Spiral

"Show them the league table."

I cringe recalling how many times I heard such advice intended to improve the grades or job performance. Am I supposed to advocate for creating pressure to conform? My brow furrowed and the crow's feet deepened as I struggled to understand any real good impact of such league table.

Curious if this might really do good, the award-winning behavioral scientist Katy Milkman analyzed reams of research, only to find the results otherwise. The league tables backfire more often than not.

Contrary to those who expect peer pressure to boost the results, she finds that league tables have been harmful. The pressure can sometimes be too overwhelming.

Imagine a social universe in which your colleagues or classmates are constantly oustripping you. Oh crap! You discover that you earned less, ran slower, tested worse, and your patients' length of stay in hospital paled in comparison to your peers. All these comparisons, and so many more like them, can be bundled up into one package called hopelessness. And hopelessness can be summed up in one word - deflation.

Distancing

If you pick up a book on writing good plain English, you are going to be reminded the problem of starting a new paragraph using the word I.

It may not be particularly surprising to use words like I and me. But it's an accidental egocentric showing-off by using too much I. Too much I ends up looking like the Carmen Miranda song, I-I-I-I like you very much!

Here comes the example: I was going to get my flu shot when I bumped into an old friend.

We can re-write it as: On my way to get the flu shot, I bumped into an old friend.

Putting that I mid-sentence sounds far less intrusive. On another note, shifting from the I and disclaiming the me me me are serving a more important psychological purpose. Ask Elmo. When Elmo explains his commitment to the life of the mind, he favors constructions like "Elmo loves to learn!" Talking about ourselves in the third person, as I've learned from Daniel Pink's book The Power of Regret, is known as "illeism." An easier term for this strategy, as what social psychologists call it, is "self-distancing."

That's what I did after my laptop was stolen during my overseas training. It’s been twenty years and I still think about this nightmare. My slumped shoulders and devastated expression were heavier than two atomic bombs. To find a better way than rumination, I wrote email to my wife and friends, telling the story of KM instead of me. The fly-on-the-wall in me decided to zoom out and write in the third person. The distancing helped me to spend the next forty-eight hours doing everything I could to salvage the loss.

The secret of converting negative thoughts into third-person sentences, it turns out, is supported by scientific evidence. Third-person self-talk reduces worry and increases rational thinking, research shows. Randomly assigning people to use their own name, instead of "I", was shown to generate better fact-based reasons during the 2014 Ebola outbreak. Try it.

Access

Three years ago, a dear secondary school teacher of mine was struggling with his worn-out heart valve. A normal heart valve is a smooth, glistening, pliable surface that seals off and then opens to the chambers of the heart with every beat. Blood glides over the normal valve. My teacher's heart valve roughened with age, and became a kind of stiff squeaky door stuck with faulty handle. Over time, blood could hardly go through the door. Every time his blood squeezed through the narrow thoroughfare, I could hear the unpleasant screeching sound.

After a while I began to realize that he could hardly survive without getting the squeaky valve fixed. Yet, to state the obvious, it's not as simple as fixing a door handle when we're referring to a door inside an eighty-something-year-old heart. It was a truly challenging operation, coinciding with our cutting non-emergency services to meet the demand from patients infected with the coronavirus. Improbable as it would have seemed to almost anyone else, we tackled his faulty heart valve by inserting an artificial one to widen the opening. All because of our talented cardiologists with state-of-the-art everything.

In effect, the artificial valve acts like a slip coupling for a leaking pipe. The more congruent, the stronger and more secure the case.

It was a big temptation to brag about the success, and sometimes I did. But after less than a year my teacher had a fall at home during a fever spell. Little did I know at the time how sinister that fever was. He didn't text me, as what he usually did in the event of serious medical problem. By the time he found me - after his getting delirious at another hospital - I knew it was something serious. So I took him back to my hospital without second thought, drawing blood myself on the way. Within two days, the blood came back to show sticky bacteria attacking his heart valve; he passed away three days later. "Why didn't he call me earlier?" I kept asking myself.

