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.
Saturday, October 11, 2008
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.
Tuesday, September 30, 2008
Charlie Brown
Charles Monroe Schulz has always been one of my favourite cartoonists. He told us wonderful stories about Charles Brown, whom I shall never forget.
One day, Charlie Brown lied on the bed, murmuring to himself, "Sometimes, I lie awake at night, and I ask, why me?"
Can you imagine how Charlie Brown comes up with the answer himself?
Then a voice answers, "Nothing personal… your name just happened to come up."
One can envisage ourselves engaging in these endless "why me" whines, grumbling and getting upset. And it is true that literally everything can go awry and end up chaotic in a very single person. During my recent trip to Japan, the departure flight had a great deal of delay because of typhoon. On my way back, alas, I could not catch the scheduled flight because of the three-hour Shinkansen train delay. Years ago, I would have complained and asked "why me." Today, the answer of Charlie Brown reminds me that, indeed, it isn't really anyone's fault – just a melodrama of errors, bad luck and poor weather. Come on, we all have bad days every once in a while and, as Charlie Brown said, there is nothing personal. It must have been my turn.
One day, Charlie Brown lied on the bed, murmuring to himself, "Sometimes, I lie awake at night, and I ask, why me?"
Can you imagine how Charlie Brown comes up with the answer himself?
Then a voice answers, "Nothing personal… your name just happened to come up."
One can envisage ourselves engaging in these endless "why me" whines, grumbling and getting upset. And it is true that literally everything can go awry and end up chaotic in a very single person. During my recent trip to Japan, the departure flight had a great deal of delay because of typhoon. On my way back, alas, I could not catch the scheduled flight because of the three-hour Shinkansen train delay. Years ago, I would have complained and asked "why me." Today, the answer of Charlie Brown reminds me that, indeed, it isn't really anyone's fault – just a melodrama of errors, bad luck and poor weather. Come on, we all have bad days every once in a while and, as Charlie Brown said, there is nothing personal. It must have been my turn.
Sunday, September 21, 2008
Pastimes
I believe I am the only child I know of who grew up without a television set at home.
I used to either change topics or walk away whenever my classmates exchanged words on television stories. My unnerving conclusion was that people will laugh at me when they found me tongue-tied with the language of television. I use the past tense not because I have become familiar with the television stories but because I get over the inferiority complex of growing up without television.
My love for the alphabet and reading, which endures, started ever since my early years without television. I began to learn writing before going to kindergarten. In my story books, before I could read them for my younger sister, I fell in love with the legends of Robinson Crusoe, Gulliver, Huckleberry Finn, Oliver Twist, and even Ali Baba. I missed numerous television programmes, but I could never miss the chance to visit the library every week. Today my wife still find it unbelievable to hear that I was the librarian throughout the six years at high school.
I am not going to enter the debate here about whether television is a vice or not. There is barely an inkling of what my childhood was about to change if my mum bought a television. But I have the feeling, after so many years, that the absence of television at home left me much more time to read books, which by itself is a blessing. Without a doubt it is.
I used to either change topics or walk away whenever my classmates exchanged words on television stories. My unnerving conclusion was that people will laugh at me when they found me tongue-tied with the language of television. I use the past tense not because I have become familiar with the television stories but because I get over the inferiority complex of growing up without television.
My love for the alphabet and reading, which endures, started ever since my early years without television. I began to learn writing before going to kindergarten. In my story books, before I could read them for my younger sister, I fell in love with the legends of Robinson Crusoe, Gulliver, Huckleberry Finn, Oliver Twist, and even Ali Baba. I missed numerous television programmes, but I could never miss the chance to visit the library every week. Today my wife still find it unbelievable to hear that I was the librarian throughout the six years at high school.
I am not going to enter the debate here about whether television is a vice or not. There is barely an inkling of what my childhood was about to change if my mum bought a television. But I have the feeling, after so many years, that the absence of television at home left me much more time to read books, which by itself is a blessing. Without a doubt it is.
