Big Guns, Tree-gun, and Election

 

I wish you a Merry Christmas and a Happy New Year!

Wish all members Merry Christmas and Happy New Year.  The blessing goes particularly to one of our young member, Dr. KWONG, who defeated the Kowloon City District Council Chairman LAU Wai Wing in Whampoa West in the 2015 District Council Election.  My wish also go to “Tree Gun”, which is the name better known of the ex-District Councilor Christopher CHUNG Shu Kun.  He was defeated by a newbie TSUI Chi Kin in Yue Wan District.  It was said that TSUI decided to run the election to challenge the “big gun” only on the last day of the nomination period.  What newspapers described TSUI was that he was that he was almost never heard of in the political field.  Of course my wish here is not slightly comparable to the celebration held outside Tree Gun’s to-be-ex-office when the news broke out that he was voted out.  Champagne bottles were opened, poppers were set off, and there came as usual Paula TSUI Siu Fung’s celebration song for losers.

Elections are too common.  When you read this Editorial, the results of the Medical Council election should have been known.  There is only one young candidate this year.  See if he can make it.  Next Year, in 2016, which is just a few days ahead, there will be new office bearers election for the HKMA, the Medical Functional Constituency election for the Legislative Council, and the Election Committee Subsector election for electing the Chief Executive.  

It is always interesting to speculate potential candidates and results of elections.  Legislative Council election is for big guns.  I wonder if any young doctor or newbie will run for the Medical Constituency election.  LEUNG Ka Lau has been our Legislator for 2 terms.  He was first elected in 2008 (2217 votes) when he ran against KWOK Ka Ki (1869 votes), who was the Councilor of the Medical Constituency at that time, HO Pak Leung (2138 votes) and YEUNG Chiu Fat (580 votes).  LEUNG succeeded to stay in the LEGCO in 2012 by beating TSE Hung Hing by a lead of 2336 votes (4541 against 2205 votes).  Although the 2012 result was promising, I speculate that LEUNG will not run for another term.

It would be a wise bet to put your money on Ho Pak Leung.  From limited statistics, HO shared the same group of voters with LEUNG (adding up to around 4500).  Although he is a microbiologist, I guess he has the macroscopic wisdom to enter the playing field.  If you are to bet on who would come out as candidates, a better bet would be on TSE Hung Hing.  TSE is the Immediate Past President of the HKMA.  He might also run for the Presidency of the HKMA just like in 2012.  However, he has added advantage compared to 2012 as he is now a Justice of Peace and might gain much support from pro-governmental voters.

If my memory does not fail me, I remember reading in newspaper some time ago that CHOI Kin would like to run for the LEGCO and the HKMA Presidency in 2016.  Appeared as the “Angry Man” of the HKMA, CHOI has an out-spoken image.  This has been more so with his full-of-sound-bites-if-not-wisdom criticism against the current President of the HKMA.  CHOI has been very successful in various elections.  However, he has never been a candidate for the LEGCO.  If CHOI Has not changed his mind, he needs to take care of the fact that TSE shares the same group of voters with him from the private sector and from the HKMA.  One obvious difference between CHOI and TSE would be their attitude towards the Umbrella Movement.

Of course, there can be other candidates who are surely capable of getting more than 2000 votes to take part.  There can also be spoilers to intervene.  Prediction is never easy.  

While it is interesting to speculate about the LEGCO election, it is difficult to arouse discussion in lunch meetings about the HKMA Presidency election.  Between 2004 and 2015, we have CHOI Kin as President for 3 terms, TSE Hung Hing for 2 terms, and SHIH Tai Cho whose term will end in 2016.  We were only given the chance to cast our votes twice.  Once was CHOI Kin against FUNG Yee Leung in 2004, and the other was CHOI Kin against YEUNG Chiu Fat in 2010.  For the 2 terms of TSE, for one term of CHOI, and for the current term of Presidency of SHIH, they were all “elected” ipso facto.  Each time, there was only one candidate nominated for the post and no voting was needed.  I speculated that it did not happen that there was only one person coming out to take the challenge.  However, negotiation was preferred to election.  Deals were made among a few.  For members, they could not ask what believes the candidates held towards important issues.  The only candidate did not need to make any promise to all and there was no problem of failure to cash his promise in his term.  In the term 2012 to 2014, there was election of the Chief Executive.  In the current term of 2014 to 2016, there was the Hong Kong Electoral Reform consultation and legislative proposal.  The role of the President was vital in leading the HKMA to take part in these issues.  We were not able to ask, to understand, to challenge or to choose.  We could not even vote the candidate out because there was no other choice.  Some might view this as a sign of unity.  However, something that feels good does not mean that it is healthy.  For example, gaining weight continuously is surely not healthy.

The traditional view is that elections are for big guns.  However, with the recent “Tree-gun Incident”, let us see if this view point will hold true in the coming elections.  

