Last week, GW, HC and SW were discussing what to say on the university orientation day. They were quite surprised when they learned that I did not have to speak at the sharing sessions. After all, the Faculty even invited colleagues who graduated from other medical schools.
I explained that I talked at one of those occasions four years ago. My speech could be summarized as follows:
“Dear students and parents, thank you for coming to our university today. When you go through different exhibitions, you would be wondering what career to pursue and which university to enter. What a question. If you come twenty years ago, many people would tell you that doctors could make a fortune. Not anymore. Although doctors are still whining about manpower shortage, it is clear that many new doctors are produced every year. It does not take a deep knowledge in economics to understand that the income of doctors will decline significantly in the years to come. Take the private market for example; newcomers are already earning less than half of their predecessors.
“This to me is a good thing. High achievers who wish to earn as much as possible are better off doing businesses primarily about money. This is better than trying to get the same amount out of our patients’ pockets. At the end of the day, I hope that those of you who choose to enter our medical school will instead focus on serving the public and improving medical care. Thank you very much.”
After these years, I can elaborate much more on this topic. For some uncertain reasons, however, no one invites me to talk again.
13 Oct 2011
6 Oct 2011
Vote
Last month, our dear colleague asked us to vote him as a representative in the Faculty. I could not be more surprised. Clearly not every researcher, including brilliant ones, dreads meetings. Summer bugs cannot talk about ice.
Every year there are at least several entries at the Freakonomics blog on voting. One of the earlier stories goes like this:
An economist met another economist at a polling station. After an embarrassing moment of silence, one of them said sheepishly, “My wife made me come.” The other responded, “Me too.” The first economist came up with an idea, “If you promise not to tell anybody I came here, neither would I.” The colleague eagerly shook his hand and said, “Deal.”
As Steven Levitt explained, the chance of a single vote to change the outcome of an election is infinitesimal. Therefore, at the individual level, voting is almost always a waste of time.
This view is a taboo according to the current general education curriculum. Voting is our civil responsibility. You may also argue that if everybody holds the same pragmatic view and does not show up at elections, the society would be at stake.
Let me ask you a question: Have you helped at an elderly home last weekend? Okay, some of you have. Have you helped in Fukushima then? There are many things ought to be done in this world, but it does not mean we have to do every one of those ourselves. For example, I regularly do volunteer work in some areas, and can feel at ease when I cannot help on other occasions. Of course, it could be problematic if nobody shows up at elections. But would it really happen?
So, did I vote in the end?
What a question! First, I promised to vote. Second, our colleague would make a great representative. Third, unlike a usual election, I need to lower my own chance of being elected.
Congratulations, R!
Every year there are at least several entries at the Freakonomics blog on voting. One of the earlier stories goes like this:
An economist met another economist at a polling station. After an embarrassing moment of silence, one of them said sheepishly, “My wife made me come.” The other responded, “Me too.” The first economist came up with an idea, “If you promise not to tell anybody I came here, neither would I.” The colleague eagerly shook his hand and said, “Deal.”
As Steven Levitt explained, the chance of a single vote to change the outcome of an election is infinitesimal. Therefore, at the individual level, voting is almost always a waste of time.
This view is a taboo according to the current general education curriculum. Voting is our civil responsibility. You may also argue that if everybody holds the same pragmatic view and does not show up at elections, the society would be at stake.
Let me ask you a question: Have you helped at an elderly home last weekend? Okay, some of you have. Have you helped in Fukushima then? There are many things ought to be done in this world, but it does not mean we have to do every one of those ourselves. For example, I regularly do volunteer work in some areas, and can feel at ease when I cannot help on other occasions. Of course, it could be problematic if nobody shows up at elections. But would it really happen?
So, did I vote in the end?
What a question! First, I promised to vote. Second, our colleague would make a great representative. Third, unlike a usual election, I need to lower my own chance of being elected.
Congratulations, R!
29 Sept 2011
Confidence
Throughout our school years, our teachers keep asking us to be humble. In medical school, we are taught not to jump to conclusions. We should always consider differential diagnoses and perform more confirmatory tests.
Have we followed their advice? Is the advice sound?
Let’s consider the second question first. In the last issue of Nature, Dominic Johnson and James Fowler used an evolutionary model to show that overconfidence confers survival advantage. [Nature 2011;477:317-20] When more than one person competes for resources, the decision to fight depends on the chance of winning as well as the cost of losing. If each person has perfect knowledge on the strength of oneself and the other competitors, the decision is straightforward. You only claim the resources when you are stronger than others, and should not fight at all in face of a stronger opponent.
