As a medical professional on the flight to Chicago this morning, I was called upon to see a gentleman who passed out twice after bouts of vomiting and diarrhoea.
It was not an exciting story. Instead, it reminds me the very first time when I, as a graduate medical student, was to help someone fallen sick aboard.
We were having the Outward Bound School sea diploma course then. The sea was rough, the majority of us miserable with throwing up. My teammates turned to me, who was supposed to be the best guy to treat their sea sickness. Medical doctor is surely the most appropriate one to be relied upon when you fall sick, except when it is not.
I dutifully reached across the bed in the cabin and fetched my stock of medicine. Nevertheless, I knew very well that my medical degree has never granted me a magic cure whatsoever for sea sickness. Worse, as I fumbled around the medication, I found not even a drug for motion sickness.
But I was not supposed to disappoint my teammates. "Friends, the good news is that I bring with me the best medication for sea sickness. The bad news is that I got one such marvellous tablet only." I announced. "Come on. Don't get mad with me. That being the case, we gotta help Jenny, who is the worst hit by the sea."
With that, I handed Jenny a "precious tablet", which was simply paracetamol (and has nothing to do with sea sickness).
She got far better after taking my remedy.
Thursday, October 30, 2008
Saturday, October 25, 2008
Work
After finishing my round on a Saturday morning, I was about to leave the hospital. I then heard someone calling my name, and it turned out to be an old friend of mine.
There followed a five-minute conversation starting with "What do you do?" on the corridor. This familiar conversation opener, whether you like it or not, is everywhere around us.
The way we ask or answer this question simply reflects how we identify ourselves in terms of the work we do. In virtually every society, people are defined by the work they perform. It is almost impossible nowadays to say that you "know" somebody without first knowing his or her job title. When we meet someone, the first question we ask is "What do you do?" In a wedding party, we often hear the question "What does the bridegroom (or bride) do?"
On the other hand, we seldom ask, "How do you spend most of your time?" So much so, in fact, that the latter is reserved as a tactful euphemism for asking the question "What do you do?"
There followed a five-minute conversation starting with "What do you do?" on the corridor. This familiar conversation opener, whether you like it or not, is everywhere around us.
The way we ask or answer this question simply reflects how we identify ourselves in terms of the work we do. In virtually every society, people are defined by the work they perform. It is almost impossible nowadays to say that you "know" somebody without first knowing his or her job title. When we meet someone, the first question we ask is "What do you do?" In a wedding party, we often hear the question "What does the bridegroom (or bride) do?"
On the other hand, we seldom ask, "How do you spend most of your time?" So much so, in fact, that the latter is reserved as a tactful euphemism for asking the question "What do you do?"
Thursday, October 16, 2008
Violence
Suppose you're going for dinner and the waitress forgets to place your order, keeping you hungry at the restaurant for thirty minutes without a good reason. What would you do? Never shall I forget the last time when the waitress tried to hide the mistake and asked me to tell her my order again "so that she could trace the dishes for me." Seizing on her mistake and her "courageous move" to deny and hide it, I rose to my feet and taught her a good lesson.
"Take the response of the waitress to the scenario of a doctor," I told my medical students yesterday, "and you will see the point of open disclosure after our making a mistake."
Whilst eschewing the hackneyed moral responsibility of beneficence (meaning "to do good"), I thought about the medical doctor scenario played out in a different setting such as restaurant or departmental store customer encounter. Yes, you might rightly scratch your heads and wonder about similarity of health care service and other customer service. But trust me, they are alike in an intriguing way, but differ under certain circumstances.
This leads me to my recent encounter with a patient who approached my secretary with hostility, "I want to see my doctor NOW. Don't ask me why, you stupid bitch, it's urgent but none of your business."
I phoned up the police.
If this scenario is played out in a different setting, say, when a customer confronts a shop assistant with demands to see her manager, the decision might well have been to calm the situation, hear the customer out under the "customer knows best" mantra. Why, then, is this so different in the health care setting?
