Complete

Recently, one of the consultants who used to supervise Vivian resigned from the Hospital Authority and set up his own practice. In the opening ceremony of his clinic, he gave a short speech.

And I consider one small piece particularly remarkable:

“Do you know the difference between complete and finish?

That’s simple.

If you have a good wife, your life is complete.

If you have a bad wife, your life is finished.

And, no matter your wife is good or bad, if she finds that you mix up with a mistress, your life is completely finished.”

Taking that as the analogy, I hope you find today the year 2012 is about to complete.

Happy New Year.

Buffon

To me, the story about how Zu Chongzhi derived the value of π was an important lesson in itself.

It goes like this: When I first read about this as a Form 1 student,  I was told that Zu did it by the needle-throwing experiment. In short, by throwing a needle of length ℓ on a surface on which parallel lines are drawn 2ℓ units apart for n times, and, when n is very large and in x of those times the needle comes to rest crossing a line, then one could determine the value of π by this formula:

π = n / x

But, like many other stories that I heard from that crooked universe, the above account is not true. The scenario that I described just now is, as I learnt latter, known as the Buffon's needle problem – a question first posed in the 18th century by Georges-Louis Leclerc, Comte de Buffon. Simulations that make use of this strategy to determine the value of π involves the famous Monte Carlo-style method of conducting virtual experiments.

Alas, although we may love to, it has nothing to do with Chinese.

PS. It is not entirely difficult to prove mathematically π = n / x. To me, it actually took less time to prove this than to determine how to use three “9”s to make a “20”.

π

As soon as I mentioned the concept of Pi (π) amongst ancient civilizations a few days ago, I could not resist the temptation to look up the topic again.

The official record is straightforward. The first rigorous algorithm for the calculation of π was a geometrical approach using polygons, devised by Archimedes. Possibly by coincidence, ancient Chinese mathematicians used the same approach in the following centuries. For example, Liu Hui (劉徽) if the Wei Empire (魏) created a polygon-based iterative algorithm - some 500 years after Archimedes - and used it with a 3072-sided polygon to obtain the value of π. Another 200 years later, Zu Chongzhi (祖沖之) used the same algorithm of Liu Hui and applied it to a 12288-sided polygon.

But, the controversy is no one seems to be very sure how Zu calculated his π.

PS. Zu actually described in details his methods in the book Zhui Shu (綴術) (literally The Method of Interpolation) - the textbook on mathematics once used by the Tang Empire in the National Academy (國子監). The black humor is Zhui Shu was too difficult to be understood by students and was therefore removed from the syllabus after a few years.

Pyramids

One remarkable achievement of the Mayan people is their construction of pyramids.

And, when we talk about the technology of Mayan people, it is a romantic idea of many of us that the ability of building huge pyramids indicates extraordinary technological standard of the Mayan and ancient Egyptian people.

The very fact is, the remarkable part of raising an Egyptian pyramid in those days was related to the difficulty in the coordination of a huge team of worker, and in the limited availability of metallic tools. (In essence, copper was the best metal that ancient Egyptians had. To build the Great Pyramid, in addition to all the workers that you could imagine, there was an additional team of people who did nothing but kept sharpening the copper tools for the front line workers.) The construction of these gigantic buildings actually did not depend on sophisticated mathematical and scientific knowledge. A wide-based pointed-top building is, in a sense, easy to rise. All you need is an accurate method of measuring, and the ability to handle formula for the calculation of weights and volumes.

And these were, and only these were, exactly what ancient Egyptian mathematics could do. In fact, they had difficulty to work with decimal numerations, and, in spite of their remarkably accurate ability to make astronomical observations, the quality of their prediction was much inferior to the Babylonians.

Technology

I must say from the very beginning we should not be to serious about the Mayan calendar.

My argument is simple: Mayan people had very limited technology.

The classical rumor is, you know what, Mayan people did not have wheels (arguably the second most important invention in the history of mankind – the first being fire). That’s certainly not true – the Mayan calendar is actually called The Wheel. Nonetheless, they did not have metallic tools, trolley, or large domestic animal to pull carts; although they had circles, they did not have the concept of Pi.

Or, to put it simply, if they had difficulty in securing an all-year water supply, why should they be able to predict the end of the world?

PS. It is interesting to compare the technological achievement at that era between different cultures. The classic period of the Mayan Empire was between 250 AD to 900 AD, roughly around the time of the Tang (唐) dynasty in China. Paper and printing were in routine daily use. The Arabian people at the same time could master complicated mathematics and the ability to plan long distance sailing.

End

While talking about the preparation for the Doomsday in a lunch time discussion, we were all amazed to hear the remarkable story of a woman, who keeps at home a few months supply of water, rice, biscuits, instant noodles, and what not, to prepare for the End Time. 

After all, it seems obvious that if the whole world comes to the end and we all have to die, what could be the use of the bottled water and instant noodle?

(The analogy in the financial market, unfortunately, is less well appreciated: If the entire market crashes, why should we believe the stock that we hold could escape from the tsunami?)

Most of us came to the conclusion, "If that woman really believes in the Mayan calendar, she really should use up all her money and enjoy until the very last second."

For me, although not a fan of the Apple, I shall take the advise of Steve Jobs: I have looked in the mirror every morning and asked myself: "If today were the last day of my life, would I want to do what I am about to do today?"

And I would like to thank you if you happen to see the difference between the two.

Apocalypse

Although we have passed the End Time of the Mayan calendar, there are many other Doomsdays ahead of us.

For example, if you believe in the traditional Chinese calendar, this triple-round (三元運) will end in the year of 2043. (It seems a possible year to Hong Kong people.) You know, according to the Chinese astrological system, each round encompasses 180 years. Last triple-round ended in the year 1863, when Abraham Lincoln signed the Emancipation Proclamation, and the London Underground Railway opened.

No, nothing really exciting.

But, if you consider the grand-round (周份), which consists of nine triple-rounds, it will end in the year 3123 - not really something we have to worry about. This grand-round began in 1504 - when Christopher Columbus discovered America.

Sounds more convincing, eh?

PS. In Chinese astrology, round (元) is the same as Hua-Jia (花甲), which means 60 years. The idea of round comes from the observation that the orbital periods of Jupiter and Saturn are roughly 12 and 30 years, respectively, and the two stars should meet once every 60 years.

Doomsday

If you can read this, I suppose we have passed the Doomsday, safe and intact.

I write this blog on the morning of 22 December, Saturday. But no, I am not sure we have not reached the End Time yet - this is the common misconception. When we talk about the end of the world in the Mayan calendar, it is 21 December 2012 - in the time zone of central America, which is around 15 hours behind us.

There are still about 6 hours to go.

But I believe we are safe.

Merry Christmas.

