Hewlett

After reading a story of Hewlett-Packard recently, I learn that we may lose our trust without even noticing it. Trust is the easiest to lose and the hardest to survive without.

The story goes that its cofounder William Bill Hewlett stopped off one weekend at a company storeroom to pick up a tool, only to find that there was a lock on the tool bin. This was, as a matter of fact, contrary to the explicit practice the Hewlett-Packard company had established from the very beginning to keep all parts bins and storerooms open so that HP employees would have free access to any tools they might need.

Much to his chagrin, Hewlett broke the lock open and threw it away, and put up a sign where the lock had been. The sign read: HP TRUSTS IT'S EMPLOYEES.

At the same time, I had a real-life story nagging at me, one that I get frustrated for the umpteenth time.

Can you imagine the very first thing I need to do before starting my specialist outpatient clinic session in my own institution? To help you set the scene in your mind's eye, I should tell you that doctors can't enter the clinic through the front door because it is simply locked. Utter the word "lock" and the mind envisages a stoic and nitpicky boss who keeps everything locked up. Each morning we doctors need to fetch the key and unlock the drawer keeping all the ophthalmoscope, tuning fork and tendon hammer – all locked up! The more the things are being locked up, the madder I got. Normally, I hate using exclamation marks, but boy, am I mad!

Years ago, the name and title of the doctors were being displayed outside the clinic door. If you come to see us at the clinic, the name of the doctor whom you're going to see will be missing. Where is it?

Locked up. Again.

If you ask me who would be the one keen on hiding one's name and maintaining the highest standard of anonymity, that guy should be the least trustworthy. Whether our clinic nurse-in-charge knew it or not – and apparently she did not – her real job was to make the best lock.

While we laugh at the lock itself, we need to remember that the idea of such lock is not new. Our department policy of displaying the doctor's name next to the bed of our patients was banned just a month ago. You'll still find such matters difficult to understand. And – I will just say it – untrustworthy.

Doctoring

It took forever for medical doctors to reckon that we should avoid doctoring our loved ones or family members. It has taken even longer for me to learn to toe the line by not acting as the doctor of myself. I suppose that most of doctors want the privacy when they get sick. By treating my own illness, I am further tempted to expedite the care by pulling strings within the health care system.

Which means that, over the years, I have been confusing my professional and personal roles, for example, by acting as a medical student and fetching medication from the drug trolley to treat myself at the same time. There was the issue of bias, the fine details of which I will spare you, except to say that I had previously thrown away my blood-streaked sputum instead of sending the specimen to look for tuberculosis. Whoa. All these years, I've made – or, avoided making – numerous diagnoses and given treatments for myself. I simply feel like a gymnast who has got more and more self-confident after performing a few apparently fabulous and flawless somersaults (in an empty auditorium, I confess). For my part, I simply can't resist the idea that I am doing a reasonable job of treading the fine line between offering objective diagnoses and being a bit personal. Such claim is insightful, reassuring, and completely wrong. I know.

That is not to say that our medical student who committed suicide recently had been treating herself. It would have been wrong for me, I believe, to fabricate and surmise what might happen to someone else I don't even know. I can't. After all, I don't even get the license to diagnose myself.

Bump

I found out recently that, among all those characters in the Mr. Men series by Roger Hargreaves, my wife loves Mr. Bump the most, ever since her childhood.

It didn't take me long to realize the reason.

For those of you who haven't read the children's literature of Mr. Men, Mr. Bump fell out of his bedroom window and bumped his head, leaving him wrapped up in bandage and loss of his memory. He keeps his looks after the injury and just can't help having accidents, including being cleaned in a car wash.

People might rightly scratch their heads and wonder how on earth Mr. Bump can bump into so many silly blunders. But trust me, I am no better than Mr. Bump. Throughout these years, my habits of imprudence ensure that not a week goes by without having accidents like mixing up shampoo with bathing lotion, wearing my roommate's spectacles after getting up and nearly ending up like Humpty Dumpty.

Flannery O'Connor said that anyone who has survived childhood has enough material to write for the rest of his or her life. Now, come to think of it, someone like me who have survived as a Mr. Bump should have enough to write in the next life.

