After seeing GY, the same group of students approached me for an extra tutorial. (See http://ccszeto.blogspot.com/2010/10/absent.html for details.) I could not help mentioning that they had skipped several clinic sessions during their rotation.
“We know we were irresponsible,” the student was most apologetic. “This will never happen again.”
Irresponsible? They had totally missed the point. Learning from patients is not a responsibility. It is a privilege. Seeing that they still did not understand, I asked them to join our ward rounds and promised some teaching.
They never came.
I refused to be disappointed last time but now I do. They probably considered me unkind not to offer the extra tutorial right away. But I really can't just sell point-form notes and exam skills like the local tuition classes.
He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all. –William Osler
25 Nov 2010
18 Nov 2010
Checklist
How many people does it take to perform a gastroscopy?
As an on-call endoscopist, I often settle with the assistance of one student nurse. With luck, I may have a house officer too. So the answer is – two or three.
“How wrong you are,” sneered AJ.
That was a trick question. We cannot perform endoscopy without a patient. The answer should be four.
Seeing I was hopeless, LL enlightened me on this subject.
As part of the hospital accreditation exercise (I didn’t know this term either but was too ashamed to ask), every team had to prepare checklists for different procedures to improve safety. Since I was too dumb to be involved, I had never seen this kind of things. Anyway, according to LL, before a staff took blood from a patient, he or she was expected to fill in a form like this:
Blood taking checklist (Version 27.3, last updated at 16:17, 17 Nov 2010)
This checklist is the latest version. (Y/N)
I have completed training in blood taking. (Y/N)
I have brought a tourniquet. (Y/N)
The name and ID on the request form match those of the patient. (Y/N)
The scanner is in good function. (Y/N)
The label printer is in good function. (Y/N)
Scan the barcode on the request form. (Y/N)
Scan the barcode on the wrist band of the patient. (Y/N)
Print the labels. (Y/N)
The name and ID on the labels match those of the patient. (Y/N)
Check the expiry date of the needle. (Y/N)
Check the expiry dates of the specimen tubes. (Y/N)
Check the name and ID on the labels again. (Y/N)
Stick the labels on the specimen tubes. (Y/N)
Put on the tourniquet. (Y/N)
Draw blood. (Y/N)
Release the tourniquet. (Y/N)
Pull the needle out. (Y/N)
Cover the puncture site with a piece of gauze. (Y/N)
Discard the needle in the sharp box. (Y/N)
Put the request form in a designated box for proper disposal. (Y/N)
Put the specimen tubes in a designated specimen box. (Y/N)
Check for leftover needles and tourniquets at the bedside. (Y/N)
Put this checklist in the patient’s folder. (Y/N)
Fax a copy of this checklist to Room XXX. (Y/N)
“Very well,” said LL, “this is just a simple form for a simple procedure. Our job, however, is to develop a checklist for endoscopic procedures. We have to prepare for all expected and unexpected circumstances that may happen to an endoscopist and the team.”
I was wondering how they might foresee unexpected circumstances, but was interrupted by AJ.
“After the first meeting, we have not even gone beyond step three. The trouble was one of the committee members immediately smelled danger in the item ‘The endoscope is in good function’”.
“I don’t get it,” I was puzzled. “We always check our instruments. The item is quite reasonable.”
“The colleague said none of us were engineers. We were not qualified to certify that the endoscope was in good order. If we signed the checklist and complications occurred because of mechanical failure, we would be held responsible.”
“Hearing this, the nursing officer immediately declared the nurses would not sign the checklist either,” added LL. “And so the meeting went on and on for three hours.”
KL always says the only way to avoid trouble is by not doing anything.
But if we do not do anything, what are we doing here?
“We will hold another meeting,” concluded AJ and LL.
As an on-call endoscopist, I often settle with the assistance of one student nurse. With luck, I may have a house officer too. So the answer is – two or three.
“How wrong you are,” sneered AJ.
That was a trick question. We cannot perform endoscopy without a patient. The answer should be four.
Seeing I was hopeless, LL enlightened me on this subject.
As part of the hospital accreditation exercise (I didn’t know this term either but was too ashamed to ask), every team had to prepare checklists for different procedures to improve safety. Since I was too dumb to be involved, I had never seen this kind of things. Anyway, according to LL, before a staff took blood from a patient, he or she was expected to fill in a form like this:
Blood taking checklist (Version 27.3, last updated at 16:17, 17 Nov 2010)
This checklist is the latest version. (Y/N)
I have completed training in blood taking. (Y/N)
I have brought a tourniquet. (Y/N)
The name and ID on the request form match those of the patient. (Y/N)
The scanner is in good function. (Y/N)
The label printer is in good function. (Y/N)
Scan the barcode on the request form. (Y/N)
Scan the barcode on the wrist band of the patient. (Y/N)
Print the labels. (Y/N)
The name and ID on the labels match those of the patient. (Y/N)
Check the expiry date of the needle. (Y/N)
Check the expiry dates of the specimen tubes. (Y/N)
Check the name and ID on the labels again. (Y/N)
Stick the labels on the specimen tubes. (Y/N)
Put on the tourniquet. (Y/N)
Draw blood. (Y/N)
Release the tourniquet. (Y/N)
Pull the needle out. (Y/N)
Cover the puncture site with a piece of gauze. (Y/N)
Discard the needle in the sharp box. (Y/N)
Put the request form in a designated box for proper disposal. (Y/N)
Put the specimen tubes in a designated specimen box. (Y/N)
Check for leftover needles and tourniquets at the bedside. (Y/N)
Put this checklist in the patient’s folder. (Y/N)
Fax a copy of this checklist to Room XXX. (Y/N)
“Very well,” said LL, “this is just a simple form for a simple procedure. Our job, however, is to develop a checklist for endoscopic procedures. We have to prepare for all expected and unexpected circumstances that may happen to an endoscopist and the team.”