Wednesday, September 17, 2008
Hoofbeats
"Don't fill your photo with more than necessary," I told my younger sister during our recent photography trip. "Life is never rosy," I continued, "We'd better crop out the thorn and leave behind the roses that will stay etched in the picture, and our memory."
The trick with selective memory is especially germane to our work in the hospital. The medical encounter, it turns out, has been replete with less-than-exciting patients of all sorts. "Good clinicians think of horses when they hear hoofbeats," I taught my students last night, "but we never forget that the hoofbeats are once in a while made by zebras." There can be no gainsaying the fact that medical doctors are often bored by the frail elderly patients who come in with pneumonia, twenty-four hours a day, seven days a week. Fortunately they seldom stay in our memory; we would rather marvel at our ever making a zebra-diagnosis, which is to stay in our memory forever.
A clinician might not be able to pull a diagnostic rabbit (or zebra) out of a hat at the end of each morning round, as what Dr. Gregory House did. Don't worry. Few of us remember the number of times we hear the hoofbeats, but I will never forget the once-in-a-lifetime chance to make a diagnosis of Wilson’s disease or acute porphyria masquerading the hoofbeats of the horses.
The trick with selective memory is especially germane to our work in the hospital. The medical encounter, it turns out, has been replete with less-than-exciting patients of all sorts. "Good clinicians think of horses when they hear hoofbeats," I taught my students last night, "but we never forget that the hoofbeats are once in a while made by zebras." There can be no gainsaying the fact that medical doctors are often bored by the frail elderly patients who come in with pneumonia, twenty-four hours a day, seven days a week. Fortunately they seldom stay in our memory; we would rather marvel at our ever making a zebra-diagnosis, which is to stay in our memory forever.
A clinician might not be able to pull a diagnostic rabbit (or zebra) out of a hat at the end of each morning round, as what Dr. Gregory House did. Don't worry. Few of us remember the number of times we hear the hoofbeats, but I will never forget the once-in-a-lifetime chance to make a diagnosis of Wilson’s disease or acute porphyria masquerading the hoofbeats of the horses.
Saturday, September 13, 2008
Fracture
"Your humerus bone at the right arm has broken, at the site called greater tuberosity."
I told my friend firmly, with an authoritative tone, when he called me for help after a fall around one year ago.
Months later, I still remember the moment when I was first shown his X-ray at the emergency room waiting hall. "Going to be nonoperative treatment and short period of shoulder immobilization," I advised. "Well, at most two weeks," I continued, almost whispering to myself, "as what I just read from the British Medical Journal yesterday."
This is, of course, terribly strange and coincident that my friend had a humerus bone fracture the day after my reading the same topic. Alas, why on earth should a medical physician (like me) read about the subjects of broken bones? Usually that means doing a lot, and outside my specialty, obviously. Does this story – or revelation, if you prefer – imply that I am a prophet who can look up a subject before it happens?
Quite the opposite.
I have come to see that in real life, we can never make good predictions. Back in 1899, Charles H. Duell, the United States commissioner of patents, predicted that everything that can be invented has been invented. Even the visionary Bill Gates of Microsoft, tech guru that he is, wrote in 1981 that when it comes to computing, "640K should be enough for anyone."
How about the practice of medicine? Having a "highly differentiated" specialty, if not subspecialty, is part and parcel of entering the guild of medicine nowadays. Why should we choose to read something outside our destined interest? This sounds like picking a movie according to our taste, you might ponder. We simply go and buy the front-row seat tickets for the show that interests ourselves. Simple. The question is, who is going to buy the tickets in a doctor's life? Doctors or the patients? Honestly, doctors can never predict who will "buy the ticket" and come through the door of the clinics or hospitals. This reminds me again the gorgeous quote of Sir Geoffrey Vickers, "Even the dogs may eat of the crumbs which fall from the rich man's table; and in these days, when the rich in knowledge eat such specialized food at such separable tables, only the dogs have a chance of a balanced diet."
A healthy balanced diet helps to protect us from breaking a bone, I was told as a child.
I told my friend firmly, with an authoritative tone, when he called me for help after a fall around one year ago.
