These notes represent thoughts that crossed my mind and lessons that
stood out when I read the book. They are by no means comprehensive and
complete. They do show that the book contains a lot of valuable lessons that
would benefit professionals and management beyond the Psychiatry field.
The Audience
The book
reads more like guidance for the making of a competent, caring doctor than random
thoughts. Dr. Zhang made specific, deliberate efforts to link his work and life
experiences.
While the stories were told through psychiatry case studies, the
messages and lessons are applicable to all fields and professions. We are all problem solvers, strategists, decision makers
and management of self and others, regardless of what professions we are in. There
are many similarities in skills and operating philosophies for success in
various fields. The book will benefit a much
broader audience.
A case in point, I am an accountant, auditor,
risk management and governance professional, financial controller, and
corporate management by profession. We need a holistic and multidisciplinary approach
to train our staff. I have engaged professionals outside my fields (e.g., a coroner,
medical professors, chemist, inventors, news reporters, sport coaches, etc.) to
conduct training. The audience found their sessions inspirational, interesting
and memorable. The presenters’ diversified perspectives
expanded their horizons.
Therefore the audience for this book could include:Professionals
in all fields who want to develop their thought processes and skills for
success.
Leaders
and managers who want to improve their training and development approaches for
themselves and their teams.
People
who want to be proactive in managing their relationships with doctors and
healthcare professionals. (Just like Dr. Zhang having to learn about the Jewish
culture to work with his colleagues and treat his patients. These parties
should know something about operating philosophy and backgrounds of their
physicians/psychiatrists!)
The Format
The chapters were short and easy to read. Since the primary audience
are psychiatrists, a couple of cases were more technical for the laymen. The
photos added a human touch to the stories. The book captured a lot of lessons
learned. It would help the readers to recall these important lessons if they
were highlighted at the end of each chapter or consolidated in a chapter. I
gave some examples below on what I get out of the book as a
non-psychiatrist.
What I Like About the Book
Integrating
lifelong hobbies (meeting people from all walks of life, travelling, savoring
food and wine, and photography), work experience, lessons learned, historical
perspectives and the latest medical research and advancements. I am sure Dr.
Zhang has many golfing-related stories that could be included in his future
books
Amazing details about the people Dr. Zhang met. Detailed, vivid
descriptions of the people involved in the cases (parents, patients, physicians,
nurses and even the secretaries).
Insights gained from case studies. Case studies provided a deep
dive into the context, the facts, the
diagnoses and the solutions to create memorable lessons. Case studies should be
used a lot more in the business world.
What Would Be
Helpful to Non-Psychiatrists
For readers outside the field, it would be
beneficial to have a brief overview of the main branches and hierarchy of Psychiatry
and how they interact and support each other.
Lessons Learned, Observations and Comments
Some of the messages and lessons in the
book are explicit, some required the readers’ reflection and interpretation. I consolidated the examples under key
themes. Some themes ran through multiple chapters. Arguably, some of
examples can be classified under different and multiple themes. I tried to keep
it simple. Specific references in italics have been included to
facilitate review. Feedback are in blue.
Key Skills
A. Keen Observation Power and Ability to
Connect the Dots
p.165 It was at a stall in this
farmers' market that I unexpectedly came across an interesting medical case.
What caught my attention was a small poster titled "Climbing Back". A
lady… was promoting her book about her son's journey back to life after a very
serious accident. Elise Rosenhaupt is her name and her book is Climbing Back: A
Family's Journey through Brain Injury.
Elise's son Martin, at the start of his second year at Harvard, was
hit by a car and thrown 150ft. He landed on his head, suffering severe traumatic brain
injury, and she chronicled in detail her son's slow process of recovery. This conversation reminded me of
a six-year old boy I saw many years ago back in Wessex. He was involved in a
serious car accident, suffered fairly serious concussions and was unconscious
for around ten days. Of course we now know a lot more about the brain and the
nervous system, but more of that later.
p.189 -90 “The nurses seem to know you do not like to use sedating
medication. Doesn’t that make their job more difficult?” Dr. V asked me. “They
were quick to grasp that it was my preferred way and I had good reasons. Without the habitual
prescription of tranquilisers, we are able to assess a patient in the raw…”
p.283 After all she spent a good five
years with Winnicott. Winnicott, like many of his generation, was brought up to
exercise very sharp powers of observation…
p.
