Leave

After the Nestle drivers and delivery workers ended a three-day-old strike, we heard a new story from another bank company in Hong Kong. To my amazement, they announced granting a day off for the employees on their very days of birthday. Like many "aha" ideas, it's so simple you wonder why nobody had thought of it before.

Why? You might ask. As Gordon Livingston has pointed out, life's two most important questions are "Why?" and "Why not?" The trick is knowing which one to ask.

If we are to program a computer to simulate a model of absence from work, it should probably take a whole year to complete the task. Absence from work is a strange term – but we've got quite used to it. The dictionary describes it as "nonattendance at work by an employee when attendance is expected by the employer." Think of it as not quite a simple phenomenon but more than mere human behaviour of calling in sick.

We may propose that much absence is attributed to sickness. Or is it?

If sickness is a major (true) cause of absence then one would expect absence rates to have fallen over the past 100 years as health care has improved. As a matter of fact, the rates of absence have not declined; they started to rise in all industrialized countries from about 1955. Clearly, sickness alone cannot be the sole cause of absence.

But I digress. How about an entitled leave on your day of birthday? This is not to say that leaves cause no blips. The fundamental difference between such leave and the absence by phoning in sick, as we can imagine, is that the former is planned ahead and therefore less costly to the organisations. This might not have measurable impact on the absence rates, I must admit. After all, the best litmus test touted for predicting worker absenteeism remains to be economic model. An essential tenet of the economic model is that employees absent themselves in order to engage in more attractive alternatives. This means that when unemployment is high absence rates would tend to plummet, indicating that employees may be considering the trade-offs (cost-benefit analysis, in technical terms) when they decide whether to phone in sick. If being absent implies a greater chance of job loss when jobs are scarce, the relative value of leisure may decrease.

All right, I am exaggerating – but only a little.

Birth

My colleague raised questions about the developmental milestones of babies and toddlers this afternoon. Can we imagine what we are able to do after birth? To be honest, not much.

As I reflected on what I managed to do after birth – I had premature birth - I was drawn back to those scenes of National Geographic, where a newborn elephant (not to mention our immediate ancestors chimpanzee) is able to walk with the herd and hold onto his mother on the very first day of life.

To that matter, what are we to think? Are we humans born too soon? Good question – to which I'm afraid the answer is affirmative. In biological or anthropological terms, precocious animals (like us) are born helpless and must be fed and taken care for a long time, whereas altricial species (such as gorilla and elephant) refer to those relatively mature and mobile from the moment of birth. The question, as you might then ask, is why we are born so soon, putting ourselves in even more jeopardy in case of premature birth (like me).

For example, a renowned anthropologist has concluded that human beings should have a 21-month gestation period, instead of 9 months in our mothers' womb and 12 months out of the uterus. From my anthropology reading, the most important reasons for our "premature" birth are related to the bipedal gait (walking upright with two rear limbs instead of walking on four) and our large brain. Compare us with the monkeys and the great apes. Their infants are always delivered in an occiput posterior position, facing their mothers. Imagine giving birth to your kid as a monkey mother, inside a forest with enemies around you. The occiput posterior positioning of your baby is the best way for you to guide it out of the birth canal towards your nipples and wipe mucus away from its mouth to assist breathing. You simply do not require assistance. It is much safer to give birth alone, away from your rivals and predators.

For humans, the evolution of a bipedal gait and a large brain has brought about competing demands (or adaptations) in the shape of the human pelvis. The human (female) pelvic outlet became smaller than our primate ancestors, making birth more difficult for humans. To overcome the ordeal of obstructed labour, almost unheard of in other primates, human infant is to be born in an occiput anterior position, facing away from its mother. This creates difficulty for the mother, as attempts to guide her infant out of the birth canal may result in extension of the head and damage to the infant. It is this disadvantage that has resulted in the involvement of others to assist childbirth. Contemporary anthropological studies of aboriginal cultures confirm that assistance during childbirth is universal. Obviously, midwifery has developed not as a result of conscious endeavour on the part of human beings; rather, its origin is in the evolution of human beings, where by a process of natural selection women who were more likely to accept assistance during childbirth were more likely to withstand the rigours of a long labour, and survive. That being said, human babies have to be born early, before getting too large and then obstructed on the way out of the narrow pelvis.

Call it old wives' tales; call it evolutionary speculation; call it, as Darwin did, "content to remain an agnostic" – whatever you call it, there seems a grain of truth in the story.

Heart Breaking News

There is no better way to learn making reckless conclusion on hearsay than reading the "stunning" newspaper story in Hong Kong.

Lest you doubt the impact of heart-breaking news among the local media, consider the recent talk of the town concerning patient death after the doctors' attempt to open the blocked arteries with balloon.

The balloon procedure meant to prop open an artery, called angioplasty, is always a high-stakes treatment decision (or gamble, if you like) and in particular so if performed in an emergency setting. Cataclysmic uproars after the death of two patients undergoing such procedure is fueled by the large-circulation newspaper coverage with eye-catching words like "irrational heroic medicine", "victim of the cutthroat hospital", and so forth. Along with the front-page news comes a flurry of charges to lambaste the hospital in question. On this matter, I find it disheartening to believe that only one newspaper quoted the viewpoint (alas, from representatives for the patient rights) that dissemination of stories like this might not be in the best interest of the community because they discourage medical doctors from providing treatment for high-risk patients with heart attacks.

