Linchpin: Are you Indispensable?

Recently, I had the pleasure of joining a company hosted virtual book club. As part of my company's professional development program, each of us are required to invest 40 hours a year on continuing education. The types of classes span from general management related issues to industry learning courses, or even technical skills like Access database modeling. When the opportunity came to join a general management book club to credit those learning hours, of course, the geek in me jumped at the chance! What's more, the company was going to reimburse for the cost of the book and I was going to be able to get 6 hours of learning credits. Needless to say, I was looking forward to reading this book.

However, I retained mixed reviews about the Linchpin: Are you Indispensable? by Seth Godin. My primary frustration probably resulted from his blogger style of writing; whatever hit him in the spur of the moment and piqued his interests, he would write it down. As a result, the snippets of his blog stories created a rather choppy flow to his book, which I did not particularly enjoy. Having read another of his book (We are All Weird), undoubtedly, this was a classic style of his writing - modern, unpolished, and conversational. His success with his books (he has published 14 books to date) probably meant that I am one of the few people unable to really appreciate the "depth" of his writing.

The overall thesis of the book was pretty good though. That as individuals in society, we need to demonstrate autonomy and independence in following our path. It is too easy to jump on the bandwagon and be one of the many identical cogs in the wheel. It requires emotional hardship, passion, and determination to chart our own course and be leaders along the way. Driven by the combination of passion and art, one can become a linchpin - someone who is indispensable.

Godin argues that capitalism has created a self-fulfilling model of compliant workers. Capitalists need compliant workers, who will be productive and willing to work for less than the value that their productivity creates. The gap between what they are paid and what the capitalist receives, equates to profit. Therefore, in the quest to be all efficient and productive, our society has created an over-abundance of workers while the artists in every one of us have lost sight of the quest to create our own "art".

In order to avoid being the cogs in the wheel, one needs to create art by doing things that no one can tell you exactly how to do it. Art is created when one takes personal responsibility, challenges the status quo and changes people. One also become an artist when you give gifts unconditionally. When one is willing to dedicate hours and invest emotional labor (remember the times your head hurts when you need to think so much) and create novel ideas or products, one starts to find the passion. This brings to my mind a concept in positive psychology, proposed by Csikszentmihalyi: The flow - the mental state of completed focused motivation where one becomes fully immersed in a feeling of energized focus, full involvement and success in the process of the activity - is the perfect combination of art and passion right there.

I support Seth Godin's challenge to every individual reader to rethink their destiny. Don't find excuses for yourself, because you really do have all the potential you want in you. The overall optimism of this theory also coincides in what I believe  - that you are exactly what you believe in yourself to be. Maybe you are not where you would really like yourself to be at this time, but as long as you are "charting" and defining your path in every step of the way you go, one day, you will get there.

"Hope is like a path in the countryside: Originally there was no path.

Yet, as people are walking all the time in the same way, a path appears." 

by Lu Xun, One of the Greatest Chinese Writer of 20th century

However, some of Godin's other arguments do not stick very well with me. Godin argues that the theory of  "I did well in school and therefore will do a great job working for you" is not valid. Along those lines, he also slams education as being completely antithetical, fear-based battlefields that kill the heretical thought we so badly need. Schools only create conformity and kills the artists, entrepreneurs, adventurists, soloists in us. 

While I agree that school GPA performance is not the sole indicator to one's success, GPA scores are one of the best indication of an individual's determination. My take is that determination is the MOST important factor to being a linchpin and that schools are the best grounds for cultivating that environment. You think those Chemistry class, English class, or even art or tennis classes in school could have made you an artist/inventor? Nope, not even close. What school, at least from elementary through high school, does best is to provide the platform for long grueling hours to train an individual to be focused, determined enough to master the material. As we all know, creating novel ideas, or art according to Godin, requires mastery and effort, perhaps also combined with a splash of talent, so I would disagree that art creation is something that we could actually "teach" in school. 

Perhaps this also ties back to the Asian upbringing in me. "Nothing is fun until you're good at it," according to Amy Chua (the infamous tiger mum) in Battle Hymn of the Tiger Mother. Her theory is that as kids, you really don't know what you're good at, and through sheer determination, practice, and effort, one will become better at everything you do. That is when things become more enjoyable and you continue to invest more time to become even better at it. 

