13 February 2000

Deeds rather than words to bring light to the
"Dark Years" in Medical Scene 
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"Letter to Hong Kong" by Dr Leong Che Hung

(Keywords: medical incidents, dramatisation, understanding, health care reform, Hospital Authority)

          At the beginning of each Lunar New Year, it is customary to wish people around you good health. The Year of the Dragon poses no exception.

          Let me stress from the onset that health is everybody's business. Yes, any responsible government should try its best to provide the beset environment for healthy living. Yes, any health care providers should offer the best service for those that are sick. Yet, unless and until every members of the public is willing to take their own health as their own personal responsibility, Hong Kong will never be able to achieve the status of a "healthy city".

          Yet, irrespective, people do get sick. The question then must be: with all the negative medical mishaps of the last two years, are our health care providers trustworthy? With mounting complaints of grossly overburden with work from our public health care frontline workers, are our public health care system up to par?

          Like it or not, the past two years have been dark years for the medical profession. Medical incidents, often unnecessarily dramatised frequent prominent pages of our newspapers. Even the Harvard consultant team employed to advise Government to review Hong Kong's health care system and health care financing policies has been unkind to the profession, though as many have pointed out, the criticisms were based on non-factual examples.

Reasons for criticisms against medical profession

          Whilst these negative performance must be minimised, they should not be considered as a stigma of declining standards of the medical profession. Instead the all too common attacks on them could be due to:

          The keyword today is transparency and openness. This applies from buying groceries to consulting a doctor. Patients today want to know everything from the basis of diagnosis to the different available treatment modalities. They want to make their own choice. "What you think is good for me may not be what I want," they would tell their doctors. Yet, many doctors, however, unfortunately still cling to the concept of "doctor knows best". Regrettably often when a choice is made even by the patient and the result not quite as expected, the doctor gets the blame for "after all, doctor, you know best". Patients' rights are rampant but patients' responsibilities often ignored.

Changing Political Climate

          The introduction of democratisation has brought much to the improvement of the society. Yet it is often abused. Overnight the public realise that they have a voice through their elected representatives. Often times, they would approach legislators to make complaints and demands for them, and many will comply even before getting to the details, to assure of their votes. In a recent incident, a legislator went all the way to arrange a press conference to condemn a hospital on behalf of a patient, not realising that patient is actually making a fuss for not getting the "addicting drug" he wanted after frequent "hospital shopping".

          This incident took front pages in some newspapers. The hospital was smeared before even getting the other side of the story. Such is by no means uncommon.

Lacking Understanding between the Profession and Public

          The public and the media seemed to be oblivious of the fact that whilst medicine is a science, the practice of medicine is not an exact science. It is based on knowledge as well experience. In short, with all the good intention in the world, a doctor can make mistakes. Evidence based medicine has helped to reduce these flaws, but mistakes will still occur. Should it be proven that it is committed in good faith, there is no justification in over dramatisation.

          Similarly any treatment, no matter how appropriate, could have their complications depending on patients' reactions. At the same time, any operation can never be as exact as it had been mapped out. Often times what is done or what could be done can only be decided during the surgery itself. An intended appendictomy for a diseased appendix which was discovered at operation to be entangled in a solid mass non-separately from the fallopian tubes and part of the intestine of the patient may end up removing the whole mass instead of just the appendix alone, all to the dismay of both the patient and the surgeon. Yet it must be done and it could be the only way.

          The bugbear is the lack of understanding of the public on the "work" of the medical professions. Yes, doctors should not consider themselves as demigods. Similarly, the public should not accuse them of not being all-mighty demigods when they are in trouble!

Medical Profession should be proactive

          Yet, the medical profession cannot be absolved completely from blame either. For whilst democratisation takes time to mature, so too does public attitude towards proper exercising rather than abusing their rights. It is for the medical profession to take on the role actively themselves to promote and deliver proper public education hoping that the maturation could accelerate and be done in a less painful way for all.

          The respect of the society towards a profession or a trade depend on how that profession or trade can feel the pulse, judge the needs of the public and take proactive strides to satisfy the societal needs through influencing government policies and decisions, or taking upon its own shoulders to promulgate. Unfortunately, this has not been obvious within the medical profession to collect their well earned credit. It is high time the profession should stand up and take this important leap forward.

Health Care Revamp being the Crux

          Let us now turn to the health care system. The recent reports of inhumane extension of working hours for frontline medical staff, the packed accident and emergency departments during the lunar new year holidays in our public health care system has raised concern. The obvious question is why do our staff need to work extended hours? Why are our casualty units so overcrowded, often with non-urgent nor semi-urgent patients? The answer is simple.

          The bugbear must be the underlined Government motto "nobody should be devoid of adequate care due to lack of means". These are honourable words. Regrettably, it is often mis-interpreted as no matter how rich or poor one is, one is entitled to the heavily subsidised public health care" -- and the public do utilise it.

          With a limited budget trying to provide an infinite need, little wonder that the public health service has become a victim of its own success. For some $68 a day, any in-patient will get the most up-to-date state-of-the-art investigations and the very efficient treatment to boost. At the casualty units, anyone can get the necessary attention and treatment for free, from common-a-garden flu to serious injuries.

          Yes, health care is an essential service for which no accountable government should shed responsibility. Government must provide an adequate safety net for the catastrophic, the poor, the indigent and those of high financial risk. But should taxpayers be footing the bills for all those in need of any kinds of care irrespective of affordability?

          It is imperative that Government must define what highly subsidised health care is for, and to be provided for whom? Anything beyond must be the users' responsibility -- through either out-of-pocket payment, medical insurance or contributory health care schemes.

Hospital Authority Board should fulfill its role

          It is heartening that there are indications that Government may well accept this line and that our new Secretary for Health and Welfare will be charged with detailing and promulgating the policy.

          Yet, a good policy is only successful if it is properly delivered. On this the Secretary for Health and Welfare will have to depend on the profession and in particular the Hospital Authority, which commands the lion's share of the public medical services, to make his policy work. It is not an easy job.

          The Hospital Authority through its appointed Board must be able to gain the complete confidence of the public that it is doing its best for them and to show that it is doing so by actively involving in the governance of the public hospitals as demand by statue. The Hospital Authority Board must be able to command the respect of all the staff to work in unison as one body -- the Board, the Administration and the staff. This must be done through active participation in their affairs by the Board and taking ownership of problems.

          Regrettably, such commitment is lacking in the current Hospital Authority Board.

(Radio Television Hong Kong)