463 Not being skiers, we have never stayed at Verbier, a popular village
boasting the most renowned
Swiss skiing and thriving night life. However, Verbier reminded me of Cordelia,
an overdose
patient, and the tricky business of protocols.
Lesson: Good doctors, psychiatrists and their teams must be
keen observers. They constantly absorb, filter, integrate and reorganize
information to develop new knowledge and solutions. The eyes see and the brain
connects the dots. Just like a kaleidoscope presenting new pictures all the
time.
p.4 Dissecting
the cockroach salivary glands requires not only anatomical knowledge of the
said insect but also a degree of manual dexterity, which is required in many
branches of medicine. Little did our teachers know then that those same
salivary glands are now being studied for neuro-transmitters.
p. 4 I did practice dissecting them at home and getting good marks
for biology was never a problem. It could even be said that the cockroaches put
me ahead of others in my ultimate pursuance of a medical career!
p.222 My prime years of child psychiatric
training in a drug free environment were fantastic in ways that I only realised
years later. I am what you would call a true organic free range Child
Psychiatrist!
Lesson: Don’t overlook what seems trivial and
basic. They can have a significant impact on the profession and to the professionals.
B. Effective
Problem-Solving Strategies
p.228-229 Others were more assertive and
felt compelled to make interpretations, not realising that often one was
limited by one's own psyche or understanding of it. Hence the need for some personal
analysis to deal with that aspect. There is of course a world of difference
between reflection and interpretation. My personal feeling is that there needs
to be a balance between the 2.
Lesson: Know our limitations. Balance
reflection with interpretation and synthesize the information. Conduct
independent analyses to validate where appropriate.
p.229 Psychotherapy is thus quite far removed
from medical history taking. In a serious medical episode, there is a need to
get a clear view of the events leading up to the episode. This enables
appropriate investigations to be carried out, and the right course of treatment
determined
p. 281 Her lead social worker, Miss W, was a
Quaker. They were the exceptions at the clinic,which was staffed mostly with Jewish
professionals. I became extremely friendly with a psychologist who was an
Orthodox Jew and from him I learned a great deal about the Jewish way of life,
their customs and their culture. That was important because the majority of our
patients undergoing therapy at the clinic were, you guess right, Jewish.
Lesson: Take a holistic view and go back as
far as necessary in time, event, and process to get a good understanding of the
problems/issues and their root causes. Don’t just focus on the present condition and the symptoms.
An effective psychiatrist seeks to understand
the culture and background of his/her colleagues, the patients and their
families.
p. 297 I could well remember this boy with two extremely worried
parents. To me, Ataxia (clumsy voluntary movements caused by poor muscle
control) stood out to be the most significant symptom, not psychiatric ones.
And he had not been put on any medications at all. That was definitely worth
investigating.
Lesson: Don’t be fooled by the symptoms.
Symptoms could be misleading. They may not be what they seem or what we expect.
Be curious.
p.189 -90 “The nurses seem to know you do not like to use sedating
medication. Doesn’t that make their job more difficult?” Dr. V asked me. “They
were quick to grasp that it was my preferred way and I had good reasons. Without the habitual
prescription of tranquilisers, we are able to assess a patient in the raw…”
Lesson: Know the downside of medications.
Medications could mask symptoms. A “true organic free range Child Psychiatrist”
is a vivid description of Dr. Zhang.
p.332 In Finland, could they have found vodka to be the answer? No,
not the drinking of it, but the principle behind using simple ideas.
p.391 “Yes,
six huge bottles of Coke!” Ah, Caffeine.
