Walk the Talk

When we fall in love with arguing with people, it is a good feeling that will lead to a darn bad effect. Dale Carnegie claimed that we can't win an argument. We can't because if we lose it, we lose it; and if we win it, we lose it. Why? As often happens, the moment we triumph over the other man and shoot his argument full of holes in an apparently landslide victory, we feel good. But that particular person gets hurt and resents our triumph. And, according to Carnegie, a man convinced against his will is of the same opinion still.

Let me tell you my story. My friend phoned me up yesterday about her mum, who has been seeing me for high blood pressure. She is worried about the "water pill" that I gave her mum, and asked for a "better one." Not every doctor would like the idea – and I bet that many do not – to be challenged. I wasn't sure I'd heard her correctly. "Problem?"

"No, not really, but in case that medication gets rid of too much salt from my mum."

I sighed. I knew there seemed to be nothing I can do, although I have checked her mother's salt level after starting the humble medication. She'd won and I knew it. That medication, indeed, is far cheaper – at least ten times less expensive than those you see in the advertisement. "Fine," I said humbly, "I'm glad that you raised the concern, and yes, I couldn't see the problem with switching to another class of drug. Let me know when she is ready to come to see me."

One final reference was necessary, I thought to myself, after hanging up the phone. So I sent my friend a short message, "Forget to tell you I give the same drug to my mum for her blood pressure. It is not a second class drug, really."

Do I have to tell you the rest of the story, when she replied me about her final decision last night?

Counts

I would be lying if I told you that I never pay attention to the whims and words of others. It is not that the external opinion is the gold standard of judging ourselves. We are simply human beings who tend to fall prey to the others' view. When the story of our hospital or unit appears in the press, I simply can't ignore it and then answer like Socrates who was once asked if he would worry about being called names, "Why? Do you think I should resent it if an ass had kicked me?"

You might argue that we should convince ourselves that we may be lovable even outside the halo of the praise of others. What's wrong with ignoring the comments from others? Aren't we all comfortable without the worry?

Not as long as you have gone through a whole life of education with emphasis on the grades assigned to you, and with your transcripts studded with those shameful Bs, instead of As.

Without a doubt, the thing that sticks in our mind about our student days has to be that moment we received the report cards. Everyone simply loves a number, a particular number assigned to you by others and reckoned as a good measure by most, if not all, people. Such scoring system haunts us ever since the day we entered the school, and continue to do so for the rest of our life. The popularity of citation index as a means to rank the scientists is just an example of our obsession with the numbers. After an academic researcher has published his works, the number of times that his publications have been cited would then be meticulously counted. Mind you, they only count those citations made by other scientists, but not by the researcher himself or herself. The message is clear and that makes tactical sense: you can't boost up your citation index by yourself and have to rely upon the external voices. Under the big name of bibliometrics, such counting exercise simply drives the university staff busy in their jostle for a better citation index.

Lest you think that I am immune from the obsession with all these numbers, I must confess here that I do time and again look at the number of visitors at my blog. Yes, you count.

Doc 2.0

My boss showed me his recent discussion with one of the chair professors concerning our patient last weekend. It was not very long – or, I should say, deceptively simple.

"Thank you for asking me to see Mr. X. We did review him on daily basis. As a matter of fact, the blood test requested today was not yet received and hence the parameters are all as yesterday."

"Thanks for your information. I am sure he is in good hands but the patient is very concerned. Next time when you drop by, he will be very appreciative if you pad his shoulder."

The last sentence unnerved me and for a moment I floundered.

Sure enough, from the perspective of electronic culture, it's tempting to treat our patients as an icon on the computer screen. Such phenomenon of spending time in front of a computer tracking the patients' blood count like a Dow Jones Index has been pointed out by Dr. Verghese in the New England Journal of Medicine last week. He put up the quote of Alfred Korzybski – that the map is not the territory – to laugh at this cockamamie chart-as-surrogate-for-the-patient approach.

Electronic system is glorious and helpful in a thousand all too obvious ways, but it's always perilous to use computer science to solve every human problem. If you don't believe me, think about the last time you made an enquiry phone call anxiously and ended up being directed to a digital answering machine. Mind you, this is quite similar to an answer like this: "Thank you for calling. Your doctor is currently busy. He or she is behind the screen, making every effort to monitor your health. Please press one for questions related to your white blood count and press two if…"