班聚

與為家母祝壽同時，筆者的大學同學也正在安排畢業二十五年班聚。出乎意料，各同學為此事竟掀起了一段頗為熱烈的討論。

長話短說，各人爭論的事情可以用一個哲學題目來表達：假設經濟情況許可，我們是否應該多享受一下，抑或繼續克己的生活，而用多餘的錢去盡力幫助貧苦大衆？

**************
首先，要注意這個議題的措詞經常直接影響答案。試想，要是把題目寫成「我們應否過奢侈的生活，抑或繼續克己……」，答案是明顯不過。但如果把它寫成「我們是否應該先改善自己的生活，抑或只維持基本生活所需……」，大家也許便會有不同的意見。

你可能說，「奢侈」和「改善自己的生活」有明顯的分别，但是，用一個現成的例子，一餐每位千多元的晚膳，對一個實習醫生來說是奢侈，但從一個“星球”醫生看來，不過是“改善生活”罷了。

上梁

定係梁上――者候？

Note: Pictures copied from the internet.

策略

關於宣誓事件，泛民的最佳策略是：表面支持梁、游二人再宣誓，以爭取民心和道德高地，實則催化二人不能履新而致重選。經此一役，不少青年新政的支持者會轉投泛民，補選很大機會能重奪二席，增加在議會內的籌碼。

由於上述可能，建制派的最佳策略是表面排斥梁、游，卻令二人最終宣誓成功，以避免泛民籍補選壯大。縱使青政將來在政策上對抗，甚至在議會搞事，二人只是小學雞程度，不難駕御；更重要的是他俩俱是耳後見腮之輩，對泛民非但不會感恩圖報，反而偶爾與之對着幹，大可成為牽制泛民的後欄火種。

Grants

Recently read: Tori O'Neal-McElrath《Winning Grants Step by Step》

I must say I find it difficult to understand there is a fourth edition.

Specialization

I went on with my lecture, "Even for patients within the same department, the current trend is specialization rather than generalization."

"What do you mean?" My wife asked.

"For example, if a woman is under the care of a liver surgeon for gall stone, and, at the same time, she is also noticed to have a breast lump. Would the liver surgeon do the workup or refer her to a breast surgeon? There is nothing fancy about breast ultrasound, X-ray, or biopsy - all general surgeons should be fully capable. However, if there is any problem, his expertise would be challenged, and any pig-headed extraterrestrial would comment that the system never bar him from referring the patient to a breast surgeon."

"The attitude is wrong."

"Is it? I'm not entirely sure. On one hand we think generalization would save the trouble of multiple referral and improve the efficiency of the system. On the other, specialization certainly improves the outcome of many procedures - surgery, endoscopy, and what not. As Adam Smith said: The greatest improvement in the productive power of labour... have been the effects of the division of labour."

Education

"I think the idea of our extraterrestial friends is this: If a problem could be taken care of by a private doctor, why couldn't a junior surgical or medical trainee do the same thing?"

"Because a private doctor gets paid and therefore has the incentive to handle those simple problems. In contrast, a junior trainee in the Hospital Authority has no such incentive - their salary is fixed, they need to shoulder the responsibility, and, if anything happens, they get the blame. As I just said, extraterrestrial creatures are mostly mollusks. Moreover, expectations of the public - fueled by the mass media and, unfortunately, a few aliens in the Council - has also changed over the years. Em... you see, I use the word changed, not elevated."

"So, what is your conclusion - or proposal?"

"My conclusion is: More education is needed - but that's for the extraterrestrials and general public. The idea is simple: Tell them, for example, that a junior surgeon could manage a high finger prick sugar level."

PS. For new visitors who have not heard of the term mollusk, please refer to http://ccszeto.blogspot.hk/2008/07/benefit.html.

Educated

(Our discussion went on.)

"You don't agree, do you?" My wife asked.

"I'm afraid I do not. To begin with, all junior doctors are actually reasonably educated on every aspects of medicine and surgery, just that the current system prevents them from applying their knowledge - or, I dare say, from exercising their common sense."

"Dear, you are too cynical."

