29 Apr 2010


Further to my eavesdropping, Ah Kap discussed whether we should rely on human memory or information technology in this era. He argued that doctors who looked up everything were more trustworthy than those who believed in their knowledge.

Frankly speaking, my textbook knowledge has decayed faster than uranium since I passed the membership exam. Apart from a few dozens of drugs that are commonly used, I always consult the British National Formulary before prescribing. Far from being ashamed, I believe treatment is the easy part. Anyone with average intelligence can copy from a drug book and determine anything from dosage to contraindications. With the help of computer programs, one can also easily check if there is dangerous interaction among the drugs being prescribed.

However, no matter how easy it is to obtain treatment information from various sources, the treatment cannot be applied if you do not know what is happening to your patient. You can easily find data showing that Drug A reduces mortality by 25% in a patient with Disease X, but what if you cannot diagnose Disease X?

For the latter point, people may have the romantic idea that new diagnostic tests and computer programs will one day help a doctor with little knowledge make the diagnosis of Disease X. To this, I refer to the discussion by my friend Szeto (see http://ccszeto.blogspot.com/2010/04/technology.html). If advanced technology takes over simple procedures, the inevitable result is junior doctors have few things for their practice, and, therefore, they would have more difficulty to master the difficult techniques. Similarly, if most of the bread-and-butter diagnoses are made by computers, future doctors will unlikely have medical sense. When a computer fails to make the diagnosis, what contribution can you expect from the doctor? Besides, even for bread-and-butter diseases, if a doctor has nothing in mind, he has no choice but to order numerous unnecessary tests before the diagnosis is made.

As Yuen Sir always says, 90% of the diagnosis should be made by history taking alone. I would add that the percentage depends on who and how the history is taken.

P.S. Is this discussion opposite to my original remarks described by Szeto? Yes, but people believe what they want to believe. My point is if robots cannot do not only simple procedures but also difficult ones, we are doomed by the time we retire.

P.P.S. Fine novels by Ah Kap can be found at http://wongsingk.blogspot.com/.

22 Apr 2010


In old days, elders were highly respectable because of their knowledge.

Not any more. Now is the age of information technology. Youngsters only need the skills of learning and problem solving. As for factual knowledge, it has long been outsourced to Google and Wikipedia. A click on the computer leads to much more information than any scholar can possibly memorize. Don’t you realize the intelligence has been rising over generations, a phenomenon known as the Flynn effect?

Yet I found a recent conversion among our pediatricians interesting.

“Who taught the students Turner syndrome?” asked a consultant.

“The Professor himself,” a resident answered, “Why?”

“During the examination today,” the consultant explained, “the students were asked to counsel a mother of a child with Turner syndrome. I am actually not too annoyed that many candidates knew little about the condition. However, quite a number of them told the mother that though they did not know the syndrome, she was welcomed to read more from the pamphlets outside.”

“How come they did not ask her to google it?” another colleague chuckled.

Although the importance of factual knowledge has been downplayed, I suppose I still prefer to see a doctor who can explain rather than refer me to a pamphlet.

On second thoughts, they were not so bad.

“I know that I am intelligent, because I know that I know nothing.” - Socrates

15 Apr 2010

Level 5

Be an anonymous leader and let the people feel they did the job themselves. It is easier said than done.

When my Boss was a junior doctor, he once wrote a case report for medical journals. Before he submitted the manuscript, he sought advice from his physician. The senior doctor did give an advice – He put himself as the first author in front of Boss’ name.

In comparison, I have always been the lucky one. To establish my career, my mentor and supervisors often let me take credit for studies that I only had minor contribution.

Are Level 5 leaders a rare species? Why do we not see them more often?

I suppose it is indeed difficult to attain level 5. Nevertheless, it is probably even more difficult for people to spot a diamond in the rough when they are dazzled by the brilliant performance of charismatic leaders.

8 Apr 2010


My friend Szeto wrote about management lately, using Zhuge Liang as an example. (http://ccszeto.blogspot.com/2010/04/management.html). In fact, JW also loves referring to the five levels of leadership proposed by Jim Collins.

1. Highly capable individual
2. Contributing team member
3. Competent manager
4. Effective leader
5. Level 5 executive

Levels 1 to 3 are easy to comprehend. Level 4 leaders are charismatic leaders. They are often well-known to the public and peers, powerful and have strong visions. Companies usually have tremendous growth under their leadership. On the other hand, because a charismatic leader only needs a group of obedient staff who can effectively execute his/her brilliant ideas, little attention is paid to develop competent successors. Many companies suffer from significant decline after they leave.

In contrast, level 5 executive is a mixture of humility and will. Although they also have considerable will power to strive for the benefit of the company, they seldom draw attention to themselves and put emphasis on developing future leaders. From Collins’ study, companies under level 5 executives had more sustained and bigger growth.

When JW first discussed this with me, my first reaction was I had already learned this from Laozi.


1 Apr 2010


“I am the conductor of the medical association orchestra now,” JK told me recently. JK is a violinist with deep passion in music.

“Oh,” I replied, “congratulations!”

“I need time to learn more about the goals of the orchestra,” JK continued. “For example, do they want to expand? Shall we try more difficult works? By the way, we are in severe shortage of first violins. Would you like to join?”

I listened in horror (not for the last question because I knew how to reply politely). Although I have never attended any activities of this orchestra, as a medical professional I understand perfectly that expansion was the last thing they were thinking about. Orchestras and sports teams under professional bodies are mostly social gatherings. As for more difficult works, my violin teacher used to say that Mahler’s symphonies were the most fascinating. The structure was so complicated that everyone seemed to be playing different things at the same time. I think an amateur orchestra can at least achieve the latter effect.

At the end, I just answered, “If you are still there when I retire, I will certainly join.”

Somehow, the conversation reminded me of TW. When I was a junior trainee, one day TW and I were screening laboratory reports. “You know,” she spoke up suddenly, “resources are limited. One of the essential skills of a doctor is to determine when to make a big fuss and when not to. Somehow, it is curious to note that some doctors still make a big fuss over everything despite their seniority.”

Though TW was talking to me, I swear she was staring at the lady who crossed the harbor.