Watched Slumdog Millionaire with Vivian.
It is an excellent plot, with the story brilliantly told, and topped with spectacular photography. No wonder it becomes such a phenomenon.
There is one thing I noted from the questions put up for Jamal Malik: They always ask Who.
"Who was that movie star ?" "Who wrote that song ?" "Who was on the bank note ?" "Who kept that cricket record ?" "Who was the third musketeer ?" And so forth.
Yes, in a sense it is unreal. Questions would never be put up like this in the genuine TV show. Nonetheless, I see it a Freudian slip (or possibly a careful calculation) of Danny Boyle, indicating his passion and emphasis on human beings on top of other material facts.
PS. Ironically, it is in fact the musketeer bit that makes the story somewhat unreal to me: It is exceedingly unlikely that The Three Musketeers, written by our giant in French literature, would be taught in the primary school of Mumbai, a previous English colony. That should really be Charles Dickens, and Jamal Malik being Oliver Twist.
Saturday, March 7, 2009
Friday, March 6, 2009
Do
You may find my blogs in the recent few days schizophrenic. Am I for or against improving the health of a society? Was I actually making a circumventing method to support the new candidate who runs for the council ?
I am not sure.
And the old saying of Finagel's Laws comes to my mind:
I am not sure.
And the old saying of Finagel's Laws comes to my mind:
- The data we have are not the data we want.
- The data we want are not the data we need.
- The data we need are not available.
- What we are doing is not what we want to do.
- What we want to do is not what we need to do.
- What we need to do remains uncertain.
Thursday, March 5, 2009
Cost
I am not of a habit to copy-and-paste in this blog, but once we talk about improving the standard of medical care, this article from the recent issue of Clinical Medicine (formerly the Journal of the Royal College of Physicians of London) would be an exception.
*******************************
‘Charles, I sometimes think that some people, many distinguished in their fields, might benefit from your wisdom!’ I started.
‘Coe flattery gets you nowhere! What on earth have you been reading?’
‘We are repeatedly told that unless we improve, and spend more on our public health preventative services, the NHS costs are going to be astronomical.’
‘And what if we do? You know the answer!’
‘They will be just as astronomical!’
‘And possibly more so! Although the medium-term cost of illness might be reduced, any consequent improvement in survival would inevitably increase long-term NHS and social costs. That is unless you can arrange for the majority of 90 year olds to die of a coronary during their daily jog!’ Charles added with a smile.
‘Or game of tennis! But you are not opposed to all this type of expenditure?’
‘No I am not! Sixty years ago, it was excusable that Nye Bevan did not realise that successful medicine has long-term costs, but the authorities should realise by now that total cost might be even more astronomical if we do improve preventative services. The point is that saving money or even human resources should play no part in the equation. These measures should be judged on what they are trying to do, which is to extend healthy lifespan!’
(from Clin Med 2009; 9: 95-96)
*******************************
Well, I find it often difficult to tell whether someone is joking or using a laughter to cover the grim fact, or to tell a clever crook from an idiot.
*******************************
‘Charles, I sometimes think that some people, many distinguished in their fields, might benefit from your wisdom!’ I started.
‘Coe flattery gets you nowhere! What on earth have you been reading?’
‘We are repeatedly told that unless we improve, and spend more on our public health preventative services, the NHS costs are going to be astronomical.’
‘And what if we do? You know the answer!’
‘They will be just as astronomical!’
‘And possibly more so! Although the medium-term cost of illness might be reduced, any consequent improvement in survival would inevitably increase long-term NHS and social costs. That is unless you can arrange for the majority of 90 year olds to die of a coronary during their daily jog!’ Charles added with a smile.
‘Or game of tennis! But you are not opposed to all this type of expenditure?’
‘No I am not! Sixty years ago, it was excusable that Nye Bevan did not realise that successful medicine has long-term costs, but the authorities should realise by now that total cost might be even more astronomical if we do improve preventative services. The point is that saving money or even human resources should play no part in the equation. These measures should be judged on what they are trying to do, which is to extend healthy lifespan!’