 

"Am I? Take your high finger prick glucose as an example. When I was a surgical house officer, I was allowed to take care of all those problems - not because I was a medical gold medalist, but because my consultant had the confidence that house officers had the capability, and he was willing to shoulder all responsibility for the consequence. Nowadays, on one hand the administrators say they encourage applying general medical knowledge. On the other, whenever troubles or complaints arise, all they would say is they have never prohibited frontline doctors from consulting experts of other specialties!"

Generalization

My wife Vivian attended the consultant interview recently. After that unsuccessful attempt, I asked her, "What did they ask?"

"Everything. Nonetheless, I was puzzled by one question."

"What?"

"They asked what do I think of generalization, that is, expanding the general training amongst, for example, basic surgical trainees."

"What do they mean?"

"They mean the plan of enhancing the knowledge and confidence of simple medical and surgical knowledge amongst junior doctors so as to cut down unnecessary consultations. For example, physicians won't consult us for lipoma, and our trainees will not consult them for a finger prick glucose level of 9 as in-patient. Alas, I know nothing about this plan - I only heard of it during the interview!"

"And what did you say?"

"Em... I said it's a good idea. We should pay more effort to educate the juniors."

I laughed and shoke my head.

Reading

Frequent visitors of my blog may be puzzled by my reading record. For example, how could I finish with 《Mindset》 on Thursday and 《後漢書》 on Saturday?

Simple. They were read at different time slots.

In fact I have four regular time slots for reading everyday - around 20 minutes each. I read medical journals (downloaded to my Samsung tablet) on my way to work, followed by reading medical textbooks in my office as the first thing after I had my breakfast. In the evening, I read a non-medical electronic book (via Amazon Kindle or Google Book in my tablet) on my way back home, and another paperback as bedtime reading.

By the way, 20 minutes is close to my concentration span of reading a book now. It used to be well over one hour when I was in medical school, and 30 minutes some 10 years ago. The process of aging is obvious.

後漢

Recently read：《二十五史新編――後漢書》

The attraction is not what it describes, but what it doesn't.

杭州

母壽誕，於灣仔杭州酒家設宴慶生。菜單如下：

前菜：醉乳鴿；醬鴨；炸響鈴；素鵝

湯品：火朣老鴨湯

主菜：富貴雞；清炒蝦仁；三鮮魚丸；黃魚腐皮卷；家常豆腐；上湯豆苗

單尾：杭州炒麵；家常大餅

甜品：高力豆沙

一行十五人，埋單四仟壹有找，價錢合理而質素也非常不俗。

後記：長輩慶生傳統須有麵食作單尾。家母不吃蛋糕，故以家常大餅濫竽充數，順便作為提醒大家唱生日歌的記號，亦一新嘗試也。

Power

Recently read: Moisés Naím《The End of Power》

It is by and large another version of Thomas Friedman's《The World is Flat》.

Information

(The conversation with my wife went on.)

"Since you mention reading a lot without any practical experience, I come to realize medical students are very fortunate nowadays." Vivian said, "In the old days, when we encountered a particular disease or specific drug in the ward and we wanted to look it up, we had to search through several textbooks, and, many a time, we still could not get a satisfactory answer. Now, a student just goes to the Internet and key in anything you need, you can get a very detail answer - in Medscape or Wikipedia or whatever. In short, they have all the information at their fingertips."

"My dear, I'm not sure you could call that fortunate. Maybe I can explain my concern in a philosophical way: You read a lot of martial arts novels (武俠小說), don't you?"

"Yes... so what?"

“咁你有幾何見絕世高手係住喺藏經閣㗎？”

Or, as TS Eliot said:
Where is the wisdom we have lost in knowledge?
Where is the knowledge we have lost in infomation?

Talk

During a casual dinner conversation, I told my wife, "You know, I was late for dinner yesterday."

"Yes. What happened?"

"I was attending a talk that I had to be present for administrative reasons, and the speaker was absolutely remarkable. His lecture was supposed to be 20 minutes, but he prepared over 120 slides, which he took well over 40 minutes to finish."

"I suppose he just tried to be thorough?"

"He probably wanted to tell us all he knew about kidney disease - and I'm afraid even that wouldn't take 20 minutes. It was plain obvious that he has no practical experience in that subject, and he just copy-and-paste everything he could found in textbook and recent review articles to his PowerPoint slides."

By the way, I shouldn't really call that young man speaker - all he did was playing karaoke.