Overall, if I really had to rate this book, I would give it a 3 out of 5 stars. If Seth Godin had showed some damn effort in performing research for his book and actually polishing up his arguments instead of his nonchalance efforts in thinking his venn diagrams or his brilliance alone would compensate for the lack of everything else, I would have been a bigger fan of this book. He simply closed out his main argument of the need for everyone to chart their own path by stating that because everyone is unique, there was no need for him to spell that out. That was quite the major letdown towards the end of the book. So, my recommendation for this book is: Read it if you think that you want some inspiration in your career, but don't set your hopes too high for it. 

Sixth Sense

Sorry for my hiatus! It's summer time and I having been making such lame excuses to go out and forget about this blog.

This time we have a guest writer-Mr LapHung Chung, who shares his opinion on the power of sixth sense.

Have you heard of the term “sixth sense”? Have you ever wondered if sixth sense actually exists? What exactly is sixth sense?

Vision, hearing, taste, smell, and touch are the five commonly known senses. To scientific researchers, immune sensing, where your immune system detects unfriendly microbes, is the technical explanation behind the existence of the sixth sense.

To most people, however, sixth sense is related to an intuitive emotion – often known as a gut feeling or simply a hunch that is often beyond explanation. Have you encountered a personal experience where you had an uneasy feeling while seeing a man in the distance staring at you? Or have you experienced a situation where you paused yourself at a critical decision juncture, with no particular reason for an uneasy cloud hanging over your head?

When you had such moments, how did you react and what were your actions?

Unfortunately, at the current juncture, research in cognitive neuroscience has yet to shed light on this aspect. Much are still in the stages of presumptive research and hypotheses testing. Here, I’ll try to provide a rational explanation which I hope is worth a pause for some thoughts.

It is, however, important to have a similar understanding of the adaptive learning ability of human brains. Sixth sense is actually an incomplete recollection of your real-time senses in cognitive processing with memory. In another words, your brain is in the midst of processing inputs from your five senses and matching them with your previous experiences. For instance, when you type a search criterion on your computer, you may not always have a 100% match result. In fact, if there is truly a 100% match, you should have been able to recall the event or person that jogged your memory. This means that there is a direct link between your senses and your experiences. Even if the matching is imperfect, fortunately, our brain would still be able to form weak associations based on some similar experiences.  This ability to form associations due to adaptive learning is what governs the development of Artificial Intelligence (AI). At present times, AI technology is still at a rudimentary stage where computers can only respond within known programmed parameters. On the contrary, once human brains learn the basis of card games, we can improvise moves that we have never been taught before. The extent of adaptive modification, however, may depend on the individual’s creativity. We call this talent because the degree of improvisation ability often varies between individuals. Nonetheless, most of anyone’s experience can be attributed to secondary experience. Fortunately, one does not have to jump-off the cliff to learn that this is a dangerous act but rather one can learn by association from the experiences of other unfortunate victims.

Back to the example of the unidentified man in the distance who posed as a danger to you. Unknown to you, your brain is already rapidly processing various visual sensory images such as his dressing and his behaviour. Your sense of hearing picks up sounds that he may be making. Your sense of touch becomes heightened to be aware of your surroundings. Your sense of smell may already be attuned to the olfactory sensation from your environment.

Chances are that although you have never experienced this specific scenario before, your brain is already subconsciously processing all the sensory inputs based on information provided by the other five known senses. Once the assimilation process is completed, your brain begins to search for association. At times the connection could be instantaneous; because of near-identical past experience to the current situation. At other times, your brain may have to depend on inferences drawn from dissimilar sources. This can be in the form of personal or secondary experience from adaptive learning such as communications with previous victims or via mass media. The frequency of sixth sense encounters is therefore proportional to the amount of relevant experience your brain can draw upon. As such, the more personal and secondary experiences, the more frequent you might feel an overwhelming sixth sense.

What this really means is that one can hone your sixth sense, through either personal experiences or secondary experiences, learning vicariously in the latter. Still, you may doubt whether we should trust our sixth sense. Of course, there could be mis-perceptions in each of your five senses and due to the weak associations between sensing and your memory. As a result, basing your sixth sense on those perceptions may not present an accurate picture or be completely reliable.