便宜

素菜是燒雙冬及鍋塌豆腐。前者即滬式赤醬煮冬菇、冬筍，乃仲冬時令，這裡做的，亦惹味非常。祇稍嫌筍條微老而偶有酸味。此乃來貨問題，烹調功夫倒是到家的。

鍋塌豆腐來源已不可考，作法是豆腐切塊，沾漿略炸，再燴以蠔油、蝦籽。是次所吃，蝦籽下得未夠，論香氣惹味，便不如黃大仙四川菜館。然而豆腐甚滑，此夕亦多濃味食制，清淡一下，也無不可。

單尾是叉子燒餅併榨菜肉末。餅烤得香脆，唯獨榨菜浸水過久，鹹辣不足，炒以肉末，便失乾香惹味之原意，是以此物雖然老少咸宜，卻似乎為嘩眾而失性格矣。

老式京菜館子，甜品多為奉送的高力豆沙，此處亦然。平心而論，這裡的出品頗為不修篇幅，上桌之時，有些已乾澀凹陷，豆沙餡也是東歪西倒，時而外露，而蛋白外皮亦略嫌炒老，失了嫩滑。只是此時各人已是十二分飽，敬送之物，倒也不必深究，嘻笑啖之便是。

總的來說，此餐吃得甚是歡娛，彷彿是拜訪舊友，雖過盛年而丰彩不及昔日，仍自有味道而談得盡興。侍者雖老，仍服務殷致，無可置喙。一行十二人，埋單千八，用蔡瀾說法，是便宜得不能柤信。

泰豐廔

正訝於北京酒樓結業，內人郤已於去月敲定於泰豐廔做冬。一如以往，菜單為區區所訂。

前菜為醬牛蹍和三絲粉皮。碟頭俱極大，牛蹍滷煮火候充足，腍而入味，粉皮甚滑，麻醬亦香，只是油份稍多。

湯品是雲吞雞。此處沿用舊法，湯底純係雞湯而不加火朣吊味，雲吞皮厚肉多，有乒乓球大。以大鍋上，煲湯原雞奉客，足料二十碗，聲勢已是懾人。

熱葷是山東燒雞，鐵板宮保明蝦，京燒羊腩。山東燒雞乃此店名物，究其傳統，係用歲大春雞，先炸後煮，手續繁複。而此店出品，與北京酒樓的手撕雞，菜出同源卻又風味各異。這次用的是二斤中雞，大扺滷煮過久，夠腍卻少了油炸香氣，肉入味而略鹹，隨碟上的蒜蓉醬油便無所用。雖是不錯，較之全盛時期，仍稍有距離。

明蝦當然是便宜貸，但肉質仍爽，宮保汁甜酸微辣，掩蓋了雪味，鐵板上桌也引來小孩一陣喧笑之聲，剎是不錯。

京燒羊腩原為滿州食制。以香料醃連骨坑腩，半燒半炸而成。此品以鹿鳴春所製，最為精彩，這裡的便燒得略乾，且醃料香氣不及，唯邊位烤得焦脆，羊脂軟羔，滲透其中，仍極美味。

北京酒樓

把兄楊君稱佐敦北京酒樓將於月內結業，聽後不禁有點戚戚然。

此酒樓隱居煙花之地，創業已逾四十年，與一箭之遙的鹿鳴春、泰豐廔、仙宮摟，可稱九龍四大傳統京式館子。此四處菜單雖大同小異，然各有特色所長，非現代連鎖集團所能及。北京酒樓的手撕雞、賽螃蟹，簡單而味雋永。較之鮑參翅肚，更顯百吃而不膩。而今仙宮已過海，此處亦結業，四去其二，不免可惜。

區區並非此肆熟客，初訪是九七回歸後，赴英受訓前夕，江蘇姑娘為余踐行，其時初嚐名菜頗有驚為天人，大隱隱於巿之感。其後數次到訪，水準俱能保持。十年前嘉利大厦火災而此處無恙，竊自慶幸。不意苛政猛於虎而土地公惡過祝融，霸權之說，未必無因。

或曰此處侍者大多年邁，招呼不週。然而粗獷而不拘小節，正是易水豪傑遺風。而菜式重實惠輕花巧，亦是燕趙冀北傳統，與嶺南精緻細密，大相逕庭而各擅勝長。不明此中差異，便如只識諸葛孔明多智，卻不察司馬仲達韜略，殊可哂也。

Senior

(The interview continued.)

The junior lecturer took quite some minutes to make sure he is not dreaming. Finally, he says, “The budget is fixed… what’s it all about? Oh, I mean, how could it happen?”

The chairman makes a bitter smile, “It is quite beyond the point to ask how. It happens because someone high up says it happens. Isn’t it how we have light since the Genesis? The real issue is the amount of money we have to run this department – the salary of everyone of us, secretary and amah, printer and cartridge, tea and coffee, water and electricity, everything included – is fixed. If some of us get promoted and, in the jargon of the extra-terrestrials, have an advancement in our pay scale, we have to cut down the expense in some other areas to cover for that extra amount of salary.”

“My god, it can’t be real!” Dr. X exclaimed, “Shouldn’t it be the primary aim of the university to encourage every academic staff to excel in their own field, and the reward of that is promotion? If we have a fix budget, it simply sets a limit to the chairperson, or whoever holding the department account, to manipulate so that no one in his department would get promoted?”

“Well, I can only say you sum up the situation rather clearly.” The chairman twists his lips, “Nonetheless, I know some divisions have their own way to make money for their staff promotion.”

“Really? How?” The younger lecture is certainly interested.

“Em… Dr. X, if you agree to answer all phone calls yourself, type your own letters and envelops, and manage your own daily schedule, we can fire your secretary and use her salary to top up your post…” The chair professor says slowly.

“Alas, do you mean, rather than having all my academic achievement, if I do both the work of my own and my secretary, I could become a senior lecturer? Or should I be called secretary lecturer ?” Dr. X says – finding himself more cynical than ever.

Budget

(In the promotion interview of a junior lecturer of medicine.)

“Dr. X, let’s come straight. Why do you think you should be promoted?” The chairman begins.

“Em… I’ve published lots of papers. Some appear in journals with a high impact factor. I have a few grants, and I have sufficiently pleased my students – alas, I mean my teaching record is reasonably good. I try my best to appear as if I am paying some effort to contribute to the clinical service. Isn’t that good enough?” The young academic staff says calmly.

“Oh, yes, I know all these,” the man with much silver hair waves his hand impatiently, “But, let’s solve the critical question: Who is going to pay for you?”

“What?” Dr. X cannot believe his ears.

“I mean what I say,” the chair professor nods his head (or is he shaking instead?), “If you are promoted to become a senior lecturer, we need to increase your salary correspondingly. The problem is, the budget of our department is fixed, and, therefore, where does the money come from?”

(To be continued.)

Party

Took a half day off to attend the Christmas party of Adler’s kindergarten.

Frequent visitors of this site may know Euterpe studied in the same kindergarten three years ago, and there was the same Christmas party – in the same place. I was so impressed by the seamless running and terrific time keeping at that time that I came to the conclusion their management skill is better than most of the extraterrestrials we encounter in hospitals and universities. (See http://ccszeto.blogspot.hk/2009/12/party.html)

How about this time?

I must say with the experience three years ago, Vivian and I were not as much excited. The program was by and large the same. The headmistress took a bit longer to give her speech – because she was apparently having a cold and needed to clear her throat a few times in the middle of the talk. In the little drama about Jesus Christ’s birth, a few kids – playing the part of sheep – found the floor of the stage too slippery to crawl. When the Santa Claus appeared, a few children were too involved in the dancing and forgot to collect their presents…

The program was scheduled to finish at 4:30 PM. In spite of all these small hiccups, at 4:25 PM, the last song was sung, and the headmistress rose to the stage again and thanked everyone for coming. I could not resist to say to myself, “This is real first-class management: It’s not about doing something right, but doing something right repeatedly – no matter how monotonous these things are, and prepare for all unexpected developments.”

Prevention

To my surprise, SL was not very impressed with the health care system of Australia.

“What’s wrong?” I asked.

“They have so many problems – but, to me, the most remarkable point is they are too mean.” My friend said.

“Eh …?” I could not believe my ears.

“Let me give you a little story. Close to New Guinea, there are a few outlying islands that are occupied mostly by aborigines. As you expect, tuberculosis is common amongst these people. In the past, our government sent a medical team to visit them regularly by helicopter, and treatment of tuberculosis was provided free of charge. Not too long ago, however, this service was stopped because of our tight health care budget. Soon after that, because these aborigine patients are poorly and not properly treated, many of them develop multiple drug resistance. To seek some proper medical treatment, a few of them get to the Australia mainland by legal or very often illegal means, and, once multi-resistant tuberculosis is found, they need to be kept in top standard isolation facilities for a long time. You know, taking care of one patient like this cost more than the entire helicopter doctor program in the past!”