In reality, however, perfect knowledge is rare. The decision is therefore based on an estimation of one’s strength in relation to others. As a result, a person who overestimates his strength would fight more often than average, while one who underestimates oneself would more likely give up. According to Johnson’s and Fowler’s model, overconfident populations would claim more resources in most situations and gradually grow in strength. The only exception is when the cost of losing is particularly harsh. For example, when KL was a senior medical officer, you would be a fool to argue with him about call duties. First, you still lose the argument. Second, he gives you an extra call next month.
No wonder we see so many arrogant people around. Now that we understand how they evolved, we should no longer hate them but congratulate them for improving our species. In an accompanying commentary, van Veelen and Nowak named a number of real life examples. [Nature 2011;477:282-3]
"Most people report their driving abilities to be above average. 70 percent of high school students think their academic performance is above average. 94 percent of professors rate their teaching abilities as above average."
I can easily add more items to the list. 100 percent of endoscopists underestimate their average cecal intubation time. 95 percent also overestimate the size of peptic ulcers they treated and polyps they removed. Don’t be surprised if you read an endoscopy report saying there was a 5 cm ulcer in the narrow first part of duodenum.
That is why we are so competitive.
Have we followed their advice? Is the advice sound?
Let’s consider the second question first. In the last issue of Nature, Dominic Johnson and James Fowler used an evolutionary model to show that overconfidence confers survival advantage. [Nature 2011;477:317-20] When more than one person competes for resources, the decision to fight depends on the chance of winning as well as the cost of losing. If each person has perfect knowledge on the strength of oneself and the other competitors, the decision is straightforward. You only claim the resources when you are stronger than others, and should not fight at all in face of a stronger opponent.
In reality, however, perfect knowledge is rare. The decision is therefore based on an estimation of one’s strength in relation to others. As a result, a person who overestimates his strength would fight more often than average, while one who underestimates oneself would more likely give up. According to Johnson’s and Fowler’s model, overconfident populations would claim more resources in most situations and gradually grow in strength. The only exception is when the cost of losing is particularly harsh. For example, when KL was a senior medical officer, you would be a fool to argue with him about call duties. First, you still lose the argument. Second, he gives you an extra call next month.
No wonder we see so many arrogant people around. Now that we understand how they evolved, we should no longer hate them but congratulate them for improving our species. In an accompanying commentary, van Veelen and Nowak named a number of real life examples. [Nature 2011;477:282-3]
"Most people report their driving abilities to be above average. 70 percent of high school students think their academic performance is above average. 94 percent of professors rate their teaching abilities as above average."
I can easily add more items to the list. 100 percent of endoscopists underestimate their average cecal intubation time. 95 percent also overestimate the size of peptic ulcers they treated and polyps they removed. Don’t be surprised if you read an endoscopy report saying there was a 5 cm ulcer in the narrow first part of duodenum.
That is why we are so competitive.
22 Sept 2011
July
A recent meta-analysis confirmed the “July effect”. [Young et al. Ann Intern Med 2011;155-309-15] During changeover to a new group of interns, mortality of in-patients increases by 4-12%. This is accompanied by an increase in medical errors and prolongation of hospital stay.
It is often a relief to note that terrible things do not occur only locally. On the other hand, the fact that “July effect” is genuine and widespread is disconcerting. If a disease is causing deaths of this magnitude, it would have drawn a lot of attention. New treatments would be developed and introduced every year. The same does not apply to human errors. Professionals tend to accept that it is natural and inevitable that newcomers would commit errors.
While I was pondering this question, KM joined us for lunch. “I have a new proposal,” he announced. “Let’s ask interns to take care of all emergency cases. To ensure compliance, we can assign whole day clinics to on-call medical officers. The cases would then be reviewed only by the physicians in the evening.”
LS was speechless. After a while, the intern coordinator finally said, “But our patients will die!”
“Interns are supposed to see emergency cases now,” reminded my mentor. “Why do we have to change?”
“I was approached by an intern,” KM explained. “She wished to see emergency cases, but said she could only do so if we put it as a policy.”
“Why?” all of us asked. “If she is eager to see the cases, who would stop her?”
It is often a relief to note that terrible things do not occur only locally. On the other hand, the fact that “July effect” is genuine and widespread is disconcerting. If a disease is causing deaths of this magnitude, it would have drawn a lot of attention. New treatments would be developed and introduced every year. The same does not apply to human errors. Professionals tend to accept that it is natural and inevitable that newcomers would commit errors.
While I was pondering this question, KM joined us for lunch. “I have a new proposal,” he announced. “Let’s ask interns to take care of all emergency cases. To ensure compliance, we can assign whole day clinics to on-call medical officers. The cases would then be reviewed only by the physicians in the evening.”
LS was speechless. After a while, the intern coordinator finally said, “But our patients will die!”
“Interns are supposed to see emergency cases now,” reminded my mentor. “Why do we have to change?”
“I was approached by an intern,” KM explained. “She wished to see emergency cases, but said she could only do so if we put it as a policy.”
