Itineraries

My Indonesian domestic maid really wants us to visit South Korea. Well, Korea is not a bad choice, but we kept thinking until recently.

The downside with Korea is that my maid's boyfriend works there as an illegal citizen. She'd love to go there and meet her sweetheart - but she can't get the visa without our company.

We finally agreed to go. That made my maid happy. This isn't to say that going to Korea doesn't take any kind of courage. I'd be lying if I swear my maid won't hide in Korea and elope.

I told my daughter we won't travel together with our maid in Seoul. She nodded. This time we bought a travel guidebook (that tells us a great deal about the parks there) and borrowed a Lonely Planet guide. We didn't speak Korean and yet we found ourselves bouncing around in the enormous Children's Grand Park. One of the best things that we found in the park is that she'd never run out of ideas (or energy) in the playground. She ran up and down and made new songs - she really loved the castle with two decks.

It was much more than that. At the zoo in the park, she learned how to distinguish boy mandarin ducks from girl ones by their plumage. She became fixated by the way how cormorants catch and swallow fish.

Two days later, my daughter thought of going to the park again. We did.

We combined the activity with a visit to the Seoul Children's Museum just next to the park, and that turned out to be right decision. As we wandered and wondered through the museum, discovering grasshoppers and tadpoles with magnifying glass, learning to create handmade motion pictures, we almost missed the chance to visit the royal palace - one of the "has to see" items listed in travel books. That's perfectly fine. Trust me, you should consider yourself really lucky to make up and tick your own to-do list within a journey.

We left Seoul (together with our maid, by the way) feeling enlivened and proud that we'd stumbled on an itinerary that celebrated the triumph of the travel with children.

Metric

I'm not a great fan of performance indicator, particularly those key performance index in our hospital setting. It's really about a quality metric that is worse than useless.

It is often the case that hospitals struggle to get a better score to prove their quality. But the score might tell otherwise. The performance score runs lower and lower, unlike the hospital team's anxiety that swelled and swelled with each passing day. So eager we're to fulfill the quest of performance index that we strive for the top score by hook or by crook.

The obsession with scoring system is understandable. The scoreboard has been in place for all of us in school, from clan to clan, culture to culture, and it is embraced earnestly and repeatedly. The hard truth is, most parents believe in the score. Some students, and many teachers, do. An important and oft-quoted metric on the scoreboard is the "intelligence quotient." But there's an old parable in which two cavemen were frightened when the earth shook with each footfall of a grumpy sabre-toothed tiger. The first caveman named Ug, with his mathematical and logical intelligence, tapped his chin and calculated the angle from which the tiger is approaching to the nearest degree. His mate, Thug, with the bodily or kinetic intelligence, ran away. "Who's the clever one now? Ug or Thug?"

I will say that, whether you're a parent or a hospital manager, should not miss the article "Performance Anxiety - What Can Health Care Learn from K-12 Education?" published recently in the New England Journal of Medicine. So, then. You will see how similar the health care and education system have been misled by the shortsighted performance measures. Examples of the top-down performance measures at school: students' achievement in standardized mathematics or reading tests, teacher's certification status. Just as how physicians lose performance points when patients cannot meet certain performance targets because they were dealt bad genetic and environmental hands, teachers are hold accountable for students' varied developmental timeline and many other uncontrollable factors in their lives. In turn, the author proposed a new bottom-up performance measuring system that, for instance, looks at the discussion and questioning skills, ability to engage students in learning, the expectation that students will correct their mistakes. The proposed measures to be assessed in hospital are similar: measures of patient experience such as effectiveness of physician communication about diagnosis and treatment.

Still, in the presence of pay-for-performance programs, many of us will pay more attention to the top-down performance measures. One good example of such outcome measures is the complication of venous thromboembolism after surgery. That's referring to a blood clot that forms in a vein deep in the body. It's a neat trick to blame and punish the "bad apples," referring here to those hospitals with more event rates of venous thromboembolism. Is it that simple? A new study, using data for nearly 1 million surgical discharges from 2800 hospitals, makes a solid argument against this measure. To cut the story short, the venous thromboembolism rates simply reflect how aggressively doctors look for them, but probably are not directly related to quality of care.

In other words, because some doctors more aggressively look for complications, they find more and appear to have worse outcomes. Good lesson to learn.

Praise

I received a phone call from my daughter's kindergarten yesterday morning. That's her school picnic day. If you're worried that the call was to announce the cancellation of picnic, don't worry - the weather was perfect. The call was all about my daughter's lunch box.

"Hi Jasmine's daddy. Auntie Elsa didn't give Jasmine back the lunch box yesterday when the school bus came. The lunch box is with us, and Miss Rebecca will bring you the lunch box today. Remember to ask Rebecca in case she forgets; Jasmine will need the box to bring her lunch tomorrow."

I didn't say much, except the two big words "Thank you." It's beautiful to have such a sunny day and a fabulous school team.

We received the lunch box, and then told Jasmine the story.

"Well, not really," my daughter answered in a soft tone. "Auntie Elsa didn't forget. It's me. I forgot to take the lunch box."