Being a Mr. Bump is not so difficult, but quitting it is nearly impossible. This is not to say that my wife made a mistake in marrying me. Far from it. It's me who made the mistake during our wedding ceremony. No, don't get me wrong; I am not saying that I put the wedding ring on the wrong person's finger (Bump!). I simply put the wrong ring (mine instead of hers) on my wife's finger in front of all my guest friends.

Vampire Bats

During a sharing session with the medical interns this afternoon, our consultant taught us to be generous in offering a helping hand in hard times.

It brings to mind the fascinating story of vampire bats who, like our medical interns with their pockets full of syringes, feed on blood. Besides, the fact that both vampire bats and medical interns seldom have sleep at night suggests that these two species share more than simply a common ancestor. They look enough alike that I could see they are related.

Time and again, vampire bats have been observed to drink more blood than they would require. Those bats would take the surplus to other hungry bats staying behind. Just in case you didn't know, their generosity seems to extend beyond kinship; they do not share their meals with their offspring only. Whenever a vampire bat fails to find adequate nourishment, it may simply contact another vampire bat to solicit food donation by licking the lips of the potential donor. After observing them over a period of five years, a zoologist professor found (and published in Nature) that bats were far more likely to share gift with those that had fed them in the past, but not with new bats added to the group he was studying.

Some will argue that helping each other with a willful view for a return of the favour in the future can’t be righteous giving. Okay. Let's be honest. The truth is I can tell you that I am no better than those vampire bats.

Science

My mentor speaks of medicine's interest in the similarity and difference between individual patients. With huge variation from person to person, it is never possible to consider medicine in the same scientific way as Newtonian physics. To paraphrase the old saying, medicine is knowledge, judgment, experience, and luck.

It is ironic that as we are getting a better picture of how epidemiology studies get closer to predicting illness (or recovery from an illness), we are learning at the same time to realize how irrelevant the scientific statistics can apply to a single individual patient who is sitting in front of a medical doctor. Despite evidence based medicine's miracles like the oft-quoted p values or gene-expression signatures of human diseases – and they are touted as the elixir to make you a crystal ball – clinical knowing for the individual patient in acute care is not certain, nor will it ever be.

In the midst of cudgeling your computer and googling the chance of having a heart attack, you will soon stumble on the illusion how precise the prediction rule can be. These prediction rules might fare well in a population, but seldom work wonder for an individual patient. In the past few decades, for example, medical journals have published a flurry of scientific papers on the link between tobacco and heart attacks. But in case your patient complains of sudden chest pain, dare you forget about doing a workup for myocardial infarction because he doesn't smoke?

I dare not.

Sorry

My recent leisure reading on apology brought back my memory of a long-run Blondie comic strip, in which Mr. Dithers decides to apologize to Dagwood for calling him a "dimwitted noodle brain." Dithers then apologizes by saying, "Dagwood, I'm sorry you're a dimwitted noodle brain" and declares that his conscience is clear because of his "heartfelt apology." (And no prizes for guessing that Mr. Dithers uses the words "I'm sorry" in the sense to express compassion for Dagwood's being a dimwitted noodle brain.)

While I chuckle at the humour, I must confess that it takes time for me to learn how to apologize. It takes forever.

More often than not, people sling accusations at us offhandedly, we snarl back, they yell, we growl, and our voices clashing. There is hardly any place for apology, not to mention sincere apology. On reflection, I simply cannot let go of blame. Blame, by itself, has more claw marks than most of the things I try to let go of. Always the truth, from the alpha to the omega.

Well, blame has always been my knee-jerk response: figure out whose faults things are, and then try to manipulate that person into correcting his or her behaviour so that I can be more comfortable. And oh, yes, our natural human response is simply to look for someone to blame. I did it again and again, only to find out that our overwhelming need to lay blame is never an effective way to apologize.

Cripple

It was another routine morning. I went back to office, and started the computer before doing anything else. After fumbling through the keyboard, I found an Internet connection problem, and thereafter my work ground to a halt.

I couldn't open the tax computation message from the Inland Revenue Department. Interim report form for my research project could not be completed. I had no way to send out the reference letter for my intern. It was impossible for me to read the new issue of the New England Journal of Medicine.

Gone are the days when we survived perfectly well without computer and the Internet. In the event of computer crash nowadays, we doctors can't even read our old notes or figure out what drugs our patients have been taking, not to mention prescribe new ones.

If our computers do contribute to the flattening of the world, we are the guys who really cannot walk without falling whenever the field becomes less flat after a computer crash.