During one of my university summer laboratory internships, I was performing a routine procedure according to standard protocols when I suddenly had a very strong hunch that something was wrong. At that moment, there were no visible or apparent signs of mistakes to support my suspicion. Nonetheless, I paused as I chose to lean toward my inherent sixth sense and stopped to revisit all my prior procedures. Painstakingly, I reviewed all the prior steps through my notes systematically for the next two hours. To my surprise,  I discovered that I mistakenly doubled the amount of a chemical. Upon recognising this fact, the unusual smell and colour of the solution then became very apparent to me. Thankfully for my sixth sense, I had avoided wasting a large batch of bacteria culture and saved myself tons of hours of work down the road. Perhaps it was the subconscious awareness of the unusual smell and colour of the culture that had awoken my sixth sense.

So the next time you feel a strong intuition, rather than quickly dismissing it, why not pause and trust your inherent sixth sense for once!   

Next two topics will be on two new books: The Power of Habit- Why we do what we do in life and in business, by Charless Duhigg and the Linchpin, by Seth Godin. Coming back soon!

My right knee MRI

A single fall while skiing at the Devil's Head Resort, WI, turned out to be a little more than what my knee could handle. Symptoms: Pain in right knee, no swelling (immediate or delayed), unable to straighten knee, and weakness in right knee. Hypotheses: Meniscus tear or torn ACL.

I looked up my enrolled healthcare plan choice - a HDHP (High Deductible Health Plan). It definitely made sense for me at the time when I enrolled since I am the "young invincible". My total annual premiums are $650, which has a $2.7K deductible, and an average 10% co-pay after I hit my deductible. Flashback to Leon Wyszewianski's HMP601 class, "Typical young invincibles include people in the early twenties. Individuals who have less need for health care, so HDHP which comes with lower premiums and higher deductibles is an appropriate choice for them". 


My four other choices were a 1) PPO which I would pay $1.56K annually, 2) an Open Access (almost 90% coverage for everything) pegged at $1.664K annually, 3) a basic plan (almost everything out of pocket) at $286 or 4) no coverage. There was no way I would take option 3 because that's just useless and given I'm a strong supporter of Obama's mandatory health insurance, there was also no way I would go against my own principles by taking option 4.

Well, five weeks later, I am in the midst of packing my bags to go home to Singapore for a 2 week vacation. I decided to confess my knee injury to my mum and asked her to set up an appointment with a orthopedic specialist to look at my knee. I assured her that there was nothing wrong with my knee, but I just wanted a second opinion. But deep inside, I knew that an MRI was probably imminent. But either way, I would have rather gotten an MRI in Singapore than in the states because of the ease in accessibility and cheaper cost since I was paying out of pocket.

First visit to the orthopedic specialist's office took a 45 min wait even though I had been scheduled a slot at 12.15 pm. The doctor finally waved me in at 1 pm and the whole check-up took about 5-7 min. Conclusion: Get an MRI.

"What is the turnaround time for an MRI"- me.
"Today or later this afternoon if you want. The assistant will schedule our follow up appointment". -Doctor
"Okay....I'll schedule for next week then".
"No problem".

I think to the doctor it sounded ridiculous that I asked what the turnaround time was for an MRI. Because in the states, it would take quite a few days! Granted that Mount Alvernia where I was scheduled to get an MRI was a private hospital, but I wouldn't have imagined a same turnaround time for for-profit hospitals here in the States. Turns out that the MRI would cost $588 SGD in total after taxes, which translates to about $470K in USD. Not bad at all. In  the states, an MRI would have made me USD$1K poorer, at least.

Before you start thinking that healthcare is all cheap, efficient, and accessible and all perfect in Singapore.. hang on till I finish my story.

The scheduled day of my MRI finally comes. I had asked for the first slot in the day at 8.30 am so that I wouldn't have to wait. In fact, I got to Mount Alvernia's imaging department at about 8.10 am and submitted my name for registration promptly. Not before long, I was cued by the MRI technician (last name Li) to enter the MRI room.
All too familiar to me. I can probably spew off more facts about the MRI machine than he can. Typical questions- are you pregnant? are you on drugs?  etc. and then I am off to change into my patient gown.