Lesson: Sometimes the answers are starring at
us, as in the case of Coke. We may miss the simple, obvious answers - the root
cause in this case was the caffeine in Coke.
p.173 - 174 These families mostly had mothers who would never raise
their voice to their child. We have to be careful what we say to them as
whatever we say would be taken as 'gospel'. These were mums with sheltered
upbringing, living in quite comfortable homes, and married to husbands who
brought in good income. Yet most did not seem able to tap into their
instinctual pool. They were a generation of instruction readers, the generation
who spent time reading manuals on DVDs, microwaves and other kitchen
appliances. They were certainly not Ivan Illich's great self- taught group who could figure out how the
mechanics of a bicycle or an old clock worked, without reading a single manual.
Unfortunately, babies do not come with a good manual!
p.352 Child Psychiatry is
one discipline where “tickbox” approach favoured by those in power does not
work. In dealing with Autism, it is often better to think outside the box! Do
not check the box as though from a list of the approved conditions. There is no
standard treatment.
p.357 - 358 Dr. Temple
Grandin did not use the Asperger tag. At the age of three, she was diagnosed
with autism and her parents were told she should be
institutionalized. She would not talk until she was three and a half years old,
communicating her frustration instead by screaming, humming and peeping…most
professionals and parents assumed that an autism diagnosis was virtually a
death knell for achievement or productivity in life. She instead turned her
unique talent into the development of a behavioural tool that revolutionized
the cattle industry, and achieved fame as one of the world’s renowned experts
in two fields: animal welfare and autism.
Lesson: On the other hand, be aware of doctors
and people who rely on manuals. Human beings are not products of cookie
cutters; they do not come with manuals. Everyone is unique. There are no
instruction manuals, treatments and recipes in dealing with individuals.
Similarly, straight application of tick-box
approach does not work for psychiatry, or for any other fields. Doctors have
to engage whole-brained thinking, combining analytical and logical (left brain)
with creative and intuitive (right brain) thinking skills with their people,
relationship and communication skills.
Seek examples of individuals who break the
mold to achieve the inconceivable to show what is possible.
C. Embrace Opportunities - Quantity as well
as Diversity
p.71 When a job was advertised at a premier
psychoanalytic out-patient clinic in England, I saw an opportunity to broaden
my horizon and was only too happy to send in an application. For some reason, I
got the job.
p.210 There was a psychoanalyst who worked one day a week, as he was
mainly in private practice. He was kind enough to give us a weekly seminar on
psychoanalysis. Little did I know that this would pave the way to my next job.
Lesson: Embrace enrichment opportunities.
Opportunities favor those who are prepared.
When there is a fork at the road, take the one that will provide new
experience and broaden our horizon. Each experience is a building block for
future jobs.
The weekly seminar is a win-win. The
participants and the psychoanalyst learned about diversified practices,
experiences and perspectives. The psychoanalyst got the opportunity to practice
presentation skills and organize his knowledge. Teachers learn the most through
the teaching process.
p.145 In part, I was enjoying my new role, being in constant contact
with over ten other Child Psychiatrists in the county, forever trying to prioritise and
arrange for proper admission of some very difficult patients especially adolescents.
4Lesson: We get the most out of our work if we
enjoy the experience. Collaborating with our peers broaden our perspectives,
grow our experience and stimulate our minds.
p.171 As time went on, Dr. CH would regularly "feed" me
cases so that I got to deal with a good variety. As I became more experienced,
I was assigned the younger children. Often it was not because their cases were
more complex or tough, but Dr. CH liked to get a feel of how well I could
communicate with parents who had very young children.
p.173 There is no question that many of my trainees liked to
concentrate on how to deal with challenging cases.
p.207 On a night call in Internal
Medicine, it was not unusual to admit thirty patients with various serious life
threatening conditions… The extremely high caseload was
good practical training.
Lesson: We can learn from all types of cases.
We learn the most from difficult cases. High case load exposes psychiatrists to
a broad range of cases, provides opportunities to connect the dots, and develop
skills to make decisions and set priorities. Immersion is key to developing
deep knowledge and understanding of any topic.
p.281 It was a total culture shock for
me to be suddenly immersed in the world of psychoanalysis, essentially
Freudian, and their special lingo, although I already had a taste from my
Jewish guru in prior jobs.
Lesson: To learn something new and get new experience, we have
to be willing to step out of our comfort zone.
