Quite a number of interesting things are happening around the world.
The Shanghai Expo 2010 began. In the opening ceremony, Andrea Bocelli sang Nessun Dorma. This was the first time I missed Pavarotti.
Gordon Brown is ruined by that bigoted woman. What may skip your eyes is Nick Clegg is equally, if not more, damaged - because David Cameron now has a real chance of getting a solo win.
A woman collapsed on the surgical table in the office of a private gynecologist. Ambulance men were accused of delaying resuscitation and intubation. What about those fully trained doctors at the scene ?
A 4-hour radio program was sold to a political party; the owner of the radio channel received much criticism. But, is it not democracy all about respecting the right of people to say things that we do not agree ?
PS. Unfortunately, we also have to face their occasional annoying behaviour of not respecting our right to say things that they do not agree.
Friday, May 7, 2010
Thursday, May 6, 2010
Story
I took a half-day leave on a Thursday morning and went to Euterpe's kindergarten to tell a story.
Yes, to a class of pre-nursery children.
(For those who are not yet parents, it is actually very common for kindergartens to invite parents to take turn and tell stories in the class. Kids love seeing their parents in the classroom; the parents would also like to have a glimpse on what's going on in the school.)
Kids of that age do not have very long attention span (but who has ?) and we have to finish with a story in 15 minutes.
The deed was not that difficult. I borrowed a picture story book from the public library, did some rehearsal (just to make sure of the time-keeping), and there I go. In short, I met a class of 10 or 12 lovely kids sitting in a line, and showed them the pictures in the book while going through the story. None of them ran around or cried. They were eager to say what they think, but were absolutely non-disturbing.
On my way back to the hospital, the scene of teaching our first year medical school two weeks ago flashed back in my mind (see http://ccszeto.blogspot.com/2010/04/blog-post_19.html).
I am sure I give today the best lecture in my past 10 years.
Yes, to a class of pre-nursery children.
(For those who are not yet parents, it is actually very common for kindergartens to invite parents to take turn and tell stories in the class. Kids love seeing their parents in the classroom; the parents would also like to have a glimpse on what's going on in the school.)
Kids of that age do not have very long attention span (but who has ?) and we have to finish with a story in 15 minutes.
The deed was not that difficult. I borrowed a picture story book from the public library, did some rehearsal (just to make sure of the time-keeping), and there I go. In short, I met a class of 10 or 12 lovely kids sitting in a line, and showed them the pictures in the book while going through the story. None of them ran around or cried. They were eager to say what they think, but were absolutely non-disturbing.
On my way back to the hospital, the scene of teaching our first year medical school two weeks ago flashed back in my mind (see http://ccszeto.blogspot.com/2010/04/blog-post_19.html).
I am sure I give today the best lecture in my past 10 years.
Wednesday, May 5, 2010
Know
You may think it is a basic right for our patient to know the pros and cons of every treatment option so that they could make their own decision.
True, it is a right that we, as clinicians, should respect. (A shrewd reader would note that I did not say facilitate.) However, it is, to say the least, silly to exercise this right when we become patients. We know just too well the consequence from the Genesis, when Adam exercised his right and ate the apple in Eden.
You may think it is necessary to weight the pros and cons for our own decisions. But no, as patients, we are not in the best position - we are often biased and blinded, and, as King Nikochan's servant loves to say, do not see the whole picture. We need someone cool and objective to balance the risk for us.
That's why we need the doctor, who does not only treat our disease and relief our suffering. Equally important, he takes the trouble and worry of knowing everything from our shoulder, so that we could sleep well under his hands.
In other words, I prefer to exercise my right not to know.
Go read Foster C. Autonomy should chair, not rule in Lancet 2010; 375: 368.
True, it is a right that we, as clinicians, should respect. (A shrewd reader would note that I did not say facilitate.) However, it is, to say the least, silly to exercise this right when we become patients. We know just too well the consequence from the Genesis, when Adam exercised his right and ate the apple in Eden.