Patient gown was impressive! In fact, it was very comfortable. Unlike the gowns in the states which really don't protect the modesty of the patients, these gowns were made from materials with high thread count and  was worn like the Japanese yukata. The process of putting on was simple as ABC; there was even a poster on the wall explaining how to wear the patient gown.

Upon entering the MRI room, I made a special note to myself to put the locker key on a separate location. I was surprised that the technician didn't really ask. (I've heard of horror stories of MRI or X-ray imaging with metal objects). Finally I lay prostate on the imaging bed, which was  a really uncomfortable board. The bed itself was so narrow. Before long, I was lying there wondering how someone with a wider waist girth could possibly fit onto this bed. Anyway, it proceeded to be a pretty pleasant experience with Li offering me a pair of headphones, briefly explaining to me what was going to happen with the "machine making funny sounds" but "please don't move", and asked me for my favorite music channel to play.

And so I lay there listening to morning news on Channel 95.5 while lying on this uncomfortable board, right knee strapped up, unable to budge, and being semi-naked under the patient gown and a pretty thick blanket.

Ten minutes later as nothing really happens, Li walks into the imaging room and starts pushing some buttons on the machine. He seemed to shut it down and reboot it again. Then he told me that he needed to "restart the machine because it is overheated".

OVERHEATED?! My heart just skipped a beat when I heard that. What if he didn't check that I was overheated and had already sent me into that MRI machine. Would I have suffered from over-radiation? Would I get horrific visible burns like that one picture I saw a year ago of a patient who was applied too much radiation intensity during an X-ray?

Being the obedient patient who didn't want any over-radiation, I continued to lie on the uncomfortable bed, unbudging, uncomplaining. For another 30 minutes.

After what seemed like an eternity, Li walks in the door and unloosens my right knee strap and asks me to stretch a little before I get numb lying in the same position. Thanks for the heads up, really.

Another 20 minutes passed before Li finally walks in the door and gives me an apologetic face. He said, " I'm so sorry, the machine is overheated and we have to get the maintenance guys to come and add the coolant. It will be another few hours before it will be done". At this point, I was just happy to be able to get off that narrow imaging bed and change into my normal clothes rather than being mad that it took so long before he came in to tell me what the problem was. Li responded that I would be the first on the line if I wanted to re-schedule for one or two hours later when the machine was up and running.

Being the first in this situation may not necessarily had been the best thing, given my fears of over-radiation still running through my head. I said I would have to call my specialist to see what his availability would be  for later in the afternoon since I was leaving the country in two days and wanted him to read my films and give me my diagnosis.

Anyway, I proceeded to go the registration front desk myself to get my own patient card and dialed my physician's office. I got the doctor on the phone and told him about the MRI backlog. He said that I should probably still get the MRI, and although he was not available, he would give me a call later that afternoon once he got my films to give me a verbal report. I conveyed my wishes to reschedule to Li and he stated he would give me a call later when the machine was fixed. By this time, the waiting room was swamped with people, technicians were running around like crazy, and the registration assistants were just confused on what to do with so many people constantly asking them questions. I left for the cafe with my mum to get a bite and just to get away from the crowded waiting room.

In about 1.5 hours, I got that much-awaited call from Li and went back to get my MRI performed. This time it went all smoothly, with the MRI only taking 20 minutes to complete. I got my film immediately from them since I was already late for my original appointment, brought the films up to the specialist department myself, and paid for my MRI there. My doctor called about 3 hours later, telling me I have a partial ACL. Although I won't need surgery but I should get 6-10 sessions of PT to strengthen my muscles.

