The psychology professor Robert Cialdini keeps saying that reciprocity is the most powerful of all the forces that influence behaviour - give what you want to receive. The Max Planck Institute for Evolutionary Anthropology in Germany just reported a study that makes this very point.
After observing 3-year-olds' behaviour in a between-subjects design, researchers concluded that children are much less likely to help a person who has been seen to harm someone else – in this case adult actors tearing up or breaking another adult's drawing or clay bird. But it was the judgment of intention that characterizes the linchpin. Indeed, the odds are low for a toddler to help one person even if that person tried to harm someone else but didn't succeed. And as if that's not enough, when the toddler observed a person accidentally cause harm to another, the youngster was more willing to help that person.
Hooray for the toddlers' ability to understand another's intent.
In fact, such ability has been demonstrated to be universally present even in preverbal infants. Few years back, Yale professor Paul Bloom conducted similar experiments and published their findings in Nature. At the age of six months and 10 months, babies were shown one figure (made of wood and with large eyes glued onto it) initially at rest at the bottom of a hill. The babies witnessed events in which the figure struggled to climb the hill, and on the third attempt was either aided up by a helper who pushed it from behind, or was pushed down by a hinderer. In the test phrase, the babies showed a robust preference for the helper over the hinderer. And then, the hindering figure was either punished or rewarded. In this case, the babies preferred a character who was punishing the hinderer over ones being nice to it.
The moral of these two studies is enormous, particularly to parents like me. I remember reading once that experience may be the sculptor of the baby's mind but it is we adults who provide the chisel.
I'd better behave myself.
Monday, November 22, 2010
Monday, November 8, 2010
William Osler
A glance at my dialysis patient's blood count reminds me the Recession – everything went down except the level of anxiety. It's the third month like this. I told my patient, "Well, we don't really know what's happening. Your white cell and platelet counts are both coming down, almost as quickly as you're going anaemic." I suggested him to have a bone marrow test to figure out the problem.
Of course, my patient didn't believe me. He was nervous about the bone marrow biopsy examination. "Yeah, I bet you must have come to this decision after several round of blood tests," he hesitated. "But I'd rather wait and see. I'm feeling well."
I shook my head, but I gave in. All I knew was that I couldn't be sure I would miss something treatable. After all, the patient has already a problem list long enough to bother about, including his diabetes, kidney failure, blocked blood flow to the legs.
My patient returned to my clinic last week. "C'mon, let's be brave," I asked him again. "Have you decided on the bone marrow study?"
"No, I guess not," my patient answered. "Not at the moment. I wish you don't mind. Can I say something? The problem seems to start ever since my leg problem three months ago. Right? The vascular surgeon saw me when my toes turned dark. And then I was told to take the medication cilostazol, which is supposed to open up my blocked blood vessels. I have a hunch that it's this drug that causes the plummeting blood counts that you kept mentioning to me over the last few months. I never have problem with my blood counts before taking cilostazol."
I paused, nodded, and was wordless. There was nothing to say. I looked at my patient for as long as I could without embarrassment, and then took a quick look at the desk reference of drug information. Bingo! The problem with blood counts after taking cilostazol has been well documented before. My patient has a point. Who in his right mind would want to go for a gruesome and painful bone marrow biopsy procedure if the problem might be solved by stopping a medication? I had never thought about it.
Well, we all know the moral of this story, don't we? William Osler taught us almost a century ago to listen to the patients because they are trying to tell us the diagnosis.
Of course, my patient didn't believe me. He was nervous about the bone marrow biopsy examination. "Yeah, I bet you must have come to this decision after several round of blood tests," he hesitated. "But I'd rather wait and see. I'm feeling well."
I shook my head, but I gave in. All I knew was that I couldn't be sure I would miss something treatable. After all, the patient has already a problem list long enough to bother about, including his diabetes, kidney failure, blocked blood flow to the legs.
My patient returned to my clinic last week. "C'mon, let's be brave," I asked him again. "Have you decided on the bone marrow study?"
