Empathy

I have spent years with cracking through mysterious diseases. Every time I solve a case - observing, gathering information, and asking questions - I relive the thrill of sleuthing at 221B Baker Street.

This Wednesday morning I received a call from my friend after her father suffered from recalcitrant attacks running amok all over the body. Crippled with dry cough, night sweats, weight loss, and leg swelling, he didn't get any better after staying in hospital for more than a week. Both the patient and his laboratory test results looked bad. So much so that his doctor wanted a costly scan called positron emission tomography.

After the phone conversation, it appeared to me as if this is an "immunological misfiring" instead of a solid organ cancer. Rather than pursuing a diagnostic tool with high dose of radiation, I asked my friend to bring her father to see me. An urine test and a kidney biopsy the next morning made a compelling diagnosis of immune system dysregulation kicking off relentless inflammation in the blood vessels.

The job of a doctor didn't stop here: we have to help the patient handle the bad news and tackle the disease. I have been lucky enough to be healthy most of the time. That being the case, I tend to have difficulty picturing myself in the patients' shoes. It's hard enough for a healthy doctor to imagine the patient's fear, not to mention the pain from a knife and creepiness under the drapes.

During my recent reading of a breast cancer surgeon's memoir, I learned about her own battle with depression, followed by finding a lump on her left breast (which turned out to be just a cyst), and then a large irregular mass on her left breast fiver years later (this time a six centimetre lobular cancer), chemotherapy, radiotherapy surgery and tamoxifen, and yet a locoregional chest wall recurrence. Her ordeal with tears, hair loss, radiotherapy skin burn, incessant night sweats from ovary shutdown, gets stuck in my head. Her story is more than a patient journey. It is a doctor’s reflection on what a patient’s life is like. I know more about patient's suffering, and have told myself to be a better listener.

As it turns out, I took better care of my patient's emotional health, and not just his immune bushfire.

Curse

I’m not the sort of person who knows how to teach. I like to teach, don’t get me wrong, but my colleagues know very well I prefer to get the task done on my own. Instead of guiding my young doctors to find their way, I feel more comfortable with managing the patients myself. 

The older I grow, the less skilful I am to walk others through my route. Yes, that’s the curse of knowledge. The curse makes it hard for me to imagine not knowing what I know. It is often said that those who can’t do, teach. It would be more appropriate, as the organizational psychologist Adam Grant emphasises, that those who can do, can’t teach the basics.

And that brings me to a study I published over 15 years ago. At that time, I thought it’s important to explore the trainers’ experience in teaching our patients with kidney failure. It bothered me, then, when my patients on peritoneal dialysis got infection because of improper technique. I took a good look at their dialysis training nurses’ level of experience. As I pored over the results, I was in for a surprise. The patients who were trained by nurses with more than 3 years of experience were running a two-fold increased chance of subsequent infection secondary to behavioural lapse such as improper handwashing.

Many were angry with my counterintuitive finding that more experienced nurses weren’t doing better with teaching patients. Oh, the stare I got. “How dare you suggest experts are worse off?”

Now I know the way to explain my findings. Much as an experienced doctor has a harder time teaching the beginners, an experienced nurse who almost stays on autopilot can have a hard time to explain the simple steps of handwashing. If you hear about Einstein's curse in his classroom, you wouldn’t be surprised that Einstein knew too much, and his students knew too little. He had so many ideas in his head that he didn’t know what his students didn’t know. Curse of knowledge. This, I believe, is the reason his thermodynamics course attracted only three students.

To me, the message is clear: we can sometimes be too experienced to teach.

Early Bird

This is the second day of the new year. A Tuesday morning with sunshine behind the cloud, as shy as Bambi hidden behind his mother.

I was heading to Section 2 of the Lantau Trail, all the way from Pak Kung Au to the iconic Stone Chalet. Normally, on a Tuesday like this, rather than walk in the countryside, I would work in the hospital seeing one patient after another without break, grabbing a cup of coffee or two at best. But on this day, I broke the rule and took a day off to climb the slopes of Sunset Peak and Yi Tung Shan.

If there's one thing Lantau has in spades, it's the hiking routes for everyone. As the second loftiest peak in Lantau, Sunset Peak has matched well, if not outshone, the majestic Lantau Peak nearby. The legacy of Sunset Peak, as its name implies, remains the unmissable sunset view, and the best way to soak up the breathtaking view is getting there at the right time.

I didn't stay till sunset today, however. One of my private patients got sick and had to be admitted to hospital. "Never mind," I told my buddy who came with me. "We shall come back on a clear day. Soon."