A few thoughts on the whole process:
1. Process improvements on work flow. Imaging department could do with a lot of process flow improvements, in terms of registration to patient departure. I overheard the nurses talking about mixed up films loudly in the waiting area. Not a very good sign of quality and patient confidence, is that? Also, why was I paying at the doctor's office instead of at the imaging department? Somebody could have clarified that better for me. (Could be because the doctor had a fee arrangement with the hospital, and then retroactively paid the hospital for the number of services provided.)
2. Technical difficulties/ patient overflow process. Imaging department should have an emergency backlog/ technical difficulties process. Really, I should not have been the person who went around dialing and asking for my own reschedules. From a continuum of care perspective, the registrars should have done that for me. Also, were they starting to call to cancel patients who were scheduled for an MRI for later that day given the backlog? Or simply just letting patients know about a new scheduled time? This way, no one would have came in later in the day and waited for 3 hours like I did, or worse, came in but never got their MRI done because of the backlog.
3. Long wait lines at the clinics. Each patient in the specialist office had been complaining of long waiting time. This was supposed to be a private clinic/hospital which offered more accessible care. I think their scheduler/registrar placed blocks of 10 mins for scheduling, but honestly they could really do with a better scheduling system to better predict their patient volume.
4. Service quality.. The registrar was the most stuck-up and rude woman I have encountered. In her flat, high-pitched tone, she said " Doctor only comes in 2,4,6 (referring to days of the week) in the morning. You can have an appointment at 11.15 am. Can or not?" The tone of itself was perhaps not the part that irked me the most, but the fact that NO EYE CONTACT was made the whole time we had this conversation, and she was looking AWAY from me. Also, she was impatiently knocking the table with her pen while waiting for me to decide the times that worked best for me.

I hope my right knee's MRI serves as an illuminating story of the differences in challenges for healthcare in the states and in Singapore. I would probably get outstanding interpersonal care and treatment here in the states, albeit a high cost and a longer horizon in scheduling an appointment. In Singapore, I get rather affordable care with high accessibility, but at perhaps dubious clinical quality and pretty poor service quality. Lots of work to be done in both areas with different challenges and different ways to work those.

The Real Way to Build a Network

Starting on a new job and moving to a new city has provided me with a lot of learning opportunities. A major change relates to building a network, both socially and professionally. I have always viewed professional networking as a pretty cumbersome task - inauthentic, transactional, and forced. However, over time my perspective have changed because I actually find it very interesting to meet new people and learn about their interesting lives. My personal opinion is that by finding the hidden joy behind networking and perceiving networking as a relationship building exercise, professional or social networking could be pretty satisfying! Today's post is going to take a break from health care and discuss social and professional networking.

This post is inspired by two sources. The first is an article I recently read in my monthly Fortune magazine subscription by Reid Hoffman and the second is a book called The Happiness Project by Gretchen Rubin. (Thanks to the Michigan HMP ladies virtual book club for this great recommendation!). I haven't had the chance to read "The Start-up of You: Adapt to the Future and Invest in Yourself, and Transform your Career" by Reid Hoffman and Ben Casnocha. But based on the article, I would vouch that this is a pretty insightful and powerful book. As for the Happiness Project, I would definitely encourage anyone, gentlemen and ladies alike, to enjoy this easy-read and a highly self-introspective book about pursuing happiness in the course of daily life activities. 

According to Reid Hoffman, the "guru" of networking, the founder of LinkedIn, and an early investor in Zynga and Facebook, building a genuine relationship with another person depends on two abilities. The first is seeing the world from another person's perspective and the second is the ability to think about how you can collaborate with and help with the other person rather than thinking about what you can get. The best way to strengthen a relationship is to do something for another person. 

His theory of a diversity of "weak ties" was pretty refreshing to me. This means that those acquaintances from elementary school or third-degree friends are actually more meaningful than you think.There are studies that show that job referrals actually mainly came from "weak ties". This makes sense since your good friends tend to be from the same industry, neighborhood, religious group etc. Therefore, a job or a news that a friend knows about, you probably already know about that. 

What is a good number to determine how diverse your peripheral group should be? Based on experiments and projections of human's cortex size, Robin Dunbar, an evolutionary psychologist, predicted that humans should be able to maintain 150 relationships at a time. Hence, the Dunbar number of 150 if you have heard of that before. Of course, you shouldn't feel limited by this number because you can actually maintain a much broader social network than the people you currently "know". In fact, I'm sure you have already heard of the 7 degrees of connectivity theory; that any individual can be connected to another individual in this world in less than 7 degrees. Seems like 3 is actually the magic number, according to Hoffman, because 3 degrees of connection is how trust is preserved. Anytime you want to meet a new person in your extended network, you should ask for an introduction. Always remember that your network is at anytime larger than what you think it is.

