13
February 2000
Deeds
rather than words to bring light to the
"Dark
Years" in Medical Scene
--------------------------------------------------
"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:
(a)
the changing political climate and societal needs;
(b)
the occasional irresponsible over-dramatised media reports;
(c)
the lack of understanding between the public and the
profession; and
(d)
the insensitiveness of the professional bodies to public
needs.
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.
(Letter to Hong Kong, RTHK)
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