"No, I guess not," my patient answered. "Not at the moment. I wish you don't mind. Can I say something? The problem seems to start ever since my leg problem three months ago. Right? The vascular surgeon saw me when my toes turned dark. And then I was told to take the medication cilostazol, which is supposed to open up my blocked blood vessels. I have a hunch that it's this drug that causes the plummeting blood counts that you kept mentioning to me over the last few months. I never have problem with my blood counts before taking cilostazol."
I paused, nodded, and was wordless. There was nothing to say. I looked at my patient for as long as I could without embarrassment, and then took a quick look at the desk reference of drug information. Bingo! The problem with blood counts after taking cilostazol has been well documented before. My patient has a point. Who in his right mind would want to go for a gruesome and painful bone marrow biopsy procedure if the problem might be solved by stopping a medication? I had never thought about it.
Well, we all know the moral of this story, don't we? William Osler taught us almost a century ago to listen to the patients because they are trying to tell us the diagnosis.
Friday, November 5, 2010
Dictionary
When I walked into my office of the new hospital building, I saw an uncluttered desk. The only thing I wish to do to my room is to keep it tidy. I make the wish like we make New Year's resolution.
To celebrate the new office, I bought a gift for myself last night. It's the seventh edition of the Oxford Advanced Learner's English-Chinese Dictionary. The last dictionary I bought has been with me for over twenty years, like a loyal golden retriever with dog-eared pages.
"Gee, why do you need to buy a dictionary in printed hard copy when we can search any word on the net?" you might ask.
My first answer is, "I don't know." I mean that. I can't say why. I simply like to go back to the printed dictionary. That's how looking up words has been for me ever since I got my first elementary learner's dictionary at the age of six. This is how it works: each time I home in on the word when I leaf through the pages, I meet other words in the neighbourhood. It's just the same for drinking coffee: you've always wanted to get your coffee at the café, but instead you meet your friends sitting around. I guess old habits like addiction to dictionary or coffee die hard.
Keeping the habit of having a good cup of coffee has always been easy, but a decent printed dictionary? That's another story – Oxford University Press, the publisher of the Oxford English Dictionary, said that they're considering not printing their next edition. Such move is, obviously, related to the free, instant online dictionary. The printed copy currently sitting on the desk of my new office was published in 2008, and it seems to be the last edition that I can buy.
To celebrate the new office, I bought a gift for myself last night. It's the seventh edition of the Oxford Advanced Learner's English-Chinese Dictionary. The last dictionary I bought has been with me for over twenty years, like a loyal golden retriever with dog-eared pages.
"Gee, why do you need to buy a dictionary in printed hard copy when we can search any word on the net?" you might ask.
My first answer is, "I don't know." I mean that. I can't say why. I simply like to go back to the printed dictionary. That's how looking up words has been for me ever since I got my first elementary learner's dictionary at the age of six. This is how it works: each time I home in on the word when I leaf through the pages, I meet other words in the neighbourhood. It's just the same for drinking coffee: you've always wanted to get your coffee at the café, but instead you meet your friends sitting around. I guess old habits like addiction to dictionary or coffee die hard.
Keeping the habit of having a good cup of coffee has always been easy, but a decent printed dictionary? That's another story – Oxford University Press, the publisher of the Oxford English Dictionary, said that they're considering not printing their next edition. Such move is, obviously, related to the free, instant online dictionary. The printed copy currently sitting on the desk of my new office was published in 2008, and it seems to be the last edition that I can buy.
Friday, October 29, 2010
Calpurnia
The stories of au pair taking care of kids have formed a genre of their own in Hong Kong.
Too often, the working parents – me included – are hiring domestic maids to look after children at a very young age. As is often the case, the children spend more time with the maid than the parents, whether we admit it or not. While much has been written about the proper way to wean a child from the breast or bottles, neither Dr. Spock nor the parenting guidebook What to Expect the Toddler Years covered what to do when we try to "wean" the children from the maid. Admit it: we don't know, and we don't want to.
Growing up with a maid is simply a new whole way of life, a way of seeing, learning, being. Here's a case in point. My friend's maid is going to leave after living together for six years. Her eight-year-old son wrote a touching piece that leaves everybody in tears. I can see that it's a deep, deep attachment much harder to cut than the umbilical cord.