On the other hand, most people only maintain 5 to 10 deep alliances. An ally is someone whom you proactively share and collaborate opportunities together, also someone you consult for advice, someone whose brand you actively promote and talk up.

A combination of diverse weak ties and selectively deep alliances is the best model for a professional/social network.

Before signing out, here's another strong argument why you should network, or just hang out, using more socially accepted colloquial terms. Everyone from contemporary scientists to ancient philosophers agrees that having strong social bonds is probably the most meaningful contributor to happiness! 

Quote from the Happiness Project: "One of the best ways to make yourself happy is to make other people happy. One of the best ways to make other people happy is to be happy yourself."

In summary, some golden rules:

1. The best network is wide and selectively deep. The best professional network is both narrow/ deep (allies whom you collaborate regularly) and wide/shallow (weak-tie acquaintances who offer fresh information and ideas)

2 . Open a conversation. ALWAYS start with a friendly gesture, a warm smile, and mean it. In a professional situation, one of the first questions you can always ask (if you are in that position) is: "How can I help you?". 

3. In the next day, look at your calendar for the past 6 months and identify five people you spend the most time with - are you happy with their influence on you?

4. In the next week, introduce two people who do not know each other but ought to. Imagine you got laid off from your job today. Who are the 10 people you'd email for advice? Invest in these relationships right now - don't hesitate!

5. In the next month, identify a weaker tie with whom you'd like to build an alliance. Start the relationship building by giving him or her a small gift- forward an article or job posting or buy him/her coffee.

6. Create an "interesting people fund" to which you automatically funnel a certain percentage of your paycheck to pay for coffees and the occasional plane tickets to meet new people and shore up existing relationships.

7. Make three new friends. New friends expand your world by providing an entrance to new interests, opportunities, and activities. Bring people together- organize food clubs, organize book clubs, use the "bring another friend" rule.

8. Remember birthdays. You can use happybirthday.com or Facebook to keep track of everyone's birthdays.

9. Show up. 

10. Don't gossip.

Do you have any suggestions to add to this list? Write a comment!

The Blue Sweater by Jacqueline Novogratz

I started this book over the Christmas and New Year's break and it proved to be an engaging and intellectually challenging read. Fresh out of college, Jacqueline joined a renowned bank as an international credit analyst which endowed on her the opportunity to travel extensively and compare international banking systems. Before long, she was offered a once in a lifetime opportunity to travel to various parts of Africa to implement a micro-finance system.

Micro-finance is a generic term referred to the practice of providing financial services to low income people and sometimes the self-employed who traditionally lack access to banking and related services. These individuals have no credit reports or credit history, a fundamental problem, which deem them as trustworthy customers by the banks. The idea of micro-finance was invented perhaps hundreds of years ago first by the Franciscan monks and also has its origins stemming from the microcredit movement led by Muhammad Yunus, who is almost synonymous with the Grameen Bank in Bangladesh.

Using her international banking knowledge, Jacqueline embarked on a treacherous career to help create the infrastructure for microfinance at Duterimbere in Rwanda. It was a bold move, given the oppression of women in many African countries, the language barrier, cultural differences in "conducting business", and many other forms of difficulties which she obviously hadn't thought through so well before agreeing to the job. Nonetheless, the 2009 book shares lascivious details on how she stumbled upon each of these difficulties and relentlessly worked her way around them.

Unfortunately for her, her illustrious work in microfinance at Duterimbere, which is Rwanda's first microfinance institution, and a couple other business led by women were eradicated by the Rwanda genocide in 1994. What was astounding is that, given her account, she had simply no idea that the tension between the minority Tutsi and the majority Hutu even existed while she was in Rwanda. Although on various occasions, she did find her security threatened especially as a white female, but never could she had predicted the genocide of over 800,000 people a few years after she left. The Rwanda genocide was brought into the mainstream media by a popular movie called Hotel Rwanda, which I also highly recommend on a side note.

After leaving Rwanda, Jacqueline moved on to establish the Acumen Fund, a non-profit global venture capital fund to solve the problems of global poverty. Acumen Fund's approach is entrepreneurial and refreshing in a world that is inundated with lofty goals to alleviate world poverty but with little results to provide. A dedicated arm of the Acumen Fund focuses on health care related issues, providing investment capital for ambulance fleets in Mumbai, India for example.

