Earlier this month, my mentor, GW and I attended a meeting in Phuket and gave some talks. After the session, the Associate Dean at the Thai university invited us to watch his rehearsal. Much to our surprise, he and his fellows were going to dance in the celebration dinner. They chose a few scenes from High School Musical.
If you have never heard of High School Musical, you do not have a kid in primary or secondary school. This is a popular TV show featuring American students going to school, playing sports, dating, etc.
While the Associate Dean was jumping up and down on stage and gasping for air, we joked about the possibility of having our Boss give such a show.
“We will all be asked to accompany him,” GW reminded us.
“I’d rather give three talks than dance on stage,” said my mentor.
“Thais can enjoy life,” our Singaporean friend in the audience concluded. “On the other hand, we are too complex and would be worried that others may laugh at us.”
Watching the Thai professor laughing wholeheartedly with his colleagues, we felt happy for them. After all, this is what life is all about.
16 Apr 2009
9 Apr 2009
Choice
Without the voices of our trainees, the story would be incomplete. Some older people believe they have already known what the youngsters think. Some even believe that the youngsters do not know how to think and they know what is best for them. To a certain extent, I also agree that young people may not tell you the truth even if you ask, but I wished to ask.
In March 2009, two investigators (VW and KY) independently generated a list of basic trainees in our department who have taken or passed the MRCP exam and expressed interest in joining a specialty. A standard set of open questions was sent by e-mail. For confidentiality reasons, the identity of trainees and the exact specialties would not be revealed. Overall, eight of nine trainees responded (response rate 89%).
Decision
The median number of specialties the trainees had seriously considered was 3 (range 2 to 4). Six trainees made the final decision after the MRCP exam and one made the decision during internship. One notable exception was a trainee who determined to join a specialty even before entering the medical school. That trainee continued to pursue the dream despite failing to enter the medical school at the first attempt. He/she is now generally agreed to be one of the most responsible and competent colleagues in our department. Based on this touching story, I am ready to help all youngsters to develop their careers.
Factors affecting the decision
Not surprisingly, five trainees stated interest as their main reason of choosing a specialty. Five also considered the team spirit and the behavior of other team members important. Three respondents considered future prospects (one stated promotion, one stated the likelihood of staying in the team after the completion of training, and one reported the prospect in the private market). Three trainees also thought the leadership of team heads was important. On the other hand, only one trainee wished to join a team for research and challenge. One trainee said that the decision was affected by what the other trainees chose.
One interesting phenomenon recently is that specialties with more trainees and fellows continue to attract the biggest number of new recruits. Some people have questioned this behavior on the ground that the promotion and training opportunities may be adversely affected. When we asked the same questions, three trainees thought that the number of existing members in a specialty was unimportant in their decision process. Three other trainees believed that bigger teams were more attractive because they would get more support and have better exchange of ideas. Only two respondents were worried about the prospect and said that specialties with more existing trainees were less attractive.
Pro-choice or Pro-life?
Under the current system, most trainees can enter their first-choice specialties. When we asked about their view on the possibility of job assignment by the department according to service need, four trainees stated that they would seek training posts in other hospitals and one would negotiate with the department. Two trainees would accept the offer if they could join their other favorite specialties, but would still leave us if the team was not what they wanted. None of these seven trainees believed they could excel in specialties they did not like. Only one respondent agreed to accept any offer and try the work first.
In March 2009, two investigators (VW and KY) independently generated a list of basic trainees in our department who have taken or passed the MRCP exam and expressed interest in joining a specialty. A standard set of open questions was sent by e-mail. For confidentiality reasons, the identity of trainees and the exact specialties would not be revealed. Overall, eight of nine trainees responded (response rate 89%).
Decision
The median number of specialties the trainees had seriously considered was 3 (range 2 to 4). Six trainees made the final decision after the MRCP exam and one made the decision during internship. One notable exception was a trainee who determined to join a specialty even before entering the medical school. That trainee continued to pursue the dream despite failing to enter the medical school at the first attempt. He/she is now generally agreed to be one of the most responsible and competent colleagues in our department. Based on this touching story, I am ready to help all youngsters to develop their careers.