(Source: HKMA News December 2015)

Be happy

Happy November!

I decided to be happy in November and I wish everyone happiness in November.  I came to such decision when I thought about the topic of the Editorial.  I reviewed the past 10 issues in this year and realized that most of them were gloomy and heavy.  It is time to be happy, to relax and to inspire hope.

Like most people, I first tired to figure out a reason to be happy.  November is followed by December and there will soon be Christmas.  November is the month when graduates, filled with hope and joy, take photos in university campuses.  In November, you can usually enjoy discounted tours and flight tickets.  November 2015 is better than November 2014 as there is no more mass demonstration.  Or is it better?  Maybe try the other way round: there is no reason to be unhappy in November.  

Finding a reason seemed not very much inspiring.  As I had written on before, and exemplified by the teachings of Zen Master Thich Nhat Hanh, happiness is the way to happiness.  You do not need to find a reason to be happy.  You just need to act to be and to become happy.  This is like some sort of behavioural therapy.  Sadly, acting happy is also as difficult as self behavioural therapy.  It is in fact more difficult, because it is circular self bahavioural therapy.  You are not happy, therefore you cannot act happy.  A hundred thousand dollar watch would not move time faster in a boring meeting.  A 450PS car would still be caught in traffic jam, with the addiction worry of an over-heated engine.  There are reasons why people down stronger and stronger coffee; and move from beer to vodka.

I remembered in the past, going movie was a big event.  It was entertainment.  Entertainment by definition should make you happy.  At least there was no harm trying, as it was not costly.  Nowadays cinemas are more comfortable.  It was not a bad idea to fall asleep for a while for the whole 2 hours.  I watched Bridge of Spies and The Martian.

James Donovan (Tom Hanks) was a New York insurance lawyer in 1957.  By some hard-to-believe reasons, he became the defense lawyer of a Russian spy Rudolf Abel (Mark Rylance).  He succeeded in sparing Abel from the electric chair.  He then miraculously exchanged Abel for an American spy caught in the Soviet Union and an innocent American student claimed to be a spy by East Germany.  His success was because of his insistence and his ever fighting.  Steven Spielberg, the director, convinced us by filing a constantly deeply frowned Donovan.  I even got headache after watching his tense corrugator supercilii for 2 hours.  When confronted with the whole world and then the FBI agent, Donovan explained, “My name’s Donovan.  Irish, both sides, mother and father.  I’m Irish, you’re German.  But what makes us both Americans?  Just one thing.  One, one, one: the rule book. We call it the Constitution and we agree to the rules.  And that’s what makes us Americans.  And it’s all that makes us Americans.  So don’t tell me there’s no rule book.”  This was in stark contrast to the expressionless face of Abel.  When asked by Donovan why he seemed not worried, he answered with a question: “Does it help?”

In The Martian, Mark Watney (Matt Damon) was left alone in Mars after an accident during their mission.  All he got was a mission base with 300 odd days of food to support minimal daily calories.  However, even if NASA found out that he was alive there, a rescue team could only reach him in 4 years.  Luckily he was a botanist and he invented various “Home-alone” tools, techniques and strategies and “made a living” in the Mars.  He survived until somehow the original space shuttle came to rescue just in time.  Of course there were many accidents and near escapes.  What made the movie a fiction was not all the pseudo-science.  It was how (come) Mark could always maintain his mood and spirit.  He was, again, never giving up.  As an over-kill move, the movie ended with Mark teaching survival classes after his return.  He preached, “At some point, everything’s gonna go south on you and you’re going to say, this is it.  This is how I end.  Now you can either accept that, or you can get to work.  That’s all it is.  You just begin.  You do the math.  You solve one problem and you solve the next one, and then the next.  And if you solve enough problems, you get to come home.”

Mark survived.  He was somewhat elated for the whole stay on Mars.  I was not sure it was because of hyperbaric oxygen, food deprivation, or the vicodin he took with potatoes after he ran out of ketchup.  But I did not think he was happy, either on Mars or back on Earth.  Donovan was able to save three people, and most importantly, to keep his faith to the rule book.  He did not say that he was happy.  Instead, he was tired.  

After the movies, apart from the headache, I was none the happier, but tired.  What kept echoing in my head was Abel saying, “Does it help?"

(Source: HKMA News November 2015)

When Logic kills you

Last month, when I was in a discussion group, the group leader threw out the following quiz: “Imagine waiting in line at the post office.  There is one person in front of you and another behind.  The door suddenly bursts open and in walks a man.  He has a bag containing 4 hats (2 white and 2 black).  The man makes everyone in the line shut their eyes, takes 3 hats from the bag and places one on each person’s head.  Then he tells you all to look straight ahead and open your eyes, thus ensuring that each of you can only see the colour of any hats directly in front of you.

