Dental Discoveries #1

Dental insurance companies love me. I've only used the McMaster student dental plan twice in the last four years. Both times involved a regular checkup and two sets of X-rays. During my second time, which was last week, I saw a new dentist on campus. The cleaning and X-ray imaging was performed by an assistant, while the dentist did a thorough assessment and inspection of my teeth, palate, jaw, and other parts of the mouth. She also interpreted the X-ray findings and found three impacted wisdom teeth and a cavity between a molar and pre-molar (egad!). I was impressed by the efficiency of this system and it reminded me of the setup of the primary care clinic in the McMaster Student Centre. At this clinic, a nurse records a patient's history on a computer software program, which is then thoroughly examined and followed through by a doctor. Having a system like this in place provides a few benefits: nurses and doctors learn to work cooperatively together, the doctor can determine the complexity of a case before actually meeting the patient, and a proper division of responsibility ensures that services are carried out at the least possible cost.

However, there are also potential pitfalls to this system. With any history-taking procedure, the type of questions asked directs what the patient will reveal. Information that the nurses gather will be filtered according to their interview style. Therefore, the doctor who follows up with the patient will only be able to build on the nurse's foundation - a bad thing if it turns out that he/she missed something important. This is the price that is paid for efficiency. Of course, one can make the counter-argument that improper diagnoses do not happen frequently, that a more efficient system allows for more patients to be seen per hour.

Bringing it back to my dental experience, a dental assistant's responsibilities are uniquely different from a nurse's. The assistant does not do any history-taking (at least mine didn't) and they are highly specialized in performing certain tasks, such as cleaning teeth and taking X-rays. With practice, an assistant can become more efficient in doing their selected responsibilities than a dentist. On the surface, this type of system does not seem to come with the same bag of problems that may be present in a primary care setting where nurses and doctors have to work together. In fact, as a client, I prefer this system because I will pay less if an assistant performs most of the mundane tasks. With this in mind, can the argument for more highly specialized roles be extended to a primary care setting? This seems to contradict the very nature of this field, which is purposely wide in scope to ensure a first point of consultation for patients.

WC

Boy Should Be Taken Down - Part II

This post is a response to a dilemma that my friend found herself in last Saturday. As she mentions in her blog, she witnessed a larger and older male bully a young girl after a ride for no apparent reason. I was also present when this incident happened and in the company of a few other friends. We all witnessed this event unfold before our eyes, but due to the influence of each other and those around us we did not react. My friend concludes her post by saying that she will remember to intervene when a similar situation presents itself in the future.

I beg to differ on this last statement.

Diffusion of responsibility is a social phenomenon that definitely played a role in our lack of action. Each of us may have believed that we were not qualified to handle the situation; thus, diffusing the responsibility of taking action onto someone else. Personally, I am guilty of this because I assumed that amusement park staff, who were operating the ride, would take action. In my mind, I thought they were trained to handle conflict situations.

However, before looking at who should have taken action in this situation its important to take a step back. In the first place, did we understand that the situation demanded some type of emergency action? In retrospect, it is easy to say yes to this question after ample time for reflection, but at the heat of the moment I don't think we had the answer.

Our ability to evaluate whether a situation is an emergency or not is, like the diffusion of responsibility, based on the social behaviours of those around us - a concept known as collective ignorance. If no one responds to an incident, then we determine that it is not an emergency and therefore not deserving of some type of intervention. Making an emergency assessment is necessary for mobilizing action, even if we know exactly what and how to intervene on a victim's behalf. This speaks to the power of other's influences - their behaviour can override all of our individual convictions, no matter how compelling they are.

If the situation was different, I am sure we would have acted. For example, if we saw another person take initiative in calling out the bully, this would break our collective ignorance. If we were closer to where the incident took place and not restricted by a barrier, we would feel more responsibility to intervene because of proximity. Finally, if the young girl had reacted more openly to the offense, we would have likely determined that the situation was an emergency that required attention.

All of this has got me thinking - when are we to blame for inaction?

WC

"1987"

When I was young, I tried to be different. Setting up an e-mail account was the popular thing to do in elementary school and while some people opted for flashy names such as pixiegirl_xoxo and sticky_fingerz_blingbling, I was less creative. Where I lacked in creativity, I prided myself for thinking prospectively. I knew that my boring yet neutral e-mail address would one day save me from embarassment. In retrospect, this was wishful thinking for a naive boy.

williamc1987@hotmail.com

What's wrong with this e-mail address? Nothing seems obviously out of the norm. It has my first name and the initial of my last name (for identity purposes of course), seems simple to remember, and is associated with a popular e-mail account. However, there's one thing that bugs me about it - "1987" is not my favourite number!

