Reciprocity

The psychology professor Robert Cialdini keeps saying that reciprocity is the most powerful of all the forces that influence behaviour - give what you want to receive. The Max Planck Institute for Evolutionary Anthropology in Germany just reported a study that makes this very point.

After observing 3-year-olds' behaviour in a between-subjects design, researchers concluded that children are much less likely to help a person who has been seen to harm someone else – in this case adult actors tearing up or breaking another adult's drawing or clay bird. But it was the judgment of intention that characterizes the linchpin. Indeed, the odds are low for a toddler to help one person even if that person tried to harm someone else but didn't succeed. And as if that's not enough, when the toddler observed a person accidentally cause harm to another, the youngster was more willing to help that person.

Hooray for the toddlers' ability to understand another's intent.

In fact, such ability has been demonstrated to be universally present even in preverbal infants. Few years back, Yale professor Paul Bloom conducted similar experiments and published their findings in Nature. At the age of six months and 10 months, babies were shown one figure (made of wood and with large eyes glued onto it) initially at rest at the bottom of a hill. The babies witnessed events in which the figure struggled to climb the hill, and on the third attempt was either aided up by a helper who pushed it from behind, or was pushed down by a hinderer. In the test phrase, the babies showed a robust preference for the helper over the hinderer. And then, the hindering figure was either punished or rewarded. In this case, the babies preferred a character who was punishing the hinderer over ones being nice to it.

The moral of these two studies is enormous, particularly to parents like me. I remember reading once that experience may be the sculptor of the baby's mind but it is we adults who provide the chisel.

I'd better behave myself.

William Osler

A glance at my dialysis patient's blood count reminds me the Recession – everything went down except the level of anxiety. It's the third month like this. I told my patient, "Well, we don't really know what's happening. Your white cell and platelet counts are both coming down, almost as quickly as you're going anaemic." I suggested him to have a bone marrow test to figure out the problem.

Of course, my patient didn't believe me. He was nervous about the bone marrow biopsy examination. "Yeah, I bet you must have come to this decision after several round of blood tests," he hesitated. "But I'd rather wait and see. I'm feeling well."

I shook my head, but I gave in. All I knew was that I couldn't be sure I would miss something treatable. After all, the patient has already a problem list long enough to bother about, including his diabetes, kidney failure, blocked blood flow to the legs.

My patient returned to my clinic last week. "C'mon, let's be brave," I asked him again. "Have you decided on the bone marrow study?"

"No, I guess not," my patient answered. "Not at the moment. I wish you don't mind. Can I say something? The problem seems to start ever since my leg problem three months ago. Right? The vascular surgeon saw me when my toes turned dark. And then I was told to take the medication cilostazol, which is supposed to open up my blocked blood vessels. I have a hunch that it's this drug that causes the plummeting blood counts that you kept mentioning to me over the last few months. I never have problem with my blood counts before taking cilostazol."

I paused, nodded, and was wordless. There was nothing to say. I looked at my patient for as long as I could without embarrassment, and then took a quick look at the desk reference of drug information. Bingo! The problem with blood counts after taking cilostazol has been well documented before. My patient has a point. Who in his right mind would want to go for a gruesome and painful bone marrow biopsy procedure if the problem might be solved by stopping a medication? I had never thought about it.

Well, we all know the moral of this story, don't we? William Osler taught us almost a century ago to listen to the patients because they are trying to tell us the diagnosis.

Dictionary

When I walked into my office of the new hospital building, I saw an uncluttered desk. The only thing I wish to do to my room is to keep it tidy. I make the wish like we make New Year's resolution.

To celebrate the new office, I bought a gift for myself last night. It's the seventh edition of the Oxford Advanced Learner's English-Chinese Dictionary. The last dictionary I bought has been with me for over twenty years, like a loyal golden retriever with dog-eared pages.

"Gee, why do you need to buy a dictionary in printed hard copy when we can search any word on the net?" you might ask.

My first answer is, "I don't know." I mean that. I can't say why. I simply like to go back to the printed dictionary. That's how looking up words has been for me ever since I got my first elementary learner's dictionary at the age of six. This is how it works: each time I home in on the word when I leaf through the pages, I meet other words in the neighbourhood. It's just the same for drinking coffee: you've always wanted to get your coffee at the café, but instead you meet your friends sitting around. I guess old habits like addiction to dictionary or coffee die hard.

Keeping the habit of having a good cup of coffee has always been easy, but a decent printed dictionary? That's another story – Oxford University Press, the publisher of the Oxford English Dictionary, said that they're considering not printing their next edition. Such move is, obviously, related to the free, instant online dictionary. The printed copy currently sitting on the desk of my new office was published in 2008, and it seems to be the last edition that I can buy.