The man then issues his ultimatum.  “First, you are not allowed to say anything to one another.  Now, if any of you can correctly state the colour of the hat you are wearing, all 3 of you will live.  However, if you get it wrong then something nasty will happen to all 3 of you.  

Not surprisingly, you are shocked.  After all, you only came in for some stamps and a bar of chocolate.  After about a minute of pin-dropping silence you suddenly name the colour of your hat.  There are no mirrors or reflective surfaces in the post office, so how do you do it?”

I knew the answer right away.  That was not because I was smart, but because I had read this quiz in the book Puzzled: 101  Cunning Conundrums and Sneaky Solutions by one of my favourite writers Richard Wiseman.  And in fact I could vaguely remember encountering similar stories in novels by Taiwan writers when I was in secondary school.  Soon enough, some members of the discussion group came to the right answer.  No one asked, and thus I did not know whether they were smart or they had read about it.  Have readers got the answer yet?  If not and if you want to try on it, don’t read the following paragraph yet, as I shall give the answer.

The answer was pretty straight-forward.  The colour of my hat was different from that of the one in front of me.  The essential point was that you did not miss the important “minute of pin-dropping silence”.  Of course the one in front could not see anything including the colour of his hat.  But the one behind you also did not give an answer.  That meant he did not see 2 hats of the same colour in front of him.  Otherwise he could deduce easily that his hat was of the other colour because there were only 2 white and 2 black hats.  So, I was wearing a hat with a different colour from the one in front of me.  

That was not the end of discussion.  Otherwise it was super “primary-school-chicken” and I would not have joined.  The follow-up question was, “You were killed in the incident even though you worked out the answer.  Logic killed you.  Why?  Do readers have any ideas?“

There were not one, but unlimited answers to it.  But all those answers could be summarized in one sentence: “You are living in the real world!”  In the real world, any one of you might freak out and run around, causing the man to kill you all.  The other 2 might not be intellectual enough to understand the complicated instructions.  The one in front might be a gambler and knew nothing about logic, and just yelled out whatever colour that came to his mind.  The one behind might be silent just because he was too shock to think or to say anything.  Last but not the least, the man was likely to be crazy.  Crazy man did not talk logic.  He would just kill you, no mater how smart you were and what you said.

Remember?  I did not say what occasion or what discussion group it was.  In fact it was a survival skill discussion group: survival skills in recent hostile environment.  Here and now is where and when logic would likely get you killed.  There are numerous examples involving government officials, law enforcement bodies, and even scholars of renowned institutes.  It is logical to list some examples.  But do not forget that I have equipped myself with survival skills.  So, please figure them out yourselves.

The discussion group did not end by bringing your thought out of the box but leaving you with learnt-helplessness.  We were guided to come up with some strategies to survive this real-world-illogical-scenario.  We were given video clips and newspaper replica of how people who appeared in Yahoo’s Top Local Searches talked and behaved.  Although readers have not paid for the discussion group, I am generous enough to give you some hints and directions.  You know what?  We even had role play to work out who could survive and who definitely died.  The fittest guy confessed that he was inspired by the movie of Stephen Chow.  He first assessed correctly the man was in power, no matter his power was legitimate or not.  He then knew that he should figure out what would be in the man’s mind, no matter he was crazy or not.  He acted according to his conclusion.  He took off his expensive watch and handed it to the man.  He survived.

I was a dead man.

(Source: HKMA News October 2015)

Rules and Procedures

The 14^th day of the 7^th month in the lunar calendar is the Hungry Ghost Festival.  I guess the younger generation living in newly developed housing estates, especially those luxurious ones, might not have seen the rituals.  They might read in newspapers and magazines, electronic versions of course, about some of the ghost stories and taboos for the Hungry Ghost Festival.  I wonder how many would go and watch the Chinese operas held on temporary bamboo stages to praise the charitable and pious deeds of the deities.  My clinic is at Western District, one of the oldest parts of Hong Kong Island where very old buildings and old traditions are kept.  Even the MTR Sai Ying Pun Station features many photographs and pictures of the old days.  Each year, I can tell the beginning of the 7^th month by seeing and smelling people tending roadside fires and burning faux money and offerings.  These rituals climax on the 14^th and 15^th days.  People believe that business is linked somehow to ghosts.  Therefore shops take such rituals and offerings very seriously.  They practically set fire on the motor roads.  The fires easily reach 3 stories high and need hoses and fire extinguishers to put off after the ceremonies.

I always wonder: Is it dangerous to do so?  Would it block the roads and affect traffic?