You may think it is necessary to weight the pros and cons for our own decisions. But no, as patients, we are not in the best position - we are often biased and blinded, and, as King Nikochan's servant loves to say, do not see the whole picture. We need someone cool and objective to balance the risk for us.
That's why we need the doctor, who does not only treat our disease and relief our suffering. Equally important, he takes the trouble and worry of knowing everything from our shoulder, so that we could sleep well under his hands.
In other words, I prefer to exercise my right not to know.
Go read Foster C. Autonomy should chair, not rule in Lancet 2010; 375: 368.
Tuesday, May 4, 2010
Right
Many of my friend would have the same experience of being asked to give medical advice on topics entirely outside our own specialty.
(Although having a grandiose personality disorder of knowing everything, I must admit, to say the least, I do not have the necessary detail. As Hercule Poirot always said, it is risky to form a conclusion before having sufficient information.)
Maybe I should show you my reply email.
****************************
Dear Sister,
The situation is no good, and I could understand her frustration. My opinion is there is no need to give too much thought to the pros and cons of various forms of treatment. If I were the patient, I would stick to the advice of the single best specialist that I could get. (I am no expert in cancer and would not be in the caliber to give a better advice.)
Szeto
****************************
You may think I am not giving a concrete response.
On that, you are wrong. My very solid advise could be condensed into five words: Do not think, just follow.
(Although having a grandiose personality disorder of knowing everything, I must admit, to say the least, I do not have the necessary detail. As Hercule Poirot always said, it is risky to form a conclusion before having sufficient information.)
Maybe I should show you my reply email.
****************************
Dear Sister,
The situation is no good, and I could understand her frustration. My opinion is there is no need to give too much thought to the pros and cons of various forms of treatment. If I were the patient, I would stick to the advice of the single best specialist that I could get. (I am no expert in cancer and would not be in the caliber to give a better advice.)
Szeto
****************************
You may think I am not giving a concrete response.
On that, you are wrong. My very solid advise could be condensed into five words: Do not think, just follow.
Monday, May 3, 2010
PM
My sister Jenny is not in the best of her mood recently.
Her best friend, PM, whom I also know personally, has colon cancer at the age of 40.
To complicate the matter, our friend is living alone in another country. (She communicates with my sister largely by SMS and emails.)
From what I was told, surgery was done a few months ago, which was followed by chemotherapy. Nonetheless, the tumor seemed to have spread to other organs. The decision now is apparently whether she should have another surgery or further chemotherapy.
"A losing battle," I said to myself.
But it is not easy to ask our friend to surrender. She does the best of what an educated patient could do: gets a detailed explanation from her doctor, searches for relevant information from all on-line resource, reads up medical books (she is a chemical engineer by training and has an exceptional capability of understanding jargon), and weights carefully the pros and cons of the two treatment options.
And, naturally, she also asks for my opinion via my sister.
Her best friend, PM, whom I also know personally, has colon cancer at the age of 40.
To complicate the matter, our friend is living alone in another country. (She communicates with my sister largely by SMS and emails.)
From what I was told, surgery was done a few months ago, which was followed by chemotherapy. Nonetheless, the tumor seemed to have spread to other organs. The decision now is apparently whether she should have another surgery or further chemotherapy.
"A losing battle," I said to myself.
But it is not easy to ask our friend to surrender. She does the best of what an educated patient could do: gets a detailed explanation from her doctor, searches for relevant information from all on-line resource, reads up medical books (she is a chemical engineer by training and has an exceptional capability of understanding jargon), and weights carefully the pros and cons of the two treatment options.
And, naturally, she also asks for my opinion via my sister.
Sunday, May 2, 2010
Letter
In the afternoon that I was back from Chengdu, Vivian and I paid a visit to her secondary school - it was the open day to celebrate its 120th anniversary.