I was wondering how they might foresee unexpected circumstances, but was interrupted by AJ.
“After the first meeting, we have not even gone beyond step three. The trouble was one of the committee members immediately smelled danger in the item ‘The endoscope is in good function’”.
“I don’t get it,” I was puzzled. “We always check our instruments. The item is quite reasonable.”
“The colleague said none of us were engineers. We were not qualified to certify that the endoscope was in good order. If we signed the checklist and complications occurred because of mechanical failure, we would be held responsible.”
“Hearing this, the nursing officer immediately declared the nurses would not sign the checklist either,” added LL. “And so the meeting went on and on for three hours.”
KL always says the only way to avoid trouble is by not doing anything.
But if we do not do anything, what are we doing here?
“We will hold another meeting,” concluded AJ and LL.
11 Nov 2010
Manchester
In the last few months, I attended more farewell parties than I would wish.
Then came the news of Sir Ferguson and Wayne Rooney. Despite all scandals, the story ended with Wayne holding a new contract. He was smiling. Sir Ferguson was smiling. Everybody was happy.
The salaries at local public hospitals are strictly regulated by the point scale. Similarly, Manchester United capped the salaries of its players to ensure financial stability. Therefore, it is interesting to learn what others do to keep their brilliant players.
Above all, players want to win. Although the club may not be able to offer crazy salaries like its rivals, some players are willing to accept a lower pay to win trophies. It is also attractive to play in the first team.
Second, a good club helps its players to improve everyday. A friendly environment and comradeship are also important.
Finally, as in Rooney’s case, the club is ready to break existing rules to build a better team when it is necessary.
While the last point is debatable, have we created the environment for our youngsters to live up to their potential?
Then came the news of Sir Ferguson and Wayne Rooney. Despite all scandals, the story ended with Wayne holding a new contract. He was smiling. Sir Ferguson was smiling. Everybody was happy.
The salaries at local public hospitals are strictly regulated by the point scale. Similarly, Manchester United capped the salaries of its players to ensure financial stability. Therefore, it is interesting to learn what others do to keep their brilliant players.
Above all, players want to win. Although the club may not be able to offer crazy salaries like its rivals, some players are willing to accept a lower pay to win trophies. It is also attractive to play in the first team.
Second, a good club helps its players to improve everyday. A friendly environment and comradeship are also important.
Finally, as in Rooney’s case, the club is ready to break existing rules to build a better team when it is necessary.
While the last point is debatable, have we created the environment for our youngsters to live up to their potential?
4 Nov 2010
Fire
夫戰勝攻取，而不修其功者凶，命曰費留。故曰：明主慮之，良將修之。非利不動，非得不用，非危不戰。主不可以怒而興師，將不可以慍而致戰。合於利而動，不合於利而止。怒可以復喜，慍可以復悅，亡國不可以復存，死者不可以復生。故明君慎之，良將警之。此安國全軍之道也。《孫子兵法火攻篇》
I have never been too interested in military news. I still remember how my secondary school classmates excitedly discussed the tactics at the Gulf War. I could not have cared less. What can be so interesting about a one-sided match?
The Art of War by Sun Tzu, however, is an exception. Often hailed as the first book on military strategies in China, The Art of War actually taught us that war should always be the last resort. One should never declare war out of anger. Having one hundred victories in one hundred battles is not the best. Seizing the enemy without fighting is the best.
In addition, Sun Tzu taught us not to depend on luck. Although history mostly described stories about people winning in extreme conditions, Sun Tzu did not think much of it. The duty of a commander is to protect his country and people, not to get his name recorded in history. One should always be prepared and in an undefeatable condition. As such, victory should seem logical and not come as a surprise to other people.
No wonder so many teams embrace defensive football.
I have never been too interested in military news. I still remember how my secondary school classmates excitedly discussed the tactics at the Gulf War. I could not have cared less. What can be so interesting about a one-sided match?
The Art of War by Sun Tzu, however, is an exception. Often hailed as the first book on military strategies in China, The Art of War actually taught us that war should always be the last resort. One should never declare war out of anger. Having one hundred victories in one hundred battles is not the best. Seizing the enemy without fighting is the best.
In addition, Sun Tzu taught us not to depend on luck. Although history mostly described stories about people winning in extreme conditions, Sun Tzu did not think much of it. The duty of a commander is to protect his country and people, not to get his name recorded in history. One should always be prepared and in an undefeatable condition. As such, victory should seem logical and not come as a surprise to other people.
No wonder so many teams embrace defensive football.
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