PS. Frequent visitors of this site would know I have a specific phobia to speakers who overrun. To me, wasting other people's time means wasting their life, and therefore a kind of miniature murder.

阿基拉

當然，對大部份我這個年紀的人來說，「akira」只有一個解釋：大友克洋的經典動畫「阿基拉」。

一般的說法是大友克洋非常崇拜黑澤明，所以將故事的中心人物取名「阿基拉」。我對此一傳言頗有保留，為的是用自己偶像多名字，替一個引致東京大爆炸的怪物命名，似乎有違常理。說黑澤明對日本電影有毁滅性的影響，也與事實不符。

用現代的觀點，「阿基拉」和「島鐵雄」幾乎是指現代網絡科技――都是源於年輕人，威力遠大於傳統武器，容易變異而失去控制，兩大巨頭又互相攻伐。「阿基拉」原意是帶來光明，但卻因太過耀眼而令人盲目，確實是現代活生生的諷刺。只是「阿基拉」拍攝於1988年，是作者有大智慧預知未來，抑或另有所指，便不得而知了。

明

和不少對文字演化有研究的朋友一樣，當我看到黑澤明的日文原名，便會有很奇怪的感覺：「明」的日文是 「akira」，語音和平假名的結構和許多常用字大有分別。

事實上，「akira」是典型印度語或梵語類的發音。現代梵語的 akira 也是解作「光芒」。同一個字西傳歐洲，和大部份的梵文一樣，第一個 「a」省略了，變成了女性名字「Kira」，就是「光明開朗的人」。

奇怪的是，梵文詞彙影響中、日語文，是魏晋後和佛教一同而來。在此之前，一則路途阻隔，兼且別無他用，借用梵文詞語是絕無僅有。然而「akira」日語是「光」，則於唐初已然確立。究竟是梵語對東亞語文影響遠大於傳統說法，抑或兩字只屬浪漫的巧合，使只有留待將來研究。

黑澤

偶然看到電影《七俠蘯寇誌》的廣告。這套1960年的西部片局今重拍，又令人想起1954年上映的日本原著，黑澤明的經典傑作《七俠四義》。此片台灣譯名為《七武士》實在更為貼切，因為片中其實並無另外四位義士。

平心而論，《七俠四義》負盛名而又有娛樂性，但未必是黑澤明的最佳作品。論格局有《羅生門》和《天國與地獄》，論精彩有《影武者》和《姿三四郎》，論為西方主流媒體接受有《亂》和《德蘇烏扎拉》。但個人而言，最喜歡的卻是《用心棒》。柴刀對手槍，比雞蛋對高牆更反映現實。

那個故事也代表了黑澤明早年的心態：世道混亂，但不乏人性光輝，每有俠義之士，能濟世匡民。待得年事漸長，黑澤明的世界觀也逐漸悲觀。由《天國與地獄》到《沒有季節的小墟》的絕望，再到《亂》，明白到天道無常，邪常能勝正，致有無語問蒼天之概。而作為凡夫俗子，自己便寧可喜歡仍有鋤強扶弱的年代。

按：《亂》乃改編自莎劇《李爾王》，相較强國改《哈夢雷特》為《夜宴》，境界之别殊不可以道里計矣。

名實

[續昨]

張居正摇摇頭：那些侍郎、少傅並不需要宦官一般的退休安排。

申：為什麼？

張：他們用自己的官銜，退休後在外設帳授徒，或給人寫碑題字，收入極為豐厚，那裏會稀罕一個大學士的虚銜？

申：那麼馮保等大太監為甚麼又不這樣做？

張：啊呀！因為他們沒有真才實學呀！

申：所以，可悲的結論是大學士只是留給一些有名無實的人。真有才學人的不會，也不需要成為大學士。

張苦笑點頭。

[筆者按：正史不論，但明宣宗三楊中楊士奇的書法卻是罕有其比。其楷書之精，依愚之見，勝過顏柳，與歐陽詢、趙孟頫在史上實鼎足而三，隔代輝映也。]

合约

[續昨]