Lest I be misunderstood: I do not want to suggest we parents are to "outsource" the job of childcare. Nor do I think it always proper to feel guilty about hiring a maid. Remember the father of Jem and Scout in the novel To Kill a Mockingbird? Atticus Finch is doing a good job, and so is the black housekeeper Calpurnia. There's no better lesson for parents to remember.
Too often, the working parents – me included – are hiring domestic maids to look after children at a very young age. As is often the case, the children spend more time with the maid than the parents, whether we admit it or not. While much has been written about the proper way to wean a child from the breast or bottles, neither Dr. Spock nor the parenting guidebook What to Expect the Toddler Years covered what to do when we try to "wean" the children from the maid. Admit it: we don't know, and we don't want to.
Growing up with a maid is simply a new whole way of life, a way of seeing, learning, being. Here's a case in point. My friend's maid is going to leave after living together for six years. Her eight-year-old son wrote a touching piece that leaves everybody in tears. I can see that it's a deep, deep attachment much harder to cut than the umbilical cord.
Lest I be misunderstood: I do not want to suggest we parents are to "outsource" the job of childcare. Nor do I think it always proper to feel guilty about hiring a maid. Remember the father of Jem and Scout in the novel To Kill a Mockingbird? Atticus Finch is doing a good job, and so is the black housekeeper Calpurnia. There's no better lesson for parents to remember.
Monday, October 11, 2010
Mockingbird
In the Pulitzer Prize winning novel To Kill a Mockingbird, the middle-aged lawyer Atticus Finch taught his daughter a simple trick to get along better with all kinds of folks.
"You never understand a person until you consider things from his point of view," he inspired, "or, until you climb into his skin and walk around in it."
But the real problem is that we have to make sure we've completely shaken off our feelings and dogma before we can really climb into someone's skin. Try as we might, we just can't, most of the time.
And is that all? Not really. We can try Atticus' trick for same-sex marriage and – well, yes – many of us, I suspect, simply find it hard to feel connected.
To the teaching of Atticus we must now add a "fly on the wall" position, a position where we are a neutral observer. From there, we can look at both ourselves and others, and find out what's going on between us. That would then give us a new perspective, somewhat like Gregor's metamorphosis in the story by Franz Kafka.
I think.
"You never understand a person until you consider things from his point of view," he inspired, "or, until you climb into his skin and walk around in it."
But the real problem is that we have to make sure we've completely shaken off our feelings and dogma before we can really climb into someone's skin. Try as we might, we just can't, most of the time.
And is that all? Not really. We can try Atticus' trick for same-sex marriage and – well, yes – many of us, I suspect, simply find it hard to feel connected.
To the teaching of Atticus we must now add a "fly on the wall" position, a position where we are a neutral observer. From there, we can look at both ourselves and others, and find out what's going on between us. That would then give us a new perspective, somewhat like Gregor's metamorphosis in the story by Franz Kafka.
I think.
Wednesday, October 6, 2010
Round
My favorite essay from the recent Annals of Internal Medicine is "Attending Round," named after the doctors' job description.
The narrated events took place one morning in 1963, when the doctors seized the moment of looking after their patients themselves, with little assistance from others, drawing blood, preparing the slides of the urine sediment, the peripheral blood smear, and the sputum Gram stain. After conducting rounds with the nurse, the doctors rushed to look at the bone marrow biopsy. It was followed by tidying the laboratory result folders and shepherding the patients back to the ward, before the attending physician started the senior medical round.
I began to see parallels when I told my intern to poke a needle into a swollen knee and rushed to examine the joint fluid under the microscope. My intern's eye grew wide and stared at me as if I'd forgot that we could simply send out the knee joint fluid for our pathologist to trace the suspects.