“Alas, in this case we are forced to agree with Mary Lasker,” I smiled, “If you think prevention is expensive, try disease.”

Classmate

Had afternoon tea with SL. We did not see each other for 5 or 6 years, and I was too happy to have the opportunity to chat with my old friend again.

You know, the two of us have so many old stories to share. We were in the same class all through the six years of our secondary school study, and we were in the same volley ball team. (Difficult to believe I used to play volley ball, eh? But yes, I did. The more difficult thing to imagine is: Our department chairman used to be in the other team.)

SL and I continued to be classmates in the medical school and now, he is working in Australia as a consultant. (He comes back this time for a conference as well as to visit his parents.) His wife used to be a classmate of ours when we first entered the medical school, but she soon emigrated to Melbourne and continued her medical study in Monash.

(Since they were separated so early, their romantic story remains one of the most unexplainable incident that I have ever encountered.)

When we were final year medical students, we shared the same room in the hostel. I’m afraid the two of us were the least well off students in my class, because our room was probably the only one that did not have air conditioning. (Those were the days when medical students had to bought and set up their own air conditioner in the hostel.) Nevertheless, thanks to his endurance of my awkward living habit, I could do what I liked and had a most enjoyable year.

晚餐後

My recent leisure reading is Nazotoki Wa Dinner No Ato De (推理要在晚餐後) by Higashigawa Tokuya (東川篤哉).

Contrary to most of the detection fictions I read in recent years, this one was bought by Vivian. Although well infused with amusing details, this tiny paperback could, I'm afraid, only please detective fiction readers who are craving for some new stories - like what a heroin addict finds in methadone.

In my opinion, it is a romantic but naïve idea to have a super-detective who simply sits there, listens to the story, and makes a logical deduction. Sherlock Holmes claimed that he was one of those kinds, but, in reality, he was very much a hands-on person and preferred see to the things himself for some first-hand evidence.

And, it is against normal physiology to have good deductions after dinner. Our biological clock is set in such a way that analytical function is best early in the morning, with a second but lower peak in the late afternoon.  As to the period after dinner, the best type of mental activity is Brownian movement of synapses.

Strategy

On a second thought, maybe we should not be too critical of TM about his (lack of) method of time management, or should we be too enthusiastic about GTD and improving our productivity.

The argument is simple: Success does not (only) depend on doing things right, but, more importantly, doing the right thing. As the old English proverb says: What good is running if one is on the wrong road?

You may argue: Working hard and being efficient are important characters to excel. Yes, but they are not sufficient. To go one step forward, these characters would only bear fruit if everyone in the field provides a similar kind of work or service. And, because these characters are easily followed, the likely result is a fierce competition (i.e. everyone needs to work harder and more efficient) but none would have a material benefit.

It is, therefore, more important to cultivate yourself and nurture an edge.

Go read Competitive Strategy of Michael Porter.

GTD

During a casual discussion, we are surprised to learn that TM, one of our physician trainees, does not use a personal diary to mark his calendar. Apparently he is simply using his own brain to put down when to do what.

“How could that happen?” We all asked, “Our schedule is so busy and there are so many appointments. It would be a chaos – if not disaster – for us to have one day passed without a calendar.”

And we are serious. My friend CB uses the Outlook calendar to manage his life, KM puts everything in his digital diary, and I have my Moleskine. In fact, as a reminder system, human brain is distinctly inefficient and seldom reminds us of what we need to do at the time and place when we can do it. To improve our productivity, we need to do away with remember what tasks to do from our mind by recording them externally, followed by thinking in advance to generate a series of actions which can be carried out later without further planning. In this way the brain can concentrate on performing the tasks.

Go read Getting Things Done of David Allen.

Interview

Actually I could not think of the story of Lĭ Guăng very long. In a gloomy Friday afternoon, I took a half-day leave and brought Adler, my younger daughter, to attend the interview of a local kindergarten.

We arrived slightly early, but the place was already flooded with anxious parents and suspicious-looking kids. Thank goodness, unlike the slightly chaotic arrangement in the previous years (I did bring Euterpe here for the same purpose some time ago. See http://ccszeto.blogspot.hk/2008/12/interview.html), we were allowed to go into the playground and line up. A few minutes later, we were led to a small classroom for the interview.

Contrary to the previous arrangement, it was a group interview. There were 8 kids sitting in a row and facing the teacher - a blondie. Behind the kids were their parents (some 12 or 14 of us). The content of the interview was very expected: The kids were asked to raise their hands when their names were called. Then they sang a song together, followed by listening to a story, and so forth and so forth. During that 15 minutes, the teacher just focused on delivering this sample kindergarten lesson.

Two other women stood at the back of the room; they observed the kids' performance and gave the score.

I suspect we may use the same system to conduct bedside tutorial - maybe the final examination as well.

Intrinsic

If you think Lĭ Guăng was a victim of wrong timing, hold on. Don't feel sorry for him that quickly.

The reason is simple: A single mishap may be the result of bad luck, but, a series of unfortunate events usually implies an underlying intrinsic problem.

And, if you look at the life and time of Lĭ Guăng at bit more carefully, he might have a fair return of his own capability: He did participated in a number of battles, but in none did he make any decisive victory. His soldiers loved him because he did not pay much attention to rules and regulations. His archery skill was superb, but he was more an icon of personal heroism and not a good leader.

PS. For those interested in history study or medical research, the story of Lĭ Guăng, as outlined in The Records of the Grand Historian (史記) by Sima Qian (司馬遷), is a perfect reminder for us to be careful of possible conflict of interest and be critical about what we read, even if the document is written by a highly respected person and published in a famous journal. Sima Qian certainly gave in his masterpiece a distinctly biased account on the life and time of the flying general.

李廣

After the lunch with my friends, I actually kept thinking of Li Guăng (李廣) - the "flying general" (飛將軍) of the Han dynasty.

I read the story of Li Guăng when I was a primary school student.

In spite of his excellent archery skill and was highly praised by contemporary people, the military career of Li Guăng could hardly be called successful. When he first joined the army (probably at the age of 18 or 20), the Han Empire was under the reign of Liu Heng (劉恆), who once commented that if Li Guăng had been born in the time of Emperor Gaozu (漢高祖), he would have become a grand duke without any difficulty.

But no. It was not a good time because Emperor Wen (漢文帝) preferred to have peace with the Huns (匈奴), and, as a young and energetic general, Li Guăng had no way to win his honor.

The irony is, many years later, when Liu Che (劉徹) became the emperor and decided to put up campaigns against the Huns, he considered Li Guăng too old to play any important role in the battles. (Li was around 60 by that time.) After all, Emperor Wu (漢武帝) had Wei Qing (衛青) and Huo Qubing (霍去病) - excellent generals at the prime time of their career.

Li Guăng committed suicide, at the age of around 65, after leading his army astray in a battle - he was a subordinate of Wei Qing at that time.

Integrity

The very word that our city recently argues about is integrity (誠信).

On the face of it, the idea is simple: A leaders should not tell lie.

You may ask: How about economy of truth (as suggested by Humphrey Appleby), or simply being evasive? In fact, integrity is much more than not telling lies. As Stephen Carter (who wrote the book Integrity) pointed out, integrity requires three steps: discerning what is right and what is wrong; acting on what you have discerned, even at personal cost; and saying openly that you are acting on your understanding of right from wrong. In short, integrity is distinct from honesty.

And, what is the antonym of integrity?

Here is what you find in Wikipedia: Hypocrisy: A state of promoting or administering virtues ... or ... principles ... that one does not actually have. 

In Chinese, we call that 偽君子.

Hero

(A story I heard recently from my friend.)

Dear Sir,

Re: Case feedback

I have got a case feedback from our sergeant and police officer on duty last Wednesday.