I find myself agreeing too much with Jacqueline's perspective and approach, which doesn't happen too often. Perhaps the business part of myself appreciates her deep belief in the importance of a competitive business, regardless whether it is a for-profit, non-profit, or social business. Only when the fundamental design is surrounded by controls, accountability, and progressiveness can a business be sustainable. Her story also invokes the understanding that financing is the foundation of any enterprise. Health care financing is no different, again allow me to use the fact that the unsustainable growth of the American health care enterprise is because its financing network is broken.

I highly recommend this book for anyone who is interested in international development, or just craving for a non-fiction book with great, moving anecdotes. By the way, to satisfy your curiosity, the book is titled the Blue Sweater based on her donation of a blue sweater to Goodwill, only to find the same sweater years later on a young Rwandan boy; the true epitome of an interconnected world!

Better, by Atul Gawande

Atul Gawande is a practicing physician at Brigham and Women’s Hospital in Boston. He is also an Associate Professor of Surgery at Harvard Medical School and Associate Professor in the Department of Health Policy and Management at the Harvard School of Public Health. He also wears many other hats as a writer for New Yorker magazine, researcher on systems innovation for improving patient safety. The Foreign Policy Magazine and TIME magazine has honored Atul Gawande as one of the world’s top 100 influential thinkers. Recently, I read his second book, Better, which was published in 2005.

The book is shaped into ten different chapters with three arching themes of diligence, excellence, and perfection. Because of Gawande’s literature prowess, he writes with such convincing and fascinating details that illuminates the world of medicine practice. Medicine is often untidy, messy at times, but investigative and carefully conscientious.

 My favorite chapter was the one on Cystic Fibrosis (CF). If you haven’t heard of CF before, you are not alone, especially if you grew up in the post baby-boomer era. Cystic Fibrosis is a hereditary disease that is life threatening. Although it is a genetically inherited disease, but it is of the recessive form, meaning that it can skip generations of manifestation and symptoms only surfaces when an individual inherits a copy of the defective gene from each of his / her parents. CF causes the body to produce abnormally thick and sticky fluid, called mucus that builds up in the breathing passages of the lungs and in the pancreas, the organ that helps to break down and absorb food. This collection of sticky mucus results in life-threatening lung infections and serious digestion problems.

 Today, the average life span for people with CF who live to adulthood is approximately 37 years, a dramatic increase over the last three decades which averaged around 6 years ago. The treatment regimen for CF has rigorously improved over the years. Decades ago, manual chest therapy was the traditional airway clearance technique for CF patients. In simple terms, the patient stays in one of few recommended physiotherapy positions while another helper cups his or her hands and thumps on the chest repeatedly. Today there are various less mechanical options like the PEP (Positive Expiratory Pressure) valve which can be used to assist the clearance of excessive mucus from the lungs.

 Gawande took on a quest to understand the reasons behind the differences in performance standards for an average performing facility, Cincinnati Children’s Hospital, and the best in the country, Fairview-University Children’s Hospital. Protocols and technology were largely similar between the two facilities. But what could have resulted in the difference between Fairview at the forefront of the bell curve, and Cincinnati as an average performer? At both facilities, physicians follow the same set of questionnaire to investigate any unexplained decreases in the measurement of lung function, a major indicator of CF prognosis. “Any cough lately? No. Colds? No. Fevers? No. Taking her treatments regularly? Yes, of course. Every day? Yes. Ever miss treatments? Sure. Everyone does once in a while. How often is once in a while?”

 Most physicians would stop right here.

 The distinction lies in the daily pursuance of excellence; the relentless pursuance of the truth behind the numbers. At Fairview, the inquisition goes on until the Fairview physician is able to piece together that this teenager patient has been experimenting with her treatment on a daily basis. Dating a new guy, mixing with new friends would have made her treatment regimen at home difficult to maintain. With this, the Fairview physician doesn’t reprimand, doesn’t blame, and least of all doesn’t get angry. Instead he explains the numbers to his patient, who is still not yet convinced that she is in any peril. “A person’s daily risk of getting a bad lung illness with CF is 0.5 per cent.” He wrote the number down as the patient began welling up. “The daily risk of getting a bad lung illness with CF plus treatment is 0.05 per cent,” he went on, and he wrote that number down. “So when you experiment you’re looking at the difference between a 99.95-per-cent chance of staying well and a 99.5-per- cent chance of staying well. Seems hardly any difference, right? On any given day, you have basically a one-hundred-percent chance of being well. But it is a big difference.” He chalked out the calculations.“ Sum it up over a year, and it is the difference between an eighty-three per-cent chance of making it through 2004 without getting sick and only a sixteen-per-cent chance.”