Most of us – certainly I include myself – have a long way to go before we will accept that "our patients know best." And, even if you talk to a medical ethicist, he or she will not accept infinite tolerance to patients who are abusive or violent. Although you might argue that health care workers' primary concern is to act in the best interests of their patients, it is equally important to think about the welfare of our staff, and clearly that of a wider patient group instead of one single aggressive patient. It would seem only common sense to put aside the moral responsibility to a violent patient whenever the medical staff is put at risk by that patient's aggressive or demanding behaviour. This we know best.
"Take the response of the waitress to the scenario of a doctor," I told my medical students yesterday, "and you will see the point of open disclosure after our making a mistake."
Whilst eschewing the hackneyed moral responsibility of beneficence (meaning "to do good"), I thought about the medical doctor scenario played out in a different setting such as restaurant or departmental store customer encounter. Yes, you might rightly scratch your heads and wonder about similarity of health care service and other customer service. But trust me, they are alike in an intriguing way, but differ under certain circumstances.
This leads me to my recent encounter with a patient who approached my secretary with hostility, "I want to see my doctor NOW. Don't ask me why, you stupid bitch, it's urgent but none of your business."
I phoned up the police.
If this scenario is played out in a different setting, say, when a customer confronts a shop assistant with demands to see her manager, the decision might well have been to calm the situation, hear the customer out under the "customer knows best" mantra. Why, then, is this so different in the health care setting?
Most of us – certainly I include myself – have a long way to go before we will accept that "our patients know best." And, even if you talk to a medical ethicist, he or she will not accept infinite tolerance to patients who are abusive or violent. Although you might argue that health care workers' primary concern is to act in the best interests of their patients, it is equally important to think about the welfare of our staff, and clearly that of a wider patient group instead of one single aggressive patient. It would seem only common sense to put aside the moral responsibility to a violent patient whenever the medical staff is put at risk by that patient's aggressive or demanding behaviour. This we know best.
Saturday, October 11, 2008
Gawande
I have been enjoying a book teaching us to make fun of reading and how to enjoy writing. The author didn't say a lot about writing skills. Rather, it's the trick for staying in our writing chairs that really impresses me.
One of the most pleasant lessons was drawn from the perspective of Atul Gawande, an award-winning doctor-writer. The author quoted Gawande, "To be sure, talent helps… Nonetheless, attending surgeons say that what is most important to them is finding people who are conscientious, industrious, and boneheaded enough to keep at practicing this one difficult thing day and night for years on end."
"Skill, surgeons believe, can be taught," says Gawande. "Tenacity cannot… And it works."
And that makes me absolutely impressed.
As every one of us knows very well, it's hard to be mediocre, dogged, and to practice, day after day. During my childhood, I kept writing diary and I wrote plenty. Hmm, I then graduated, got a job, didn’t think a lot about the diary. Not a single page of diary thereafter. Never.
The wonderful lesson from Atul Gawande reminds me of my mentor’s willingness to keep practicing the same thing day after day. By the way, he is élite instead of mediocre, but it's rather beside the point. And, he does it anyway. He keeps blog writing, not to mention seeing his patients, days after days, years after years. This sounds flattering. I know. Bear with me. It's a tale I wish didn't need telling. I have lost count of the number of times I have been late for my clinics and rounds. I rush to the clinics late, time after time, and feel humbled and ashamed of myself whenever I find my mentor already there.
That's humbling, isn't it?
You decide.
One of the most pleasant lessons was drawn from the perspective of Atul Gawande, an award-winning doctor-writer. The author quoted Gawande, "To be sure, talent helps… Nonetheless, attending surgeons say that what is most important to them is finding people who are conscientious, industrious, and boneheaded enough to keep at practicing this one difficult thing day and night for years on end."
"Skill, surgeons believe, can be taught," says Gawande. "Tenacity cannot… And it works."
And that makes me absolutely impressed.
As every one of us knows very well, it's hard to be mediocre, dogged, and to practice, day after day. During my childhood, I kept writing diary and I wrote plenty. Hmm, I then graduated, got a job, didn’t think a lot about the diary. Not a single page of diary thereafter. Never.