Factors affecting the decision
Not surprisingly, five trainees stated interest as their main reason of choosing a specialty. Five also considered the team spirit and the behavior of other team members important. Three respondents considered future prospects (one stated promotion, one stated the likelihood of staying in the team after the completion of training, and one reported the prospect in the private market). Three trainees also thought the leadership of team heads was important. On the other hand, only one trainee wished to join a team for research and challenge. One trainee said that the decision was affected by what the other trainees chose.
One interesting phenomenon recently is that specialties with more trainees and fellows continue to attract the biggest number of new recruits. Some people have questioned this behavior on the ground that the promotion and training opportunities may be adversely affected. When we asked the same questions, three trainees thought that the number of existing members in a specialty was unimportant in their decision process. Three other trainees believed that bigger teams were more attractive because they would get more support and have better exchange of ideas. Only two respondents were worried about the prospect and said that specialties with more existing trainees were less attractive.
Pro-choice or Pro-life?
Under the current system, most trainees can enter their first-choice specialties. When we asked about their view on the possibility of job assignment by the department according to service need, four trainees stated that they would seek training posts in other hospitals and one would negotiate with the department. Two trainees would accept the offer if they could join their other favorite specialties, but would still leave us if the team was not what they wanted. None of these seven trainees believed they could excel in specialties they did not like. Only one respondent agreed to accept any offer and try the work first.
2 Apr 2009
Training
Recently, there has been some discussion on the recruitment of trainees into different specialties in our department. Understandably, some team heads are not too happy when all trainees are attracted to a few popular specialties, while their own teams suffer from insufficient manpower. With immense interest in human thinking and behavior, I asked some colleagues for their opinion.
Prof Szeto answered, "I have decided that I do not need to have any opinion." (For details, please visit http://ccszeto.blogspot.com/2009/03/opinion.html.)
When I asked the same question, my mentor wrote down four words: '寧缺莫濫'. According to him, teammates are not just manpower. They are brothers and sisters. When a leader recruits a new teammate, he should help him/her develop a career as well. Therefore, he would rather wait patiently for suitable candidates.
As usual, I learned a lot by asking.
Prof Szeto answered, "I have decided that I do not need to have any opinion." (For details, please visit http://ccszeto.blogspot.com/2009/03/opinion.html.)
When I asked the same question, my mentor wrote down four words: '寧缺莫濫'. According to him, teammates are not just manpower. They are brothers and sisters. When a leader recruits a new teammate, he should help him/her develop a career as well. Therefore, he would rather wait patiently for suitable candidates.
As usual, I learned a lot by asking.
26 Mar 2009
Research
Our department held the research day last Saturday. Sadly, none of our trainees attended the meeting. I hope they were just skeptical about the quality of the meeting instead of having no interest in research at all.
This is not to say that research must be of prime importance. In fact, I am afraid some people put too much emphasis on research output in judging one’s worth. I am all too happy to see youngsters striving to become responsible and competent doctors. However, in the era of evidence-based medicine, even doctors not doing research should know how research is done and if the conclusion of a report does justice.
The event led me to reflect why I am doing research.
Hopefully, it is not for fame, prize and money. If I choose those, the temptations to do wrong are too great.
It is the sheer joy of finding things out. Not only do I want to learn the truth, I am also eager to see how people get the answer. Our nephrologists were probably fed up during my attachment when I asked silly questions like ‘Why does proteinuria lead to frothy urine? When is frothy urine pathological (I often see bubbles in urine)? Does the size or number of bubbles matter?’
Recently, I brought our youngest and talented trainee to a laboratory meeting. After the presentation, she summarized the whole work in one question – ‘What is the use?’ At that time, I nodded politely. (Friends familiar with both of us would understand that I had no other choice.) Deep in my heart, however, my answer was, ‘You never know.’
When Osamu Shimomura applied for a research post to investigate why jellyfish glowed in the early 1960s, many might also question the significance of his work. Who would have imagined that the discovery of the green fluorescent protein would transform biomedical research and earn him a Nobel Prize in Chemistry 40 years later?