Mr. X attended our police station that day after being robbed and shot. While he was waiting for our police officer to obtain his testimony and consider if he needed any medical treatment, a man disguised as a gigantic spider from your department picked him up among other people waiting.  Without acknowledging any police officer, Mr. X jumped the queue – the robber was soon arrested by this Spider-Man, and Mr. X was sent to the hospital for urgent surgery. Our colleagues would like to ask for further clarification: 

• Can an ordinary citizen tackle crime and help sick people without (our) authorization?
• Does the Spider-Man have any privilege of helping people in the police station?
• Was Spider-Man helping his own friend?
• Can criminals be arrested without being endorsed by our police officer? Does it violate the purpose of having police in this city?

The work flow in the police station nowadays is already very busy and congested. Police officers are continuously taking orders from sergeants and inspectors. If any person tries to arrest more criminals, it will create more chaos and endanger all the others waiting in the police station. And, our officers are responsible for all those patients registered under the police station.

Our staff also suggested that if Spider-Man have extra time to help people in the police station, he is encouraged to join us as part-time staff and be my junior, in order to relieve our manpower deficit.

XXX

Associate Director

Police Department of New York City

Murderer

Lunch with AL, JW and VM.

I did not meet AL for some time since she left the university, and it is gratifying to see her pursuing another career path.

AL and I are both fans of detective fictions, and many of the novels that I read in the recent years were borrowed from her. In the middle of the lunch, she asked, “Szeto, you read Dochira Kaga Kanojo Koroshita (誰殺了她) of Higashino Keigo (東野圭吾), didn’t you?”

“Yes…?”

“Then, who killed her?” She went on. (For those who have not read this novel, it is an open-end detective fiction. In other words, although the author does have an objective answer in his mind, readers have to judge themselves who the murderer is. See http://ccszeto.blogspot.hk/2012/10/entertainment.html)

“No idea. I suppose I thought of it for 2 minutes and gave up.” I smiled, “You know, I am very  acceptant to unresolved mysteries in life…”

My friend was certainly not very happy with my answer.

Age

Shortly after my discussion with L, the result of the Discretionary Places Admission to Primary One (小一自行分派學位) for Euterpe was announced. In the next morning, Vivian took an urgent two-hour leave and rushed to the responsible school in order to get the registration documents.

That evening, when we were at the dining table, I asked if everything was in order.

“Em… yes, except the taxi driver was a bit annoying,” my wife said.

“Well…?” My eyebrow rose.

“You know, I took a taxi to the school, but the taxi driver did not know the way and asked me back.” She explained, “I told him I was not sure, because I’d not been there for 30 years…”

“Yes…?” I knew my wife had not hit the punch line.

“The taxi-driver said that he was surprised because I did not appear to be 50 years of age!”

Of course not; my wife is actually far from 40 – although far is a subjective opinion.

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

I suddenly remember my friend TW had an almost identical experience in the clinic:

Patient (about to leave after the consultation finished): Doctor, you look really young. Are you 50 already?

TW (trying to squeeze up some smile, as she was not yet 40): Hahaha…

What my friend actually wanted to say was: Don’t go away yet; I need to amend your prescription – how do you want to be poisoned?

Mediocre

I remained silent for a moment because I felt slightly uneasy with my friend’s conclusion.

“You may be right, my friend.” I hesitated a bit, “But the context is slightly different between helping borderline students and cultivating brilliant ones.”

“Yes…?” My friend looked puzzled.

“We try to help borderline students as undergraduates, and our aim is to make sure they achieve a certain minimal standard when they come out and practice – although, yes, I agree, the most reliable way of ensuring the standard of our graduate is to eliminate everyone who does not perform well.” I explained, “But top students are a different lot. More often than not we can only identify them after they graduated – sometimes a few years later. Medical school is not in the position to cultivate them. Moreover, if we try to identify these high flyers at a very early stage, it is likely we put our money on the wrong ones and inadvertently jeopardize the growth and development of true future leaders.”

“Alas, you may be right,” L nodded, “At the end of the day, we have to agree with Immanuel Kant. Genius doesn’t need education, and idiots could not be educated; a teacher should therefore put most of their effort on mediocre students!”

Good

(My conversation with L continued.)

“What do you mean?” I was slightly alarmed.

“I mean the brilliant students,” L remained serious, “My friend, let’s face it: In spite of the effort that we put up for the borderline students, all we achieve is having a handful of extra graduates each year – as compare to doing nothing but terminate their study and kick them out of the medical school. From a societal point of view, we may have saved a small sum of taxpayers’ money, but we run the risk of allowing inappropriate persons practice medicine!”

“Em… you may have a point, but we should not discriminate borderline students.” I tried to speak for the other side.

“Alas, I suppose you know perfectly well your argument doesn’t hold water,” he chuckled, “For obvious reasons a medical school should provide an equal opportunity to each and every student – bright ones as well as others who are slightly dense. But what we are now doing is providing extra opportunities to the bottom layer. In other words, we are discriminating against the crème de la crème – maybe our students as well. And, I remind you, it is this small group of top students who are our future. Ten or twenty years later they should be prolific researchers, eminent clinicians, or holding key positions in the administration hierarchy. It is our responsibility to find them out and nurture their strength. After all, this is to the advantage of the medical school!”

I was speechless.

Spectrum

Met my friend L again while I was going home.

"Hello, Szeto. How was the supplementary examination?" He asked.

"Well, it was smooth. We don't expect anything exciting, do we?" I smiled.

"Of course not," my friend appeared slightly more serious, "It is exactly for that reason I find it difficult to understand why we put up so much effort to entertain just a few students."

"Em... I suppose we have to put up extra effort to help students who are not doing very well?" I hesitated for a moment and suggested, "In fact, a responsible medical school should try and identify, as early as possible, students who are going to struggle through the curriculum, and offer assistance as much as possible. Isn't that right?"

To my surprise, L shook his head, "Yes and no. If a medical school is doing so much for bad students, what has it done for those at the other side of the spectrum?"

Pan

It was a quiet Sunday and my maid was on leave. The weather was horrible - cold with some occasional shower. Early in the afternoon, after settling my two princesses to their afternoon nap, I had a rather moment of peacefulness so that I could really do some leisure activity myself.

What I did was trying my new frying pan.

Don't laugh. When Vivian asked me some months ago what birthday present I wished this year, I specifically asked for a frying pan - a flat bottom non-stick one suitable for steak, or similar kinds of thing. Although a traditional round-bottom Chinese wok is good enough for most purposes, I find it a bit trying to keep the heat evenly distributed when the object at hand is turnip cake or omelette.

And I need that layer of Teflon because fish under my hands almost always stick with a Chinese wok.

PS. At the end of the day, I tried a piece of New Zealand sirloin and am happy with the product. Seriously the joy is no different from what I felt after I did my first polymerase chain reaction experiment all by myself.

Level

Shortly after encountering that trivial war between snail horns, I had, for political reasons, the privilege to dine again with a group of senior physicians.

I shall not explain what triggered this gathering. For some unknown reason, I was assigned to sit between an famous respiratory physician and an exceptionally senior neurosurgeon. Since the former one was obviously having some problem with his hearing aids, I spent my whole evening chatting with someone specialized in opening up others' brains.

At some point, our discussion came to Professor Y, the host of the evening.

"You know, Y is highly praised by the medical students," my new acquaintance said. For obvious reasons he was referring to the students over the other side of the harbour.

"Yes...?"

"Yes, because he always appears very kind and smile to the students," he continued.

"Em... I think Y has... er... his own character...?" Knowing Y's real personality well, I tried to put forward my opinion with some ambivalent wordings.

"Alas, I know what you mean," the neurosurgeon said, "But, as a rule, Y does not shout to medical students - he just teases on the ones whom he doesn't like. Since Y has a slightly convoluted mind, most of the students do not know they were being laughed at - they just think that the senior professor of nephrology is making some harmless jokes!"