The wonderful lesson from Atul Gawande reminds me of my mentor’s willingness to keep practicing the same thing day after day. By the way, he is élite instead of mediocre, but it's rather beside the point. And, he does it anyway. He keeps blog writing, not to mention seeing his patients, days after days, years after years. This sounds flattering. I know. Bear with me. It's a tale I wish didn't need telling. I have lost count of the number of times I have been late for my clinics and rounds. I rush to the clinics late, time after time, and feel humbled and ashamed of myself whenever I find my mentor already there.
That's humbling, isn't it?
You decide.
Monday, October 6, 2008
Gut Feeling
How many times have you been making decision by gut feeling, which turns out to be wrong?
To be fair, our brains tend to interpret the world within the limitation of sensory perception, which is incredibly biased and doesn't make sense at all. While we think that we are given choices, we have difficulty understanding the fact that we have been coaxed to follow the wrong instinct. Well, if you don't believe me, think about the example of making decisions on what we eat and drink.
Humankind behaviour is such that we have an unspoken tendency to eat (or drink) based on what our senses tell us is the right amount. It seems that every one of us ever since birth, perhaps without even thinking about it, would start crying when hungry and stop eating if full.
I remember studying physiology, and being struck by the tightly regulated feedback loop of satiety signals. Is it true? The literature teems with studies showing how vulnerable we are to bias. Lots. Think, for instance, about the popcorn that moviegoers buy. In a famous psychology study, two groups of people were asked by researchers to rate a movie. As part of the study, each group was given a free bucket of popcorn. One group received an extraordinarily large bucket of popcorn whereas the other got a medium bucket of popcorn. At the same point in time the buckets of popcorn were taken away. Alas, the group with the largest bucket ended up eating a whole lot more popcorn within the same amount of time than the group with the smaller bucket.
What's more, visual cues from the portion size affect not only how much we eat, but how much we drink. I read about an interesting study in which both lean and obese young adults were given a meal of tomato soup in special bowls for lunch. The tricky "self-refilling soup bowls", unbeknownst to them, slowly refilled as their contents were consumed. Believe it or not, these individuals took 73% more than those who consumed tomato soup from normal bowls. Of course, as you might have guessed by now, they did not believe they had consumed more than those who consumed more, nor did they report being more satiated than the other participants.
Oh dear.
No wonder the average dinner plate nowadays is much larger than those used before the 1980's. And yes, as soon as I learn about these funny experiments, I am thinking about bringing my own dinner plate to celebrate the promotion dinner with Bonnie tonight.
To be fair, our brains tend to interpret the world within the limitation of sensory perception, which is incredibly biased and doesn't make sense at all. While we think that we are given choices, we have difficulty understanding the fact that we have been coaxed to follow the wrong instinct. Well, if you don't believe me, think about the example of making decisions on what we eat and drink.
Humankind behaviour is such that we have an unspoken tendency to eat (or drink) based on what our senses tell us is the right amount. It seems that every one of us ever since birth, perhaps without even thinking about it, would start crying when hungry and stop eating if full.
I remember studying physiology, and being struck by the tightly regulated feedback loop of satiety signals. Is it true? The literature teems with studies showing how vulnerable we are to bias. Lots. Think, for instance, about the popcorn that moviegoers buy. In a famous psychology study, two groups of people were asked by researchers to rate a movie. As part of the study, each group was given a free bucket of popcorn. One group received an extraordinarily large bucket of popcorn whereas the other got a medium bucket of popcorn. At the same point in time the buckets of popcorn were taken away. Alas, the group with the largest bucket ended up eating a whole lot more popcorn within the same amount of time than the group with the smaller bucket.
What's more, visual cues from the portion size affect not only how much we eat, but how much we drink. I read about an interesting study in which both lean and obese young adults were given a meal of tomato soup in special bowls for lunch. The tricky "self-refilling soup bowls", unbeknownst to them, slowly refilled as their contents were consumed. Believe it or not, these individuals took 73% more than those who consumed tomato soup from normal bowls. Of course, as you might have guessed by now, they did not believe they had consumed more than those who consumed more, nor did they report being more satiated than the other participants.
Oh dear.
No wonder the average dinner plate nowadays is much larger than those used before the 1980's. And yes, as soon as I learn about these funny experiments, I am thinking about bringing my own dinner plate to celebrate the promotion dinner with Bonnie tonight.
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