Coffee

After coming back from Austria, I have numerous nights without good sleep and need to begin each day with coffee. What, you might ask, is wrong with having coffee? The irony is that I had just returned from Austria, a country with great passion for coffee culture.

Most coffee aficionados know this. When ordering a cup of the brown stuff in Austria, a "coffee, please" doesn't suffice. You will find dozen of coffee variations in a decent Kaffeehaus (coffee house), where ordering simply "coffee" can never impress the waiters who take pride in their coffee variety. True, I won't forget the aroma of the Maria Theresia coffee. For amateur coffee drinker like me, nevertheless, I can't understand all the fuss.

"The more exposure people have to higher-quality coffee", my sage mentor once said, "the less willing they'll be to experience anything else." He is certainly right. People walking barefoot in poverty will never know how big a loss that would be for them to be denied the luxury of (nonexistent or unheard-of) Mercedes-Benz. To that end, I leave the Seven-Eleven, self-satisfied with a can of down-to-earth Nescafe coffee in my hand.

Chores

Try this. Ask a wife and a husband (or yourselves if you happen to be married) to estimate what percent of the time they each do the dishes, fold the laundry, walk the dog, make the bed, turn out the lights, and all the humdrum chores throughout the day. Can you guess what the answers would be? Their estimates will usually sum to more than 100 percent. This reminds myself how we human accept more responsibility for good deeds than for bad, and for successes than failures.

One of psychology's maxims is that most of our responses and behaviour can be explained by this self-serving bias. I think there is a lot of truth here. I have just used couples sharing house chores as an example to illustrate the point, not because they are the worst one being infected by the bias (they aren't) but because my domestic helper happens to resign recently. Be honest, medical doctors exhibit similar - if not more - degree of self-serving bias. We are keen to take credit for patients' improvement but tend to blame (treatment) failure on the patients. Sometimes our patient has cancer, say, and then suffers from relapse of the disease after one cycle of cancer drugs. Guess how we doctors describe the aforementioned fact, "Ms A fails the induction therapy."

You see. Is Ms A who fails or the drug prescribed by we doctors fails?

P.S. The guy who is writing this blog is not immune to such bias (Ouch!) – I tend to rate my writing as better than others.

Risk

An easy-to-read chart, intended for posting in physicians’ offices, has been recently described, comparing the odds of death in the coming 10 years for different ages and diseases. It was even suggested to have similar charts to be placed in the waiting room of every doctor’s office.

Risk, indeed, is a difficult concept, often mixed with emotion and mathematics. We humans tend to fear some diseases more than others. Some fears we exaggerate, others we underplay. Many women, for instance, worry breast cancer far more than heart disease, although five times as many women die of heart disease. The amygadala (a pair of almond-shaped emotional control centres within our brain's primitive core) sends more neural projections up to the cerebral cortex than it receives, as brain researchers noted. That makes it easier for our feelings to hijack our thinking than for our thinking to rule our feelings. Well, this sounds a little primitive for we genius humans, but it is really the case. In the forest, our ancestors – and probably me too - jumped at the sound of rustling leaves, leaving the cortex to decide later whether the sound was made by a predator or just by the wind.

Yesterday afternoon, medication incidents related to drug allergy were high on the agenda in my hospital, where people discussed the ways to curb the incidents of giving ampicillin (by mistake) to patients with known allergy to penicillin, for example. To my open-mouthed astonishment the Prime Minister proposed to stop keeping antibiotics at all the medical wards. This courageous move would theoretically force the doctors to prescribe and order medication from the pharmacy, which then scrutinizes the allergy list before sending the drugs to the medical wards. That being the case, you might ponder, it should help to save life. Great move? Let's step back and think. Think of the thorny delay in getting the antibiotic for an elderly hospitalized for pneumonia, in particular with the really long "boarding time" for our patients waiting for a bed in the emergency room nowadays. Of every 100 patients with pneumonia and delayed administration of antibiotic (say, after four hours), an extra patient will die, according to numerous published studies. Such inherent risk of delayed drug administration, as you can see, looms large as compared to the woefully meager benefit in double-checking the drug allergy by another human. I cannot help thinking about the metaphor of denying young people the availability of condom merely "for the sake of safety."

Alas, intuition (or hysteria, if you wish to call it) gone awry defeats rationality.

Reading

Should doctors or medical students read more literature? No, I am not referring to medical literature published in the New England Journal of Medicine here, but literacy reading in the area of humanities.

This question comes to my mind partly because I am currently reading Ian McEwan’s novel about a neurosurgeon who knows literally nothing outside the lens of his dissecting microscope within the operating theatre. His tale helps shed light on the mess of a doctor's life immersed in a universe of Latin and Greek names (running through the big list of items, alas, like hippocampus, abducens nerve, amygdala, globus pallidus, blah, blah, blah) and many many corporeal facts.

Not long ago, I heard about a medical doctor taking a three-month sabbatical to sit on an island in the Mediterranean and do very little more than reading novels. Does art really make people better doctors? Or is it too big a claim? Good question. Indeed, there is nowadays growing enthusiasm in accepting the value of arts and humanities in medicine. The public might soon want an educated doctor – someone who masters the requisite clinical skills and superb knowledge in anatomy, but also the talent to read a patient as a real human being with thoughts and emotions. Go and quiz the medical students the antidotes for opioid or benzodiazepine overdose, and most of them might be able to give you the answers. As for the pain pathway, some nose-to-the-grindstone students might even lecture you on the mu receptor. So, why bother the extra reading? If there is something doctors can learn from novels in particular, then perhaps it is the compassionate judgment. At the very least, a doctor needs to care (or bother, whatever you call it) in order to sense that a human is in pain. This, I must agree, can be learnt a whole lot more from a novel than from the Harrison’s Principles of Internal Medicine.

Urine

I was struck by how often the book Saturday by Ian McEwan led to revelations. Pearls are found throughout the story of a day in the life of Henry Perowne, a neurosurgeon and his minute-to-minute thoughts in reaction to those events.

One startling story is about the neurosurgeon's thought whilst flushing the loo, when he remembered a magazine lying around in the operating suite coffee room. At least one molecule of his own urine will at some time fall on him one day as rain, according to an article in that magazine. The numbers say so, by statistical probabilities, I presume. This reminded Henry Perowne the famous nostalgic lyrics "We'll meet again, don't know where, don't know when."

So, my hat's off, not to greet my own molecule of raindrops, but to the life lesson taught by this story. The lesson for the rest of us is pretty obvious. Think again, if it is really the case that someday somewhere we will meet again the one we appreciate as well as the ones whom we don't like, we might be able to treat everyone of them in an equal manner, and with love.