Sunday, November 22, 2009

As brilliant as TV's "House". But nicer !!!


Cryptic clues and offbeat remarks? Check. Toronto pays tribute to a diagnostic magician with a global legacy...

[From Saturday's Globe and Mail Published on Friday, Nov. 20, 2009 10:29PM EST Last updated on Saturday, Nov. 21, 2009 9:57AM EST]


‘What does the drooping face suggest, Jason?”
“Stroke?”
“Ah,” replies Dr. Herbert Ho Ping Kong, “you want to be pessimistic.”

It's Wednesday at 8 a.m., and a group of about 20 young doctors – third- and fourth-year students, junior and senior residents – are meeting around a conference table at Toronto Western Hospital for Morning Report.

The hour-long tutorial, based on a single patient's case file, is led every week by legendary internist Dr. Ho Ping Kong, who turns 70 Sunday. This week's case: a 54-year-old Vietnamese woman admitted to a hospital in Ottawa five hours after noticing facial droop.

Chinese-Jamaican by birth, the diminutive HPK – as he is known to his peers – is in medical circles a giant, a diagnostic magician with an encyclopedic memory and a winning bedside manner.

By title, he's senior consulting physician at the University Health Network; Chang chair in teaching of internal medicine at the University of Toronto; and co-founder of the Toronto General and Western Hospital's new Centre for Excellence in Education and Practice (CEEP). His many teaching awards notably include the 3M Fellowship Award (1999), the country's most prestigious prize for teaching at Canadian universities.

But the titles and accolades don't begin to encompass the range of his achievements. Nearly two generations of his disciples are now teaching and practising in universities and hospitals around the world.

“Give me an optimistic picture,” HPK says to the tutorial group. “So where's Todd?”
There is no doctor named Todd in attendance. The question is one of his characteristically obscure and playful clues, an allusion to Todd's paralysis (or paresis), weakness in the body after a seizure. Eventually one of the interns picks up the hint.

“Okay, what else,” Dr. Ho Ping Kong continues. “How about politics?”
“Bell's palsy,” one alert young doctor chips in immediately.
“How did you know that?” HPK asks, laughing.
This time, the word “politics” was a hint about former prime minister Jean Chr├ętien, who suffered from the condition, which is marked by paralysis of a facial nerve.

For Dr. Ho Ping Kong, the core case under discussion is merely an excuse for all manner of relevant digression, including geographic and ethnic medicine (to what illnesses might immigrant Vietnamese be most prone?). A little later, for example, informed that the patient's medical history is significant only for hyperthyroidism, he guides them through Graves' disease, Hashitoxicosis, the risks of atrial fibrillation, posterior inferior cerebellar artery syndrome, and the incidence of stroke among the young.

But he rarely lectures, relying instead on the Socratic method and lacing his rapid-fire questions and asides with cryptic verbal clues. Nothing he says is extraneous. His offbeat, seemingly incongruous remarks are designed to test what the assembled physicians know – and still don't know. The hour fairly whizzes by, probably as much as fun as any medical lesson could be.

HPK's diagnostic approach is more Oslerian (after 19th-century medical pioneer Dr. William Osler), based on the conviction that if a doctor listens carefully enough, the patient himself will deliver the diagnosis. When he enters a clinic room, HPK stands and stares at the patient for a long moment, taking in such indicia as colour, posture, energy, demeanour, eye contact – the telltale language of the body – all potential signs of illness. For all the advances in biochemistry and other disciplines, Dr. Ho Ping Kong is convinced that medicine remains as much about art as about science.

A gold medalist in medicine at the University of the West Indies (UWI), Dr. Ho Ping Kong completed post-graduate studies in the U.K., then spent more than a decade at McGill University, where he established the first division of internal medicine at Royal Victoria Hospital. He was lured to Toronto in 1984.

One Saturday night last month, an elite group of Torontonians gathered in a downtown hotel ballroom to pay tribute to him. There were half a dozen speeches (and numerous telegrams) extolling his prodigious diagnostic gifts and innovative teaching abilities – and one announcing a new, anonymous donation of $2.5-million to CEEP, established last year with his Toronto Western colleague, Dr. Rodrigo Cavalcanti.

As a result of the anonymous donation, the centre – designed to incubate new approaches to medical education – will henceforth have Dr. Herbert Ho Ping Kong's name permanently attached to the front of it. Among its prize acquisitions is “Harvey,” a $60,000 cardio-pulmonary simulator in the guise of a full-size manikin that mimics 30 cardiovascular conditions, everything from mitral regurgitation to atrial septal defect.

In his own remarks last month – he will be feted again next February, as a recipient of a vice-chancellor's award from the UWI – Dr. Ho Ping Kong insisted the evening was not only about him, but rather represented a call to all doctors, young and old, specialist and generalist, to seek the good in others, help those less fortunate, heal the sick and “not let even insurmountable difficulties stand in the way of good and heroic deeds. There is no greater joy than being your brothers' and sisters' keepers.”

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