“Why?” all of us asked. “If she is eager to see the cases, who would stop her?”
15 Sept 2011
Rumors
趙孝成王七年，秦與趙兵相距長平，時趙奢已死，而藺相如病篤，趙使廉頗將攻秦，秦數敗趙軍，趙軍固壁不戰。秦數挑戰，廉頗不肯。趙王信秦之間。秦之間言曰：「秦之所惡，獨畏馬服君趙奢之子趙括為將耳。」趙王因以括為將，代廉頗。趙括既代廉頗，悉更約束，易置軍吏。秦將白起聞之，縱奇兵，詳敗走，而絕其糧道，分斷其軍為二，士卒離心。四十餘日，軍餓，趙括出銳卒自博戰，秦軍射殺趙括。括軍敗，數十萬之眾遂降秦，秦悉阬之。【史記•廉頗藺相如列傳】
“As a leader, one hears rumors about his staff from time to time. If you were the King of Zhao, how would you handle the situation?” asked my mentor one day.
My mentor rarely talks about Chinese history, so I knew it must be important. “With hindsight,” I answered, “sacking the general would of course be the worst option. I suppose I would not do anything.”
“If you have known your staff for years, you should understand his temperament and not be affected by rumors easily. Having said that, keeping silent is not good enough. Your staff is not stupid. He must have heard the rumor, too. If you do nothing, he would think you are plotting something. In this situation, I would tell the general that I heard some rumors but I believe in him.”
“As a leader, one hears rumors about his staff from time to time. If you were the King of Zhao, how would you handle the situation?” asked my mentor one day.
My mentor rarely talks about Chinese history, so I knew it must be important. “With hindsight,” I answered, “sacking the general would of course be the worst option. I suppose I would not do anything.”
“If you have known your staff for years, you should understand his temperament and not be affected by rumors easily. Having said that, keeping silent is not good enough. Your staff is not stupid. He must have heard the rumor, too. If you do nothing, he would think you are plotting something. In this situation, I would tell the general that I heard some rumors but I believe in him.”
8 Sept 2011
Alpha
Angelina began her life as a primary school student last Friday. To celebrate this important event, parents prepare all sorts of gifts for their children. Some may choose books, others toys, or even stocks. We did something different. The answer can be found at www.ahwwong.blogspot.com.
1 Sept 2011
Citations
“You have been on Szeto’s blog for 5 consecutive days!” exclaimed LL and HC.
They were talking about my post 3 weeks ago (http://vwswong.blogspot.com/2011/08/unlucky.html). That piece was written for fun, but the subsequent elaboration by my friend was a masterpiece. As a result, there was also a modest increase in the number of views on my blog.
If that was a scientific article, it would have become a highly-cited paper. After impact factor, universities worldwide are now obsessed about citations. This is a fairer way to evaluate scientific works. After all, impact factor was designed to measure the performance of journals but not individual papers (see http://vwswong.blogspot.com/2011/01/impact.html for details). Individual papers are better judged by how often they get cited by others and whether they stimulate further works in related fields.
Nevertheless, my example illustrates that this system is imperfect. True, landmark studies and major breakthroughs are highly cited. But so are controversial and flawed works. Others cannot help refuting a shaky article. At the same time, however, they are forced to cite the original work.
P.S. Yes, I do look at my blog statistics because it is so interesting. At one time, I could not understand why so many Russians were reading my scribbles. LL enlightened me. That happened because similar blogs were blocked by the Chinese government. The ‘Russians’ were actually friends from mainland China (I forgot the technical term describing this phenomenon). Anyhow, I cannot be more grateful.
They were talking about my post 3 weeks ago (http://vwswong.blogspot.com/2011/08/unlucky.html). That piece was written for fun, but the subsequent elaboration by my friend was a masterpiece. As a result, there was also a modest increase in the number of views on my blog.
If that was a scientific article, it would have become a highly-cited paper. After impact factor, universities worldwide are now obsessed about citations. This is a fairer way to evaluate scientific works. After all, impact factor was designed to measure the performance of journals but not individual papers (see http://vwswong.blogspot.com/2011/01/impact.html for details). Individual papers are better judged by how often they get cited by others and whether they stimulate further works in related fields.
Nevertheless, my example illustrates that this system is imperfect. True, landmark studies and major breakthroughs are highly cited. But so are controversial and flawed works. Others cannot help refuting a shaky article. At the same time, however, they are forced to cite the original work.
P.S. Yes, I do look at my blog statistics because it is so interesting. At one time, I could not understand why so many Russians were reading my scribbles. LL enlightened me. That happened because similar blogs were blocked by the Chinese government. The ‘Russians’ were actually friends from mainland China (I forgot the technical term describing this phenomenon). Anyhow, I cannot be more grateful.
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