Freedom

I must say in spite of my disapproving attitude, I didn't really stop that woman to talk about her alternative regimen. My logical mind says that I shouldn't do that - for freedom of speech is a human right, and, as Voltaire said, although I do not agree with what she says, I shall defend to death her right to say so.

But, am I doing my duty (of protecting other patients' welfare) if I allow that woman to disseminate wrong information on a potentially harmful treatment?

If you become slightly uncertain, let's go one step forward: What if this woman is the owner of a large company involved in the trading of free-range chicken and pumpkin from organic farms?

PS. As a believer of David Hume (that's a self-contradicting term, I know), I also doubt my own ground: Am I all certain that I know the best treatment and what that woman said is a total rubbish?

I always worry I may have unknowingly taken the apple from the Tree of Justice in Eden.

Remedy

This very woman obviously did not sense my tone of disagreement and went on with her speech.

"You know, it is an old traditional Chinese remedy - but a very simple one too. All you need is 1 tael of fresh red pepper seed, 2 taels of chicken oil, 3 taels of meshed pumpkin, and 4 taels of steamed gelatinous rice, thoroughly mixed and to be taken twice a day. Other than that, you can take whatever you like. No dietary restriction what-so-ever, and it cures 90% of all kidney diseases. Isn't it fantastic?"

I tried my best not to laugh aloud, wondering what appetite is left for the patient after taking such a splendid feast of medicine. However, I would like to pretend to be nice, "Em... madam, isn't this remedy too simple?"

"Doctor, you are pulling my leg. But I am serious. First, not every chicken is suitable for making the oil. It must be free range ones (走地雞) that never receive artificial feed, antibiotics, and hormones. Similarly, we can only use pumpkins from organic farms. Any trace of chemical fertilizer or insecticide is not acceptable."

"That seems more complicated. Although an easy remedy it first seems, there is a quota of live chicken for the Hong Kong market, and pumpkin from an organic farm is not easily available. How many patients could actually be treated with this remedy?" I continued with a polite smile.

***************************
On my way home after the seminar, I was confused.

No, it's not about traditional and alternative medicine. My mind was absorbed in a more profound question:

Should I shut her up?

Cure

As a rule, I do not describe in this site my clinical encounters. Nonetheless, a recent incident really caught my attention.

(No, it's nothing exciting. I am only interested in trivial and unimportant matters.)

The story goes like this: My unit conducts a bi-monthly patient education class for patients with kidney disease, and we doctors take turn to sit in and give some occasional comments in case an audience put up some difficult medical questions in the Q&A session.

It was my turn last month. Towards the end of the two-hour session, an elegantly dressed middle-age woman, who was sitting at the front row, put up her hand and said, "Excuse me. I have something to share."

"Yes...?" My mental alarm rang. That sentence is no ordinary statement that a common-place patient would begin with.

"You know, I have here with me a secret remedy that can cure all kidney diseases."

"Really!? What's that all about?" I felt light beaming from my eyes.

Pride

I could sense the hue of irony in L's reply.

"What happened in reality?" I asked.

"Nothing," my friend continued with his wicked smile, "Or I should say the business of the two shops remain very much the same. If anything, the real big spenders tend to go to H a trifle more."

"Why should that be the case?"

"That's quite natural. First, many potential customers pick a brand of handbag rather than the other by the brand per se; customer service has very little to do on the decision. If the craft and material of one brand is better than the other - or, if, in reality, one brand is the market leader because of a longer tradition - customers from a strong nation will follow their tradition and vote by their legs."

"I can understand that. But I suppose many of the customers do not have any pre-determined idea on which shop to go?"

"Very true. But, you know, handbag is something that they carry along with them, probably for many many years. The bag is a symbol of the owner's pride and something to show off. A shop run by cool and mask-face shopkeepers would be interpreted as elegant and high class, while an excessively friendly and obedient team of servant may appear to be grovelling - the honor of getting into the shop would be, ironically, depreciated."

Greet

(L went on to tell his story.)

"Szeto, I suppose you know the usual happenings. Everyday, early in the morning, there are a hundred people or so lining up outside the shops of C and H - they are all wealthy potential customers waiting to get admittance to the stores!"

I nodded.

"And, you know, both brands are eager to attract all big spenders. For that purpose, C comes up with a new tactics recently."

"What's that?"

"Alas, before the business hour every morning, shopkeepers of C will go out of the store and greet - in the most hearty way - all those people who are lining up and waiting. The idea is simple. People should choose the shop that has a better customer service and whose staff is more friendly."

"It sounds a good move." I remarked.

"Yes... or so we should imagine," L put up a mysterious smile.

Shop

As you may expect, as soon as I conclude that patients may not be in the best position to assess their doctors (especially physicians) because emphasis would be put inadvertently on skin-deep manner and short term symptom relief rather than genuine long term benefit, I come to realize students (not only medical students) may not assess their teachers properly.

But I could not dwell on this topic very long. I met L that evening and was about to tell him what I learnt in the specialty board examination. But, my friend was not in the mood.

His mind was obviously engaged in something else.

"You know, I went pass TST several times in the recent weeks," he explained, "To put it simply, I am intrigued by how those shoppes compete for business."

I nodded, because I knew what L meant. TST is the mecca of shopping and there are several dozens of famous stores, all selling exquisite and expensive shoes, handbags, jewels, and what not.

"So, have you heard of the recent story of C and H - the two most prestigious brands of handbag?"

Of course I had no idea.

Delayed

After the examination, when I reflected what FK said, however, I was not that sure.

My concern is simple: Could patients judge which doctor is good and which not?

Don't gasp. Yes, for treatment with short term immediate effects (for example, surgery), it would be obvious to the patient whether the doctor has done a good job. However, for physicians who take care of the long term medical problems (notably prevention and risk reduction in various aspects), good and lousy ones are usually not immediately discernible. In this situation, patients generally become clients or customers and judge their doctors by their manner and attitude, as well as their capability of providing short term symptom relief.

Oh, I'm not saying these latter aspects are not important in the overall medical care. Nonetheless, over-emphasis on immediate result may compromise the long term benefit, and a nice doctor may well pave his patient's road to hell.

PS. Do you know the difference between how Alex Ferguson and José Mourinho run their football teams?