Professional performance and training

D K T Li 李國棟
President, The Hong Kong College of Family Physicians

To celebrate the 25th Anniversary of our College, a Scientific Meeting has been organized by our College this month with the theme "Professional Performance and Training". A working group on the reform of the medical council of Hong Kong was established in May 2001 to reform the council with a view to restore public confidence and to satisfy public expectations for transparency. Amongst the significant proposals, one was the maintenance of standards with the establishment of a "Professional Performance Committee" which will receive complaints relating to substandard performance of doctors. We applaud this move which also responds to the call of our College for the profession to pay attention to the quality assurance of primary care doctors. Indicators of good quality of care of the doctor include adequate knowledge, proper attitude, proper process of care as well as consultation skills of an expected standard. The quality of the practice of the provider is equally important which includes maintaining medical records of acceptable standards, possessing sufficient facilities and equipment, good hygiene as well as proper management of the dispensary. We believe in continuing medical education in maintaining standards and performing medical audit to ensure standards are regularly maintained.

Moreover, there needs to be re-certification of practitioners when there are indicators of doubt. It is accepted that standards of primary care in Hong Kong vary. In 1999, our College recommended an exercise to ascertain the quality of primary care doctors in Hong Kong. Those who meet the standards were awarded with a "Certificate of Primary Medical Care" Our College saw this as a move to fulfill immediate social needs for consistent, quality primary medical care. The proposal was unfortunately seen as threatening to most primary care doctors who had never undergone structured training and only a handful underwent this program. In 2000, our College therefore launched a primary care assessment program in the form of the Practice Assessment Package which we distributed to all members of our College free of charge. The package allowed primary care doctors to audit their own practice. Peer review of specialists versus primary care doctors may entail different standards. The Primary Medical Certificate Assessment and Practice Assessment Package should be useful documents to the future professional performance committee of the medical council in assessing primary care doctors whose competence may be in doubt.

Although addressing the professional performance of medical practitioners may be a good start towards quality assurance of doctors providing primary care to the public of Hong Kong, the way ahead is to require all doctors who provide primary medical care to receive proper vocational training. Government need to fund the requirement for training and to ensure sufficient medical graduates go into Family Medicine training as advocated by experts around the world. I must commend the administrators for a drastic change of attitude since the release of the Harvard report. More than 300 family medicine trainees are now on the production line. Nonetheless, resources have yet to be properly allocated and are stretched to the limit to accommodate the training of this large number of trainees. In order to be admitted as a founding member of the Hong Kong Academy of Medicine, the training program of family doctors had to follow the rules of other specialties to conform with regulations not necessarily suitable for a community based specialty. Nonetheless, throughout the years our College has constantly made modifications to maintain flexibility such as introducing part time training.

Changing patient culture and expectations also tell us that training programs need to be dynamic and constantly reviewed to produce quality doctors who can provide comprehensive and lifelong holistic health care which is humane and as valued as medicine and technology based interventions. Perhaps with 25 years of experience of training behind us and being the oldest academic college in existence in Hong Kong, it is time to tell the other specialists that we are ready for more drastic changes. The Academy of Medicine should grant our College the freedom to structure a training program with the intensity and duration that is appropriate for Hong Kong whilst conforming with family medicine training programs in other parts of the world.