Shrink

If the tunnel fee of the Tate's Cairn Tunnel is raised, does anyone demur? On the other hand, if the grocery product - be it yogurt, toothpaste or toilet paper - shrinks in size without change in price, does anyone make a sound? Not much - and that's a problem.

Unbeknownst to most of consumers, manufacturers around the globe have been quietly trimming the content of their packaged products to maintain their profit margins. People might read intently the price tag during shopping and complain about the flagging economy. But trust me, most of us have never realised that decades-old tactic of product downsizing with the "same price". Under the disguise of a strategy called "weight out" in industry parlance, Dreyer's ice creams no longer come in the half-gallon (65 oz.) tub; the 12% smaller cartons hold only 56 oz.

All this - and there's much more, but I won't labour the point - is incredibly difficult for a consumer to take note of. Utter the phrase "consumer fraud" and the mind envisages a shrewd and cunning businessman in front of us. Now, I am having trouble deciding whether our health care management boss belongs to one of those businessmen. Reductions in services on the weekend are the norms in most hospital settings, under the disguise of restricting doctors' work hours (in order to minimize medical mishaps). Those of you who admire the improved patient safety, as a result of reduced sleepiness and fatigue of medical doctors, might not have paid attention to the staff shortfalls on weekends. All right, I am exaggerating - but only a little. If you don't believe me, come to hospitals and take a look at the hospital parking lots on weekends.

If you ask me what is the difference between downsizing the ice cream silently and cutting the hospital service on weekends, the obvious answer is that the former cost-control measure won't kill.

Erhu

Listening to her erhu teacher playing the instrument, as my wife told me, always makes her look stupid as a novice.

And her teacher said, "What does it take to be an erhu player? It takes audacity, devotedness and endless hours of playing erhu." The sentence went off in my head like a Roman candle.

The teacher went on to tell my wife his story when he was young: "When I was riding the bus to and from school, I clinched the passenger pole, running my fingers on that pole as if it was the string of an erhu. You need to tell yourself playing erhu twenty-four hours a day is feeling good." Then he added: "Even if it isn't." That sentence hit me hard.

It is hard not to be intimidated by his long hours devoted to playing musical instrument.

This leads me to the question how many working hours are enough — or too much — for doctors to learn. Many hospitals, including mine, have called for and mandated a reduction in doctors' working hours. Nobody really dares to answer for sure if medical doctors in training nowadays still have to work all night to learn how to heal? Often overlooked is that limited working hours can mean a step backward. Skills are lost, dependency fostered and patient care fragmented. And one thing seems certain: shorter and shorter working hours make us look small before an erhu guru.

Toothache

Once upon a time, a guy from Pluto came to visit a specialist gastroenterologist. "I hate to bother you, and as we all know, it is late," a voice pleaded eagerly. "But I'm in trouble and need to talk to you about my indigestion…"

"Fine – can you tell me how the indigestion is bothering you at such late hours?"

"Oh, yes. The stomach problem all started when I took the steak for my dinner."

"When did you start to have indigestion after taking steak?"

"Not a long time ago. I can be quite sure that the problem comes when my left lower wisdom tooth began to ache yesterday. It must be the culprit, I bet."

"I’ve got an answer to that!" screamed the gastroenterologist who has been exhausted after a whole day’s clinic work. "Gotta get your dentist - and not a gastroenterologist like me - to loosen the Gordian knot."

"Sure, my wisdom tooth used to be cared by my wisdom teeth dental surgeon, who happened to be on vacation. What a pity! How can I trust my incisor dentist who has been taking care of my incisor teeth but never touches my wisdom tooth?"

"Just a moment," the specialist gastroenterologist drew a deep breath and asked in a polite manner. "It is not for me to stick my head in there, but it's the left lower wisdom toothache that bothers you. Would it be fine, then, to let the right teeth to do the job?"

"No, no. You didn't seem to know my problems, Doc." Disappointment and resignation hang in the air. "Let me tell you, throughout the years, I chewed the steak with my left wisdom teeth, whereas the right teeth are dedicated to chicken meat. This is what we mean by specialised care."