I didn't know what to say, except two words "Good girl."

Confession time. I had not the foggiest idea where her laudable honesty comes from.

Alphabet

If I had to choose one teacher my daughter couldn't do without, it would be my wife. None of that is to say that her kindergarten teachers aren't terrific. They are.

What I don't say, what I should say, is that I'm far below my wife's teaching skill.

Let me tell you the story of my debut into teaching my daughter's writing. Anyone familiar with teaching kids to write English alphabets will know what I mean. Permit me to correct you, there are more than 26 ways to write the alphabets if you mix up the direction each alphabet faces. For the kids, words - like practically everything else - can either be written in the right way or in its mirror image. Even my daughter can write her name with the first letter J facing the wrong way. Yes: it is different. The difference for these two ways to write the letter J is so trivial that a 3-year-old won't bother.

Writing the alphabet J in itself is a piece of cake for me, of course. I never answer wrongly when my daughter asks me which direction the letter faces. I just know the fundamental truth how a letter J should face. "Curve this way. Got that?"

And then my wife had her turn to teach Jasmine, and she made an intriguing discovery: the alphabet J lines up in front of other letters, and of course, this lovely letter J behaves in such a nice manner she won't turn around and step on the foot of others standing behind. Ah yes - here it is. No book has taught me this, nor have I heard it from my teacher. Real good fun to learn alphabets in this way.

Sure, I admit my daughter can still get her J in the wrong way. But then she will smile, "Oops, this J is naughty today; she turns around and chitchats with her classmates again."

Preconditioning

It was the first Saturday morning after my return from an overseas conference. There's no denying that it takes a bit of time to adjust ourselves to the working mode after a holiday. But I did it. I went back to the hospital and my routines.

Saturday routines have been many things to many people: a morning to sleep in and have brunch, a holiday to recover after long working hours, and tutorial time for students. According to my Saturday routines, I first pick up a topic to read, followed by an one-hour teaching of remedial class students, and then morning round at 9.

Here's what I read this morning: remote ischaemic preconditioning and kidneys, and it's a promising way to save our patients' kidneys from being knocked out by contrast dye (as used in a lot of imaging in hospitals). Such cases are common. In order to show the blood vessels in the heart, for example, doctors need to inject dye. Just as remarkable as the dye's power to outline the blood vessels, is how powerful the dye can damage the kidneys. So how do doctors get around the problem? The idea for such a protective drug to safeguard the kidneys has been around for close to 20 years, but none had pulled off a miracle. Easy to say, hard to do.

Last year, news broke that a trick called remote ischaemic preconditioning could cut the odds of kidney damage by 80 percent after dye injection in the heart.

An unusual trick.

What they did was to inflate a blood pressure cuff on the arm for four cycles, five minutes on and then five minutes off. The action of the inflated cuff, of course, is to apply brakes on the blood flow, and if short-lived, won't suffocate anybody. It's hard to think of any tool, any drug, any machine in history with which so many can afford so easily. It's a form of rehearsal or disaster drill, to the point that our patients' kidneys get better prepared before the real attack.

Which makes me wonder: Just how similar can I apply the concept of preconditioning to prepare my medical students for their examination?

School

My annual leave keeps accumulating. So it came as little surprise that almost two months after my daughter's new school year, I haven't had chance to pick her up after school. A year ago, she wasn't ready to attend school on her own and I've lost count of the number of times she cried at the kindergarten's door. But that was then. Now that Jasmine, more than three years old, is carrying the backpack and lunch box all by herself.

I took half day off yesterday to pick up my little girl, and that means she didn't have to jump on the school bus immediately after class.

It's easy to spend an hour weaving through the kindergarten campus, and around each corner of the playground you're rewarded - with laughter or smile of the kids. Is there any happier sound in the world than your child's giggling with her navigation of a rope course? Or the silly guffaw after a quick slide, landing with the butt? 

Soon after my half day leave, I knew I'm going to take another one soon to join my daughter after school.

Vernacular

Never heard of "TL;DR"? Then you're obviously older than 30. If you've learned English since young and you're having problem with new words, it just might be because of your age.

The list of new entries in the Oxford Dictionaries Online has been expanding faster than the waist size at your belly. Look at those slangs and shorthands that come with digital communication. See how they make communication easier - or not.

I've just read from the Washington Post that a "selfie" refers to a photograph of oneself, typically "with a smartphone or webcam and uploaded to a social media website." It's not as if we don't have the term "self-portrait" in English. But "selfie" is another matter. It's hard to replace "selfie" by "self-portrait" without losing the meaning. Hard as putting panty hose on a porcupine.

That said, it would be important to set a quota for admitting new words. Evolution of lexicon is a series of flukes, some good, many bad. I admit it: words or acronyms like FOMO (meaning "fear of missing out," in case you aren't updated) always give me agita. I'm rock-solid certain that I have absolutely no fear missing out the word FOMO. That's also why I don't think we need "TL;DR" to indicate "too long; didn't read."