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.
.jpg)
Gateshead
On 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.
.JPG)
Dry Falls
p.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!.
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.
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.
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.
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.
Thank You for Sharing the Book!!!
AMAZON-UK The Cockroach Catcher II: Attempted Living
Cockroach Catcher-Seven Minute Cure