Of course, many activities monitor statistics like that: catching fly balls, manufacturing microchips, delivering overnight packages. Medicine’s only distinction is that lives are lost in those slim margins. The physician who cares not just about the medical symptoms of the patient, but also understands the temperament, social background, personality of every one of his or her patient, is the physician who keeps at the forefront of the bell curve. Collectively as a society, we seek to shift out the bell curve progressively because that is how to do better over time. The cell curve distribution will always be there, with purported “pioneers” or “average-rs” or “laggards”. But where would you, if you were a physician choose to be? 

Medicine will never be perfect, because it is after all a quasi-social science in continuous experimentation. But to all my newly minted physician friends out there – practice daily excellence in the work that you do. Yes, the hours are long and the benefits may not be commensurate with what you what. But always remember that every decision you make and every patient you see depends on you and only you to do the right thing for them. We always need physicians who lead, experiment, and relentless pursue excellence in their daily practice to illuminate the way.

 For me? This story only serves to affirm my belief that numbers never lie. Always question the numbers and never take I-don’t-know for an answer.

 Memorable quote: Real medicine is “untidy, human and careful conscientious practice”

Website for further reading: http://www.leighbureau.com/speaker_documents.asp?view=article&id=255

Revamping this blog

Hola- I decided to be back after a long hiatus. Several reasons prompted me to revive this fledgling blog. In a recent conversation with a good friend of mine, I had expressed my desire to have a better memory and actually be able to speak or recall with fascinating details. In his usual casual laid-back mannerism, my friend revealed in his computer engineer speech patterns that he just
"learns to upload and download information" because there is too much to remember. In his complex world of computer coding, he often encounters many types of bugs, pardon me for my layman terms. And although he doens't often have the answer immediate on hand, the blog that he keeps to document all the problems he has encountered to date serves as a quick refresher of the approaches and methodologies that he had worked on previously. A small revolution was pulsing within me as I recalled about this abandoned solitude blog. Where were the days when I was so deeply passionate about instituting change in the health care system? Where was the enthusiastic HMP student who was always thinking about whether this could work somewhere else....Perhaps this blog might have a grander purpose for documenting the spontaneous number of ideas that I have about health reform (on a micro scale)!

In recent months I have been reading a couple of social media books, health care books, all of which seemed to be screaming something into my head. In my daily work as a health care consultant, I always ask about the numbers, the metrics, the data and who is accountable for it. For equity's argument, shouldn't I put myself through the same lens which I often judge my clients?
"There are only two mistakes one can make along the way to truth; not going all the way, and not starting," -Buddha
Guess I still have time to recover from my mistake. On pompously starting this blog and then single-handedly throwing it away.

The last reason is perhaps a little more selfish than the others. I can proudly proclaim that I have a memory like a goldfish. I can probably remember things for up to a couple of days and then after that, with the exception of dates and numbers, I often find myself on the tip of my tongue. I had better quit playing that game of taboo with my friends which I am so bad at..

In the spirit of the new year, I wanted to set some metrics to hold me accountable:
1. Blog at least twice every month. In my defense, as you can tell, most of my blog posts can be pretty dense and require some amount of research. Give me a break.
2. Accrue at least 20 followers on this blog. And by that I refer to invested, interested individuals who are actually reading and commenting.
3. Read at least 10 books this year! Obviously book suggestions are very welcome.


Next two posts will be on the two books I recently read. Better by Atul Gawande, a book on Gawande's illuminating experience as a surgeon and what his stories tell us about our world. Next, the Blue Sweater by Jacqueline Novogratz, a International Banker formerly with Chase who followed her heart to better the world through microcredit and her journeys through Ivory Coast, Zaire, Rwanda etc..