Show

With the announcement of our CE, the scar of our behaviour surfaces once again. (See my blog http://ccszeto.blogspot.com/2008/03/scar.html)

Alas, we hurried to give advice on personal hygiene, wearing masks in public places, scrutinizing port entrants, massive cleansing of everywhere you could think of. It seems logical, eh ? I shall take you through some politically incorrect considerations:

1. Are the measures useful ? If it is not transmitted by fomites, what's the value of cleaning everything with clorox ? (More so, if it is not transmitted by mosquito, why on earth do we ask our senior officials to tackle sewage pipes in our backyard ?) In fact, if there comes more evidence that the disease is airborne (rather than via droplets), are we going to ask everything to wear N95 ?
2. Let's assume the measures are useful or important, why do we do it now - but not earlier or regularly ? Is it because we have evidence the swine flu and ordinary ones are biologically entirely different diseases, or because the former has a much higher mortality?

Come, let's enjoy the show.

PS. An old Chinese duilian (對聯) suddenly comes to my mind: 上台須念下台日, 看戲無非做戲人.

Announcement

Just learned from the urgent evening news that the first case of swine flu in our city was confirmed.

And this ground-breaking information was announced by no one but our CE. (I must say it is quite a bit of fun to hear him reading out the case history; I have a deja vu feeling of conducting a junior clerkship tutorial.)

But, why does it need the head of our government to do the deed ?

It sounds like asking Mr. Hu to tell us the biochemistry of melamine, or President Obama to do the press release and explain the financial details of the Chrysler, which filed for Chapter 11 just lately.

More than ever I find Chen Ping (陳平) of the Han (漢) empire a real genius.

"自有負責人."
(典出: 史記•陳丞相世家)

PS. Of course Mr. Tsang might not want to do this kind of thing either - there is so much pressure by our council members and the general public that he should come out and do something.

Lakeside

Read Lakeside (湖邊凶殺案) of Keigo Higashino (東野圭吾) during the weekend.

Yes, that's the same author of the TV series Galileo (神探伽利略) and the movie Yōgisha X no Kenshin (容疑者Xの獻身) - both of which I did not have a chance to watch.

But, the Lakeside is good. It has the typical layout of "plot-within-a-plot", which - to my knowledge - was first used by Agatha Christie in Murder on the Links. The trick is no doubt the favorite of Higashino, and he plays it well this time. (I shall turn a blind eye to its so-called ambition in sociological meaning that so many book critics put forward. It is parsley on the dish - it looks good, gives a bit of flavour, but most of us would put it aside before swallowing the fish down our throat.)

One of the best plots built out of this framework was The Tragedy of W (W的悲劇) by Natsuki Shizuko (夏樹靜子), yet another Japanese novelist. Ironically, the Tragedy has a superb plot clumsily told, while Higashino has his story brilliantly presented - although I think he could have made the water a bit deeper.

(How about that teacher - making use of his students as a blind ?)

Necessary

While we are on the benefit of those minute things, one common question that we encounter in the clinic is: Can I eat this ?

(And the this could be anything - salted fish, candy, ginseng, abalone, and what not.)

My usual answer is: It is not poisonous - you won't die by taking a little. Of course, that often means the patient ends up taking a lot and has all the problems.

For the same reason, many (male) candidates ask: Is it necessary to wear a tie for the examination?

Of course not.

In fact, it is not necessary to shave, comb your hair, wear a white coat, bring your own stethoscope (we can always provide a spare one), or even be polite to the examiner. By definition no one could fail for any of these reasons.

But you could imagine the result if a candidate does all of them (or, seriously, just the last one).

As RK, our previous chief of neurology, says: They are all useless. But, when you put all these useless things together, they may become useful.

And if you put many things with no value together, they may become invaluable.

One

In fact, my advise yesterday does not apply only to professional examination, but almost every aspect of our life - for the vast majority of our problems and activities are scored in the same four point scale, and it is usually impossible to change a particular thing from failure to successful because it often depends on luck and circumstances and many other factors that we cannot control.

But that's not a reason to give up.

We can always do something to make thing change from hopeless to marginal, or from good to better. The only question one need to ask themself is: What can I do to go one step further, or make the situation less bad ?

No, we are not asking for a miracle to change something bad to good. But there is almost always something solid for making it less bad.

Remember, life does not depend on one, but is an aggregate of many four-point scores. At the end of the day, you will always have a gratifying result if you keep scoring 2 or 4 - instead of 1 or 3.

Score

You may say, "But the Blitzkrieg tactic won't work now ! We see several examiners (six to ten, depending on which examination you talk about), and each of them gives us a blinded score with an equal-weight."

True, but there are other ways.

You know what, the major component of our current marking scheme - be it final MB or MRCP - is a list of 4-point scores (which add up to give an overall score): It is 0 to 3 in final MB, and 1 to 4 in MRCP; in the latter, 2 being borderline fail and 3 borderline pass. If you get that component right, you score 3 or 4; if wrong, 1 or 2.

That's the point ! No trick or teaching could move a candidate from 2 to 3 (i.e. fail to pass) if they make a mess, but one can always do something to move from 1 to 2, or from 3 to 4. If you fail, do something so that the examiner think you are wrong at a certain point but not completely hopeless; if you pass, show that you are thinking or doing one step further.

And it is the one extra point here and another there that gives you a higher score overall, which not uncommonly changes fail to pass.

You think it just the truth from a Sunday school (老生常談) ?

管輅曰：「老生者見不生，常談者見不談。」
(資治通鑑, 第75卷; 亦見 三國演義, 第106回)

PS. On the last bit, please refer to the modern translation by Bo Yang (柏楊）; most of the others you find from the Internet probably mistake the original meaning of our great fortune teller.

Blitzkrieg

If you are still keen to have some practical tips for clinical examination, I could show you one that we used in the old days.

I call it the Blitzkrieg tactic - which I first learned from the story of Adolf Hitler, when he conquered Poland and France in late 1930s.

In the old days, the major hurdle of a clinical examination is the short case, which the candidate had to face two examiners. Usually one of them being much more senior than the other, and had naturally much influence on the actual scoring. The marking scheme was, alas, the time-honoured impression marking - the examiner could give you anything between 45 to 60 in the final MB, or 0 to 12 in MRCP.

In other words, you only have to impress one person in order to score high.

And you only need to impress that one in the first two or three minutes; once they are taken in, everything you do they feel satisfied.

How ? I shall leave it to your imagination.