My complaint is straightforward. Showing people how old you are through your e-mail address grows more embarassing with age. You might be asking why I don't change it. Here's the problem...

1) My current e-mail account is impeccably organized. I spent too many hours reforming it and I would hate to see all my effort go to waste.

2) There are too many William Chan's in this world and all the variations of my name for a new e-mail address have been taken. "william.k.chan", "chan.k.william", "willy_k_chan", "billiam_chan", etc. are all being used. It makes me wish I had a wacky and crazy first/last name.

Unfortunately, I'm stuck with this e-mail address and must learn to live with it. That, or I could reembrace my lost youth by making a new address that begins with "sillywilly..." - an apt name to characterize the writer of this most random of posts.

I dedicate this to others who share my pain.

WC

Can I justify playing video games?

Whenever I hear the words "video game", I shudder. It brings back dreadful memories of me staring in front of a bright computer screen for countless hours battling make-believe villains in a fantasy world. Some people have addictions to gambling, drugs, maybe even sex - my addiction was to video games.

The word "addiction" has a strong connotation to it, especially when used in a clinical setting. According to wikipedia.org, the ideal video game addict displays the following list of symptoms:

• play many hours a day
  
• gain/lose significant weight due to playing
• disrupt sleep patterns to play
• play at work/school
• avoid phone calls from friends
  
• lie about play time
• strained relationships with family and friends
• performance suffers at work/school

I am guilty of symptoms #1, #3, #6, and #7 - so perhaps I might have a mild form of videogame-itis. But to be quite serious for a moment, addictions of any sort are no small matter. People have died from video game binges in countries such as China, South Korea, and Vietnam. One has to question whether this problem is bigger than it seems and worthy of some form of intervention.

I started playing video games when I was in elementary school. My mother was a computer software programmer at the time and, needless to say, had containers full of games on retro 3.5 inch floppy disks. I played them fervently. My brother was often the local video game competitor, but even he was and still is no match for my skills. Beating him gave me a chance to get back at him for his occasional displays of physical dominance. I showed no mercy...

Come high school, I started meddling with online multiplayer action. My brother grew out of videogaming and so I buddied up with a hardcore Korean gamer named Lloyd. He was a natural marksman at Counterstrike and introduced me to some of the sketchiest web cafes in downtown Toronto. Oddly enough, these places got me exhilarated about being a rebellious young adolescent. I know...I was such a badass!

Gaming became a problem when I was able to play by myself for hours on end after school, lied to my parents about where I was, and became infatuated with winning. The problem only got worse when my parents set up high-speed Internet at home and could see the monster in its full hideous form. I regret those nights where I locked myself in my room without making a single exchange with the P-unit.

When I moved into my new off-campus house in second year, my interest in video games began to wane. My housemates didn't game at all so it was easy to get distracted with other things. Suddenly, I felt that I could assert control over my obsession as long as I was exposed to the right environment. Obviously, action was needed on my part too. I actively deleted all games on my laptop and even bought a MacBook to limit future purchases.

I would lie to you if I said that I don't still suffer from occasional video game relapse. After a stressful night, I often unwind by wasting time on miniclip.net. Last week, in order to cope with the anxiety of waiting for medical school acceptances, I installed my long-last War III Frozen Throne on my computer. It seems that I still have the superior gaming skills intact, but other than giving me a sense of gratification, I often find myself struggling to answer the following question: what have I accomplished with this fruitless squandering of precious time?

Getting into medicine might give me an excuse to play video games...that is, only if I decide on becoming a surgeon! According to simulation and training research done in Arizona, playing game consoles can hone the scalpel skills of surgeons-in-training. Apparently, the Wii can improve eye-hand coordination more so than any other gaming console, which comes as no surprise because it demands more complicated physical maneuvers. Admittedly, playing more Counterstrike or Warcraft III will perhaps improve my manual dexterity, but it will not prepare me for performing simulated surgical procedures such as laparoscopy. Adapting to such a procedure would be like learning a new computer game, and the skills gained in one game are not always transferable to another.

For all its worth, spending time on video games means forgoing doing more productive and intellectually stimulating things such as reading, blogging, exercising, cooking, and socializing. The truth of the matter is that these activities are sometimes mentally, emotionally, or even physically draining while videogaming as well as YouTubing, Facebooking, sitcoming, and MSNing seem to provide me with an outlet for mindless time wasting. My opinion is bound to differ from others.