This is not to say that research must be of prime importance. In fact, I am afraid some people put too much emphasis on research output in judging one’s worth. I am all too happy to see youngsters striving to become responsible and competent doctors. However, in the era of evidence-based medicine, even doctors not doing research should know how research is done and if the conclusion of a report does justice.
The event led me to reflect why I am doing research.
Hopefully, it is not for fame, prize and money. If I choose those, the temptations to do wrong are too great.
It is the sheer joy of finding things out. Not only do I want to learn the truth, I am also eager to see how people get the answer. Our nephrologists were probably fed up during my attachment when I asked silly questions like ‘Why does proteinuria lead to frothy urine? When is frothy urine pathological (I often see bubbles in urine)? Does the size or number of bubbles matter?’
Recently, I brought our youngest and talented trainee to a laboratory meeting. After the presentation, she summarized the whole work in one question – ‘What is the use?’ At that time, I nodded politely. (Friends familiar with both of us would understand that I had no other choice.) Deep in my heart, however, my answer was, ‘You never know.’
When Osamu Shimomura applied for a research post to investigate why jellyfish glowed in the early 1960s, many might also question the significance of his work. Who would have imagined that the discovery of the green fluorescent protein would transform biomedical research and earn him a Nobel Prize in Chemistry 40 years later?
19 Mar 2009
Coca Cola Classic
Have you noticed the word “Classic” beside the Coca Cola logo in some of its products? What is so classical about a can of coke?
In 1980s, Pepsi launched an aggressive advertising campaign to boost sales. People at my age would probably remember television advertisements featuring a boy or girl trying two cups of unlabelled coke and being asked to choose the better one. After he/she had made the decision, the better coke always turned out to be Pepsi. You may think this is rubbish. We can always hire an actor to do this, right?
The Coca Cola Company certainly did not trust it either. However, being a big company, it decided to be cautious and secretly performed similar tests on volunteers. Much to their distress, Pepsi really seemed to be winning. Over 60% of testers thought Pepsi tasted better. The company saw this as a potential disaster, and quickly changed the formula of the drink with “New Coke” on 23 April 1985.
The result? The company converted a potential disaster to a real one. Customers just hated the new products and protested. Sales dropped. The company quickly returned back to the original formula in less than 3 months. To be absolutely sure that the customers were pleased, it added the word “Classic” next to the logo.
What went wrong? In a sip test, a tester only takes a mouthful of soft drink. The sweeter product is more likely to win. In real life, people drink the whole can of coke, not a sip. In such settings, it may taste too sweet.
Therefore, you must understand what an investigation is measuring before you can use it. Misusing an investigation is not useless. It is worse than useless. It is misleading.
Some weeks ago, I noticed a young doctor checking blood for carcinoembryonic antigen in a patient with anemia. “This is not supposed to be a screening or diagnostic test,” I said.
“A positive test increases our suspicion of colorectal cancer,” the doctor protested. “Taking some blood causes no harm anyway.”
“No,” I disagreed, “you can still harm the patient. Imagine what would happen if you decide not to perform endoscopy to rule out cancer if the blood test is negative.”
In 1980s, Pepsi launched an aggressive advertising campaign to boost sales. People at my age would probably remember television advertisements featuring a boy or girl trying two cups of unlabelled coke and being asked to choose the better one. After he/she had made the decision, the better coke always turned out to be Pepsi. You may think this is rubbish. We can always hire an actor to do this, right?
The Coca Cola Company certainly did not trust it either. However, being a big company, it decided to be cautious and secretly performed similar tests on volunteers. Much to their distress, Pepsi really seemed to be winning. Over 60% of testers thought Pepsi tasted better. The company saw this as a potential disaster, and quickly changed the formula of the drink with “New Coke” on 23 April 1985.
The result? The company converted a potential disaster to a real one. Customers just hated the new products and protested. Sales dropped. The company quickly returned back to the original formula in less than 3 months. To be absolutely sure that the customers were pleased, it added the word “Classic” next to the logo.
