In his elegant book All I Really Need to Know I Learned in Kindergarten, Robert Fulghum teaches us many golden rules that we can extrapolate into the sophisticated adult world. Very true. Another way to appreciate his wisdom is to see how the subsequent teachings after our kindergarten can be remarkably wrong.
As we move on from the kindergarten to elementary school through graduate school, we learn the mathematics. We were taught that "one plus two equals three" and then "minus one plus one balances out each other." Simple enough? Unfortunately, this doesn’t happen in real life. Imagine two grown-ups fighting with each other (that happens every now and then!). First, one slaps on the face of another, who then returns with another slap (and makes sure that the blow lands with the same force). It should be obvious that such equation cannot be computed from what we learned from the mathematics class. Anyone with an iota of common sense, let alone those who have attended kindergarten, realizes that "one plus minus one" here does not add up to zero.
Am I making too much of this?
Not really. I wasn't sure how many of us have tried to re-do something that we did it wrong at the first place, keeping the false hope that "minus one plus one" would negate each other. My patient went home after being hospitalized for chest pain and developed a major heart attack two days later. I called him and asked if there is anything we can do (to be exact, re-do) for him. No way! He didn't want to see us again.
Admit it. Minus one plus one never adds up to zero – not anymore after our kindergarten days.
Saturday, March 29, 2008
Monday, March 17, 2008
Age
On the weekend evening, I sat with my old classmates at an outdoor food stall when a waitress said to us (not my classmate's son!), "Hey, young boys, anything to order?"
What are we supposed to feel about her remark? Must we see it as lip service? Or do we quietly congratulate ourselves for appearing young? Would it be terribly stupid to grow old and yet acknowledge we remain young?
Absurd as it might seem to you, that depends upon how you define "young." One thing is for sure: we are living longer. Centenarians, who were encountered at a frequency of an appearance of Halley's comet, are now everywhere. Numerous countries have raised retirement ages by as much as five years.
Indeed, an unprecedented increase of the "oldest old" has simply pushed the definition of "old" farther. Imagine my medical student addressing a 55-year-old patient "senior citizen" when his 96-year-old granny has just come to visit him.
It might not be accurate to call me "young boy", but neither is it appropriate to call anyone older than your dad an "old guy."
What are we supposed to feel about her remark? Must we see it as lip service? Or do we quietly congratulate ourselves for appearing young? Would it be terribly stupid to grow old and yet acknowledge we remain young?
Absurd as it might seem to you, that depends upon how you define "young." One thing is for sure: we are living longer. Centenarians, who were encountered at a frequency of an appearance of Halley's comet, are now everywhere. Numerous countries have raised retirement ages by as much as five years.
Indeed, an unprecedented increase of the "oldest old" has simply pushed the definition of "old" farther. Imagine my medical student addressing a 55-year-old patient "senior citizen" when his 96-year-old granny has just come to visit him.
It might not be accurate to call me "young boy", but neither is it appropriate to call anyone older than your dad an "old guy."
Sunday, March 2, 2008
Moderation Rules
New technology and science make numerous dreams feasible. But it takes us long to realize that the spectacle of high-tech science does not necessarily make life easier.
"We won’t have long to wait to find out this," I told myself after my preparation of the teaching material for an intensive review course for doctors sitting for examination.
At a glance of recent medical literature, the rule of moderation strikes me. As a matter of fact, the title of this blog can be read either in the straightforward sense of "rules about moderation" or in the graffiti sense of "moderation rules!"
For example, two recently published compilations of clinical trial data — called meta-analyses — tell us that normalizing the haemoglobin levels of our anaemic patients with kidney failure or cancer by the high-tech anaemia drugs can hasten their death, instead of doing them good. I was soon reminded of recent evidence that liberal blood transfusion actually do more harms than benefits in critically ill patients with low haemoglobin levels. Low haemoglobin level has been thought to be dangerous, but pushing it high might not be wise, either.
What next? We are then taken aback by the recent news that a big clinical trial was halted prematurely when a startling increased risk for death was noted among diabetic patients who were assigned to intensive glucose-lowering therapy.
So. What have we learnt? The close resemblance of this moderation rule from clinical trials performed virtually everywhere on this planet is striking. To me that sounds convincing. But, I simply wonder if we should apply the same moderation rule to our kids who are nowadays caught up in an endless race of extra tuition sessions, tennis classes, piano lessons, French courses - and the list goes on.
"We won’t have long to wait to find out this," I told myself after my preparation of the teaching material for an intensive review course for doctors sitting for examination.
At a glance of recent medical literature, the rule of moderation strikes me. As a matter of fact, the title of this blog can be read either in the straightforward sense of "rules about moderation" or in the graffiti sense of "moderation rules!"
For example, two recently published compilations of clinical trial data — called meta-analyses — tell us that normalizing the haemoglobin levels of our anaemic patients with kidney failure or cancer by the high-tech anaemia drugs can hasten their death, instead of doing them good. I was soon reminded of recent evidence that liberal blood transfusion actually do more harms than benefits in critically ill patients with low haemoglobin levels. Low haemoglobin level has been thought to be dangerous, but pushing it high might not be wise, either.
What next? We are then taken aback by the recent news that a big clinical trial was halted prematurely when a startling increased risk for death was noted among diabetic patients who were assigned to intensive glucose-lowering therapy.
So. What have we learnt? The close resemblance of this moderation rule from clinical trials performed virtually everywhere on this planet is striking. To me that sounds convincing. But, I simply wonder if we should apply the same moderation rule to our kids who are nowadays caught up in an endless race of extra tuition sessions, tennis classes, piano lessons, French courses - and the list goes on.
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