Murphy

Over the years of medical practice after graduation, I recall an awful lot of good and bad memory, with stories interrrupted by medical errors aplenty, from wrong drugs to wrong patients. Many of these things, like leaving behind a gauze in patient's body, missing an important laboratory report, forgetting to consider the possibility of another serious illness, are the inevitable downside of having a (human) brain. And let's be clear: one definition of "human error" is "human nature."

One of the well-phrased laws is that "anything that can go wrong, will go wrong." It's a line that's been used ad nauseam by people who teach medical safety. Is it true, even a little bit, that doctors are never good at filling the gap between how things are and how we want them to be?

Murphy's Law is difficult to beat, whether we admit it or not. People might rightly scratch their heads and wonder why doctors can make careless mistakes. But trust me, I am no exception. Two weeks ago, I was sick and running a temperature. It was my view then, and still is, that I should not take sick leave without terribly good reasons. High temperature, I know, wears on the body, nipping away at the brain cells that keeps us awake and sane. Unsettling as it is, it's hard for me to resist the notion that I can pay extra attention to keep myself in the right mind, and not the other way round. I was sitting in front of the computer when I tried to copy my patient's name and identity number (to send out a special laboratory request for a blood test that is only available abroad). I looked dazed, my head spinning, and my eyes wide open but seeing nothing ahead of me. Wait. I told myself to be careful and not to copy the wrong patient's number. Who in his right mind would want to send out an expensive blood test and end up with a wrong patient's identity?

Good, fine, you think. Did I end up with the wrong number? Yes, I really did.

Cockroach

During a recent lunch meeting, my trainee met a startling cockroach in his lunchbox. He hadn't even noticed that his mouth was hanging open. He rushed out of the room as if he had stepped on the teeth of a rake or slammed his thumb with a hammer.

Uh-oh.

Which leads me to the theory of negativity dominance hypothesized by the pyschologist Paul Rozin, an expert on disgust. Just imagine a single cockroach in your most favorite dish such as a bowl of cherries. I can hear the screaming already, although I can't make out if the word is "Help" or "Hell". Now you see. A single cockroach really is enough to render a bowl of delicious cherries inedible. But what about the other way round? Consider a a dish of food that you dislike: a bowl of lima beans, cockroaches, or whatever. What could you touch to that food to make it desriable to eat - that is, any suggestion of anticockroach? Nope. As anyone in his right mind will tell you, a cherry will do nothing at all for a bowl of cockroaches.

That Russian adage said it best: "A spoonful of tar can spoil a barrrel of honey, but a spoonful of honey does nothing for a barrel of tar."

The point is not that it is never possible to make positive influence nor that there is no way to compensate. Rather, the point is simply that bad emotions, bad parents, and bad feedback have more impact than good ones.

Mobile

I was reading the Time magazine cover story Your Life Is Fully Mobile when my broadband service at home was upgraded to 30M yesterday.When it comes to the wireless mobile technology, Nancy Gibbs has commented that more people have access to mobile device than to a toilet or running water, and the average smart phone today has more computing power than Apollo II when it landed a man on the moon. She dares us to name one example of tool with which so many developed so close a relationship so quickly as we have with our phones. Two-thirds of us, myself included, take a mobile phone to bed with us.

Seriously, technology is a series of changes, some good, many bad.

Which makes me wonder: Just how much the intimate relationship with our gadgets improves the human relationships? Yes, I can now text my wife faster and better than two decades ago. The faster, the better. Everything, that is, except one: romance. When I started dating my wife at the dawn of the cell-phone era in the 1990s, we were calling one another on telephone landlines. For most of us, the memory of that long queue at the student hostel telephone kiosk has stayed for close to twenty years. Because waiting at the end of the queue can last forever in those days, every now and then I ended up running for one kilometre to meet my sweetheart instead.

"What," you might ask, "if you two are separate by far far apart, awfully longer than one kilometre? How can you possibly talk to each other without that mobile device?"

And really, there was no such mobile device (at least not available to me) when I went to Montreal for overseas training around ten years ago. Making a long distance call was one thing: we all know, each of us, that makes the world flat. Paying the phone call was another. So we wrote to each other. That's an added bonus. Believe me, there is a humanity to pen and paper that typing or taping with a stylus (or our thumbs) lack.

A letter with ink - to be exact: hundreds of letters over that one year - lasts much longer than the text messages on the smart phone screen.