D. Innovation
and Creativity Drive Changes
On p.13 While reading “Fragile Lives”
by Stephen Westaby, it occurred to me that in most branches of medicine, there
was always someone who would have tried something that had never been tried
before and if they were lucky enough, it worked and a life was saved.
GatesheadOn p.13 I was fortunate enough to be
at the Sage Gateshead Free Thinking Festival one year when Professor Westaby, a
heart surgeon and three others (a Professor of Circadian Neuroscience, a crime
writer, and a mathematician) took part in an open discussion about the pace and
rhythm of life, contemplating the speed of life and whether that runs fast or
slow depends on what you use to measure it.
p.204 We need to resurrect that and we need to let good doctors do
what they think is best, even if it is not yet NICE approved.
Otherwise, there will be no free thinking, and no progress in British medicine!
Lesson: Thinking outside the box and bucking
conventional wisdom is critical for all fields. Progress depends on innovation
and creativity. Leaders
should encourage creativity, innovation, and experimentation. They open new
paths to insights and solutions. Engage
in activities that promote free thinking. Empower good doctors to take informed
risks.
p.168 Now let me get back to my six-year old boy with brain injury.
It was one of Dr. CH's most impressive cases, a case that set the direction for me in my
understanding of how our brain could recover, contrary to the neurology I was
taught at Queen Square Institute of Neurology three years before.
Dry Fallsp.268 -269 The Dry Falls was left high and dry
thousands of years ago as the last of several Ice Age floods swept through the
area… The theory of the colossal flood was first proposed by geologist J.
Harlen Bretz of the University of Chicago. In the summer of 1922, he became
intrigued… and after seven summers of hard work and detailed research, put
forward his hypothesis and published his conclusion: a catastrophic flood of a
scale greater than any geologist had ever imagined. It boldly defied the
accepted principle of "uniformitarianism," according to which
geological changes happen slowly and
steadily. To the general geologist community, his idea was unthinkable
heresy, and criticised as ‘wholly inadequate, preposterous, and incompetent’.
p.270 Revolutionary theories are usually hard
to swallow.
Lesson: If we always do what we have always
done, we will always get what we have always got. Keep our eyes and mind open.
We never know when our next inspiration comes and where it comes from. We never
know which experiences, cases and information will open up new roads.
Learn to love opinions at odds with what is
generally accepted. Challenge conventional wisdom, regulations, policies, and
instructions with an improvement mindset. Be willing to accept new knowledge
that contradicts conventional wisdom and current practices. Integrate and
balance new knowledge and methods with the old and the tested to forge new
paths.
p.340 I had great
difficulty peeling a fat banana that we picked from a tree in our yard and
ripened in the kitchen, the ones that were particularly tricky to peel. However
hard I tried, I failed, and eventually I gave up my boyish pride and looked at
the window. Mother signaled that I should turn it round and try the other end.
Lesson: A great, simple example of keep doing
the same thing again and again and expect different results is insanity.
p.226 Now that I had been thrown into the deep
end, I had no idea what to do. I had learned from Winnicott's squiggle game the
importance of the therapist's quick response and spontaneity. Why should
talking to the older child be any different? This approach helped the doctor to
establish rapport very quickly especially with parents and served me well all
the way through to my Consultant days. I learned from my gurus and teachers
that we did not have to be held back by rigidity.
p.242 Not following the book. As we know, children cue parents in
how they respond. I have attempted to change relationships between mother and
her autistic child by suggesting an active attempt to bypass cueing, frequently
producing quite dramatic results.
Lesson: These
examples showed the merits of spontaneity, speedy response, flexibility and
thinking on our feet.
E. Insightful Management Practices
p.189 -90 “The nurses seem to know you do not like to use sedating
medication. Doesn’t that make their job more difficult?” Dr. V asked me. “They
were quick to grasp that it was my preferred way and I had good reasons. Without the habitual
prescription of tranquilisers, we are able to assess a patient in the raw. It
is not my primary job to make life easy for the nurses, and in many ways I am
proud that they have risen to the challenge…”
Lesson: Team members are trained to be
observant. Give people opportunities, they will rise to the challenges and
develop their skills.
p.192
“…The parents came in as they wanted to thank you personally. You've done
it." "No, WE, we've done it! All of us!"