Blocking the roads once or twice every year might be tolerated by the police and citizens.  It is however not unusual to find road-blocking every day.  When I sometimes cross the Western Harbour Tunnel to visit the Baptist Hospital, I have to be very careful at night time when going through Yau Ma Tei because up to 2 lanes might be blocked by workers loading and unloading boxes of fruits.  Of course I have to be careful not to run anyone down, or run into cargos.  But also I have to be careful not to sound the horn.  I have heard stories about lucky drivers being surrounded by loads of fruits after sounding horns at leisurely walking workers.  They are said to be lucky because the unlucky ones are surrounded by workers instead of fruits.

I am sure those workers block the roads and affect traffic.  I wonder if they are tolerated by law enforcement bodies because of historical reasons and the fact that road-blocking occurs at night time.

Not surprisingly, roads are blocked every day in daytime.  Take an example, in Central, Queen’s Road Central is blocked by cars in office hours and office days.  Some are lorries and vans for loading and unloading cargos.  More are private cars, expensive cars, with chauffeurs waiting for their bosses, or guests of their bosses.  Everyone knows that traffic is horrible in Central.  A don’t-know-stupid-or-clever guy even takes his time and money to write a report to look into the matter and comes up with a conclusion of cutting the trams off their rails.  Most people, or in fact most people with the power to control or to solve the problem, turn a blind eye to the obvious-to-everyone cause of the traffic jam.

I am naive to think that there are too many simple solutions to the Central traffic problem.  The police can station “Mong-Kok-officers-with-arm-extensions” there to wave illegally parked cars away.  Since money is the answer to many problems, the rich tycoons can easily solve their parking problems.  They can walk a little bit to exercise.  They can rent a dozen car parks nearby.  They can even build their own car parks on whatever locations they like as they own those buildings.

However, a hypocritical friend of mine told me that money is not used in this way to solve problems.  Money is used to enjoy privileges.  Money is to make sure that the owner is more equal before the law.  He speculates that if a police constable is complained unofficially by tycoons to his superior for carrying out his duty but at the same time causing inconvenience to them, he would sure be in trouble.  His superior would teach him a lesson so as to please the rich without costing himself a dime.  Of course he is hypocritical and I do not agree with him.

Everyone can see when a road is blocked.  Most would realize that some laws are broken without obvious consequences.  However, many a time it is not as obvious when rules are broken or when procedures are not followed.  You might not know why the University of Hong Kong Convocation has to pass a resolution to urge the University Council to act in accordance with established procedures and precedents.  You might not be surprised when the chairman of an association knows nothing about its articles of association or procedures of meetings.  You might not be as crossed as me when you find an action committee puts an important agenda item in the AOB section of a meeting and sends out documents at midnight the day before meeting.  You might not be able to stand firm when the chairman of a tribunal ridicules you only because you hold a different view from her.

Facing these, I must pay tribute to the Legco Chairman in the “Wait-for-Uncle-Fat Incident”.  He could have maneuvered not too difficultly the situation to the advantage of his affiliates.  However, maybe out of instinct, or out of respect of rules, or maybe out of conscience, he acted according to procedures.

But, I guess, those were the days.

(Source: HKMA News September 2015)

Magna Carta and Voodoo Medicine

“When the Magna Carta was drafted and agreed upon, you doctors were still practicing voodoo medicine.”  A newly met pretty barrister told me proudly, as if I did not know.

Actually I had seen one of the four exemplifications of the original Magna Carta in the British Library.  It was the document recording the negotiation between King John of England and his barons.  In 1215, the barons were not satisfied with the King and captured London.  King John was forced to agree upon and abided by some terms.  Although it mostly dealt with medieval rights and customs, Magna Carta had become the symbol of liberty.  The most famous clause read: ‘No man shall be arrested or imprisoned except by the judgment of their equals and by the law of the land.  To no one will we sell, to no one deny or delay right or justice.’  The Magna Carta had vast impacts on the constitutional law of England and other countries including the United States.  It also nourished the concept of protection of human rights and the rule of law.  Lord Denning described the Magna Carta as "the foundation of the freedom of the individual against the arbitrary authority of the despot."

Well, 1215.  Micro-organisms were proved to be the causative agents for fermentation and then postulated to be the causative agents for human diseases by Louis Pasteur in 1857.  In 1928, penicillin was first discovered to be useful as an antibiotic.  Physics seemed to do better.  Einstein worked out the Mass-energy Law in 1905.  In 1689, Newton wrote his famous three Laws of Motion.  As early as 250 BC, Archimedes described the Archimedes Principle on floatation.

But, wait.  I had been researching on “discoveries”.  They were either discoveries of natural substances or natural laws that were already existing and governing the running of this planet Earth.  Magna Carta was surely not something natural.  In the contrary, regulations, charters or laws were always inventions.  They were created to help allowing human beings to live in harmony in a society.  If we were talking about inventions, I was sure there existed numerous inventions in medicine since Stone Age.  What mattered was whether such inventions could persist and be useful.

