When I attended a cooking class
on Chicken and Mushroom Fricassée (which was the French way of
braising chicken pieces in white sauce), I was first given several potatoes. The aim was to make some Pommes Parisiennes (which were potato balls fried in butter, again, in the French way). The procedures were to peel the potatoes, to
use a melon-baller to scoop out potato balls, to soak the balls in cold water,
to put them in cold salted water and to bring it to a boil, to simmer, to drain
and to dry the cooked balls on a kitchen towel, and then to fry them in a pan
with clarified butter. Then there were
procedures for the chicken, for other side dishes and for the sauce.
Compared with the other students,
I had no difficulty in remembering and following the procedures. Doctors were good at memorizing funny words
and protocols. However, I got stuck with
the first step: to peel the potatoes. I
was no newbie in cooking. But I was also
no expert in peeling potatoes. Potatoes
were not my choice for side dishes. The
theory of peeling potatoes was simple: just use a peeler and peel them. However, in practice, there were many fine
details to look after. A fundamental
difference was between peel inwards towards yourself or peeling outwards. My observation was that Europeans tended to
peel towards their own bodies; while Asians tended to peel away from their
bodies. I am Asian and I did not want to
cut myself, so I used to peel and cut outwards. That made me the odd one out. Unfortunately, I was also the slowest one.
The potatoes I got were small. They were not new potatoes, which were usually
served unpeeled. Small potatoes were
actually more difficult to peel. In the
process, apart from the skin, you had to take care of the black spots on the
potatoes. You also had to decide whether
that potato was usable. When the potato
was half-peeled, the starch made it very slippery and the chance of hurting
your fingers increased. Luckily the
class was on a dish for family, and not for banquet. Otherwise I would end up with just Pommes Parisiennes and nothing else; or might be a cut finger.
What I learnt was of course how
to make Chicken and Mushroom Fricassée, well, with Pommes Parisiennes. But the more important lesson
was that things were not as simple as they appeared, and not as simple as you
perceived. Peeling a single small potato
with unlimited time in a stress-free setting was totally different from what I
was asked to do. It was not just holding
a peeler and peeling some skin off with every stroke. The scale mattered.
This small-potato-lesson popped
up in my mind when I read about the plan of asking retired doctors of all
specialties and administrative staff to work at GOPCs and A&E departments
to see patients in the recent summer influenza crisis. The intention was good. The move was straight-forward. When there were too many patients, we
increased working-hands and got more doctors. However, the point was that seeing patients in
outpatient settings might not be as simple as you perceived.
General practitioners are deemed,
by some laymen and doctors alike, to be small potatoes in the profession. However, seeing patients in outpatient clinics
might be a bit more complicated than peeling small potatoes. I had worked in an A&E department and have
been a general practitioner for more than 20 years. I still find it challenging in my routine
work. A patient does not come in and
tell you that he has influenza. Even if he
does so, not too rarely he is wrong. He
might be suffering from Dengue, or lobar pneumonia, or lung cancer. If he is right, he might have some underlying
diseases that need to be taken care of, or that might complicate the diagnosis
and treatment of his influenza. Studies
confirm that a patient always visits with multiple complaints. While you have finished with the history
taking and physical examination for the influenza part, he might tell you when he
raises from the chair that he has per rectal bleeding for 3 months, or that he
has episodic chest pain on exertion, or that his left third toe is itchy.
Whether to prescribe Tamiflu is
the least difficult decision to make. There
are guidelines on that, though you might not have supply of Tamiflu. If you want to give symptomatic treatments,
you need to check all contraindications, warn about side effects, and take care
of interactions with the patient’s own long term medications. Prescription is only part of the management
plan. You have to answer at least 6
related and unrelated questions, ranging from a philosophical question of why
he catches the flu and not his wife; to a practical question of quarantine from
his 3 month old son and his 82 year old grandmother with diabetes and bronchiectasis.
And, do not forget to properly look at
the itchy toe and to give a suitable cream for it. At the end, when you warn the patient about
red-flags just in case, he would probably dwell on the certainty of your
diagnosis, and then throws out a legal jargon and labels your medications
fruits of a poisoned tree. At that time,
you have to calm your furious mind. You
do not want to answer to the PIC of the Medical Council. More importantly, anger might weaken your
immune system, and anger might make you careless. Doctors will also fall sick. We will also suffer from influenza. If the
doctor is over 65, or if he has chronic medical illnesses, he would be in the
high risk group and himself needs Tamiflu, and himself runs the risks of
serious complications from the infection.
If you are drawing a conclusion
that seeing patients in the outpatient setting is complicated, you have missed
my whole point. You are still looking at
one potato in your hand. In the flu
season, you are expected to see 30 to 60 patients in 4 hours. You have to accomplish the above tasks 30 to
60 times in 4 hours, 2 times a day, 5 to 7 days a week. Even if you received a gold medal in internal
medicine 40 years ago, there is no time for you to peel and craft a
master-piece potato. You have to get
your work done.
Peeling small potatoes is not
simple. That is what I learn in cooking
class.