張居正大笑良久，才緩緩的說：給我看內廷起居注的，便是馮保。

申：所以他現在便獲聘為武英殿大學士？

張：也可以這麼說。但馮保當年和我們並沒有什麼協議，甚至我們從未有商量過甚麼安排，所以勾結是談不上。不過他知道，從前的王振、汪直、以至劉瑾，只要對我們內閣做事權宜方便的，退休後便會成為大學士。銜頭體面，俸祿也不錯，是他們夢寐以求的退休安排。

申：唔，正如那個叫 Jared Diamond 的花旗人說，在一個小圈子內，信譽足以代替合約。

張：這也是博奕理論所說的 communication by action。

申：首輔大人，我們這樣做固然可以方便行事，但是對三、四品的官員卻不甚公平。他們半生辛勤文墨，到退休卻只得到一個侍郎、太子少傅一類的頭銜。這些儒生不是更值得加封東閣大學士嗎？

張居正望着申時行，露出了難以置信的表情。

委任

[平行時空歷史]

大明內閣首輔張居正宣佈，委任剛退休的內務司禮大太監馮保為武英殿大學士。

剛入內閣的大臣申時行對此一安排甚為疑惑，便往請教張居正。

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

申：首輔大人，武英殿大學士俸祿雖然不高，卻只應授予學養極深的宿儒。馮監粗通文墨，不過寫過一兩首平仄不調的蹇腳詩，和大學士的頭銜恐怕不稱吧？

張：話倒不是這麼說。馮大人審閱奏章多年，對文學實在有極豐富的第一手經驗。

申：首輔大人，依下官之見，聘請馮監為大學士並非因為他的學術成就，而是看上他在內廷的影響力。馮大人擔任司禮太監多年，昔日部下多已身居要職。內閣聘用了馮監，便可以打通和內廷太監的關係，我們辦事大為方便，甚至影響內廷以至聖上的決策，使之變得對我們有利。

張：你既然看到了，還有甚麼問題？

申：首輔大人，我只是想這一着未必行得通。人走茶凉，馮監的昔日舊部，也不會對他唯命是從。早年我們聘請了退休後的王振擔任文淵閣大學士，他想借內廷的起居注一看，也被那些舊部諸多留難，三年竟看不到兩頁。反而首輔大人要看，只是略作疏通，便可說一馬平川了。

張居正沒有說話，只是哈哈大笑起來。

分紙

Took part in the MRCP PACES examination recently.

I shall not elaborate what I encountered. Nonetheless, a remarkable phenomenon did happen again and again throughout the day.

It went like this: All candidates were given their own score sheets before the examination and were asked to fill in the computer codes of their candidate number, center number, scenario number, and examiner number, as shown in this picture:

And, you may guess that much: The more careful the candidate filled in the boxes, the more meticulous was their technique of physical examination.

There was also a small group of candidates who filled in their candidate number carefully but left the other boxes all over the place. I shall leave it to you to decide what kind of people they are.

[Declaration: The above picture is downloaded from the Royal College of Physicians' website.]

大學

攝於某大學聚會：

容許在下用廣東話問：點解咁多有（髮）色人士？

詩韻

看到黎教授的詩牌，便從抽屜中找到內人母親從北京帶來的「䄂珍詩韻」：

紙如蟬翼，字皆蠅頭。全書不過傳呼機大小。乃供古人聚會、行酒令時作弊之用。

詩牌

While talking about Chinese history, my friend FL showed me a box that he recently acquired under the hammer:

Thanks to his explanation and additional comments by RC, I learn that these are Chinese poem plates (詩牌). It is, in essence, a kind of board game that social elites of the Qing Empire played, but is also used for teaching kids to write poems.

中史

週日，和太座閑聊。

「據說教育局打算擴大中史科課程，政府似乎是迷途知返了。」內人說。

「不錯，但我們的中史課程實在太沉悶了，難怪年輕一輩對中國既無知，又無感情。」

「啊呀！你認為可以怎麼辦？」

「老實說，我非常贊成陶傑的建議，與其教刻版的事件和朝代，不如用人做單位，選擇一些有趣又有代表性的人物，像說故事般敍述他們的生平，應該更能引起學生的興趣。」

「但是有許多歷史事件是非常重要的呀！」

「那視乎你的看法。譬如說近代史，甲午戰爭是非常重要的戰事。但對一個中學生來說，便甚麼也不是了。再說，用人物說歷史，便可以從選擇人物入手，對學生潛移默化――或者你可以說是洗腦。」