I dared not say that the Magna Carta was at the level of voodoo medicine, though I had the urge to refute the pretty barrister’s assertion.  However, I thought if I described it as rudimentary, no one would strongly object.  What it had done was creating a system in which law could evolve and improve.  I would like to say that we had evidence-based medicine.  But that was just as old as me.

The beauty of the Magna Carta was the introduction of the concept of “rule of law”.  This was against the long-recognized practice of the “rule of man”, or the rule of power.  Rule of law put “law” in the supreme.  Everyone, including the king, should be and needed to abide by it.  In 1885, an English Law Professor, A V Dicey popularized this important concept of rule of law in his “Bible of British Constitutional Law”: Introduction to the Study of Law of the Constitution.  Dicey thought that there were 3 facets to the rule of law:

1.  No man is punishable or can be lawfully made to suffer in body or goods except for a distinct breach of law established in the ordinary legal manner before the ordinary Courts.

2. Equality before the law, or the equal subjection of all classes to the ordinary law of the land administered by the ordinary Law Courts.

3. Whereas under many foreign constitutions the rights of individuals flow, or appear to flow, from the articles of the constitution, in England the law of the constitution is the result, not the source of the rights of individuals.

Rule of law was a seemingly simple but inherently complex concept. Even Dicey’s 3 points received much criticism and debate.  This was particular true for point number 3.  I of course by no means understood fully what rule of law meant.  I became alarmed when I read in newspaper repeatedly that rule of law had been threatened and undermined.  When there were protests and demonstrations, rule of law was said to be threatened.  When judges were criticized rudely, rule of law was said to be shaken.  When students marched into a meeting place of their university, rule of law was said to be undermined.  I went through definitions and explanations of rule of law.  I did not find that rule of law would be undermined when someone broke the law.  The rule of law would not be undermined even when someone broke the law and insisted that they were not guilty and were acting in whatever reasons behind.  The law still applied to them.  They might get arrested, tried, and punished accordingly if found guilty.  Only the public security and stability of the city would be undermined.

It was only the action of rulers and those in power that could undermine the rule of law.  It was the selective application of law in favor of those in power, or those favored by those in power, that caused problem.  Some called this selective action the “rule by law”.  I did not like to use this confusing term.  It still carried some sense of ruling according to existing laws.  If statutes were interpreted officially in a way causing mass demonstration, the rule of law would be threatened.  If court judgments were affronts to common sense, the rule of law would be threatened.  If due process in decision making was not following, the rule of law would again be threatened.

Pretty barrister, do you agree?

(Source: HKMA News August 2015)

你和他說法律，他和你講道德；你和他講道德，他會和你說政治；你和他說政治，他就跟你講民意；你跟他講民意，他跟你耍流氓；你跟他耍流氓，他就跟你講法律！

你和他說法律，他和你講道德；你和他講道德，他會和你說政治；你和他說政治，他就跟你講民意；你跟他講民意，他跟你耍流氓；你跟他耍流氓，他就跟你講法律！

Yes, you do not read it wrong.  The title of this Editorial is in Chinese characters.  But I am going to write in English.  In case you cannot read Chinese characters, do not expect me to explain them in English.  To talk with you without engaging in any meaningful discussion, or even not talking in a common language, is my purpose.  It is also the gist of the meaning of the quote of the title.  And, sadly, it is now the norm of meetings and dialogs, and the root of conflicts.

When I studied law, I learnt this adage: “When the facts are not on your side, argue about the law.  When the law is not on your side, argue about the facts.  If both are not with you, talk about the weather.”  There were different versions; they differed by how to handle when both the law and the facts were not on your side.  Those included yelling like hell, or calling your opponents names, or pounding the table.

There is much wisdom in this adage.  It reminds students and lawyers that there are two major components in defending a case: the facts and the law.  You do not need to attack on both.  You just need to poke a hole on either.  It is about defense tactics.  Pound on favorable points and avoid harms.  Talking irrelevance might also distract jurors.

However, I am smart enough to realize the true beauty of the adage.  After all, I am not a lawyer and court room strategies are not really vital to me.  The most important point is to know that there exists such a tactic and to recognize it when someone else is practicing it.  See?  If you are the prosecution, you need to keep on tract and counteract with what is on your side.  But it is the judge who matters most.  He needs to keep his mind clear and not to be distracted by dramatic presentations.  The whole picture should always be in his mind.

It is perfectly acceptable and in fact good practice for a defense lawyer to pound on whatever he finds fit and of benefit to the defendant.  There is always the judge or the jury to decide.  However, it is not so desirable when you encounter such tactics in meetings.  The purpose of holding a meeting is to check on progress and more importantly, to make decisions.  Therefore it is essential to have “meaningful” discussions on related issues.  It is irritating and disgusting to encounter people holding on such tactics.  Those of the lesser evil would try to lure you for a blanket mandate to work on something.  The usual strategy is to talk endlessly on the objective of the project, such as how important it is to treat diabetes, or how primary care can be the solution for our health care system.  Details on how to achieve such objective is never proposed or discussed.  Direct inquiry on any substance on implementation will be met with circumferential referral to the objective again, and again, and again.  These people are referred to as of lesser evil because they are not in power.  They can continue their oral diarrhea as long as they wish.  You just have to keep alert, and to keep healthy so as not to be out-lived by them.  Of course in the mean time, a significant portion of your precious life is ruined by them.

