27 Sep 2012

Change

When I was a house officer, the department implemented a new policy – All intravenous catheters were to be replaced every 3 days to prevent phlebitis and bloodstream infections. Our group read aghast the memo. That meant a lot of extra work.

That evening, I wrote an e-mail to Angela (I was trying to date her back then), explaining why the new policy was not evidence-based and detailing the study design required to answer this question.

Imagine how I felt when I read Lancet last Saturday. Claire Rickard and colleagues from 3 Australian hospitals randomly assigned 3283 patients who required intravenous catheters for several days to change catheters every 3 days or only when clinically indicated (Lancet 2012;380:1066-74). Phlebitis occurred in 7% of patients in both groups. Nine patients in the routine replacement group and 4 in the clinically indicated group developed bloodstream infection. The authors concluded that both groups were equivalent and the practice of routine catheter replacement should be abandoned.

The study was strikingly simple and could be designed by a house officer like me. Why then, you may ask, was the study not published by me 10 years ago instead?

During a casual discussion on study planning, I mentioned a friend with my Mentor and remarked that he had loads of brilliant ideas but surprisingly few publications. He agreed with my observation and thought for a while. Then he said, “We do not know how he does things. I suspect he lacks the ability to complete a project. You can have a wonderful idea every day, but nothing will happen if you do not do anything.”

P.S. The dating request in the same e-mail was, as you can guess, successful. The intravenous catheter policy, on the other hand, was surprisingly short-lived.

20 Sep 2012

Fight

Last weekend, we watched a powerful demonstration of national education by our countrymen in the news. We could not help but wonder if our country would be dragged into war again.

At the turn of the last century, the prevailing view among academics was that large-scale warfare would not happen in Europe anymore because of the high level of economic development. The cost of war would be too great for any country. Unfortunately, shortly after the proclamation, two biggest wars in history broke out one after another.

If economic reasons are not strong enough to stop people from making stupid decisions, can globalization help? For two groups of people to kill each other, the distinction between ‘them’ and ‘us’ has to be clear cut. Soldiers are even trained to see enemies as animals. To do so, however, one has to be sufficiently unfamiliar to people in the opposing party. Even during relatively modern combats such as the Gulf War, the average soldier knew close to nothing about the culture, religion and life of his enemies. Now, we know our neighbors so well. We visit their cities, watch their movies and eat their noodles. Some of them are nasty, but so are we and the rest are good people. Is this knowledge good enough? I am not sure.

That said, a country should be defined by its people but not the number of uninhabited islands it claims. Sacrificing precious lives for sacred and oil-soaked soil? My answer is no.

13 Sep 2012

Hugga Wugga

Jonathan’s favorite video clip on Youtube is Hugga Wugga. It features an alien chanting ‘Hugga Wugga’. When it encountered another creature singing another song, the alien bullied it by blowing steam at it. Frightened, the poor creature followed the alien and sang ‘Hugga Wugga’.

Then came a new yellow creature that sang ‘You are my sunshine’. Hugga Wugga tried to silence it by blowing steam again. This time, however, the yellow creature outwitted Hugga, blew steam in its face and subdued it.

Yes, if hunger strike is radical, the yellow creature must be a terrorist.

6 Sep 2012

Brainwash

During a case presentation at the grand round, a student kept saying Drug N was the treatment of choice for peptic ulcer. After he had mentioned the drug the fourth time, I could not help but interrupt, “N is a brand name. There are also similar drugs in the same class. You have been brainwashed by the drug company!”

People say that art and humor are the best defense against brainwashing.

At the time of Soviet rule, a government official invited a famous artist to draw a painting to celebrate Soviet-Polish friendship. Seeing his reluctance, the official promised that he would have the freedom of expression, so far if he used the title ‘Lenin in Poland’.

When the painting was unveiled a few months later, the official almost fainted. It showed an ugly peasant woman in the arms of a man in front of Kremlin.

“Who is this ugly woman?” he asked.

“She is Nadezhda Krupskaya (Lenin’s wife).”

“And the man?”

“He is Leon Trotsky.”

Catching his breath, the official asked the final question, “Then where on earth is Lenin?”

“Lenin is in Poland.”