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25 March 2000
Rising workload and Family Medicine development
should be addressed altogether
(Keywords: long working hours, workload, family physicians,
health care reform)
Amidst the uproar of inhumane working hour of frontline
public doctors, Government announces that there will be an
increase of 150 doctors this year to run new hospitals, new
services and to improve existing services. Yet, with the extensive
provision that the Hospital Authority has to cover, let alone
increase, with the inevitable surge of workload, this disproportional
expansion in manpower could hardly offer any comfort to the staff
who are constantly working up to some 70-80 hours week.
Yes, the medical profession is "unsociable" as far as working
hours are concerned. Their responsibility towards their patients
must be without reproach. Yet, any demand must be humanly
possible. Worse, patients' safety could be denigrated if doctors are
not given the adequate time to refresh and recuperate.
There are moves to allow doctors to deal only with clinical
duties. Mundane activities such as handling patients' records and
taking blood from patients for investigation are left for the less
demanding grades. Such will help. Yet, do not forget that writing
up case records is a means to learn patient's progress. More,
unless a doctor is competent to do venesection and other
seemingly minor procedures, he would not be able to lead the
health care team.
The proposal of the Hospital Authority management to
establish guidelines for hours of work must be welcome. These
include: no doctors should be on call more frequent than one in
three days; all doctors should have statutory holiday
compensation; there will be time-off for doctors after excessive
continuous hours of work, which means no more than 28-hour
continuous work for interns or junior doctors in most cases.
Yet, can these be implemented, when it is obvious that
marked disproportion exist between the increase in workload and
staff expansion?
The long term solution must lie in means to decrease
workload, given a fairly fixed mass of working hands. This could
only be achieved by redistribution of patient load, and channelling
affordable patients back to the private sector. Unless and until
Government is willing to define the role of heavily subsidised
public health care -- what is it for and for whom; unless and until
the public is willing to accept the policy that those who can pay
have to pay; our public health care staff will have to face the
impossible continuous increase in workload.
Worse, those who are sick and genuinely financially deprived
will have to face an inevitable lengthening queue and crippling
standards of service.
There are those who advocate that Hong Kong should
develop our insufficient family medicine practice as proper primary
health care is an efficient gatekeeper to curb unnecessary hospital
admission. Few would dispute the sincerity of this proposal, and a
high standard family medicine practice we must develop. Yet,
family medicine is not the be all and end all to solve our
unsustainable increase in public hospital demand.
Furthermore, to have an efficient family medicine practice,
Hong Kong will need a sizable number of such specialists. This
regrettably is currently in short supply. Nor are there adequate
training facilities.
The Hospital Authority is to take on board an accumulated
256 family medicine trainees by next financial year for four-year
training. The training programme as demanded by the College of
Family Physicians is two further years in an approved family
medicine clinic setting. Disappointedly, even the Department of
Health, which has six out of its 60 plus general out-patient clinics
being certified as training centres for family medicine, does not
plan to have the necessary training posts for the next three years
at least.
Let us hope that all these will be addressed in the
forthcoming Health Care Reform Green Paper.
(Hongkong Standard)
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