Of greater evil are those in power using such non-engaging strategy.  When they are caught acting ultra vires, they talk about the weather.  I have met such greater evil more and more commonly in recent years.  Some of them reiterate how holly the objectives are.  Some of them play judges and declare that they are legitimate to do so.  Most of them fall into a pattern as described by the title of this editorial.  Literally it starts with the law.  When you challenge them with the law, they preach ethics.  When you reason in ethics, they go into politics.  When you talk about politics, they refer you to public opinions.  When there are public opinions, they play dirty.  When you go extreme, they have the law against you.  I wonder if there are training courses on such tactics.

You have no way out.  You cannot ignore them, as there are wrongs to rectify.  There exist formal and official ways for redress.  But most of them are expensive and time consuming.  Being in power means that they are resourceful.  They can easily drag on and worn you out, using your money in most of the time.  They have the manpower, from secretariat to civil servants, to write and to fight.

In the past, we did see people in power resigned when there were uproars.  They felt shameful.  Nowadays, most of those in power (any power) have attended the non-engaging-tactic-training-course.  When challenged with ethics, they have no room to feel shameful.  They need to non-engage you with politics.  Thus, they are either correct politically, or they will tell you that it is more difficult to stay than to resign.

I have identified the root cause for dysfunction meetings, corrupted boards and councils, and the increasing violence in the society.  I have no solution to it.  Readers can either alert yourselves with the above-mentioned tactics, or you can go and find out where to enroll in a training course on it. 

(Source: HKMA News July 2015)

Out Of Focus

It was too hot.  My mind could not function.  Things, events and concepts became out of focus.  It was just like wearing the wrong pair of glasses from your super-myopic-and-ugly classmate in high school.  No matter how hard you strained your eye muscles, or strained my neurons, I could only figure out blurred images.  I could barely distinguish a deer from a horse, provided that they were near enough, and not in any disguise.   

I did not know how long this condition would last.  I told myself, that summer would go away, followed by winter.  This was the weather of Hong Kong, the old Hong Kong we knew.  The old Hong Kong we studied in high school geography.  After a few months, it would not be equally hot.  My mind would clear up then.  I told myself, repeatedly.

At the back of my out-of-focus mind was my presbyopia.  It did not get better after several summers.  It only got worse month by month.  Suppressing the memories of the good old days when I painted at ease the moustache of a 1:72 soldier, I got a pair of reading glasses.  I wore shirts more often so that I could keep and retrieve the glasses at the breast pocket more conveniently.  I gave up paper-backs and got a kindle.  It was a reading device without back-lit.  It strained the eyes less.  Most importantly, the fonts could be adjusted to an unbelievably large size.  I had to live with it.  I have to live with the presbyopia.

While there were well documentation and statistics for reflective errors, I did not think there was any formal measurement and study on blurring of mind.  I had estimated that in my 25 years’ practice, I should have seen around 100,000 patients and relatives in more than 300,000 consultations.  It was quite alarming that I had an impression that a significant proportion of them got blurred minds.  Of course there was no objective measurement.  And it was not fair to assess them when they were physically sick and mentally preoccupied by their illnesses.  So I just quote some examples and readers could try to figure out what I meant.  A university student applied some cream of unknown ingredient and unknown origin to his finger with cellulitis and was quite curious why the condition got worse.  A financial consultant tried 4 years, in vain, to control his sky high cholesterol level with various methods he learnt from discussion forum.  A teacher refused to give antibiotics to her daughter with scarlet fever because she knew that antibiotics were not good.  A businessman refused to take antihypertensive medicine because he was sure that once started, treatment could not be stopped.  A shop manager, agreed with her insurance agent, thought that it was the duty of doctors to find out some means for her to claim insurance for accidental injury that she did not suffer.  An accountant educated me that it was patients’ rights to have regular sick leave 2 days per month.  A barrister was offended because I charged her consultation fee for writing a referral letter.

I planned to go on and filled the whole page with examples.  It was so reassuring that I was not the lone ranger here.  Out of focus, I saw no difference in the survey results between those supported and those voted against the Government Proposals for Selecting the Chief Executive by Universal Suffrage.  Afterall, when this Editorial reaches our members, the outcome would have been determined.  Frankly, how many people know exactly the details of the Proposals?  How many people can elucidate the pros and cons hidden between the lines?  I agreed totally with the tycoons that most people in Hong Kong cared more about earning money than who was going to be the next Chief Executive.