Implications

You may ask: What does this little story between a snail and its parasite tell us?

Well, there are several folds of implications:

1. When you are having a war with another person for a trivial matter, it is likely both sides are infected by some malicious parasites.
2. While having the war (and as a result of being infected), you become blind and will be unaware of more sinister dangers around.
3. The very fact that you could be infected and are involved in a war means that you are part of a mollusk.
4. The whole process of parasitic propagation is a flesh-and-blood demonstration of Saṃsāra (輪迴) of Buddhism (or, to be exact, Upanishads of Hinduism).

As to the last point, there is an important difference between reincarnation and Saṃsāra. The former means the persistence of life or soul, while, in the case of the latter, it is the causes and effects of doings and wrongdoings being persistent in the realm.

We call that Karma (業).

Biology

For those who are not familiar with the story of a conflict between the two horns of a snail, you may like to refer to Zhuangzi (莊子) [則陽篇].

Yes, the idea of this little story is simple. Nonetheless, the war that Zhuangzi observed might have been a genuine biological phenomenon.

It goes like this: Leucochloridium is a group of flatworm parasite (i.e. platyhelminthes) that uses various worm-eating birds as the permanent host. The remarkable bit of its life cycle is, however, most of its species use snails as the intermediate host. When a suitable snail is infected, the parasite would grow and move to the tentacles (to we layman, the “horn”; to biologists, those are actually eyes of the mollusk). 

Depending on the actual species of the Leucochloridium, sometimes only one, but usually both of the tentacles are infected. Once the two light-sensing organs are filled with parasites, it shows off funny angry-looking colors – just like they are in war with each other. More importantly, the snail becomes blind and loses its natural tendency of avoiding light; it moves to the top of a branch, and is easily spotted by birds around.

Yes, you guess that much. To those flying creatures, the colorful light-sensing organ on the snail is no different from a worm. The infected tentacles are quickly nipped away by hungry beaks, and, hurray, the life cycle of Leucochloridium completes.

Trivial

Although I had some remarkable encounters with candidates during the licensing examination, the most remarkable story for me throughout the event was a conversation between our nursing officer and the computer staff of our admission office.

The story went like this: We recruit real patients to take part in our examination, and we always ask them to arrive at the ward by 7 AM. For medical legal reasons, these patients need to be registered as day cases under the hospital. However, for confidential considerations, the procedure of admission could only be done in the afternoon – after all candidates of the day reported to us, and we could keep an eye on them and make sure they have no chance of going through the patient list on the computer.

And there comes the dilemma: What time should the patients be recorded as being admitted? Is it 7 AM, or in the afternoon? This time, the spicy discussion came up because all parties agreed to use 7 AM in the past, but the admission office decided to use the afternoon one – when the admission procedure was actually done. (I must say I could understand the frustration of our nursing officer – the time 7 AM was originally recommended by the admission office.)

Trivial point, isn’t it?

I just think of a poem that my friend WB showed me some years ago:

蝸牛角上爭何事，石火光中寄此身。

隨富隨貧且隨喜，不開口笑是痴人。

Standard

Shortly after I survived that evening with a series of unfortunate events, we held the licensing examination in our hospital.

(For visitors outside Hong Kong, the examination is for overseas medical graduates who want to practice in our city.)

I shall not elaborate too much on what happened. To examiners, the event is, as a rule, an eye-opening experience of seeing so-called medical graduates with an exceptionally variable standard. Of course there is, at least partly, some selection bias. Since candidates need to take all clinical subjects at the same time, a doctor who, after graduated from medical school, has a few years of experience in, for example, pediatrics would not do very well in surgery.

Nonetheless, some candidates are really exceptional by any standard. Two years ago, I met a flamboyant man who could not recognize a tendon hammer. This time, I had another cheerful lady who refused to listen to the chest of her patient – because she thought that part of examination was not necessary.

I am surprised I could resist the temptation to ask why she brought along with her a stethoscope.

Memory

My fortunate evening did not end with my glasses repaired. After dinner, while winding up the clockwork of my pocket watch - the souvenir of my wedding - I slipped it on to the floor and its cover glass came off. It took me another 20 minutes to put it back.

And, an hour later, I began to have tummy cramp - followed by bouts of diarrhea.

*****************
No, my point is not to tell you how unfortunate I was that evening, or its astrological implication (if there's any).

The real issue is, that night, before I went to bed, when I wrote my diary, I could only recollect what happened throughout the day and had completely forgotten my unfortunate evening. A few days later, when I came to think of it, I was amazed with how our mind filters out unpleasant information.

A good memory is a bad (or, at least, a selective) memory.

Repair

(Cont'd)

It took me half an hour to struggle and search for my reserve glasses before I decided to put up my jacket and seek for help from the optic shop. Seriously, without that tiny gadget on my nose, everything became blurry and fuzzy, and I was slightly uneasy to do anything.

And, then, my sense came back. Why! My reserve glasses were, of course, still in my suitecase after I was back from San Diego! I quickly fetched for them - thank goodness they were there safe and intact. I put them on, and set off with more confidence.

It actually took no more than half an hour to have the problem fixed. The optician was friendly and immensely efficient. I went home and felt like a cancer patient being discharge from hospital after the tumor was resected.

PS. Vivian is actually a shareholder of this very optic shop - and I would have to declare a conflict of interest and not disclose its name.

Glasses

It was a most remarkable day for me in the past five years - to say the least, from an astrological point of view.

The story went like this: For a few weeks, I was feeling my pair of glasses was a bit shaky. It was a new pair that I bought just a few weeks ago, but, since last week I began to notice it lost its grip of my ears and tended to slide down of my nose.

I decided to fix it myself. That evening, after I was off work, I fetched a set of miniature screwdrivers (orderly kept by my mother) dislodged  and tried to screw the loosen bit tight.

But, it turned out that I screwed it up - one of the handles fell apart.

I tried to put back the part - of course it was of no avail. My myopia was rather severe, and, together with some astigmatism and presbyopia, it was almost impossible to see clearly that tiny screw hole on the disentangled handle.

"Got to get my reserve pair of glasses." I said to myself.

But, my goodness, the reserve glasses was not in my drawer (where I used to keep it), and nowhere could it be found.

(To be continued.)

Irrelevant

On the first glance, it sounds simple enough to understand why having irrelevant or incomplete basic information would lead to slow and biased decision.

But, things are never that easy in real life: How could you know your information is irrelevant or incomplete? Or, in the jargon of Bernard Woolley, how do you know something you do not know that you do not know?

And the opposite is equally true: How could you know you know absolutely nothing that could guide you a better decision? (This phenomenon should be familiar to many medical students. To many apparently difficult question by the professor, the answer could often be deduced from the principles of basic physiology or pathology that one learnt casually in the pre-clinical years.)

The real difficulty is, therefore, in my opinion, not that we have irrelevant or incomplete information, but that we have too much information - and we do not know which is relevant and which is not.

Or, let me modify the famous sayings of Charles Burwell a bit:

Half of you knowledge would lead you to a wrong decision... unfortunately, you don't know which half.

Plan

One central idea of John Lanchester is this: Over the past 30 years, there was an increasing trend of financial people to use complicated mathematical models and reduce the risk of approving a loan – basically by shifting the risk to other people, who are generally not aware of the risk.

But, the catch is, these geniuses in number were probably wrong from the very beginning, and their calculation was based on wrong assumptions. In short, the risk is not a happening of which the probability is five (or fifty) standard deviations above the average, but is the sudden change in the universe so that the distribution probability curve becomes no longer Gaussian.

It sounds familiar, eh?  My friend VW recently described how MBA holders and lay people build towers of nuts and marshmallows (see http://vwswong.blogspot.hk/2012/11/marshmallow-challenge.html).