What went wrong? In a sip test, a tester only takes a mouthful of soft drink. The sweeter product is more likely to win. In real life, people drink the whole can of coke, not a sip. In such settings, it may taste too sweet.
Therefore, you must understand what an investigation is measuring before you can use it. Misusing an investigation is not useless. It is worse than useless. It is misleading.
Some weeks ago, I noticed a young doctor checking blood for carcinoembryonic antigen in a patient with anemia. “This is not supposed to be a screening or diagnostic test,” I said.
“A positive test increases our suspicion of colorectal cancer,” the doctor protested. “Taking some blood causes no harm anyway.”
“No,” I disagreed, “you can still harm the patient. Imagine what would happen if you decide not to perform endoscopy to rule out cancer if the blood test is negative.”
12 Mar 2009
Air Pollution Index
Last month, a group of medical students from our sister university took to the streets in protest and urged the government to update the Air Pollution Index (API). Do I support the act? Of course. Do I support the proposition? I am afraid not.
The protest was an excellent piece of civil education. I hope our students would join some of these activities, too. The real question is – does updating the API do any good?
Currently, the Environmental Protection Department provides the API based on the level of 6 atmospheric pollutants, including sulfur dioxide, nitrogen dioxide, suspended particulates, carbon monoxide, ozone and lead. The index and air quality objectives were set in 1987. Actually, the medical students were not the first to criticize that the index was not update. In October 2005, Task Force on Air Pollution has already stated that the current API is ‘meaningless’. First, some harmful components are not measured. Second, our cutoffs fall short of the World Health Organization Air Quality Guidelines.
I do not doubt that the experts know a lot more about the relationship between air pollution and disease. But what if we update the API? Can we shut down a few factories in Guangdong on bad days? Can we ask our drivers not to drive? Don’t be silly. You may argue – at least we can warn patients with lung diseases not to go outdoors, right?
People working in hospitals in Hong Kong may recall that we have an alert system for avian influenza. It is funny to use the word ‘recall’ for something in the present. The trouble is we are always on yellow alert. When you are always on alert, you have no choice but to ignore it. According to Prof Anthony Hedley of the Task Force, the air pollution of Hong Kong should be stated as ‘absolutely sky high’ most of the year. Can we ask the poor men to stay at home most of the year?
At the end of my hematology rotation as a medical student, I gathered my guts and asked. “Professor GC, our patients come in every few weeks for blood transfusion, but most of them do not have a diagnosis. Wouldn’t it be nice if we perform bone marrow exam and know what we are dealing with?”
“Investigations should only be done when they change the management,” the hematologist answered. “If these people suffer from myelodysplastic syndrome, I will provide supportive transfusion. If they turn out to have leukemia, I will still provide supportive transfusion.”
So forget about more investigations. The government certainly knows that the air pollution is bad. What we should push for is the means to combat pollution, not how to measure it.
The protest was an excellent piece of civil education. I hope our students would join some of these activities, too. The real question is – does updating the API do any good?
Currently, the Environmental Protection Department provides the API based on the level of 6 atmospheric pollutants, including sulfur dioxide, nitrogen dioxide, suspended particulates, carbon monoxide, ozone and lead. The index and air quality objectives were set in 1987. Actually, the medical students were not the first to criticize that the index was not update. In October 2005, Task Force on Air Pollution has already stated that the current API is ‘meaningless’. First, some harmful components are not measured. Second, our cutoffs fall short of the World Health Organization Air Quality Guidelines.
I do not doubt that the experts know a lot more about the relationship between air pollution and disease. But what if we update the API? Can we shut down a few factories in Guangdong on bad days? Can we ask our drivers not to drive? Don’t be silly. You may argue – at least we can warn patients with lung diseases not to go outdoors, right?
People working in hospitals in Hong Kong may recall that we have an alert system for avian influenza. It is funny to use the word ‘recall’ for something in the present. The trouble is we are always on yellow alert. When you are always on alert, you have no choice but to ignore it. According to Prof Anthony Hedley of the Task Force, the air pollution of Hong Kong should be stated as ‘absolutely sky high’ most of the year. Can we ask the poor men to stay at home most of the year?
