Tradition

A few days after dinning with our past college president, I was (together with a few colleagues from other departments) invited to lunch with our new university college head.

For those who are not familiar with the structure of my university, it runs in terms of both faculties and colleges, the former govern teaching and research, while the latter focus on student affair.

Although there are now nearly a dozen of colleges in my university, there were three to start with. One with a religious background, another supported by business people, and the third has a strong tradition of Chinese culture.

I belong to the last – both as a medical student and, by coincidence, when I joined as an academic staff.

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

In the middle of the lunch, the head sighed, “You know, many of our students and alumni comment that our college motto has died. No one seems to be interested in upholding the traditional Chinese culture, and I find it impossible to promote the idea.”

“I don’t think it’s dead – but it’s certainly much diluted,” I could not refrain from coming out, “When there were just a few colleges, each could have it’s own personality – if I could use the description. When there are some many new colleges, the face and character of each become blur, and it becomes more and more difficult to tell which college is which. And, to get along with a sea of other colleges, we are forced to give away piece by piece of our own character.”

In other words, the paradoxical happening is, although the university tries to promote heterogeneity of culture by having more colleges, we end up having less individualism because all colleges are very much similar.

Blind

Dine with a group of senior physicians.

This is the first time I dine with the man from Pluto since he moves outside the solar system.

There weren't many serious discussion, just some little old funny stories to share, and the table enjoyed an excellent evening of nostalgia.

Here is an interesting one recollected by a previous president of our college, encountered when he was a medical student:

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

(In the out-patient ophthalmology clinic.)

Doctor (after examining the patient, who was an aged woman): You come too late. Now you are totally blind and we can do nothing. You should really consult a doctor earlier.

Patient: I did. In fact I was seen in the TW hospital. It was that unutterable little jackanapes of a foreigner doctor who ill-treated my eye and made me blind ... (a burst of three-word Chinese).

Doctor: Why! Can't you recognize me? I am that foreign doctor! What the hell ... (and he returned a series of four-letter words).

And our president-to-be had a good dose of education on spicy colourful explicit vocabulary.

Multitasking

On a second thought, the problem of having too much thoughts going through our mind is not only the difficulty of physicians - every mature adult faces the same difficulty.

For example, in addition to the entirely legitimate and scientific considerations that Danielle Ofri alluded to, I find myself having some additional synaptic activity on slightly unrelated areas:

• That diagnosis code in the computer is not quite right. Shall I spare a minute to amend it (so that my department could get probably a few more cents in the next round of resource allocation exercise) ?
• The discharge summary of his last hospital admission is a rubbish. Shall I spare a moment and call that house officer to give her some education (in whatever sense you prefer to believe) ?
• This chap sounds a suitable candidate of a clinical trial that my colleague just started recruiting. Shall I explore further ?
• Oh, he has a good murmur. Shall I ask him to come for our MRCP examination ?

If you think that's not enough, I've omitted the other epileptic foci from personal, financial, family problems.

And, by then, you would come to appreciate the traditional Chinese wisdom:

竹前坐消無事福，

花間補讀未完書。

What a good fortune.

Problem

You may consider I think too much on those absent students and the response to VW. Well, I agree I had a surge of neuronal activity - an inevitable habit of a physician.

In fact, just now my friend KM quote in his Facebook a recent Lancet article by Danielle Ofri (Neuron overload and the juggling physician, on 27 November 2010, p 1820-1821), which express the difficulty of being a doctor - one has to consider too many (inter-related) problems that no time could be spared to listen to the patient.

This little essay actually brings my memory back to a conversion I had many years ago with the man who used to have a moustache - at the time when I just joined the nephrologist training.

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

"Many of the patients are very complicated," I sighed after the round.

"You think so?" My mentor said.

"Of course. I am coming to the conclusion that anyone who could speak out - without taking a second breathe - the list of medical problems that this patient has, or the list of medications that he is taking, has a lung function good enough for general anesthesia!" I smiled, pointing at one particularly complicated patient.

"Yes, his problem is complicated," the professor smiled back, "But that's where the challenge comes along: you've got to make it simple."

"Well, yes ... but how?" For a moment I though the man who still had a moustache was saying nothing but a Sunday school truth.

"A good start is, each time when you see a patient, you identify the single most important problem - maybe out of a thousand of them - and focus your effort to tackle that one." He said calmly.

I nodded, reflecting this insightful advise for the rest of the day - or the rest of my career.

Responsibility

If we believe our students are not apathetic, we are forced to the conclusion that they see the whole issue quite different from us (alas, aged old-fashioned chaps), and they consider seeing patients a responsibility.

Is that a correct view?

I don't think we need to tell - we have just to act accordingly.

In other words, if they see it a responsibility, we should enforce the idea and set up an environment and regulations so that they have to fulfill the requirement. For example, we ask for seeing, presenting, examining, and writing up a certain number of cases. If it turns out that the old world is right, the students would get the benefit - even though they may not be aware of it.

As Franz Kafka said, Die Lüge ist für die Ordnung der Welt. (The lie is made for the world order.)

In contrast, if we are at the wrong, there's nothing to lose. Those tasks are responsibilities of the students; they shouldn't expect getting any benefit.

And, the doctrine is: People who see opportunities in their responsibility would prosper.

Apathetic

You may ask: Which suggestion is more likely (or, more common) for our students?

I have no idea. To begin with, I believe most of our students are intelligent. (After all, they rise to the top.) It seems reasonable to assume they could see the benefit of learning from real patients.

In that case, they are apathetic.

And this is exactly the worrying phenomenon as pointed out in Kong Kid (港孩) by Wong Ming Kit, which I briefly discussed previously (see http://ccszeto.blogspot.com/2010/08/child.html).

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

Around the same time, I had the rare opportunity to lunch with my friend JW.

"I am more involved in the college activity of the university recently, and it is really eye-opening," my friend said, "You know what, the university has now some 20% of students coming from the mainland, and they're just different from the local ones. When we hold gathering between students and teachers, or have a talk from outside speakers, most of the delegates are mainland students - and they are eager to ask questions. In contrast, local students hardly turn up - they are just not interested."

That's worrying, I agree.

Privilege

Further to my experience (or missing the chance of having some experience) with our third year students, my friend VW met them, and the encounter proved disappointing - to both side, I suspect. (See http://vwswong.blogspot.com/2010/11/extra.html)

The root of the discrepancy is obvious: To the students, seeing patients and observing what (say) our professor of hepatology does - without a didactic teaching - is their responsibility. To the young professor, he calls it a privilege to learn.

I shall not elaborate what I think is right. (Frequent visitors of this blog know just too well I am always suspicious of the existence of absolute right and wrong.) Nonetheless, the underlying mental process seems worth exploring.

Don't you see the point? There are two possibilities for the students' explanation to VW:

1. They understand, maybe subconsciously, that learning from patient is a privilege, but they are too apathetic to seize the opportunity.
2. They sincerely believe the whole business is their responsibility; the privilege that VW talks about is merely the romantic idea of a naive academic.

You may say neither is true - the students did not turn up because they were focusing on their panel examination. Factually, that's correct - but that's quite beyond the point. It is the choice of wording that the students put up as the explanation that intrigued us.

PS. This method of psychoanalysis is not my invention. For example, as pointed out by Humphrey Appleby, any statement in a politician's memoirs can represent one of six different levels of reality:

1. What happened.
2. What he believed happened.
3. What he would have liked to have happened.
4. What he wants to believe happened.
5. What he wants other people to believe happened.
6. What he wants other people to believe he believed happened.

Go read Yes Minister.