General Practice, Family Medicine and Primary Care in Hong Kong: reflections from an outsider looking in

Doris Young

HK Pract 2011;33:1-2

As I embark on my 5^th year as the external examiner for the Exit Examination (EE) of the Hong Kong College of Family Physicians (HKCFP), it is an opportune time for me to reflect on my perceptions of the development of General Practice, Family Medicine and Primary Care in Hong Kong. I valued the opportunity to share experiences with the trainees, academic colleagues and the practitioners who provide the foundation as well as the scaffolding to the Hong Kong primary care system. Being an examiner in the consultation skills assessment component of the EE also took me to various sites where General Practice /Family Medicine are practised. Thus I have come to understand the complexity of 'first point of contact' patient centred care services offered to the Hong Kong people. So, as an outsider looking in, what are the challenges facing the discipline of Family Medicine in Hong Kong and what strategies should be put in place to provide quality and safe Family Medicine care to the community and does it matter what you call the discipline, General Practice, Family Medicine or Primary Care?

What's in a name? General Practice or Family Medicine; Primary or Community Care?

Let me begin by looking at the definitions of General Practice, Family Medicine and Primary Care and see what they mean and is one superior to the other and how does it fit in to the HK health care system.

Family Medicine (FM) is a medical specialty devoted to comprehensive health care to people of all ages. It is a form of primary care that provides continuing, comprehensive health care for the individual and family across all ages, sexes, diseases, and parts of the body.¹ This term is used in USA, Canada and recently adopted by Hong Kong and a growing number of Asian countries.

A General Practitioner or GP is a medical practitioner who treats acute and chronic illnesses and provides preventive care and health education for all ages and both sexes. They have particular skills in treating people with multiple health issues and co-morbidities.² The term general practitioner or GP is common in the United Kingdom, European countries such as The Netherlands, Denmark several Commonwealth countries such as Australia and New Zealand.

Primary Care is the term for the health services which play a central role in the local community. It refers to the work of health care professionals who act as a 'first point of consultation' for all patients. Such a professional would usually be a general practitioner or family physician, depending on locality. However, at the patient's discretion and according to their self-assessment of the seriousness of their ailment, they may opt to see another health care professional first, such as a pharmacist, herbalist (TCM) or in some localities a nurse.³

Based on the definitions above, I think that GPs and Family Medicine doctors deliver similar whole person, acute, subacute and continuing 'generalist' care to patients of all ages, their families in the communities they live. In some countries like UK, Australia, New Zealand and the Netherlands they are also the 'gatekeepers' and co-ordinators of the primary care system in collaboration with a multidisciplinary team located in the community. WONCA (World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians) encompass both terms and they use Family Medicine and General Practice synonymously.

Family Medicine in Hong Kong: from identity crisis to formation of a unified front

On first impressions based on the above definitions, there is confusion in the naming of the medical 'generalist' discipline in Hong Kong. The conjoint examination awards a Fellowship of the HKCFP and a Fellowship of the Royal Australian College of General Practitioners (RACGP) to trainees after 4 years post intern. Some of these doctors will enter private practice to deliver General Practice/Family Medicine in'primary care' settings; others will continue a further 2 years of higher training to become a Fellow of the Hong Kong Academy of Medicine to become a Family Medicine Specialist. Most will eventually enter private practice as Family Medicine specialists to also deliver 'primary care'.

What about the academic institutions? Are they clearer in their charge to advance the academic discipline of General Practice/Family Medicine/Primary Care?

If we look at the names of the University Departments in Hong Kong, we would say they are representative of their'discipline identity'. At Chinese University of Hong Kong, it is known as Division of Family Medicine and Primary Health care and recently the Family Medicine Unit at University of Hong Kong has finally gained a Department status and established a new Department of Family Medicine and Primary Care. In addition to the two Universities there are also 7 Departments of Family Medicine located in 7 regional clusters of Hospital Authority providing low costs General Practice /Family Medicine services to 74 Government Out-Patient Clinics (GOPC) located in disadvantaged communities. These GOPCs provide the training grounds for the majority of the Family Medicine trainees be it basic or advance. The term 'Family Medicine' is now firmly embedded in all the institutions/organisations that represent the academic discipline in Hong Kong.

The challenges ahead for Hong Kong Family Medicine specialists

Having established the College, the assessment and the credentials of Family Medicine, Hong Kong will face the same challenges that other health care systems around the world have to grapple with in terms of quality and safety care delivery to our patients and the community. How would the Family Medicine specialists distinguish themselves from those that did not acquire this higher training? Can patients and the community tell the difference in the care they received? What will be the role of the College and the Academy to ensure standards are maintained? Will there be differential payments and charges by the Family Medicine Specialists and if so how would that weigh up against other specialists such as general internists and paediatricians?

As an outsider I can only pose the questions but provide no answers except that I am confident that my academic colleagues in Hong Kong will seek research funding to evaluate the cost effectiveness of the various models of primary care delivery by Family Medicine specialists in Hong Kong. It is indeed satisfying to know that regardless of what we call ourselves, GPs, Family Physicians, at the end of the day, we practise the same branch of medicine that William Osler, the renowned Canadian medical educator and wise scholar sent this farewell message to Canadian and American medical students 100 years ago,

' Have no higher ambition than to become an all-round family doctor, whose business in life is to know disease and to know how to treat it.' ⁴