At the end of my hematology rotation as a medical student, I gathered my guts and asked. “Professor GC, our patients come in every few weeks for blood transfusion, but most of them do not have a diagnosis. Wouldn’t it be nice if we perform bone marrow exam and know what we are dealing with?”
“Investigations should only be done when they change the management,” the hematologist answered. “If these people suffer from myelodysplastic syndrome, I will provide supportive transfusion. If they turn out to have leukemia, I will still provide supportive transfusion.”
So forget about more investigations. The government certainly knows that the air pollution is bad. What we should push for is the means to combat pollution, not how to measure it.
5 Mar 2009
Sixteen
(The original version of ‘Sixteen Things About Vincent’ appeared in Facebook on 31 January 2009. Thanks to my friends’ feedback, the arrogant phrases were modified.)
My mentor tagged me. I guess I just have to follow suit.
1. I studied in three primary schools. My mother thought that was like Mengzi’s mother, who moved house three times to pave the way for the great scholar. Through the process, I did learn how to adjust to new environment. In essence, you have to make friends quickly, and respect that others may do things differently in different places.
2. I entered primary school at the age of 5 and have been the youngest in class ever since. While I was OK with language and mathematics, I could never manage craftworks.
3. Contrary to what child educationists may suggest, my mother constantly emphasized that I was not smart at all when I was in primary school. She believed this would make me more hard-working. Some of my friends would probably agree with her – that I am hard-working and not smart.
4. I am a Wah Yan boy. Although the Wah Yan spirit has never been formally defined, most Wah Yan boys think they get it. It is very much like the Dragon Scroll in Kungfu Panda.
5. I thought I was good at physics. I am humbler now. I am glad that Stephen Hawking deleted most mathematical formulas in A Brief History of Time.
6. I was made the producer of a joint-school musical play when I was in Form 6. While all my classmates were busy dating girls, I was worried sick about how to settle the budget everyday. This was meant to be a fund-raising project for the Hong Kong Cancer Fund, but the stage staff and actors spent almost every penny in the end. During the last rehearsal, the stage curtain was torn in half by a handrail at the edge of the set, costing another $5000 (I know. Similar things happened when Jesus died on the cross.). This was the only time when an opera moved me to tears. After the event, I was rather depressed and ashamed for letting the Cancer Fund down. In retrospect, this was no big deal, and we learned a lot through the project. But it took me years to forgive myself.
7. I can play piano, violin and pipa. If you only want ‘Twinkle, Twinkle, Little Star’, I can almost play any instruments.
8. I learned handball in the university. Two other medical students attended handball class with me, but I was the only one who had scored at all (only 3 goals in 10 games).
9. Prof Jean Woo was my Physician on my first day as a resident. I later learned that she did not want a first-year trainee, but Dr Michael Fu convinced her that I would be good enough. Of course I can never be good enough. I only strived to become better everyday.
10. After my MRCP exam, Prof Sung told me that I failed. I was glad he got it wrong this time.
11. I presented an abstract in a European meeting right after the MRCP exam. After I stepped down from the stage, Prof Anna Lok praised me. This was very important for my development. Before that, I had quite severe stage flight. Now I try to praise young doctors and students whenever I could. If you have read Henry’s notes, you will know that Prof Sung and Prof Lok are the grandparents of my career.
12. I wrote my first paper with Dr Nancy Leung and Henry. I could not find ‘chi-square test’ in the pull-down menu of SPSS, and Prof CC Szeto taught me right away. I did not mention his help in the acknowledgement section because it was quite embarrassing to thank people for teaching me chi-square test in a scientific paper. I would like to thank him now.
13. My wife and I prepared a presentation on osteoporosis in my final year. The presentation went badly, but I got my wife.
14. My favorite movie is The Pianist by Roman Polanski. My wife thought I was crazy when I repeatedly played Chopin’s Ballade No. 1 in the movie. Now that my daughter is 3 years old, we can only watch Strawberry Shortcake at home.