Lesson: All work is ultimately Teamwork.
Recognize team members’ contribution often and in public.
p.97 I famously allowed her to bring
her 6-week old first born to work until she could sort out satisfactory
childcare. She became good enough for me to nominate her to become an Associate
Specialist – a success story!
Lesson: Loyalty are built on things big and
small. In this case, flexible work practices promoted dedication, diligence,
good performance and success.
p. 297 I could well remember this boy with two extremely worried
parents. To me, Ataxia (clumsy voluntary movements caused by poor muscle
control) stood out to be the most significant symptom, not psychiatric ones.
And he had not been put on any medications at all. That was definitely worth investigating.
Lesson: Be mindful that to investigate or not
investigate an issue, a problem, an illness, or a topic always depends on the
organization’s culture, value system, resources and finance.
p.381 … What could I
offer (to an Anorexia Nervosa patient)? You guess right: individual
psychotherapy. Really? With all my new patient load? When there was a will,
there was a way. Looking back, I realise I learned an awful lot from this single
case. It marked the turning point in the way I dealt with anorectics. She became my ‘practice changer’.
Lesson: When there is a will, there is a way
if we are resourceful and set appropriate priorities. We should watch out for
potential "practice changers" and make use of them to improve our
strategies and practices.
p.67 Most of us must have joined in this type of beach activity at
various stages of our lives…We realised that no matter how carefully we build, and how much
water you get on shore, the water will drain away in no time at all. We try to
repair this bit and that bit but when the next tide arrives all we have built
is going to disappear…After a lifetime spent trying to sort out some strange, some twisted
and some really hilarious minds, the psychiatrist retired and the next tide came and much of
his effort in building the best lakes and rivers evaporated. No trace
whatsoever. Do I want to leave some trace of my efforts? Perhaps some stories
are worth telling. As the water flows it changes course and it changes the
landscape Hopefully I have managed to effect a few changes along the way…
Things kept changing…
Lesson: Think about the legacy we want to
leave, the stories worth telling and what may help others in the forever
changing landscapes. As suggested in p.361, in retirement, we can turn our
profession into a hobby and side hustle. Why not take it to the next level and
leave our legacy in lessons learned from our life-long experience.
Operating Philosophies
F. Trust and Confidence Have
to be Earned
p.238 At this new District Psychiatric setup in west London, my
immediate boss, whom I often fondly refer to as my first guru, was somehow very
trusting of me and my abilities and virtually left all the day-to-day patient
management matters to me.
Lesson: Earning trust could set us free.
Leadership and clients are more likely to support us in experimenting new approaches.
p.190 “The nurses seem to know you do not like to use sedating
medication...” Dr. V asked me. “They were quick to grasp that it was my
preferred way and I had good reasons. Without the habitual prescription of
tranquilisers, we are able to assess a patient in the raw… Mother said to us,
“…So I have complete faith in what you might be able to do.”
Lesson: One way to earn patients’ and their families’ trust and support is to
explain the reasons for recommending certain treatments and communicate with
confidence. Successful treatments build confidence within the teams and among
the patients’ families.
G. Don’t Let Failures Go to Waste
p.376 We learn little or nothing from our successes. They mainly
confirm our mistakes, while our failures, on the other hand, are priceless
experiences in that they not only open up the way to a deeper truth, but force
us to change our views and methods. C.G. Jung
p.377 …After a lifetime of seeing children and adolescents, I have
come to the conclusion that sometimes what you may see as failures are not
really failures. Some cases are ‘untouchable’…all your best efforts at individual and family therapy and most of
other eclectic therapies just would not make an iota of difference…As Jung
assured us, failures are indeed priceless experiences, because they open up the
way to a deeper truth and may, if our future patients are lucky, force us to change our views and methods.
Lesson: Failures are priceless. We can learn more from failures
than successes. We should not be discouraged by and dwell on what appears to be
failures that are not actual failures. Learn from our failures and seek new
paths to success.