(from Clin Med 2009; 9: 95-96)
*******************************
Well, I find it often difficult to tell whether someone is joking or using a laughter to cover the grim fact, or to tell a clever crook from an idiot.
Wednesday, March 4, 2009
Consequence
You may consider my worry yesterday somewhat excessive; let's take aside those butterfly effects and focus on the problem at hand: Does more liberal investigation of medical incidents (in government hospitals) improve the standard of care ?
There would only be one effect: the reputation and trust to the public hospital go down.
And the consequences are not difficult to imagine:
On a first glance, the two effects seems balancing each other. But, look, public hospitals employ less than half of all the doctors, while taking care of over 90% of the patients. If 10% of the doctors and patients leave for the private, it would just be a small increase in the number of private doctor, but a double in the market.
Oh, is it the real objective ?
And I feel needless to elaborate on the quality of care for those patients (the vast majority, unfortunately) who remain in the public sector.
There would only be one effect: the reputation and trust to the public hospital go down.
And the consequences are not difficult to imagine:
- More patients would move to the private sector.
- More (capable) public doctors would move, too.
On a first glance, the two effects seems balancing each other. But, look, public hospitals employ less than half of all the doctors, while taking care of over 90% of the patients. If 10% of the doctors and patients leave for the private, it would just be a small increase in the number of private doctor, but a double in the market.
Oh, is it the real objective ?
And I feel needless to elaborate on the quality of care for those patients (the vast majority, unfortunately) who remain in the public sector.
Tuesday, March 3, 2009
Candidate
A friend shows me the news that a famous private doctor is going to run in the election for the council chairman.
Of course I am not surprised. The previous chairperson seems to have stayed in the post forever, and many people would like to see some change.
But he real thing that amazed me is what the new candidate (claims that he would) plans to do:
"I shall investigate major medical incidents in government hospitals proactively - before receiving a formal complaint."
Does any one in his right mind would agree to allow the police (or ICAC) having the authority to investigate the whole of your life - without a formal case?
You don't really need to have police or ICAC to have that authority. Imagine some other professional bodies (say, of lawyers and accountants) ask for the same right. Does that protect an average citizen, or put them at more risk ? (It is not only the problem of privacy; it puts an end to all negotiation and, above all, our right to choose who takes care of us.)
Gestapo !
Of course I am not surprised. The previous chairperson seems to have stayed in the post forever, and many people would like to see some change.
But he real thing that amazed me is what the new candidate (claims that he would) plans to do:
"I shall investigate major medical incidents in government hospitals proactively - before receiving a formal complaint."
Does any one in his right mind would agree to allow the police (or ICAC) having the authority to investigate the whole of your life - without a formal case?
You don't really need to have police or ICAC to have that authority. Imagine some other professional bodies (say, of lawyers and accountants) ask for the same right. Does that protect an average citizen, or put them at more risk ? (It is not only the problem of privacy; it puts an end to all negotiation and, above all, our right to choose who takes care of us.)
Gestapo !
Monday, March 2, 2009
Key
That night, while I was pondering on the philosophical question of the value of my existence, a glaring creature on the table drew my attention.
He was the key living in the next pocket - my master somehow left him on the table.
"Hei, man," I yelled to the smelly piece of metal, "What's funny here ?"
"Oh, nothing. Just trying to take a good breathe after all day's work. But you look gloomy. I suppose you should be happy with the recent happenings of that woman ?" My neighbour said.
I told him what's in my mind.
He considered for a while and said, "I don't think we are here to detect romantic abnormalities and make exotic diagnosis - not for me at least. It's grass root kind of work. But I am handy and immediately available, and our master won't do away with me - he cannot carry a CT scan with him in the ward. I suppose you are more sophisticated and could be of a even better use ?"
"You mean deciding whether someone has lung crackles or rhonchi or bowel sound ?" I tried to make a joke - probably onto myself.
"Don't you think they are important ? How many times did our master rely on you to decide whether someone has heart failure or bronchospasm, and bowel obstruction or ileus ? Oh, I should the one feeling jealous !" He smiled.