The situation with my courteous teacher isn't unique in that many patients of us don't want to bother the doctor too much. It's easier for our patients to get hold of our telephone number or email address - and maybe that of our secretary's, for that matter. I know what you're thinking. Who is this doctor kidding? Hear me out. I am not advocating doctors to dole out personal contact number like business card in a party. But sometimes it is worth the effort. Anyway, what's wrong with being accessible when most of our patients are reasonable? One of my patients could not come back from Liverpool in time, and had emailed to reschedule the appointment. After coming back to Hong Kong, he had bad cough and chest pain, but didn't find me again until his rescheduled appointment this Saturday morning. By the time I saw him, he was in such a bad shape I had to quickly get him into hospital, put a tube down into his windpipe and sent him to the intensive care unit for his pneumonia. "Why didn't he call me earlier?" I asked myself.

Example

The coronavirus disease pandemic has demonstrated the unpredictability of medicine - and the extremely important chance to improvise teaching. The virus itself is a monster serial killer of elderly, many of them healthy and holding a test kit with two red lines one moment, crashing with breathlessness the next. Many vulnerable patients, mostly unvaccinated, oscillated between "okay" and downright critical, sometimes within an hour.

Throughout this crisis, I have witnessed a multitude of opportunities to "learn how to learn."

Blessed are those of us who have gone through such once-in-a-lifetime public health crisis. After watching this mysterious virus in awe, we have plenty of stories to tell our our young doctors. As I looked back at our efforts to overcome the pandemic, I realized that we have turned many services into teachable moments. In the early days while we were still working out the behaviour of that coronavirus, many senior doctors like us set up isolation wards to admit all new cases, taking careful steps to triage out who were infected, and who weren't. Then we let new and young doctors follow our example, including interns to admit cases.

Which, it turned out, was the far more satisfying teaching opportunity.

Mirroring

Every now and then, conversations between doctors and patients boomerang between questions and medicalese. Not many of us nod, and even more of them struggle to make sense of doctors' words.

There is a cultural difference in play, too. Not for the first time, I encountered Chinese patients speaking in Chiuchow dialect or accent. "It seems like you're coming from Chiuchow," I enthused. It wouldn't take long for my patient to figure out I'm also from the same heritage.

But why the digression during clinic consultation? What I hope to do is improving trust by concordance. I have learned recently how doctors can make patients feel at ease when we share aspects of culture and identity, including race. Emma Goldberg, the author of Life on the Lines, taught me the emotional bonds from sharing identity between doctors and patients.

In a nutshell, like attracts like.

On the other hand, Black men visiting non-Black doctors turned down flu shot offers more than those visiting Black doctors, even when offered money incentives. Similarly, when Spanish-speaking patients see doctors who speak their language, they're more likely to adhere to their prescribed medications. 

Doctors are, obviously enough, not just the sum of our technical skills. Our gender, our cultural backgrounds, our ages, our race, our personal history matter too.

Endoscopy

The guru of good habits Stephen Covey once wrote, "Between what happens to us in life and our reaction is a space. In that space lies our power and freedom to choose our responses. In our responses lie our growth and happiness."

He had a point. It's often far more difficult to choose the weather of our mind than it is to wait for perfect weather. With that concept in mind, I've been learning not to control everything, but to control how I feel and react. Regardless of what the weather is like, I choose not to feel under the weather.

Recently, stomach pain woke me up twice. I realized that it's better to get an upper endoscopy examination. That means inserting a tube with camera through my mouth and into my stomach. That isn't a terrible medical procedure but most of us can think of a dozen reasons why we should have sedation medication: to help us rest and relax, to avoid discomfort, to go asleep without remembering the tube scratching the throat.

But then, I wish to go back to work immediately after the endoscopy examination. I did that today and sailed through the procedure smoothly without any need of sleep medication. Fifteen minutes and - ta-da! - I was back to clinic seeing patients.

Break a Leg

I was discussing with my daughter the meaning of the English idiom "break a leg' the other day.

She thought about the context of wishing luck before an audition. That way the "breaking leg" grants you the chance to be "in the cast."

Maybe she's right. Maybe I should not entertain such a question. And man, the story of "in the cast" turns out to be true. Within two months, my daughter broke her leg. Not in an audition, though. After sports injury from ankle inversion, it looked like a golf ball had been seen into her ankle. She ended up in a cast this week.

I went back to get the crutches, which have been passed from one colleague of mine to another in my department. It makes me think of the children's game known as "musical chairs." That's how it works: everyone gets the chance. My daughter's turn this time. Uh-oh.