital won't allow such a thing. Otherwise we would soon find ourselves occupying two or three wards entirely - and officially we should not have more medical wards."

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You think the argument sounds awkward? Yes and no. From the doctors' point of view, the idea is certainly absurd. But, it is far easier to ask nurses of surgical or orthopedic wards to each take care of one or two medical patients. If one particular ward is filled with medical patients, the nurses would just resign in no time.

Risk

It must be a season of joke. The next morning after CB showed me the fabulous emails, I met W in my ward round.

W has been under the care of us for quite some years. To cut the medical information short, this time, she was the night before for some urinary infection. The problem was, one regular medication of hers was a new long-acting version, but, when she was admitted, she was prescribed with the ordinary short-acting form. This mistake, which I considered minor and entirely understandable, was noted and immediately rectified by the on-call physician that evening.

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I talked to W, did a brief examination, and decided to go through her hospital notes and medication sheet - which, to my surprise, could not be found anywhere in the ward.

I asked the nursing officer, "Where's the medication sheet of this patient?"

"Oh, the incident last night was reported to AIRS," the ward sister was most apologetic, "The risk management people just come around and take away the case notes and medication sheet for detailed scrutiny ..." (For those not familiar with our system, AIRS stands for Advanced Incident Reporting System.)

"In this hour of the morning!?" I gasped, "Please go and tell them, I am now doing ward round and have the priority to look at the patients charts and records. The risk is real if they still keep all those documents at this critical moment!"

The nursing officer hurried away. I did not have a chance to elaborate the risk I mentioned was to the patient or some other extra-terrestrials.

Recurrent

(Email communication between a colleague of mine and the consultant of another department, about a recent administrative incident.)

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Dear X,

We just had this discussed ... The management of your side violated the long agreement between your department and mine from very early days.

Thanks, et cetera.

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Dear CB,

This is a recurrent issue and has stirred up a lot of heated discussions in our department. What I can say is these were isolated incidences, and I would do my best to handle the issue.

Best regards, et cetera.

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Fabulous !