I said nothing, but began to see the truth in his words. Yes, I should be happy with my grass root but material achievement, rather than wasting my time to crave for some glamorous moments.
"Maybe you're right," I said, "Oh, the pocket that you lived has a hole in it. Do you want to share mine with me tomorrow ?"
He nodded eagerly, and I was sure it would be the beginning of a great friendship.
- THE END -
He was the key living in the next pocket - my master somehow left him on the table.
"Hei, man," I yelled to the smelly piece of metal, "What's funny here ?"
"Oh, nothing. Just trying to take a good breathe after all day's work. But you look gloomy. I suppose you should be happy with the recent happenings of that woman ?" My neighbour said.
I told him what's in my mind.
He considered for a while and said, "I don't think we are here to detect romantic abnormalities and make exotic diagnosis - not for me at least. It's grass root kind of work. But I am handy and immediately available, and our master won't do away with me - he cannot carry a CT scan with him in the ward. I suppose you are more sophisticated and could be of a even better use ?"
"You mean deciding whether someone has lung crackles or rhonchi or bowel sound ?" I tried to make a joke - probably onto myself.
"Don't you think they are important ? How many times did our master rely on you to decide whether someone has heart failure or bronchospasm, and bowel obstruction or ileus ? Oh, I should the one feeling jealous !" He smiled.
I said nothing, but began to see the truth in his words. Yes, I should be happy with my grass root but material achievement, rather than wasting my time to crave for some glamorous moments.
"Maybe you're right," I said, "Oh, the pocket that you lived has a hole in it. Do you want to share mine with me tomorrow ?"
He nodded eagerly, and I was sure it would be the beginning of a great friendship.
- THE END -
Sunday, March 1, 2009
Depression
I have very little recollection of what happened for the rest of that afternoon. My master did rush back to the ward and made several phone called, and the woman was transferred to a tertiary heart surgery center before sun set. I never saw her afterwards - my master and I were soon attracted by other patients and the membership papers.
But I do remember very well the happy footstep of my master when he was rushing back to the ward. (In fact the next time I found him walking in the same joyful manner was nearly two years later - when he knew he passed the Royal College examination.) Yes, it was the kind of footsteps that come with a combination of relief, self satisfaction, and return of confidence.
And I remember after my master secured the woman in the ambulance and saw her departure, Dr. Lai tapped on his shoulder and said, "Well, after all, your stethoscope did not let you down, and it was most probable that there was really no murmur on the night of admission. Atrial myxoma classically has rapidly changing murmur because ..." For a moment I was just too happy to listen any more.
When I cooled down at night, however, I became less sure whether I should really be satisfied. Yes, I did provide correct information to my master - but what did I actually contribute ? The disease was confirmed by the expensive creature with a digital screen downstairs rather than some humble rubber tubing with a metallic bell like myself. Worse still, the noble was operated by his master who did not (have to) complete five years of medical school - my master used to call him some "technician". Alas, if I had never met my master, he would have make the diagnosis by simply asking an expensive creature to visit that woman.
But I do remember very well the happy footstep of my master when he was rushing back to the ward. (In fact the next time I found him walking in the same joyful manner was nearly two years later - when he knew he passed the Royal College examination.) Yes, it was the kind of footsteps that come with a combination of relief, self satisfaction, and return of confidence.
And I remember after my master secured the woman in the ambulance and saw her departure, Dr. Lai tapped on his shoulder and said, "Well, after all, your stethoscope did not let you down, and it was most probable that there was really no murmur on the night of admission. Atrial myxoma classically has rapidly changing murmur because ..." For a moment I was just too happy to listen any more.
When I cooled down at night, however, I became less sure whether I should really be satisfied. Yes, I did provide correct information to my master - but what did I actually contribute ? The disease was confirmed by the expensive creature with a digital screen downstairs rather than some humble rubber tubing with a metallic bell like myself. Worse still, the noble was operated by his master who did not (have to) complete five years of medical school - my master used to call him some "technician". Alas, if I had never met my master, he would have make the diagnosis by simply asking an expensive creature to visit that woman.
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