Dogma

Most shutterbugs had heard, at one time or another, the unmistakable question concerning the number of pixels when people think about the choice of digital cameras. Every so often we consider high-pixel number to be sine qua non of high-quality camera. It isn't.

If you are to go looking for a place where people fall in love with magic figure - which is not magic at all, in fact - the field of medicine is a pretty good candidate. Overwhelmed by the work at hand and with neither the support, know-how, nor the time to step back for detailed history taking, doctors long for a magic figure from laboratory test to make decisions.

I would be remiss not to mention the coagulation test (the prothrombin time and activated partial thromboplastin time, in case you're in favor of big names) as the haemostatic oracle or passport for safe surgery. Not a day passes without some doctors postponing a procedure to wait for that laboratory result of coagulation test. Of course, we don't have a whiff of evidence to support that such battery of coagulation tests offer a good prediction of bleeding risk. Ahem. Perhaps what a normal coagulation test can serve is to make doctors "feel better," and nothing else.

Kindergarten

I have been looking forward to the first day of bringing my kid to the kindergarten.

Well, really - how could you not?

I decided to take a half day off. The sun was bright, the traffic heavy. My daughter, still every inch of her a toddler, was excited and brought with her the picture book "Let's Go to School." We heard the sparrows chirping as we ran up the hill to the bungalow campus. It was the natural and lively outdoor environment I like most about the school.

Surrounded by uneven paths on the slope, riddled with holes (and some mosquitoes, too), the school looks as if it has been designed to teach and prepare for Tarzan. A good news for Tarzan, after the recent typhoon storm, is the school and most trees were not blown down. A bad news is that the tyre swing at the campus was damaged beyond repair.

No surprise we miss the tyre swing badly.

Luck

Go ask a doctor how it goes after the on-call day, and odds are that the doctor will tell you how lucky or unlucky he has been.

Some of us take solace, after a stormy night, by calling ourselves unlucky. To us, a peaceful night means luck.

But be not beguiled.

Now that I've got senior enough to be on call once in a while, what I look forward to is the luck (sort of) to see more difficult cases and learn. I remember reading once that medicine is knowledge, judgment, experience, and luck. With that in mind, I called myself lucky (I still do) when my pager was bleeping all night during my recent call days.

Lest I be misunderstood: I do not want to suggest that a good doctor is one who prays for a busy on-call day. Nor do I think it always proper to work nonstop. Yet, when I think about my two recent on-call days, I see that I was really lucky to come across patients that I can learn from them: first, I learned to stick a long needle into the pericardial sac around a patient's heart, and next, I learned to place a balloon pump into the aorta of a failing heart.

And I owe it all to a bit of luck.

Peer review

Few words are more likely to make one think of impartial judgement and idealism than that big term peer review. A beacon of justice for scientific knowledge. Almost all manuscripts submitted to biomedical journals are now sent out to reviewers, selected by virtue of their knowledge about the manuscript's topic, before any decision on publication.

Reviewers are obliged to return the review within two weeks. The deadline is not difficult to meet, unless I forget the request. When I returned from Berlin, I thought I'd finished all the reviews and didn't pay attention until a reminder appeared in my e-mail box yesterday.

"Oh man, I thought I had submitted my evaluation. Did I?" I asked myself as I quickly searched my files. I didn't keep track of the evaluation scores and decision of each manuscript reviewed, but I saved the written paragraphs that summarize for the editors (the reasons for my recommendations for disposition of the manuscript) and for authors (as requested by most, if not all, journals). Imagine that you had submitted the review over one week ago and yet the reminder was sent to you because of computer system error. Would you be able to submit an evaluation identical to the first one?

I shrugged; probably I blushed. It's odd. When we write the paragraphs, we make use of slow, deliberative, and more logical mode of thinking (the System 2, as what the psychologist and Nobel-winning economist Daniel Kahneman calls it). By the time we enter the manuscript's rating with respect to the originality, scientific accuracy, interest to the readers of a specific journal, recommendation like rejection or acceptance with major revision, we're switching to System 1, a fast, automatic, intuitive, and emotional mode with little sense of voluntary control.

I tried my best to recollect how I entered the score. But my answer came out in stammers and meanders. The situation is that I typed the paragraph in the hotel and then brought my computer to a bus station (a free wifi hotspot) for final electronic submission. I could have missed the last step when the weather turned bad, with a sudden flurry of heavy rain. And if I'm candid, I do believe that I could have entered a lower score at that time, simply because of the rainy weather.