Months later, I still remember the moment when I was first shown his X-ray at the emergency room waiting hall. "Going to be nonoperative treatment and short period of shoulder immobilization," I advised. "Well, at most two weeks," I continued, almost whispering to myself, "as what I just read from the British Medical Journal yesterday."
This is, of course, terribly strange and coincident that my friend had a humerus bone fracture the day after my reading the same topic. Alas, why on earth should a medical physician (like me) read about the subjects of broken bones? Usually that means doing a lot, and outside my specialty, obviously. Does this story – or revelation, if you prefer – imply that I am a prophet who can look up a subject before it happens?
Quite the opposite.
I have come to see that in real life, we can never make good predictions. Back in 1899, Charles H. Duell, the United States commissioner of patents, predicted that everything that can be invented has been invented. Even the visionary Bill Gates of Microsoft, tech guru that he is, wrote in 1981 that when it comes to computing, "640K should be enough for anyone."
How about the practice of medicine? Having a "highly differentiated" specialty, if not subspecialty, is part and parcel of entering the guild of medicine nowadays. Why should we choose to read something outside our destined interest? This sounds like picking a movie according to our taste, you might ponder. We simply go and buy the front-row seat tickets for the show that interests ourselves. Simple. The question is, who is going to buy the tickets in a doctor's life? Doctors or the patients? Honestly, doctors can never predict who will "buy the ticket" and come through the door of the clinics or hospitals. This reminds me again the gorgeous quote of Sir Geoffrey Vickers, "Even the dogs may eat of the crumbs which fall from the rich man's table; and in these days, when the rich in knowledge eat such specialized food at such separable tables, only the dogs have a chance of a balanced diet."
A healthy balanced diet helps to protect us from breaking a bone, I was told as a child.
Thursday, September 4, 2008
Tom Sawyer
I was amused to share The Adventures of Tom Sawyer with the son of my classmates last Sunday. The story is almost funny – except that it's not.
When we look hard enough, we can find ourselves symptomatic of what Tom Sawyer had demonstrated as a professional trickster. This condition is highly contagious, I guarantee, and not easily reversed.
It's all very well for those of us who make mistakes now and then, like what Tom Sawyer did most of the time. And it's nice to laugh at others' blunders. Still, it would then be surprising to find out that we grown-ups have been practicing the three very basic approaches of Tom Sawyer after making a mistake (before he was caught red-handed by Aunt Polly, of course). The first one, as recently described by the senior ethics adviser Julian Sheather, is to run away as far as possible and pretend it hadn't happened. Secondly, if the first trick is unsuccessful, one is to surreptitiously hunt around to see if responsibility for the mistake couldn't be handed over to someone else, or at the very least shared with them. For heaven's sake, what is the third and bravest approach, then? To try and find a way of making out that it isn't really a mistake at all.
I profess, in the sincerity of my heart, that we grown-ups are even more laughable than Tom Sawyer. And, if you don't believe that adults behave similar to Tom Sawyer, well, look around. Leave yourself room to be surprised.
When we look hard enough, we can find ourselves symptomatic of what Tom Sawyer had demonstrated as a professional trickster. This condition is highly contagious, I guarantee, and not easily reversed.
It's all very well for those of us who make mistakes now and then, like what Tom Sawyer did most of the time. And it's nice to laugh at others' blunders. Still, it would then be surprising to find out that we grown-ups have been practicing the three very basic approaches of Tom Sawyer after making a mistake (before he was caught red-handed by Aunt Polly, of course). The first one, as recently described by the senior ethics adviser Julian Sheather, is to run away as far as possible and pretend it hadn't happened. Secondly, if the first trick is unsuccessful, one is to surreptitiously hunt around to see if responsibility for the mistake couldn't be handed over to someone else, or at the very least shared with them. For heaven's sake, what is the third and bravest approach, then? To try and find a way of making out that it isn't really a mistake at all.
I profess, in the sincerity of my heart, that we grown-ups are even more laughable than Tom Sawyer. And, if you don't believe that adults behave similar to Tom Sawyer, well, look around. Leave yourself room to be surprised.
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