15. I tell my daughter bedtime stories every night. Since I am bored with her story books, I have started making up stories. The latest hits included Strawberry Shortcake meets Spiderman and Strawberry Shortcake meets Mr Incredible.
16. I know I seldom attend social gatherings now. But on the first day I went to work after the New Year holidays, my daughter complained to my wife. “My Daddy doesn’t miss me.” What else can I do?
Want to read the arrogant version in Facebook? Don’t be silly. I have already modified it.
My mentor tagged me. I guess I just have to follow suit.
1. I studied in three primary schools. My mother thought that was like Mengzi’s mother, who moved house three times to pave the way for the great scholar. Through the process, I did learn how to adjust to new environment. In essence, you have to make friends quickly, and respect that others may do things differently in different places.
2. I entered primary school at the age of 5 and have been the youngest in class ever since. While I was OK with language and mathematics, I could never manage craftworks.
3. Contrary to what child educationists may suggest, my mother constantly emphasized that I was not smart at all when I was in primary school. She believed this would make me more hard-working. Some of my friends would probably agree with her – that I am hard-working and not smart.
4. I am a Wah Yan boy. Although the Wah Yan spirit has never been formally defined, most Wah Yan boys think they get it. It is very much like the Dragon Scroll in Kungfu Panda.
5. I thought I was good at physics. I am humbler now. I am glad that Stephen Hawking deleted most mathematical formulas in A Brief History of Time.
6. I was made the producer of a joint-school musical play when I was in Form 6. While all my classmates were busy dating girls, I was worried sick about how to settle the budget everyday. This was meant to be a fund-raising project for the Hong Kong Cancer Fund, but the stage staff and actors spent almost every penny in the end. During the last rehearsal, the stage curtain was torn in half by a handrail at the edge of the set, costing another $5000 (I know. Similar things happened when Jesus died on the cross.). This was the only time when an opera moved me to tears. After the event, I was rather depressed and ashamed for letting the Cancer Fund down. In retrospect, this was no big deal, and we learned a lot through the project. But it took me years to forgive myself.
7. I can play piano, violin and pipa. If you only want ‘Twinkle, Twinkle, Little Star’, I can almost play any instruments.
8. I learned handball in the university. Two other medical students attended handball class with me, but I was the only one who had scored at all (only 3 goals in 10 games).
9. Prof Jean Woo was my Physician on my first day as a resident. I later learned that she did not want a first-year trainee, but Dr Michael Fu convinced her that I would be good enough. Of course I can never be good enough. I only strived to become better everyday.
10. After my MRCP exam, Prof Sung told me that I failed. I was glad he got it wrong this time.
11. I presented an abstract in a European meeting right after the MRCP exam. After I stepped down from the stage, Prof Anna Lok praised me. This was very important for my development. Before that, I had quite severe stage flight. Now I try to praise young doctors and students whenever I could. If you have read Henry’s notes, you will know that Prof Sung and Prof Lok are the grandparents of my career.
12. I wrote my first paper with Dr Nancy Leung and Henry. I could not find ‘chi-square test’ in the pull-down menu of SPSS, and Prof CC Szeto taught me right away. I did not mention his help in the acknowledgement section because it was quite embarrassing to thank people for teaching me chi-square test in a scientific paper. I would like to thank him now.
13. My wife and I prepared a presentation on osteoporosis in my final year. The presentation went badly, but I got my wife.
14. My favorite movie is The Pianist by Roman Polanski. My wife thought I was crazy when I repeatedly played Chopin’s Ballade No. 1 in the movie. Now that my daughter is 3 years old, we can only watch Strawberry Shortcake at home.
15. I tell my daughter bedtime stories every night. Since I am bored with her story books, I have started making up stories. The latest hits included Strawberry Shortcake meets Spiderman and Strawberry Shortcake meets Mr Incredible.
16. I know I seldom attend social gatherings now. But on the first day I went to work after the New Year holidays, my daughter complained to my wife. “My Daddy doesn’t miss me.” What else can I do?
Want to read the arrogant version in Facebook? Don’t be silly. I have already modified it.
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