And the idea is simple. If you have some relevant background knowledge, it is very well to formulate a plan for a project. If you have no such knowledge, it is fine to go ahead and adjust your plan along the way. The worst situation is, however, to plan ahead with irrelevant information – it generates bias, defers decisions, and easily leads to disasters.

Market

There is one additional idea in John Lanchester’s book that catches my attention:

Democracy and free market are two different concepts but frequently put forward as bundle selling. From what we see in the past three or four years, one may have to consider a society with democracy but not an entirely free market.

How about vice versa – free market without democracy, as proposed by some strong nation?

By the way, as suggested (and quite a water-tight proof in my opinion) by FA Hayek in The Road to Serfdom, planned economy would always lead to dictatorship. There is also good evidence (partly provided again by Hayek) that a tyrannical political system is incompatible with a truly free market.

What we don’t know is whether a free market would always lead to democracy, or, turning the coin around, a democratic system would always result in a free market.

Or, I should say, which side kicks off first.

Whoops

My recent leisure reading is Whoops! Why Everyone Owes Everyone and No One Can Pay (大債時代) by John Lanchester.

I must say I was not particularly impressed by the title when I first saw this paperback in a local bookstore last year. I bought it by an accident – I was trying to use up the cash dollar of my credit card, and this book did appear in a handy corner.

In physician’s jargon,  this book is about the pathogenesis and pathophysiology of the financial tsunami: from the development of Credit Default Swap, the application of the Gaussian copula function for risk estimation, the rise of subprime mortgage, to the intrinsic defect of credit rating.

I may not agree with everything the author says about the problem of a free market, but I must take my hat off and salute his clear and meticulous way of explaining the financial system in layman’s language.

Ten

On a recent occasion, we were asked to do some planning for our unit ten years later. Of course I have some experience on games of this type. (See ccszeto.blogspot.hk/2012/09/proposal.html)

But, seriously, who could predict what is going to happen ten years later?

On the other hand, it is really eye-opening to go through my own diary entries 10 and 20 years ago.

Here you go: 

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

Lunch with HF and D. Long time no see. Is D coming back to PWH for training? How is her mother? It was last new year eve when she came to the pediatric ward and we had to say goodbye. Too bad.

Dine with SL. We talked about KWH. RK failed FRCS again. I really couldn’t understand.

[18 Nov 1992]

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

It is surprisingly calm after the complaint letter. Would it be a sign of an approaching hurricane?

Watch I Not Stupid (小孩不笨). It’s damn good.

[18 Nov 2002]

Speech

(Excerpt of the Queen’s speech to the Royal Army.)

Friends, Romans, countrymen, lend me your ears.

Our country is in great difficulty. Our purse is tight, but we need to keep the expense for many important projects – the construction of Versailles, the Diamond Necklace project, and, em… my dresses. For these reasons, we have to cut down the budget allocated to the defence of our country – that is, to you all. From now on, it will be more difficult for you to get promoted, and your salary is going to be the only thing unchanged from now to 2046.

Don’t yell. I know your problem. Our country is going to have more battles than ever. But, that’s not a reason to increase your resource – no matter money or manpower. Some years ago, when we had a period of peace and no battle, we did not cut down the number of your men, and your salary was only slightly trimmed down, right? Now, it is time for you to pay back.

If you think we are too harsh to you, you are very welcome to leave the army and find another job. We will only keep people who like to stay in a tough time.

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

“Does his Highness wish to keep the Army at all?” I asked my friend Warren after listening to all these, “If he doesn’t, it is entirely fine to close down the military school and dismiss everyone. I’m sure all soldiers could earn their own living one way or another. But, if he still wants to have an army for the country, please ask him to shut up.  All he is doing now is grinding down the morale of all soldiers – the most malicious way of destroying an army in my opinion!”

Talk

After back from San Diego, I was more than ever convinced of the parallel universes theory.

I mean, while a gang of extraterrestrials were holding a meeting on some supposedly important matter, at the other side of the cosmo, the male version of Queen Marie Antoinette came to give a talk to the Royal Army of the House of Bourbon.

(For the previous remarkable sayings and doings of his Highness, please refer to http://ccszeto.blogspot.hk/2010/04/queen.html)

I shall not elaborate what his Highness talked about - I was not there. A few of my friends (notably Warren) joined that evening and they all felt exceedingly warm after the Queen's speech - so much so I could see their faces remained red and steam was coming out from their heads the next morning.

"What did his Highness say?" I asked them.

"Alas, the Queen said that there is no prospect to stay in the army..."

(To be continued.)

Autobot

(The meeting continued.)

After a moment of silence, over the other side of the table, the representative from Cybertron raised his hand and said, “Can we help? We may not be able to do all the work, but, for some of it, we can certainly make an effort and contribute.”

“That sounds great!” King Nikochan cheered.

“But, just one thing,” the Autobot went on, “We need back up by creatures with flesh-and-blood. On rare occasions, when we encounter difficult in the work, we need someone to fall back upon.”

“I would be happy to back you up,” the Alien said, “But my planet is too far away from yours.”

“You don't even have enough alien to stay on your own planet...” the Predator murmured.

“Em… although my place is close to Cybertron,” Godzilla looked annoyed, “I don't think any of my monstrous dinosaur could spare their time.”

“How often do you need some urgent help?” King Nikochan asked the Autobot.

“Alas, once a year... maybe even less,” the latter replied.

“Your majesty, if you insist we should offer some help, we could,” Godzilla turned to the King, “But my men would not be happy...”

*************************
“Ah...!” I woke up from my nightmare - finding myself sitting amongst a selected collection of lovely creatures.

I hurried to find a mirror to check my face.

Help

(In a meeting amongst extraterrestrials.)

"Your work is no good. The complication rate is very high." King Nikochan began.

"I object to this unfair accusation, and my performance should be carefully and extensively adjusted for by the numerous confounding and complicating factors," Godzilla roared.

“OK, OK,” King Nokochan – the leader of all extraterrestrials – was tired of statistical means for the cover up of incompetence, “But we’ve got to get the work done – and done properly!”

“Can I help?” the Alien murmured, “I am happy to take up part of the job…”

“No, don’t offer your help so lightly,” the Predator interrupted, “As the representative of carnivorous extraterrestrials, I would have to remind you that there are only a few genuine and mature Aliens, and they won’t be able to take over all the work from the monstrous dinosaurs.”

“Oh, of course you can do the work for us – as much as you like,” Godzilla turned to the Alien and grinned, “But you must do it on your own planet, and leave our paradise of dinosaur undisturbed. And, one more thing: You have to bear all the expense.”

“Alas, that’s a convoluted way to say No…” King Nikochan said to himself.

Michelin

Shortly after the gap analysis visit to my unit was over, I met several of my nurses in the ward.

“So, how’s everything getting on?” I asked.

“Fine. Of course we were very excited and anxious to begin with. But, as it turns out, we have very little to play in this drama,” one of them said.

“Is it the case?” I was surprised, “I think the accreditation group is supposed to come around and ask everyone of us all sorts of questions.”

“No, nothing like this – at least not this time. They only talked to senior people and administrative staff. You know, the most junior person whom they asked some question was JF.” (JF is the newly promoted nursing specialist of my unit.)

“Alas, in that case how could those extraterrestrials know what’s going on here and determine whether the hospital could be accreditated?” I pursed my lips, “The more meaningful way to assess the quality is, I suppose, to follow the method of the Michelin guide and send anonymous inspectors to try the service themselves!"

Visit

Shortly after I came back from San Diego, my unit was visited by the accreditation group sent by the Hospital Authority.

Our friends outside the solar system call it gap analysis – a visit that aims to identify areas of deficiency so that we could improve before the real accreditation visit takes place. In layman’s language, we call it rehearsal or mock examination. (Yes, I am more than ever amazed with the capability of extra-terrestrials. By giving a new and fancy name to an old concept, there really seems something fresh and different. What’s in a name?)