This reminds me of the famous legend about a newspaper editor who hits a pothole on his way to work, spilling coffee all over his new suit, and immediately orders a series on street maintenance when he arrives at the office. It is simply tragic for our newspaper editors and reporters to act on the prima facie evidence, in a knee-jerk manner.

If you don't believe me, read the newspaper.

Weather

One of my favourite sayings comes from Richard Carlson, author of the Don't Sweat the Small Stuff series, "There's no such thing as bad weather – only different kinds of good weather."

I admit it. There are times when I was too serious about weather, getting myself overwhelmed and uptight.

When I first arrived at Hallstatt in Austria last month, I met all that rain. The city, supposedly rich in pastel-coloured houses casting spectacular reflections onto the glassy water of the lake, did not seem to live up to its fame. To my amazement - believe it or not - the rainy day finished with a breathtaking rainbow over the scenic lake. Now and then, we are blessed with all these wonders. At first, my younger sister got disappointed with the rainy weather during her maiden outdoor photography trip at the Peak (with the new camera I bought her) this Sunday. Bad luck? Not necessarily. By noon, we were soon enthusiastic to take countless shots of the fabulous waterfalls that one can never see on a sunny day. I was overjoyed, and still am.

In a way, I have learned the tricks and come to appreciate all these different kinds of "good weather." The downpour and lightning this morning, for instance, did not seem to annoy me even though I ended up being trapped in the elevator. After all, I cannot demand that weather be fired or resign on the basis of its "bad character."

At any rate, the weather is what it is, and it obviously won't care what we think about it. Let it be.

Skating

As the saying goes, you can't teach an old dog new tricks. While there may be a grain of truth in this, I am inclined to think the opposite. Whatever your age, taking time off to do something different can be one of the best times of your life.

I decided to learn ice skating this year. The other day, I went to the ice skating rink after work and asked about lessons that fit my schedule. The receptionist at the counter smiled, apparently having already figured out my mind. "Yes, we have skating class for beginners," she replied. "May I ask how old your kid is?"

Denying adults (ahem, like me) the right to learn skating simply because they have a lot of candles on their birthday cakes reeks of ageism. When my friend heard of my joining a beginner skating class for the first time last night, he almost laughed his head off. Oh no, not any more. There is no question that old dog cannot learn new tricks. It can't. And you can't. You can't teach an old dog. Don't worry. I can simply learn to stop calling myself an old dog.

Problem solved. Case closed.

Disclosure

On my way home after dinner with my first-year medical doctor colleagues, I had a chat with one of them.

We spoke about disclosure of medical errors, which haunt bitterly many of the doctors - young and experienced ones alike. Such stories are always cropping up in the news nowadays. Hardly a day goes by without the press reporting medical errors. What if you prescribe the wrong medication to your patient who gets into trouble? What about wrong diagnosis? Or worse: Should you make immediate disclosure if you cut something which you shouldn't in the operating theatre? And yes, I did make one such blunder last week.

Time and time again doctors make mistakes, each time we agonize over whether to disclose the story, but every time the debate goes on with a barrage of controversies.

That reminds me of the maxim by James Hacker (from my favourite book Yes Prime Minister): If you are incompetent you have to be honest, and if you are crooked you have to be clever. It would, of course, be just naïve optimism for medical doctors to rate ourselves as always competent, not to mention clever. If that is the case, candid and early disclosure is a legitimate option, isn't it?

Internship

The month June comes to an end. That means another new batch of fresh graduates from the medical school.

Utter the phrase "new interns" and the mind envisages the relentlessly action-packed life of a harried and sleep-deprived neophyte, frustrated and surrounded by murmuring patients inside a hospital where he or she knows very little.

Medical intern training is known – and often despised - as a source of stress (and it is), fatigue (that too) and endless crises that need to be resolved (guilty there as well).

We can argue all day about where to draw the line between medical on-the-job training and reasonable workload. But trust me, it is this very first year of medical internship where most of the doctors learn, in ways no medical textbooks or lectures could deliver. It has been said that medical schools do not graduate physicians; they graduate young men and women who are prepared to learn to be physicians during subsequent years of increasing responsibility and stress.

I am not trying to whitewash or defend the medical education system where budding interns get their training tethered to the extended duration shifts and long hours of sleepless work. All I am saying is that we do have to find ways to overcome the stress during the training. Level of stress and mental performance is best illustrated by an upside-down U graph or Yerkes-Dodson Law. Simply stated, stress varies with challenge; at the low end, too little breeds disinterest and boredom (as any intern with tonnes of clerical job can testify). When the challenge increases it boosts interest, motivation and sense of great pride – which at their optimal level produces maximum cognitive efficiency. As challenges continue to soar and become overwhelming, stress intensifies; at its extreme or tipping point, the interns’ performance and learning collapse.

Neat solution? Nope. Obviously, fresh graduates cannot solve all the problems. The key point, perhaps, is to acquire the ability to recognize when one needs help – before the straw breaks the camel's back.