Nonetheless, how come nearly 7,000 members responded to our survey?  How come tens of thousands of citizens made history by staying on the street for 80 days?  How come students stood firm against police batons?  How come people took all the trouble, risking being charged criminally, to nail the state-of-art banner on the Lion Rock Hill?  I did not know the answer.  I do not know the answer.  And I will not know the answer.  With clouded mind, I tried to make a guess.  It was not because of the Basic Law.  It was not about the 831 decision.  It was not about the Proposals.  It was all about the way it was handled.  In the battle between David and Goliath the giant, if Goliath repeatedly hit below David’s belt, what would happen?

The weather is still hot.  My mind is still out of focus.  Politics are difficult to understand and taboos to write on.  It must be the weather that caused my mind to drift to the survey and the Chief Executive Election.  It must be the weather that caused me to write on this topic.  Or, is it now the only moment that my mind is clear enough to see the real nature of my all-along-clouded mind?

(Source: HKMA News June 2015)

Pocket First?

 

The cover story of the HKMA News this month is about the HKSAR Government’s Proposals for Selecting the Chief Executive by Universal Suffrage.  To be exact, we are actually highlighting the questionnaires sent to members asking whether they choose to support the Proposals or not.  Some people treat this survey very seriously.  Within this Council, there have been lengthy discussions on each and every aspect of the survey, from wordings of the questions, to how many questions, to methods of distribution and return, to whom to send, and to methods of analysis.  There are members writing to the Forum expressing their opinions and urging others to do so via our survey.  I even received a forwarded email from Professor David Todd (of which I doubted the authenticity very much), saying that “… I would like to appeal to you to speak your voice when the new survey comes out.  We should no longer stay in the sidelines as the silent majority.”

As if it really matters.  This is what I think when reviewing what happened after our previous responses to the consultation papers and the events in October last year.

For this survey, there is only one question is asked.  It is very straightforward.  You just state whether you support the Government Proposals or not.  There is no “if” or “provided that”.  You can take it, or beat it.  As a doctor, I must admit that I do not know how to respond.  We are advised by the Code of Practice and well-circulated court cases that doctors need to provide options for treatments to patients.  The pros and cons of each option need to be explained fully.  Even rare side-effects need to be addressed if they are considered significant to the patient by common sense.  However, for the choice between accepting the Proposals or not, several crucial and fundamental questions remain unanswered.  No one knows with any certainty what would happen if the Proposals are rejected.  Neither can anyone tell when or how the proposed methods, if adopted, can be modified or “up-graded”.  The Government is hard-selling its miracle drug.  Side effects are rarely mentioned or analysed.

I have to transcend my mode as a doctor so as to make a choice.  Can lawyers choose better?  They are good at selling lopsided theories to help their clients.  However, I guess they are none the wiser to choose between such theories.  I need a judge instead.  Afterall, the dispute arises from the interpretation of statute, namely the Basic Law of Hong Kong, particularly Article 45.  The duty to declare whether the Proposals satisfy the statute should fall on a judge.  However, by some unknown reasons, for better or for worse, I am now asked to decide, as if it really matters.

Laymen do decide cases in some circumstances.  There are jurors in criminal cases and defamation cases with leave from the judge.  Before the jury retires to deliberate, the judge will give directions to help their decision making.  Apart from guidance and explanation on legal principles, the directions are built on logics.  To facilitate my thinking process, I self-talk some directions to myself as follows.

I call what we have now for Chief Executive selection A, the Government Proposals B, and what we should have as promised C.  To over-simplify matter, I am not treating any of them as better, since different people can have different preference and interpretation.  What we have to decide now is simply whether to support B.  It is assumed that by rejecting B, we are left with A.

Apparently, B is not the same as C.  This is reflected in the slogan of the Government asking people to “pocket first”.  But, if you think that B is no difference from C, then you should support B.

If C does not bother you, you can forget about C.  Your decision then solely depends on whether you prefer A or B.

If you want to have C in the foreseeable future, then you need to consider whether B or A would have a higher chance of leading to C.  If you think that B is an inevitable step between A and C, then you should support B.  If you think that B would side-track the route from A to C, which means that it decreases the chance of reaching C, then you should reject B.  The reverse also applies.  If you do not want to have C, you can choose accordingly.

If you long for C, but is smart enough or as pessimistic as to know that there will never be C, you should allow yourself to moan for a while.  Then you should think about whether you prefer to live with A or B for the rest of your life.  You have to consider whether B, sold as a palliative treatment, makes you feel better.  You have to decide according to what have been presented to you.  You have to choose which witness to believe.  This is a civil case.  The standard of proof is on a balance of probability.

This time, you cannot take as long as you need.  There is a deadline.  There will not be any hung jury or mistrial.  The outcome will either be A or B.