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

Of course, as you would expect, the best way that I could contribute to this gap analysis is not to appear at all. I was more than happy to this suggestion. Seriously I have an eternal difficulty to make the head or tail of the entire business. For example, why should medical wards put up the number of appreciation and complaint as the key performance index? As a practising physician, I believe – for example – the number of unwitnessed cardiac arrest being far more important.

PS. By coincidence I watched the movie Prometheus on my flight back Hong Kong, and am having acute-on-chronic panic attack to aliens recently.

Character

Talking about Brussels sprout and vegetables with a character, a few other edible plants come through my mind.

What I mean is, on one hand we have ipomoea (蕹菜) and Don lettuce (唐萵). Their flavor is unique, and you either like it or not. Nonetheless, their application in cookery is limited: to most of us, ipomoea is only for stir frying with fermented bean curd (腐乳), and Don lettuce only appears in hot pot dinner.

But, on the other, there are Chinese cabbage (大白菜) and bok choi (小白菜). They have their own sweetness and taste good. Most people like them, but they lack the zest to make them stand out from a crowd. But, probably also for that reason, they get along well with many other ingredients – pork, brisket, ducks, fish, and almost everything that can appear on your dinner dish.

Well, we see the same two groups of people around.

Sprout

While in the States, I was fortunate enough to find myself dinning alone in a local restaurant one evening.

And I was happily surprised to find stir-fried Brussels sprout in the menu.

For those who have not tried this green marble that looks like miniature cabbage, it is difficult to explain what makes it so different from all other vegetables. For me, I first found it in the hospital canteen when I was having training in Bristol. As you expect, all British cook could do with it was boiling and then serve with a pinch of salt – a method that reliably rots its colour and exaggerates its bitterness.

But I soon found the raw and fresh version of it in local British supermarkets, and was selling in an amazingly cheap price. I tried the traditional Chinese way of handling vegetable – stir-frying it with some soy sauce.

And, of course, the rotted grey was actually glittering green, and the bitterness became seductive.

Too bad we can hardly find a vegetable with such a distinct character in our city.

PS. For those who love healthy food and try to lose weight, Brussels sprout makes a perfect dish for dinner. It is rich in vitamins and dietary fiber, and has very low calorie. Moreover, it fills up the stomach and gives you a sense of fullness for many hours.

Laughter

Another meeting that I attended was the editorial board meeting of a journal.

Contrary to my expectation, this small lunch-time gathering was quite fun. Towards the end of the presentation, the Editor-in-Chief showed us a list of funny paragraphs he encountered in the past one year.

Here are some:

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

(A case report submitted): The patient bought the glue from a local grocery. Following the advise of the shop-owner, he sniffed the usual amount and felt dizzy…

(In the Methods section of a manuscript): After immersed in 3% sodium nitrite solution and then dried for 30 minutes, we find that this substance…

(Author survey of the publisher): Why do you submit to this journal?

Reply: We know that the readership of this journal is alarming.

(Comment from a reviewer): Please define “total death”.

(On-line submission system): Please explain why Dr. A is suggested as the reviewer.

Author: According the your journal web site, Dr. A is the Editor-in-Chief.

(Reply from an invited reviewer): Please accept my apology for not being able to review. I have conflicts with the authors as well as the journal.

Search

One of the meetings that I attended was a work-group on some education programs.

The nature of the group and what we are doing are quite immaterial. To cut a long story short, we are gradually developing a website for people working in our field to seek professional information on clinical practice – treatment guidelines, practice protocols, performance index for auditing, and even asking the expert for specific advice.

A key item on our agenda this time was, therefore, to discuss various issues about the site.

We ended up spending quite some time to check the site and test the hyperlinks, with an aim to make sure the site is user friendly and useful information could be found when an outsider come to the site and surf.

But, when we were half-finished, one of us suddenly stood up and said, “Hold on, men. Let’s step back and think. People do not come to our site and search what they need.”

“Eh…?” We were surprised. Our subconscious mind realized the truth in his comment, but were not quite certain what our friend was getting at.

“Imagine: What would people do when they have a problem to search on the Internet?” He explained, “They will search in Google! It is quite meaningless for us to polish our site and check all hyperlinks so that visitors could surf smoothly on our site. All we have to do it to see how to make our materials easily searched by Google – and standing out on the top of the search list.

We all nodded – the implication of that remark is profound.

Language

Being my second language, I had difficulty to discern the difference between conference and meeting, and, in the past, used to call a three-day program of lectures and symposia the latter. As I grow older, I could now tell the difference very well – largely to the credit of the US Immigration staff.

(Alas, that’s another story.)

The irony is, I am more and more likely to attend activity of this kind for meetings – seeing people face to face for discussion rather than attending lectures.

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

I actually came to think of all these differences in language during one of the meetings, when a highly respected senior American nephrologist across the other side of the table kept saying, “This idea is fabulous…”

Oh, don’t get me wrong. He was entirely sincere. But that’s just the point: It is common for our friends from America to make comments like fabulous, gorgeous, fantastic, brilliant, and so forth. Around the other corner of the earth, we have the same words – but we only use it for irony.

Lag

Shortly after I adjusted my daily schedule, I set off to San Diego for a conference.

I must say as an academic staff, I do not travel that often. Nonetheless I always consider myself very suitable for international conference biologically – because I do not have much jet lag.

My trick is simple. As a caffeine addict, I would deliberately omit my coffee on the day I start my journey, resume it in the morning the day after I arrive, and, bingo, my diurnal rhythm is re-set.

You may ask, “Hey, I know you still sleep through the afternoon symposium!”

Very true. But, falling asleep in lecture is my norm – even in Hong Kong!

PS. Some of my friends may know I deliberately changed my biological clock during my final year of medical school study: I slept after dinner from 7 pm and got up at 1 pm, had a bit of night food, and then began my study till dawn. Although anti-social, that strategy turned out to be very successful.

Schedule

Discerning visitors would notice I did not say bedtime reading yesterday for the Pearly Gate book.

That’s because I did not read most of it before sleep.

The change is more profound than you would imagine. For over ten years, I take a taxi home when I’m off work. Late in the evening, when my daughters go to bed, I write my blog and do some bedtime reading before retiring to bed myself. This schedule works well, except I frequently doze off in the middle of a paragraph.

So, I decide to change. Now I leave my office half an hour earlier, take the train home, and read my (previously bedtime) book on my way. Later, after I read the bedtime favorite to my elder princess, I work for another while before bed.

Reason? Gosh, it is more difficult to fall asleep while playing with the computer!

Immortal

The book I recently read is Heidegger and a Hippo Walk Through Those Pearly Gates by Thomas Cathcart and Daniel Klein.

This tiny paperback is the follow-on of Plato and a Platypus Walk Into a Bar that I read last year. (See http://ccszeto.blogspot.hk/2011/04/platypus.html) Similar to many famous movies, sequel does not do as well. Although the theories of eternal life and heaven are described with crystal clarify in this book, it lacks the zest - or the sense of humor that makes the Platypus a bestseller.

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

To me, the most impressive story about heaven and eternal life is Galaxy Express 999 (銀河鐵路999) by Leiji Matsumoto (松本零士):

Tetsuro Hoshino (星野鐵郎) is a boy who seeks a robotic body. He meets the representative from a planet far away, and boards the train to get an immortal life free. When Tetsuro reaches the destiny, however, he realizes that in exchange for an eternal life, he has to use all his time to fight for the owner of that planet.

Vatican should treat Matsumoto as Copernicus.

Sunset

You may be asked: What could be worse than giving you money?

Well, without extra manpower and beds to treat more patients, one may waste the resource and give expensive but unnecessary treatment. That's not too bad.

