22 Aug 2013


Shortly before the interview, I was asked to give two talks for secondary school students. I was wondering why I was invited after what happened several years ago, but when I arrived at the venue, I realized that none of the people in the last event was present anymore (http://vwswong.blogspot.hk/2011/10/orientation.html).

Nonetheless, the administrators said I gave a terrific talk. At least I did not say anything to terrify them, I thought.

What did I learn? First, no matter how gloomy a situation is, there is always a second chance. Second, things change. The most important of all, however, is I changed, too.

15 Aug 2013


The next candidate was a boy. At the end of the interview, we asked whether he tried to figure out a doctor’s life through various channels.

“Ah yes,” he replied. “I read doctors’ blogs from time to time. One entry was particularly impressive. The doctor encountered a man with newly diagnosed lung cancer. He scolded the patient for smoking, but later found that he was actually a non-smoker. He regretted scolding the patient and explained the need to avoid stereotyping.”

“I beg to disagree,” my co-interviewer AC said. “We do not blame our patients regardless of what they have done. The patient may be a smoker, a drug addict, or a thief. But when he comes to us, he is our patient and deserves our attention and care.”

8 Aug 2013


Last month, we held the admission interview. The function was very smooth, and I expected to go back to the hospital early. Towards the end, a girl entered. As usual, we asked the candidate to introduce herself.

“I am a very shy person,” she began, “and I am interested in science.” She was honest. She stopped after that sentence.

After all these years, I found that perfectly acceptable. There are many jobs suitable for shy medical graduates. Just to explore gently, I returned to the topic after a few other general questions, “Medicine involves communication. Do you feel comfortable talking to all kinds of patients in the future?”

After thinking for a while, the girl replied, “I think I can do it.”

“I believe you can,” I continued, “but my question is: would you enjoy it?”

Then she began to explain that many of her family members were doctors and how much her patients wanted her to become a doctor too.

I must say I have never encountered this before. Most candidates are desperate to enter the medical school. Others would pretend to be interested in medicine, only to be found to have trouble after admission.

In the end, I explained to the girl that because of her excellent academic results, she would probably be selected. I also did not feel it right to mark her down because of her honesty. Nevertheless, we sincerely hoped that she would choose a subject she loved and enjoy university life.

1 Aug 2013


If a woman is diagnosed breast cancer and decides not to undergo treatment, we would persuade her but would accept her final decision. This is respect of autonomy and is one of the cornerstones of modern medical ethics.

In January 2013, a premature baby was born at a hospital in Hong Kong. Because of a complication of brain infection, the doctors recommended surgery. The father refused. That night, the hospital applied for guardianship and performed the brain surgery against the family’s wish. In April, the team operated on the baby’s eye, again despite the father’s protest. Last month, the baby was finally stable enough to enjoy a weekend at home. This time, however, the father refused to bring his son back to the hospital. The hospital obtained another court order and took the baby back.

Was autonomy being violated in this case? The doctors would argue that the father was after all not the baby himself. In the consent process, healthcare professionals were not asking what the guardian wished but what the baby would want should he have the ability to choose. When the father’s decision did not appear to be in the best interest of the baby, the team overrode his choice based on beneficence (to do good).

This story drew my attention as our team was involved in the care of two old ladies with bile duct obstruction and infection recently. Both ladies were in their nineties and suffered from multiple illnesses. Without intervention, the infection could be lethal. On the other hand, to clear the obstruction, we had to perform endoscopy, which was also very risky given their background. In face of such dilemmas, we used the standard tactics – explain everything to the families and let them choose. Ironically, the family of the sicker lady, who even depended on mechanical ventilation at night, insisted on aggressive treatment. She underwent two endoscopic procedures. More is yet to come.

In difficult situations like this, letting family members make the decision is the safest approach if the primary aim is to avoid complaints. Come to think of it, however, seldom do we ask what the patient herself really wants.

25 Jul 2013


Last week, my friend AC invited me to write a review with him. At the end, he sheepishly added, “We expect the work in two weeks. The deadline has already passed.”

I sighed. Although I know many people who miss deadlines all the time, I have never done it before and find it hard to understand.

When I mentioned this to GW, she was most understanding. “It is quite natural. After you have missed the first deadline, everything else is postponed and will not be finished on time.”

“But then at least you should turn down new requests when you know you can’t meet the deadline?”

“When that becomes a habit, it does not matter anymore.”

What really surprises me, however, is that punctuality has little correlation with success. One of the best clinical researchers I know is notorious for being late. He would not even start working until he has received the first reminder. Yet people continue to beg him for help the next time. In a way, being good is more important than being punctual.

18 Jul 2013


Last weekend, our team attended a research workshop. That evening, my teammates taught me to play Monopoly Deal. I must say I have not formulated any winning strategy yet. Everything I put on the table was snatched by the other players.

At one point, SW charged me 5 million. I protested, “But I have no money. Why don’t you collect money from richer people?”

“Because I want your land,” SW explained. After a while, he added, “This is what happens in real life.”

How very true.

11 Jul 2013


On the next day, AL showed me a set of photos she took during our medical grand round. I was wondering why she took photos of us, but alas, it was not us.

That was a student bored to death by our talk. The gentleman first took off his sandals, and then rubbed his toes one by one with his fingers. He turned on his laptop and flipped between Facebook and Yahoo. Despite all these, we speakers seemed not aware of his annoyance. He finally gave up and slept with his mouth wide open.

After seeing the photos, I was first quite defensive. “But we didn’t initiate that. The external examiners made us run that talk.” On second thoughts, I owed that student an apology.

That said, while we were waiting for the grand round to start, Szeto and I actually discussed what we would rather talk about. I suggested detective stories.

“Nah,” Szeto sneered, “that is beyond your expertise. If you talk about Mozart, I would have to discuss Beethoven.”

That would be interesting. One of the theories is that Mozart died of poststreptococcal glomerulonephritis (Ann Intern Med 2009;151:274-8). Perfect for a renal grand round.