"There is so much to learn by looking after our patients on our own," I reminded my intern. I mean that. The nub of the problem is we're spending less and less time in really looking after the patients. It should be obvious from all these years (but I'll say it anyway) that doctors are often destined to sit in front of the computer screen, with the dollar sign hanging sternly atop. We need to enter the diagnostic coding meticulously, prepare one protocol after another protocol, and document everything to secure the hospital accreditation. I won't argue whether these exercises would benefit the patients, but I'm pretty sure that they steal time away from hands-on personalized care of our patients.
My intern took off his glasses and squinted at the eyepiece when I rotated the polarizer. "Glittering crystals," he exclaimed. "That's gout."
The narrated events took place one morning in 1963, when the doctors seized the moment of looking after their patients themselves, with little assistance from others, drawing blood, preparing the slides of the urine sediment, the peripheral blood smear, and the sputum Gram stain. After conducting rounds with the nurse, the doctors rushed to look at the bone marrow biopsy. It was followed by tidying the laboratory result folders and shepherding the patients back to the ward, before the attending physician started the senior medical round.
I began to see parallels when I told my intern to poke a needle into a swollen knee and rushed to examine the joint fluid under the microscope. My intern's eye grew wide and stared at me as if I'd forgot that we could simply send out the knee joint fluid for our pathologist to trace the suspects.
"There is so much to learn by looking after our patients on our own," I reminded my intern. I mean that. The nub of the problem is we're spending less and less time in really looking after the patients. It should be obvious from all these years (but I'll say it anyway) that doctors are often destined to sit in front of the computer screen, with the dollar sign hanging sternly atop. We need to enter the diagnostic coding meticulously, prepare one protocol after another protocol, and document everything to secure the hospital accreditation. I won't argue whether these exercises would benefit the patients, but I'm pretty sure that they steal time away from hands-on personalized care of our patients.
My intern took off his glasses and squinted at the eyepiece when I rotated the polarizer. "Glittering crystals," he exclaimed. "That's gout."
Saturday, October 2, 2010
Cockroach
Few years back, I learned from Time magazine that a KitKat bar isn't the same all over the planet; a Russian KitKat is smaller than a Bulgarian one, and the chocolate isn't as sweet as in a German one. The Nescafé instant coffee won't taste the same everywhere, too. There are around 200 different types of Nescafé, including the "three-in-one" sachets that we buy locally.
If the ice cream, tomato soup, chocolate – and what not – require modification to find the balance of local taste, it shouldn't be surprising that the most successful foodstuff for the cockroaches need to be prepared for the indigenous population. That's a simple truth that I learned recently. Before that, I'd been buying Japanese product to attract the cockroaches in my house – to no avail.
Just before giving up the ambition to clear the cockroaches, I thought of buying the genuinely local cockroach food that caters for the culture of our own cockroaches. The level of food consumption – or food poisoning if truth be told – by the cockroaches in my house is much higher than the days when I supplied them the imported Japanese meals. A colossal success, I must say.
In any event, this is probably the best personal experience from the products linked with the three words MADE IN CHINA, despite all those stories of tainted baby milk, recalled pet foods, oversulfated chondroitin sulfate contaminated heparin.
I'm not sure of the moral of my personal story, except that if you trust none of Chinese products it would be erroneous not to pay tribute to the Chinese cockroach bait.
If the ice cream, tomato soup, chocolate – and what not – require modification to find the balance of local taste, it shouldn't be surprising that the most successful foodstuff for the cockroaches need to be prepared for the indigenous population. That's a simple truth that I learned recently. Before that, I'd been buying Japanese product to attract the cockroaches in my house – to no avail.
Just before giving up the ambition to clear the cockroaches, I thought of buying the genuinely local cockroach food that caters for the culture of our own cockroaches. The level of food consumption – or food poisoning if truth be told – by the cockroaches in my house is much higher than the days when I supplied them the imported Japanese meals. A colossal success, I must say.
In any event, this is probably the best personal experience from the products linked with the three words MADE IN CHINA, despite all those stories of tainted baby milk, recalled pet foods, oversulfated chondroitin sulfate contaminated heparin.
I'm not sure of the moral of my personal story, except that if you trust none of Chinese products it would be erroneous not to pay tribute to the Chinese cockroach bait.
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