After contemplating the above directions from the imaginary judge, I realize that it is an ultra difficult decision for me to make.  But I am not worrying, although the clock is ticking.  I am just moaning.

And, please take it seriously in answering the survey, as if it really matters.

 

(Source: HKMA News May 2015) 

Drifting and the College of Primary Care

It is depressing to think about primary care in Hong Kong.  It seems common consensus that primary care is all along not well taken care of by the government.  Resources allocated to primary care are out of proportionally low as compared to secondary and tertiary healthcare.  However, the outcome is not that bad.  Hong Kong people might be unhappy, but they are not in poor health.  Statistics confirm this fact.  There exists a delicate balance among the behavior of citizens, the hard working primary healthcare workers and the government input.

It is not depressing to be a general practitioner, provided that you don’t think too much.  Do ignore the people who called you names out of nothing when the Healthcare Voucher Scheme was first launched.  Do not think about the stressed-to-be-overpaid sum of $50 for vaccinating screaming kids, for explaining pros and cons, for keeping records, and for looking after them for any adverse effects.  Do not watch TV least you see the HMOs promising everything to their potential clients while giving you $105 for each consultation, plus medications, plus writing medical reports, and plus once in a while harassment from them.  Do not try to explain when your learning-to-be-kind relatives or some newly met friends-of-friends ask you “how come” you became a general practitioner rather than a dermatologist.  After twenty plus years of practice, I find it OK to be a general practitioner.  I can earn a living.  I can study or do some reading in spare time within the overtly long working hours.  I, sometimes, even, have a sense of job satisfaction by being able to help my patients. 

It was over joyous to learn that our President had come up with an idea to form a College of Primary Care early this year.  I guessed it would not be an easy job.  But our President must have talked to some big guns, pulled some strings and twisted some arms.  Some colleagues feared that such College might do more harm than good by imposing control rather than support.  Frankly, this fear was also at the back of my mind.  However, when a risk was identified, we could at least try to take care of it.  Eventually, an “Ad Hoc Committee on a College of Primary Care” was formed to work out how and when to set up a College of Primary Care.  Funny name, but some support to general practice might be better than none.

It was sad to read what the President of the Hong Kong College of Family Physicians wrote in “Message of the President” of the Family Physicians Links (March 2015 Edition). “While we welcome endeavours to promote Primary Care, we cannot support the idea of establishing a new College of Primary Care.”  All supposed-to-be-big-guns stayed at home, rubbing their twisted arms.

I was at the verge of depression.  I remembered my psychiatrist friends told me that learning something new might help to overcome depression.  It was depressing, however, that I forgot to ask them whether trying to promote primary care, or forming a college of primary care could help.  So, I decided to put down this college stuff for a while, and went to learn drifting.  From the almighty Wiki, “drifting is a driving technique where the driver intentionally oversteers, causing loss of traction in the rear wheels or all tires, while maintaining control from entry to exit of a corner.” 

I spent 24 hours, flying via London to Arlanda of Stockholm, then changed for a propeller driven plane to Arvidsjaur at the northern part of Sweden.  There was a race course temporarily built on a large frozen lake with 100cm thick ice.  When driving on ice, drifting was not something you learnt to do.  It would happen anyway with even 30km/hr on turning a corner.  Drifting was something to control, and to make use of so as to have fun, or to tackle a corner skillfully.  The instructor taught me to brake hard before entering a corner.  Then entered slow.  “Wait, wait, wait.”  He said.  “When you can see the end of the corner, then gas.”  When I got used to drifting, there were racings on different courses.  There were “hot laps” where the instructors demonstrated what racings were supposed to be.  They practically drifted all the way and the cars were moving side-way all along.  I began to doubt whether cars were built to travel forward in the “usual” sense. 

Practicing and racing from 9 to 4 everyday in -12 degree celsius was fun to many.  However, I was not the competitive made nor the strike-for-perfection type.  My mind now and then began to drift.  I forgot to mention one important point.  For such dramatic drifting, you have to first turn off the Electronic Stabilizing Program (ESP) of the car.  People do not slide or drift easily as in icy road because of the activation of this great system.  I tried driving a round with the ESP on.  Life was much easier.

Drifting is fascinating.  In expert hands, it is the fastest way to cut a slippery corner.  However, in daily lives, we need ESP instead of drifting.  Do we need a novel College before our primary care can function or flourish?  Don’t read me as against the formation of the College of Primary Care.  I am more concerned about the function of the body, whatever it is named.  As mentioned, our system is now delicately balanced.  What we need is not a disturbance of the balance.  We have to consolidate what we have.  Give our primary care workers a hand to stand against unequal terms and adverse conditions.  United in this sense, whatever the body is named, we go for it. 
 

(Source: HKMA News April 2015)