Your jowls might drop when you hear this story. It won't take us long, nevertheless, to discover that similar stories abound at our specialised outpatient clinic. Amid all the frustration and annoyance, I have to learn that a bottle dedicated to carry urine for laboratory analysis should never be used to contain urine for another purpose, such as a dipstick test.

Titanic

The New York Times ran a story describing the discovery that the shipbuilder of the Titanic struggled for years to obtain enough good rivets and riveters and ultimately settled on faulty materials that doomed the ship, which sank 96 years ago Tuesday.

The selection of the rivets has been a subject of interest. Great ships like Titanic require three million rivets that acted like glue to hold everything together. In the case of Titanic’s rivets, the builder company ordered No. 3 bar, known as "best" — not No. 4, known as "best-best." Buying the No. 4 bars cost a lot more for the shipbuilders, but the cost of getting the selection wrong turned out to be much greater.

The pages of history are replete with examples of Titanic story. Even though we have had almost one century to learn the lesson of Titanic — on which more than 1,500 people died — the recurring theme of Titanic every now and then was almost a textbook example of how we humans keep on repeating the errors. The sinking of Titanic reminds me of an all-too-common condition of osteoporosis, or thinning of the bones secondary to aging. This devastating disease breaks the bone and renders a poor old lady in great pain – not to mention the healthcare costs of broken hip. Anyone of your granny who has been faithfully taking calcium supplements in hopes of staving off osteoporosis can be forgiven for being confused by our healthcare structure. In the public health sector, you simply have no access to measurement of the bone density – not to mention the "No. 4 bar" drugs that have been well proven to tackle osteoporosis.

Did I hear the word "shame"? Is it a shame to close our eyes and pray that the bones will stay fine but not fall apart like the Titanic? That question sounds difficult for our healthcare finance boss to grasp.

Quarter

Many years ago, a psychology professor showed that he could significantly change people's ratings of their own moods by arranging for them to "find" a quarter on the floor of an experiment room before they made their mood ratings.

A pretty fascinating scenario, you might think. And what better way to go beaming with joy after simply bumping into a coin than manipulating all those complicated molecules like endorphin and serotonin?

But think again. We are simply humans whose ups and downs can be the result of completely inconsequential events. The emphasis, perhaps, should not be on unleashing our high spirits after a minor incident such as finding a quarter on the floor, the positive (albeit unspoken) impact of which has rippled throughout centuries. Another lesson we can glean from that experiment is to appreciate how vulnerable we are – to be irked and shaken by trivial events. We don’t have to be taught to laugh after finding twenty-five cents. Rather, we need to learn to remain unscathed after losing five hundred bucks.

Doctors' Gender

A few days ago my consultant mentioned that female medical graduates outnumber the male counterparts in medical schools. Such a comment did not raise much of an eyebrow until my attention was caught by a recent study which found that male medical consultants, on average, completed 160 more episodes of care each year than their female colleagues in the United Kingdom.

Well, I dare say you can guess what happened and how people responded. From the viewpoint of quantity - which was always the focus of the economists, accountants and people at management level alike - these figures represent a setback, not to mention the females doctors juggling the roles of childbearing and spending time with their infants.

Ruminating upon this, my thoughts turn to the debate (or riddle) that male and female doctors can be equal. That reminds us the criticism that the book Men Are from Mars, Women Are from Venus increases the division between the sexes. In a similar vein, can't we see each gender as doctors and not by gender?

Don't ask me why, but when a female patient requests to be seen by a female doctor, the evidence for the fundamental difference between male and female doctors is overwhelming. And, think of a doctor scurrying between patient consultation at a gallop in the clinic, squeezing meagre time for teaching, leaving little (if any) for patient's question. How many times have you seen a male doctor - I won't deny it - like this?

The accompanied editorial in the British Medical Journal this week further reminds us that, after controlling for all demographic factors, male doctors in the United States were three times more likely than women to receive complaints and get involved in litigation. Another frequently cited meta-analysis (based on 23 observational studies of communication between doctors and patients and three large studies from doctors' own reports) in 2002 reported that female doctors spend more time with their patients, talk with them more, engaged in more emotionally focused talk, seek patient input more actively, and that their patients speak more.

Chances are male and female doctors can never be equal, other than the fact that male and female doctors are equally important for their complementary roles to medicine.