28 Feb 2013


A while ago, GW asked me to sign on a pile of bills.

As I duly complied, I asked, “I am happy to pay, but listen. Your account has zero dollars. Mine has minus xx(*) dollars. Even my seven-year old daughter can tell I am poorer than you.”

“The university people say that you have earned money before and I haven’t. Therefore, they have more confidence in your ability to settle the sum.”

I began to understand the national debts.

* Omitted to protect the account holder.

21 Feb 2013


At the final year medical students’ farewell party, JW told us a story.

A middle-age man attended the emergency department of a local hospital complaining of fever, jaundice and upper abdominal pain. Blood tests showed obstructive jaundice and high white cell count. The emergency doctor diagnosed common cold and sent the man away.

The man did not feel right and decided to seek second opinion at a hospital in Shenzhen. Magnetic resonance cholangiopancreatogram was performed on the same day and showed a small stone in the bile duct. The diagnosis of acute cholangitis was made. Eventually, the man was admitted under our team, and the cholangitis was successfully treated by endoscopy.

During morning round one day, the man talked about his experience. He did not really complain, but he could not help mentioning that he only spent RMB200 for the scan and was very satisfied with the service.

JW remarked that doctors in Hong Kong had been charging a premium of 5 to 20 times by claiming to deliver better service. He questioned if the performance of future doctors could still justify the premium. He anticipated keen competition from mainland 10 to 20 years later, but it appeared that the time had already come silently.

I rarely link money with medicine, but this is one of the few occasions in which I hope our students are worth the premium.

14 Feb 2013


Recently, my friend TW was admitted to the hospital for chest infection. For a fit young man, that was quite an experience. It was so overwhelming that he reflected on his life and made the bold decision to buy an apartment to please his wife.

Lying in bed and overcome by myalgia, he also made some interesting observations. He noticed that some nurses were in traditional uniforms. They wore dresses and caps. The attire originated from that of nuns, who used to be the ones taking care of the sick in the past. In fact, we still call senior nurses ‘sisters’. Nowadays, some other nurses dress in tunics and trousers. TW remarked that the nurses in traditional uniforms were more caring and professional. He asked me for an explanation.

I answered that there were several possible explanations. First, the ones in trousers might not be nurses. There are different types of healthcare workers in the hospital. Second, the observation could be biased due to sampling variability and/or prejudice of the observer.

“Suppose your observation is correct,” I continued, “there is one more possibility. The nurses who continued to dress in traditional uniforms might be more proud of their job. This may have affected how they treat their patients.”

Outfit is of course trivial. The important thing is whether we are proud of what we are doing. Another day to declare myself a proud husband and father.

7 Feb 2013


Last month, I opened my drawer to get a certificate for photocopy. Something deep inside caught my eyes. I have forgotten it for a decade.

Then was the time of my basic training. I had just diagnosed liver cancer in an old gentleman and held a family meeting to discuss the condition. Yes, there were various treatment options, but no, the outlook was poor. His age and liver function would preclude him from most invasive treatments. The family was most understanding.

A few weeks later, the gentleman called me and asked where I was. When we finally met, he presented me with a flag, the kind you get if you win a race. It was crimson red, almost 3-foot long and bore my name and his praise. I told him I really did not do much. He just told me that if I continued what I was doing, he was sure I would do great things.

I have to confess that I did not put up the flag in the ward. It just did not seem right to take credit for what was supposed to be teamwork. At the same time, I also feared that the gentleman would find out and I might hurt his feelings. In any case, the flag ended up in my drawer and I soon forgot the whole thing.

When I looked at the flag again after all these years, I could no longer remember what the gentleman looked like. What I could vividly remember, however, were his earnest eyes, full of expectation, almost flashing with excitement. I may have forgotten the flag, but the blessings from my patients were always in me. I wish he is proud.