We didn't stay long. There's actually not very much to see. Nonetheless, in the school hall, we found an interesting letter in display - it was the original letter that a local official wrote to the Hong Kong governor at the time, proposing to set up a public girls' school.
The document was quite long (it gave details to the number of students planned, the proposed school fee, and so forth) and it took us a moment to finish. The letter was concluded in this sentence:
I have the honour to be, Sir, Your most humble obedient servant.
You find it outdated ? True. In fact, we are now often satisfied with Yours sincerely or Yours faithfully, and have done away with this kind of lengthy finale for ages. (I usually go one step further and conclude with the single word Sincerely. Well, who else could I be talking to ?)
However, wordy letters do not mean that people in that era were inefficient - quite the opposite in fact. The school was established a few months after the letter, without further paper work for surveying others' opinion or obtaining a consensus.
Good old days.
PS. The only opportunity that we could have a glimpse of elegant letters of this kind is to read Sherlock Holmes.
We didn't stay long. There's actually not very much to see. Nonetheless, in the school hall, we found an interesting letter in display - it was the original letter that a local official wrote to the Hong Kong governor at the time, proposing to set up a public girls' school.
The document was quite long (it gave details to the number of students planned, the proposed school fee, and so forth) and it took us a moment to finish. The letter was concluded in this sentence:
I have the honour to be, Sir, Your most humble obedient servant.
You find it outdated ? True. In fact, we are now often satisfied with Yours sincerely or Yours faithfully, and have done away with this kind of lengthy finale for ages. (I usually go one step further and conclude with the single word Sincerely. Well, who else could I be talking to ?)
However, wordy letters do not mean that people in that era were inefficient - quite the opposite in fact. The school was established a few months after the letter, without further paper work for surveying others' opinion or obtaining a consensus.
Good old days.
PS. The only opportunity that we could have a glimpse of elegant letters of this kind is to read Sherlock Holmes.
Saturday, May 1, 2010
Leader
You may wonder why should our applicants with excellent academic record tend to give boring answers to the interview questions - they should be bright students after all.
The obvious answer is students with a good examination result may not be always the smart ones. They may simply do well in book work but have autistic personality disorder. (Many people do believe that these two traits have a correlation.)
But that does not explain the entire phenomenon. In fact, judging from their subsequent performance in the medical school, many brilliant and shrewd students do - deliberately or subconsciously - give as dull and answer as possible to interview questions.
Why ? It is because they have very good chance of getting in the medical school anyway. The only thing that they need to avoid is irritating the one over the other side of the interview table. A brilliant answer, in that case, is not a good choice - because there is always a remote possibility that it does not suite the palate of that particular professor. A dull generic answer would score you no extra mark (which the applicant does not need), but it will never trigger a negative response.
The situation is a variant of the "reversal of follow-the-leader strategy" in competition analysis.
Go read James Miller, Game Theory at Work.
PS. Once again, it proves my prejudice: It is often difficult to tell an ingenious crook from a complete idiot.
The obvious answer is students with a good examination result may not be always the smart ones. They may simply do well in book work but have autistic personality disorder. (Many people do believe that these two traits have a correlation.)
But that does not explain the entire phenomenon. In fact, judging from their subsequent performance in the medical school, many brilliant and shrewd students do - deliberately or subconsciously - give as dull and answer as possible to interview questions.
Why ? It is because they have very good chance of getting in the medical school anyway. The only thing that they need to avoid is irritating the one over the other side of the interview table. A brilliant answer, in that case, is not a good choice - because there is always a remote possibility that it does not suite the palate of that particular professor. A dull generic answer would score you no extra mark (which the applicant does not need), but it will never trigger a negative response.
The situation is a variant of the "reversal of follow-the-leader strategy" in competition analysis.
Go read James Miller, Game Theory at Work.
PS. Once again, it proves my prejudice: It is often difficult to tell an ingenious crook from a complete idiot.
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