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.