H. Be a
Lifelong Learner - The World is Forever Changing
p. 262 As our beloved professor put it nearly half a century ago,
“We know little about what we assume we know.” If you look at how medical
experts have struggled with the current Covid 19 pandemic, you will probably
agree. You might also wonder: What do we know, and what do we not know about
diseases and illness in general?
p.327 In medical school when we learned about medical conditions and
treatment methods, we had the impression that our knowledge on those subjects
was complete. How wrong!
p.360 There are situations in
medicine that we cannot yet fathom, but often we are surprised at how a very
basic scientific principle is behind some apparently strange medical
circumstances. Despite my retirement,
medicine remains a great interest to me. In science, one should never accept what is currently
known as the whole truth. Medicine cannot stagnate, nor should we forget first
principles.
p.448 The motto given to
us by our Professor of Medicine “One Patient One Disease” is a good one. I did
not believe that my patient had Teratoma and then encephalitis of unknown
origin. In medicine, one needs always to be asking questions. I was too much in
awe to question further the diagnosis given by the top British Neurological
Hospital then. My thinking was: if they did not know the answer, nobody would.
How amazing it would have been for London to be the first to describe
Autoimmune Encephalitis in 1978!.
p. 492 With some cases we often had to learn as we went along.
Lesson: Be mindful of Gomory's tripartite division: the known, the unknown which may someday become
known, and the unknowable, which will never be known.
Knowledge will never be complete. More often
than not, we have to learn on the fly and execute. We should not assume that
experts have all the answers. We don't know what we don't know. Truth could
change.
Like many other advices in the book, the
importance of asking questions and listening is relevant to all fields, not
just medicine and science. Keep asking questions; it will lead to new
knowledge.
p. 281-282 In case discussions, there was often an assumption of the
‘given ‘, which a new comer like me found difficult to assimilate. It was all
new to me: Britain, psychoanalysis, and this strange psychoanalytic hot-house,
essentially ignored by British mainstream psychiatry, who happily carried on
with medication and ECTs (Electrical Convulsive Therapy). Later when I began to
attend World Conferences in Adult and Paediatric Psychiatry conducted by
American Associations, I realized American mainstream psychiatry had very much
embraced psychoanalysis, although this has now changed. My Tavistock background
stood me in good grounds at these academic meetings.
Lesson: Building a strong foundation is
essential. Don’t overlook the basic. The foundation should include disciplines
that go beyond our technical specialties. As we advance in our career, other
skills such as verbal and written communication, presentation, negotiation,
relationship building, networking, strategy development, etc., become the key
enablers for success.
Leaders and professionals will deliver many
presentations and training. When training team members and giving
presentations, pay attention to the “givens” we assume. The audience may not
have the “givens” to understand the content. We sometimes need to step back in
order to take the audience forward.
Throughout our career, we learn a broad range
of discreet topics organized by the institutions, the teachers, experts and
presenters. We have to take the initiative to integrate these knowledge and
information with our experience and expertise. We have to connect the dots. No
one can do it for us.
Our brain has immense capacities to store,
recall and connect information. We have to activate these capacities. Make it a
habit so we do this automatically.
p.173 There is no question
that many of my trainees liked to concentrate on how to deal with challenging
cases. A valuable advice I gave them was much of what we had to do was to work
out what the patient omitted to tell you. Some of the trickiest cases proved this
point. Patients think that they have to tell you what you want to hear. I
totally agree that we learn a lot from difficult cases.
p.284 “Your consultant is the best Child
Psychiatrist I have worked with. No nonsense and no jargon, Freud or otherwise.”
p.379 I followed their example as I believed
that listening gave me more information than asking multiple questions.
What patients or parents withheld from you
might be as significant as what they told you in the first place.
Lesson: Communication and people skills are
just as important as technical skills to successful practices. Psychiatrists
need to communicate clearly and avoid using technical terms. Often, the missing pieces (what we did not
ask or what people didn’t tell us) are the most important. Therefore, we must
not assume. Ask questions. Listen to the answers. Listen for what is not said,
watch out for gaps and missing information.
p.281 To be an effective
psychotherapist, one needs to be comfortable and familiar not only with the
basic philosophy but also with the language and vocabulary.