「洗甚麼腦？」

「又以近代史來說，只要課程仔細描述宋教仁、宋子文、汪精衞等人的遭遇生平，便很難不對民國政府感到厭惡，進而覺得共產黨統治中國是理所當然的了。」

「嘩！好彩唔係你制訂課程嘅唧！」

Card

While I was counting the numbers, my friend AP showed me a name card that she recently received:

********************************
Dr. XYZ
Founding President
International Society of Pruritis Ani
********************************

I literally scratched my head and asked, "Who's this guy? I've never heard of him."

"Of course not. It's too remote from us - he just got his fellowship earlier this year."

"Alas, that's a vivid example of title inflation. I suppose he is leaving Hospital Authority for private practice soon?"

My friend smiled and nodded.

Numbers

Let the numbers speak:

• 12 directors
• 15 advisors
• 17 workers on public access
• 10 project leaders
• 9 active projects

• 25 vacancies for potential applicants

Education

"If young people could learn everything from the Internet, why should we spend so much on education?" Hebe asked.

"My friend, education - or I should say our education system - is not meant for educating the younger generation. Look at their content and curriculum and it's pretty obvious. From the social or governmental point of view, however, education serves two important purposes."

"Yes...?"

"First, when education is free and easily available, the younger generation would spend longer in the unversity. Since old people do not retire and job vacancies are vanishing, education is an excellent strategy to bring down the unemployment rate."

Hebe nodded - she could not agree more. Her friend went on.

"And educaiton is a convenient way of brainwashing. You learn something when you are a kid and you will be convinced that it is correct - religion, patriotism, universal value, and what not. Whatever you teach a kid, it gets imprinted in their mind and won't get challenged for the rest of their life. If you give the same message to all children, they would become cohesive and believe there is some core value of their country..."

Hebe could not help shivering.

Youth

"There are several reasons," Athena explained, "First, the young people have nowadays the ever worsening difficulty to earn a living and secure a position in the society. With the advances in machines and technology, jobs that depends on physical strength are vanishing. The young people lose their edge over more senior colleagues. Obviously, neither could compete with a machine in this regard."

Hebe nodded, and her friend went on.

"On the other hand, exactly because of the advances in technology, the older people also lose their edge over younger ones. One hundred years ago, experience was valuable, and therefore senior people in many professions earned more. In those days, if a young person wanted to master a technique, he needed to be taught by an experienced person in that field. Nowadays, you can learn everything from the Internet and Youtube - and everyone could easily check whether the teaching by their senior is correct. The result is simple: Young people begin to look down upon older ones."

Job

"My friend, the water is deeper than what you see." Athena said.

"Yes...?"

"Since there is no disease and everyone lives practically forever, there is no hope in this world."

"Do you mean Since there is always a tomorrow, we do not treasure today ?"

"Partly. For the old people, they would be bored to death - or I should say bored to hell - if they do not hold on to their job and social title. Unfortunately, Hebe, that's what we are now doing."

"I see what you mean. Since we are the majority in the society and we have the resource and connection, we dominate the government. A healthy and prospering society is not our priority. We make policies in favour of our own selves."

"Very true. As to the young people, they have every reason to join a rebellion."

"Why?" Hebe asked.

Retire

Reluctantly Hebe nodded.

"You are all for this idea, aren't you?" Athena asked.

"Yes. Of course. Certainly. Definitely. Absolutely... Oh, I mean, I should. After all, we do not age nowadays. Even though I was born a century ago, my body is as young as a 30-year-old. On one hand the society is not making the best use of our ability and experience if we are forced to retire at 60 or 65. Moreover, we nonagenarians would be bored to death if we have nothing to do!"

"In that case why are you puzzled?"

"Because if we refuse to retire and stay in our position, the future of our next generation is gloomy. Take our Queen Elizabeth as an example. She is doing so well that Prince Charles, her heir apparent, seems to have no chance of becoming the King. When the Prince was 30 years old, he had a high hope of taking over the crown one day. When he was 70, alas, he came to realize he was nothing but a piece of furniture sitting next to the Queen."

"I see your point. But, can't we work out a system so that people of all age could live in harmony?"