In any event, my recovery from video game addiction is almost complete.

WC

Health Professionals

New legislation in Ontario is set to be introduced soon, allowing health professionals to have a wider scope of practice. Some of the proposed changes include the following:

• NPs prescribing ultrasounds, set casts, and prescribe certain drugs
• PTs ordering X-rays
• Midwives taking blood samples
• Pharmacists renewing prescriptions

I suppose these changes are a good thing. They may help to offload the burden of work from doctors who will then be able to spend more time on complicated tasks. Having physicians perform routine services like immunization and check-ups that other health professionals can do with the same level of quality is an inefficient use of resources if doctors get paid more for doing that service. The same can be said for ordering diagnostic tests, prescribing certain drugs, and renewing prescriptions.

However, given the wide scope of a doctor's responsibilities, do we risk making the physician's role more specialized, rendering the role of the General Practitioner obsolete? Can we trust that physician's financial incentives are aligned with treating complicated cases?

As soon as we grant more autonomy to other health-care professionals, we have to be aware of competing interests for performing overlapping services, which may deter rather than foster cooperative interdisciplinary team-building. The difference in roles needs to be clearly delineated by regulatory bodies so that there are guidelines that balance efficiency goals of the system and hierarchical structures between professions. Also, the public needs to be aware of these changing powers by generating discussion from the ground up.

Given the state of today's health care system, government action of this sort is needed. There are more pressing concerns than the rivalry it might create among different health-care professionals who are all fighting for their piece of the cake. Currently, we see evidence of this between RNs and PAs. As a health professional, it is important to remember that your foremost duty and service is to the public even if it means making concessions to your colleagues. Perspective, something that healthcare professionals understand well about their patients, gets lost in settings where professional interests clash.

WC

A Tribute to my Housemates!

Call this a cheesy post if you will, but I feel it's time to acknowledge the good men that I have lived with for the past 3 years. As this chapter in my life closes, I can only imagine what kind of success Michael, Dave, and Gabe will achieve in the years to come. Despite the fact that this was our last year living together as a Kingsmount unit, I know we will continue to keep in touch in the future (although I might have some difficulty reaching Gabe - inside joke).

Michael "Kills" Kilian


I am so glad you decided to grow your hair after high school. Keep the current length...it is better than it was in 2nd year (see picture).

Um...where should I begin. I've known you since Gr. 8 of high school. Although we've endured tough times together (i.e. family medical situations), we have somehow managed to stay tight all these years. I think it's because we share the same kind of humour. We can crack each other up in an instant by doing silly things like dancing randomly to the beat of Beyonce's "Single Ladies".

You are the number one go-to man for girl advice and could probably write your own book on relationships if you ever decided to become a writer. It would be a hot sell. At the same time, I can still talk to you about all the emotional and sensitive stuff that I keep bottled up. You have a way of listening well, being empathetic, and offering appropriate advice. Don't worry...you had these skills before taking Carl's Communication class!

Michael mannerisms:

1) "A-buff" (simulating a small explosion of some sort with minor whiplash in the head, arms, and torso).


Davide "Gwai-Lo" Cina

If only I was half the Asian you are...I would be able to speak Cantonese more fluently. You are my long last childhood friend. We have our serious moments (when we discuss about current events), but also our fair share of goofyness (when we make fun of other people in a light-hearted way). I can depend on you for Raman noodles, Pho dinners, and Timmy's coffee. You are also the inside man to get information about the latest buzz in the Asian community. I'm becoming more and more like you by the day - my wardrobe is evidence of this even though I have yet to sport the skinny tie look.

Dave idiosyncracies:

1) "Ehhhhhh"
2) "Look at that"
3) Wushu in the kitchen and the living room. As Sipreeya would say, "I hate you air!"

Although I eat more than you, I am still puzzled by the fact that you eat so quickly.

Our trip to Ottawa for our medical school interview was a blast. I was secretly jealous about your attire because it was better fitted than mine. You cracked me up when you tried using a French accent during a cab ride.

This summer, we shall have many more opportunities to play frisbee, toss the baseball around, and drink strawberry milkshakes at Saigon. We are also becoming CBC radio fanatics. Long live Anna-Maria Tremonti and Jian Ghomeshi.


Gabe "Granovsky" Grant


Last, but not least, is Mr. Gabe. You are one in a million. I could have a conversation with you about anything and everything into the waking hours of the morning. Your dance moves and facial contortions put me to shame. It puzzles me that you remain so social even after spending a full week locked up in your dungeon downstairs. I hope you keep your munchkin minions well fed!