Observation: In my experience, this is true
for all the fields and professions.
p.266 What was interesting was that although
he did a science degree course, not much electronics was taught at university
then. He was entirely self-taught. On graduation, he became a science teacher
and during the first summer vacation, he took a summer job in a new transistor
company in Hong Kong. His superior was so impressed with his amazing knowledge
that he offered him a permanent job. He never went back to teaching and the
rest as they say was history. He is thus a prime illustration of: The best part
about education is the bits they do not teach you.
Lesson: We are so lucky! Experts are generous
in sharing their knowledge. With so much information on the Internet, and
YouTube videos in particular, if we take initiative, we can learn many topics
at our pace from a diversified group of experts.
p.196 - 205 The chapter on
Heart and Empathy.
Comment: Many people thought empathy and
sympathy are the same. There is a huge difference between the two. When people
expressed their sympathy, they thought they were exercising empathy. I like the
explanation on the differences and the supporting examples. They made the
definitions more memorable.
I. Good Begets Good, And Good Teachers Make
All the Difference
p.227 Good areas with intelligent students
attracts families that value education and good teachers.
Lesson: High
performers are like magnets.
Organizations that attract good students tend to attract good management
and leaders who are interested in developing people. Competent, ethical leaders
and professionals turn good organizations into great organizations.
p.168 Now let me get
back to my six-year old boy with brain injury. It was one of Dr. CH's most impressive cases, a case that set the direction for me in my
understanding of how our brain could recover, contrary to the neurology I was
taught at Queen Square Institute of Neurology three years before.
p.169 All of us knew that for our own good, we must pay attention to
Dr. CH's every single utterance, as at any time he was apt to throw in a gem
that would change our way of thinking. Good teachers tend to open up new ways
of looking at things which may be overlooked sometimes simply because they are
too obvious… he was a pioneer in establishing three inpatient units on site: a
middle age group children’s unit, where I was mainly placed, a unit for autistic
children, and quite uniquely a mother and child unit. At the time, I did not
know of another such unit in England.
p.238 In return I received a great deal of inspiration from his
Tuesday clinical meetings, when he often made some genuinely astute remark that
would take me a whole week to digest but then remain with me for the next few
decades. I see that as the measure of a good teacher.
p.267 From the first lesson we were spell
bound…She was able to capture our imagination and made riveting what we
previously found boring. For the first time what happened millions of years ago
fascinated us. Glaciers became hot. We were so inspired that the Meteorology
Club membership increased dramatically. A guided visit to the Royal Observatory
further cemented our new found interest.
Lessons: Good teachers make all the
difference. Pay attention to pioneers and good teachers at all times to catch
the gems that would inspire us to new thinking and perspectives. Their
inspirational and insightful remarks leave lasting impressions. People
sometimes overlook things because they are too obvious and assume that everyone
knows.
Be the teacher that we appreciate and pay it
forward.
It is not enough to discover new knowledge.
Take actions to turn new knowledge to solutions.
The Why’s
Some areas of the book raised interesting
points. They begged the question “Why?” The readers would naturally be interested in knowing the
reasons for those phenomena.
For example:
p.3, It is extraordinary nowadays when many
medical schools do not even specify Biology as a prerequisite subject and many young
doctors have no idea about the biological world we live in.
Why: Biology seems
to have a strong linkage to medicine. It would be interesting to learn about
some potential reasons.
p.12, It may be of interest to readers
that the current new generation of psychiatrists, including those in the US,
were no longer brought up in psychoanalysis and as a result, they probably have
little understanding of either the personal psyche or family dynamics. Of
course psychoanalysis has its many faults but to totally dismiss it is indeed
very sad for mankind.
Why: Readers would be curious about why psychoanalysis
was excluded, and how that impacted the diagnoses and effective treatments.
p.12, “At some conferences the Anorexia themed talks were all about
which drugs to use to induce hunger and eating when treating such cases.
