Neutral

I am impressed with the decision to uphold political neutralism.

(Maybe they would, for the same argument, also ban our senior government officials from coming to the campus and promote the proposal for political reform.)

But it is your fault; you are all mistaken - and do not comprehend the meaning of neutralism.

It means they are standing on the central point (alas, neutral) of the field, or, in other words, sitting on the fence.

Therefore, if one side seizes power and dominates, they belong to the winning side.

Of course, if the wind changes in direction and the opposite side takes its turn, they would still fall on to the winning side.

Haven't you heard of market economics ?

PS. Don't laugh at my definition of neutral. It is not my invention. You may not know, but the United States Senate is chaired - according to the regulation - by the Vice President, who should in theory be neutral. What it means is he would not vote, which, in reality, implies that he only stands on the winning side.

Examiner

That evening, when we sat around the dinner table and had a few glasses of champagne, the air seemed cool down a bit, and we could devote ourselves to some less colorful discussions.

"You know, we do not have enough examiner for the membership examination." Our man from Pluto said.

"Quite so. In fact, we have even fewer examiner doing the annual and exit examination for the College." I murmured at the other side of the table.

"Indeed ..." JW was sitting next to me and looked curious.

"The College examination is now almost entirely conducted by consultants of peripheral hospitals. There is hardly any academic staff from the two medical schools sitting there. That's understandable: The examination takes quite a bit of time and is rather boring. I don't see any reason why a university professor would like to do it." I explained.

"There's in fact no reason why any one should have the incentive to become an examiner," LY, sitting at the other side of JW, added, "If a candidate passes, he would take the credit. But if he fails, the blame would go to the examiner. What a easy way to create antibody ! If you fail one candidate each time and do the examination twice a year, throughout the whole of the 25-years of your professional life, you would have 50 die-hard enemies in this profession - many of them may have take some senior positions. Just imagine the result !"

Paradox

I should not have said our government always hold the purse tight for health care. During the department dinner, I met YK, a previous colleague who moved to the government recently, and RW, another friend of mine who has regular interaction with extra-terrestrials.

"So, the life is good in the government ?" RW asked.

"Quite so, quite so," YK humbly replied, "The life is leisured, and the prospect seems not bad."

"Not bad ? What a term ! You are working in the most remarkable part of the entire health care system." RW chuckled.

"Eh ...?" The two of us made an inviting grunt.

My friend continued to explain, "Extra-terrestrials use a different system of logic. You know what, if their job ends up a mess, the conclusion is they do not have enough resource and manpower. In return, the government chips in more money, more people are employed, and more senior posts are created for promotion - so that they could make a bigger mess, and the cycle repeats."

I could not help smiling - thinking about what could rise to the top besides creme de la creme.

Expenditure

Fans of human right may argue: Indications of treatment should be based on medical evidence rather than working backward from the available budget.

The idea is not new. In response to the Great Depression, John Keynes argued that government spending should not be limited by the amount of taxation income, but be determined by the need of the society. It was proposed that a high government expenditure would boost the economy, and there are ways to cover the fiscal deficit.

I am no expert to comment on Keynes' hypothesis. But, to say the least, it was put up as a remedy for recession. By the law of mathematics, the accumulated deficit could not growth endlessly. Yes, during the bad years we may overspend a bit to keep the ball rolling, but the book needs to be balanced again when the drought is over.

Alas, some European PIGS used Keynes' strategy of over-spending during the period of economic growth - I don't think I have to elaborate on the result.

PS. Of course it is always a curious phenomenon that our government overspends in some areas (for example, bidding for some international games) while holding the purse tight for health care. That's another story.

Deficit

The very method of paving our way to hell seems everywhere. On the evening of the consultant interview, I attended a celebration dinner of my department. Our man from Pluto was slightly late. Soon after he finally arrived, he was involved in the discussion with FC on our drug budget.

It is no news that we have an astronomical deficit.

The cause of the problem is, maybe to your surprise, rather clear. There are a number of diseases (I won't say one) that, over the recent years, creatures outside the solar system decided to follow the international standard and loosened the criteria of using several expensive medicines - which was followed by a corresponding surge in the prescription of these items, of course.

The catch is: The total drug budget was not increased.

What would happen ? Imagine a gigantic dinosaur: Its legs (and ass !) agree to fled from the Tyrannosaurus near by, but the heart (controlled by the autonomic nervous system - remember, autonomic) declines to increase the blood supply to the muscle.

The result is - please excuse my language - an inevitable PK.

PS. As a response to the deficit, our man from Pluto actually suggests to use the strategy of working backward to define the indications of those expensive new gadgets: See how much we could afford, then set up corresponding criteria so that the estimated number of people would fulfill. (After all, as always proclaimed by the government of our mother country, we do not have to follow any so-called international standard.)

This is one of the rare occasions that I fully agree with my chairman.

Interview

While I was thinking about the difficulty of recruiting suitable trainees, several friends of mine attended an interview for the new consultant post of my department.

One question that appeared was: Do you think it important to set up an emergency service for the treatment of X ?

(For discussion purpose, X could be any acute medical condition that could be treated by an on-site specialist - take aside the need of some dedicated beds, skilled nursing support, and money.)

When one of my friends told me this question, I commented, "Right, the emergency treatment under question has proven value by clinical study. Nonetheless, I would insist to answer NO. There are only two or three sub-specialists in the region to offer this treatment. Setting up an emergency treatment service today would mean their resignation tomorrow. At the end of the day, we couldn't even offer the treatment on an elective basis."

PS. Unfortunately, extra-terrestrials have a different structure in their nervous system, and my opinion is in the minority. As the old proverb says, the road to hell is paved with good intentions.

Choice

Although not directly (and indirectly) involved in the process, I must say I understand very well the difficulty of recruiting new physician trainees as mentioned by MT.

In fact, it is quite a positive feedback and vicious cycle: If the department is well run and in harmony, everyone would like to stay; promotion prospect diminishes and there would be fewer place for new comers. The good thing is only the best applicants would be selected.

What you may not notice is the inadvertent effect: Consultants of those less advantaged hospitals (a term of my invention, hope you like it) tend to accept mediocre applicants - because, even if interns with an excellent academic record and working performance accept the job, they would inevitably default and take up a "better" offer.

PS. The unexplainable fact is, some consultants of those more advantaged hospitals continue to have a peculiar taste of picking new trainee - and do not see the simple fact that a healthy department needs people of different skills.

See what Florentino Pérez achieved in Real Madrid.