You are a small man with big ideas. Before meeting you, I never thought that eating vegetarian dishes could be so good. You're given me advice on a range of things and I credit you for making me a critical thinker. I don't win a lot of arguments against you, but then again we discuss more than we argue.

I have yet to get you mad...but I will by the end of this summer. You are a family person and this was evident last summer when we spent a few days at Tom's cottage. You have varied skills and varied interests and quite possibly could do anything that you set your mind to. Whatever avenue you wish to pursue in the future, please make sure that it involves interaction with people on some level!

Gabe actions:

1) "____ is necessary but not sufficient"
2) Arm flailing motion after overexaggerating a response.


More cheesiness to follow. Kingsmount housemates, I will never forget those nights where we had dinner parties at Boston Pizza, dancing marathons at Absinthe, and cooking fiascoes at our house. By getting to know each of you so well, I've learned the meaning of trust and the importance of having a close social support group. You guys have always been at the front lines of helping to deal with my problems and are the first to know about good or bad news on my end. I can't believe you still tolerate my random bouts of singing and hip-gyrating movements. I guess you get a kick out of it (at least Reena does). All in all, I shall remember our Kingsmount castle as a community rich with good company, good food, and good conversations. Although there were moments where we jousted, we were more than just knights battling fire-breathing dragons and saving damsels in distress...we lived like kings.

WC

A week before May 15th...

It's an understatement to say that May 15th is a big day. All med school hopefuls know what I mean. On May 15th, I find out if I get accepted, rejected, or put onto the waitlist of the med schools that I interviewed at. It just hit me about an hour ago that it's just under a week before I find out about the fate of my next 3-4 years. It's not only the realization of moving on that shocks me, but also the fact that I've come so far over the past 4 years.

This was me in first year.


I was tanned from a whole summer of working at a day camp as a counselor. My hair was longer and untamed (I had an aversion to hair products at the time). My rez card was around my neck, a hallmark of the stereotypical frosh. The jeans on me were way too baggy, and I thought I was cool because I enjoyed making funny faces in front of the camera.

According to this photo, some things haven't changed. I still love eating (copious amounts of food!), although its clear that my friend Michael on the left could put me to the test. I'm still a goofy person and enjoy making other people laugh when I get the chance. Maybe the weird face does show some personality after all.

My other friend Ari, on the right, is currently at Queen's Medical School finishing up his 1st year of studies. I went to high school with both Michael and Ari. I'm still supertight with Michael as we lived in the same house for the past 3 years. He's my Polish Polar Bear and I'm his Asian Sensation.

Fast forward in time and here is a current picture of me.


This is me in my parent's optical store the day after my graduate school interview at UofT. Ha, no goofy face (I screwed up a bunch of earlier photos and, frankly, my mom was getting fed up with my antics). My hair is shorter and I am dressed more formally. The dress shirt, tie, and vest combo is a new style that I tried this year. I am quite comfortable with the combination and know that it will pass as being professional.

When I look at myself in comparison to 4 years ago, I can't help but think that whatever the outcome on May 15th - I will continue to be proud about who I am, the difference I have made in some people's lives, and the experiences that have shaped the core of my values and beliefs. I've learned to overcome obstacles, such as the worry about losing a close family member to the shock of not getting a desired MCAT score. Struggle and even failure has motivated me to expend all of my resources to make the mark, but even doing my best is limited by the constraints of factors beyond my control. Attitude, as I've learned, is everything.

So seeing how far I've come, I'm anxious to understand how well prepared I am for the next stage of my life, be it grad school or med school. Do I have the knowledge and skills to be a competent researcher? Will I be able to handle the stressors of being a medical student? Is the pursuit of academia or medicine going to make me happy? How will my obligations to my family, friends, colleagues, or more broadly society change? These are all big questions that I am wrestling with and I'm sure a few readers can relate to my situation. I am intimidated about what the future has in store for me, but excited about the prospects of setting and reaching higher benchmarks.

All of this reminds me of the importance of ongoing self-reflection. Life is busy and personal reflection may seem like a nuisance for some people. When I was younger, I didn't see the value of it. Reflecting felt like a chore with no compensation, and there were better things to waste my time on. I realize that reflecting (as I'm doing now) forces me to extract meaning from major and minor experiences in my live so that I am better able to draw inductive inferences when similar situations present themselves in the future. This thought is probably no surprise to anyone, but I'm sure that most of you can agree that there is always more room in your lives for introspection.

I finish with a quote by Thomas Paine: "The real man smiles in trouble, gathers strength from distress, and grows brave by reflection."

WC