Why: Conference topics are based on demands
and interest. Readers would be curious about why the focus was on using drugs for
treatment and not on prevention strategies.
p.71 However, I was a bit confused as I thought psychiatry was about
the soul and the works of Freud and Jung. In Hong Kong, hardly anyone talked
about them then.
Why: In U.S. we were introduced to Freud and
Jung in Psychology 101. The linkage of Freud and Jung to psychiatry seems so
natural. Readers would be curious about why the disconnect in Hong Kong.
p.169
… Dr. CH… was a pioneer in establishing three inpatient units on site: a middle
age group children’s unit, where I was mainly placed, a unit for autistic
children, and quite uniquely a mother and child unit. At the time, I did not know of
another such unit in England.
Why: Readers would be curious to know why
establishing three impatient units is beneficial to the patients.
p.169 I was at first shocked by his take down of Eysenck and the IQ
test but never forgot his theory.
Why: Readers would be curious to know why the
take down and his theory.
p.214 There were two or three such
referrals of overdoes a week and very few of them required a transfer to our inpatient
wards. They provided me with a strange glimpse of a world of which I had little
knowledge then, and later in child psychiatry I could see the roots of such
cases. What I could not fathom was why we were so hopeless in preventing them!
Why: I always thought that doctors are trained
to treat the root causes. Should child psychiatry be a foundational course for other
curricula? What are the root causes for lack of focus on the root causes of
problems and issues? This would be a very worthwhile research topic with
far-reaching impacts.
p.279 Why should
‘real’ doctors have anything to do with Psychoanalysis?
Why: Physical
health and emotional health are intimately intertwined - the Mind and Body
Connection. Our chemistry and biology impact our emotions, thoughts, beliefs,
physical health and well-being. Mind and body are not two
separate entities, I am surprised that they are often treated that way. Readers would be interested in why ‘real’
doctors should not have anything to do with Psychoanalysis.
p.284
For anyone aspiring to be a paediatrician, a good understanding of child
psychiatry is crucial…Half our cases may have a psychological slant, and the
other half may have problems created by the doctors!”
Why: 50% of the cases may have problems created by the doctors!
This potential problem rate is very high and begs the question “Why?”. Doctors
should be part of the solution, not the problem.
p.454 Remarkably to some, quite a few of us in our year chose to go
into psychiatry.
Why: It sounds like a surprise. Readers would
be interested in knowing why usually few chose to go into psychiatry and why so
many of your classmates chose that path upon graduation.
p.487 He said, “When you first start a new job, strange referrals
will turn up and you need to be prepared for them.”
Why: Why the influx of strange referrals for
newcomers? Was the intent to test them, to get different opinions, or something
else?
p.502 Did I open up a can of worms? Was there some trauma? Some
near-drowning experience perhaps? The cogs of my psychiatrist’s brain could not
help turning. A doctor is like a detective, as I often tell my grandchildren,
and he is always looking for clues. He does not ask questions though.
Why: I don’t understand the statement about
the doctor is always looking for clues but does not ask questions. Other parts
of the book discussed the importance of asking questions and listening to the
answers as well as what is not said.
Other
Observations: Many Chinese cities and
references (e.g., Hakka, jiao-chou,
Teochew, Swatow, dai fu) were translated from Mandarin or Cantonese into
English phonetically. They tended to slow the readers down as they tried to
figure them out. It would be beneficial to include their Chinese terms.
The Chinese terms will also catch readers’
attention that this is not just a book about psychiatry, but also about the
journey of an immigrant.
On p.208, There is a Chinese saying: “When
the sky falls, take it as a blanket!” This idiom is so much more vivid in
Chinese.
Chinese characters would also facilitate
recalling information.
p. 256 To me one of the
most delicious lobsters I have ever tasted was from Scotland and most times I
could get Scottish lobsters from our wholesale fish market Billingsgate round
the corner from where we lived in London. This was not to degrade my memory of
the
Observation: Interesting! My husband Frank
thought the same. He ate Scottish lobsters at Taipan, Thomas Yam’s restaurant
in Milton Keynes. That and the fresh turbot in black bean sauce were among the
favorite food he had overseas.
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