But, if the extra funding is only given for one year (for example, as I learnt from this gangsters' meeting, the money from our famous Resource Allocation Exercise), how are you going to continue with the expensive treatment with the regular budget?

Maybe we should add a sunset clause to the consent form and sign it with the patient before starting any new treatment.

PS. Another inexplicable happening of our lovely solar system is how a new hospital block (and more spacious than the old one) could be constructed without adding more hospital beds. Besides the feasibility of putting up camp beds, what else could it be?

Triple

Shortly after dinning with the man who used to have a moustache, I attended another gangsters' meeting.

As always, the topic we discussed was triple insufficiency - the classical triad of Hospital Authority Syndrome:

1. not enough money
2. not enough manpower
3. not enough hospital bed

The delicacy of this very syndrome is solving one problem but leaving the others untouched would not help the situation - it actually makes things worse.

For example, giving a department more hospital beds only could only mean disaster if the manpower stays the same. To go one step further, if a department has more beds and staff but the budget does not increase correspondingly, how on earth do you think the extra patients could be treated?

Well, the situation is equally interesting if you give a department more money but no increase in manpower and hospital bed.

But this is not the worst - there is always something even worse.

Let me tell you tomorrow.

Assessment

After a brief moment of silence, another one around the table remarked, “In addition to the grant, clinical professors have very good reasons to hire scientists to do research for them. You know, the substantiation and promotion of a clinical academic staff depend almost entirely on their research output. Service and teaching are practically not considered, and, since basic science journals generally have a higher impact factor than clinical ones, it makes sense for clinical academics to focus on making money and find suitable experts to do the research work.”

“Very true,” my mentor nodded, “That brings us back to the eternal question: How to assess the performance of a clinical academic staff – especially in the situation when we have to compare a clinical professor to a basic scientist?”

My eyebrow rose. The question was certainly not a déjà vu feeling of what I was asked by TL a few days ago.

“My own suggestion is simple,” he explained, “It should be a two-stage process. When a clinical academic staff is applying for substantiation or promotion, the first thing that they have to prove is the amount – and preferably the quality – of the service and student teaching that they provided. If, and only if, this step is passed, they would be further assessed on their research output. If they have sufficient research output – by themselves or by whoever they hire, it doesn’t matter – but do not contribute to service and teaching adequately, they could still be substantiated or promoted, but they should receive the salary of a non-clinical academic staff.”

It sounds a terrific (or horrible?) idea to me.

Behalf

“You see? Many clinical professors do very little clinical service nowadays – and they hardly ever teach either,” the man who used to have a moustache went on, “They put most of their time and effort on private patients, for which they pocket a good sum of money, and a portion of it is used to pay for the salary of one or more scientists to do the research on the professor’s behalf.”

“Oh…!” Some of us gasped. Well, to be honest, we know that much already, but it remains disturbing to have a senior member of the academic hierarchy saying all these openly.

“I must say the government policy is to some extend encouraging all these,” my mentor continued, “You know, competitive grants are more likely to be given to laboratory research – because the assessment panel is dominated by basic scientists. As a clinician, what is the easiest way to prepare a grant proposal – and, logically, to follow on – a research paper on basic science? The obvious answer is to find someone to write it for you. After all, unlike clinical professors, true basic scientists are not expensive to hire.”

We all nodded eagerly.

“The real problem is, since the papers are prepared by someone else, the clinical professor may know very little about what’s going on – actually they may not even understand what’s being written – even though their name is put down as the first or last author!”

I cannot agree more.

PS. I sudden realize for clinical academic staff who avoid service and teaching but focus on research may not be that bad – at least they know what their own research is all about.

Never

For some political reasons, I was summoned to a dinner gathering by the godfather of medicine.

The man who used to have a moustache was also invited but he came late. As usual, he led the conversation around the table as soon as he made the appearance.

“You know, I am busy with some internal audit,” he said.

“And what do you find?” We all asked.

“Alas, I wouldn’t quote specific incidents,” he smiled, “Nonetheless, I see very well that many medical schools are not healthy nowadays.”

We made an inviting grunt – I’m sure he was not pinpointing at the one north to the Lion Rock Tunnel.

“Let me tell you an incident I overheard,” he went on with the following story:

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

Shortly before the final MB examination, a final year student told his classmate, “You know what? I met the external examiner in the loo.”

His classmate was surprised, “How do you know that’s the external examiner? How does he look like?”

The student described a formally dressed, serious-looking old man, and added, “After all, I could not recognize who he is.”

“Why!” His classmate yelled, “He is our professor of surgery! We have not seen him because he never teaches any student!”

How

Shortly after the talk on orphan diseases, we held the membership examination in my hospital.

My friend TL was responsible for the organization and everything was absolutely smooth. While we had a brief moment of casual chat during the break, however, the star neurologist caught my arm and asked, “Szeto, there’s something I wish to ask for your opinion – I know you are never short of opinion.”

“What’s that?” I asked; my mind was pondering about his meaningful remark.

“I read your recent blogs. I just want to ask, in your opinion, how could the faculty determine the performance of a clinical academic staff – especially in the situation when we have to compare a clinical professor to a basic scientist?” he said.

It seems that TL is another friend of mine who finds my fancy story on the big toe specialist disturbing.

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

I shall not tell you my response to TL’s question – or whether I made any meaningful response at all. To my surprise, I heard shortly afterwards a very good answer from my mentor.

I mean the man who used to have a moustache.

Subsides

A commonly used but seldom recognized means of paying for expensive treatments is government subsides on medical research.

The idea is simple: If government contributes to part of the R&D cost of a new medicine, the final price could be reduced. At least in theory, explicit agreement could be signed to limit the final market price of a new product when the research bears fruitful result.

It sounds great, eh?

The problem is, however, a conflict of local versus international interest. As a government, the aim is to help its own citizens. In other words, a new drug whose development is subsidized by, say, the American government would be affordable for patients in the States but remains astronomically expensive for other countries. After all, why should the government contributes even more for the R&D so that the price could be lower for every other people on earth?

It follows that affluent countries with more resources for R&D would enjoy dual benefit. Their people enjoy cheap technology, and their companies earn a gigantic profit from everywhere in the world.

Alas, you see, this phenomenon does not happen only in medicine, but also computer, mobile phone, and almost all fancy gadgets of our life.

Pay

I don’t think I have to discuss the problem of asking patients who could afford an expensive treatment to pay for themselves, but letting the government to pay for those who do not have the money. Interested visitors may like to read http://ccszeto.blogspot.hk/2008/07/thermodynamics.html and related posts.

How about asking the government to pay for everyone, including those who are rich enough?

No, that would mean absolute communism – a road to serfdom.

Why? Because communism discriminates against the rich. Essentially the policy could be written in this way: If the government cannot afford a treatment and pay for the poor, the rich could not have it either.

There is, however, another indirect way of paying. 

I shall elaborate tomorrow.

Philanthropy

Fans of Milton Friedman may ask: What’s wrong with market economy and let only those who could afford the treatment have it?

No, there’s nothing wrong – just that I’m afraid the actual market would become even smaller and there will be very little incentive for drug companies to develop any new treatment for uncommon diseases – because the stake is high but the chance of making a good profit is slim.

(You may ask when I am so keen on supporting research and development. No, not because I am a fan of science, but, rather, for a worldly and pragmatic reason – I shall leave the discussion on this topic of supreme importance later.)

But, let’s go back to the original question: If many patients could not afford the expensive treatment, who should pay for them?

Some would suggest a somewhat philanthropic approach: For those who have the money, please pay for it so that the company could make a profit. For those who are not that well off, the drug company has an obligation to provide the treatment.

Alas, I should not tell you my comment on this suggestion directly, but I would like to remind you it is a naive idea to believe drug companies are owned by tyrants with morbid obesity living in Miami or Zurich – many of the shareholders are humble ordinary citizens, widows, retired persons, or your mandatory provident fund.