Memoir and Passion – Personal reflection of 40 years history of HKCFP

Stephen KS Foo 傅鑑蘇

HK Pract 2018;40:32-36

Dr Angus Chan, President of Hong Kong College of Family Physicians (HKCFP), Honourable guests, Fellows of the College, Ladies & Gentlemen.

It is an honour of me to present the Sun Yat Sen Oration in this auspicious occasion of the 40^th anniversary of the HKCFP.

How did the Sun Yat Sen Oration start? and Why Dr Sun Yat Sen?

In 1989, Dr Peter Lee, the founding president of the College proposed to create “Sun Yat Sen Oration” in honour of Dr Sun Yat Sen who was a Chinese Physician, a General Practitioner, the first President and founding father of the Republic of China. Dr Sun received his professional education and training in Hong Kong in 1892. He graduated with distinction from the Hong Kong College of Medicine which later became the Faculty of Medicine, the founding Faculty of the University of Hong Kong.

Dr Peter Lee proposed to establish the Sun Yat Sen Oration as a ceremonial and memorable agenda in the annual conferment ceremony of HKCFP. Local and international scholars and dignitaries are invited to deliver the orations. The first Sun Yat Sen Oration was delivered by Dr Peter Lee with title “The Human Face of Medicine” in 1989. Today, I have the honour to present the 28^th Sun Yat Sen Oration.

In my 40 years connection with the College, I have to pay tributes to a few distinguished medical heroes who have played different roles in the College formation. The first one I would mention is Dr Peter Lee.

In 1973, Dr Lee then President of Hong Kong Medical Association (HKMA), proposed the establishment of a Hong Kong College of General Practitioners (HKCGP) whose mission was to improve the overall standards of front-line medical practitioners in Hong Kong. One year later, the HKMA Council decided to set up a working party chaired by Dr Henry Li to look into establishing such a college in Hong Kong. In 1975, a delegation sponsored by the HKMA was sent to visit the Royal Australian College of General Practitioners (RACGP) to seek assistance in forming a college. The response from RACGP was positive and they sent three high officials to Hong Kong for one week to advise on our formation.

In 1975, the HKMA formed an Interim Council under Dr Henry FK Li with the intention of spinning off a new HKCGP. Dr Henry Li was also the Chairman of the Interim Council of the HKCGP.

The first Annual General Meeting (AGM) of HKCGP was held on 13 October 1977 when Dr Peter Lee was elected founding president. The Inaugural Ceremony of the HKCGP was held at Hong Kong City Hall on 11 March 1979.

In 1985, Dr Lee saw the necessity of acquiring a place where the College could maintain its headquarters. With the assistance of Sir Professor Harry Fang, who was the President of the Federation of Medical Societies, Dr Lee in his capacity of Chairman of the Chan Tat Chee Charity Fund spent HK$500,000 for 75-year lease on half of the 8^th floor of the Duke of Windsor Social Services Building, Wanchai. The College has been housed in this premises till moving to the Hong Kong Academy of Medicine (HKAM) Building in 1992.

At a time when general practitioners were somewhat looked down by their medical brethrens, Dr Lee saw the importance of building up the credibility and recognition of our discipline to an international level. In 1983, he was elected Vice President of World Organisation of Family Doctors (WONCA) Asia-Pacific Region. In 1993, he was installed President of WONCA, a distinct honour of Hong Kong General Practice. Through his influence, HKCGP hosted the Asia- Pacific Regional Conference in 1987 and the 14^th World WONCA Conference in 1995. These activities have made Hong Kong one of the most influential countries in the region in the promotion of Family Medicine.

Dr Peter Lee was the Founding President of the College and had been in presidency for 12 years. He spent the majority of his life in the promotion and development of Family Medicine in Hong Kong. Without his vision, wisdom and knowledge, I don’t think our College can achieve today’s status. In honour of his contribution to the medical profession, he was conferred Honorary Fellowship of HKCGP in 1987 and Honorary Fellowship of HKAM in 2009.

The 2^nd person I would like to mention in our college history is Dr Henry FK Li. Dr Li was a general surgeon and General Practitioner in private practice. He had been President of British Medical Association, Hong Kong Medical Association and Federation of Medical Societies. He was a very respectable medical person and a man of great esteem in medical profession.

As a good friend of Dr Peter Lee, he shared the same vision that General Practice should be well organised with a standard. In 1995, Dr Peter Lee, then President of HKMA invited him to chair a Preparatory Committee to form the HKCGP. Later he was appointed Chairman of the Interim Council of HKCGP.

Dr Li had a special passion for General Practice development and strongly believed a high standard of Primary Care is the cornerstone in health delivery in Hong Kong. He was instrumental in helping to start the College.

20 years later in 1999, his son Dr Donald Li became President of the College. Dr Donald Li achieves beyond his father’s contributions in the field of Family Medicine. He was also the first family doctor to be President of HKAM, something the specialty of Family Medicine is proud of. Today, he is President Elect of WONCA and would be WONCA President in 2019. He is widely known in China and internationally as a very prominent leader in Family Medicine. I am proud to say that in a small place of Hong Kong, we have produced 2 Presidents of WONCA namely Dr Peter Lee and Dr Donald Li.

The 3^rd person playing a vital role in College’s formation is Dr Natalis Yuen. On returning from Australia in 1969, Dr Yuen carried with him the innovative idea of forming a college of General Practitioners in Hong Kong. He graduated from Queensland University and knows the Australian’s General Practice system well.

When Dr Natalis Yuen and I were working as medical residents in Our Lady of Maryknoll Hospital back in 1970, we noticed how chaotic and unregulated the General Practice system was in Hong Kong. We explored the feasibility of having some sort of medical body to look after the standard of General Practice.

It so happened we came across to know Dr Peter Lee who was President of HKMA. Dr Lee was a General Practitioner in private practice and he was very eager to share our idea. Dr Lee put it an agenda in the Council of HKMA to form a subcommittee to study this issue.

Later Dr Yuen while in private practice in Hong Kong, went over to Australia to attempt the Royal Australian College of General Practitioners (RACGP) Fellowship Examination in order to acquire the personal experience how to achieve the Fellowship of RACGP (FRACGP). Dr Yuen passed the examination in one attempt. He shared his experience with us how to prepare our own examination materials with local culture and ethnicity. This was the basis of our Conjoint HKCFP/RACGP Fellowship Examination with the RACGP starting in 1987. I was Chairman of the Board of Examinations for the first Conjoint Examination.

Dr Natalis Yuen has held a number of important posts in his medical career. He was the Honorary Secretary of the 1st Council of HKCGP in 1977. He was elected President of HKMA from 1982-1984, became President of HKCFP from 1988-1992, was appointed Chairman of Medical and Health Advisory Committee and Chairman of Preliminary Investigation Committee of Hong Kong Medical Council. His academy achievement included being appointed part time Professor of Department of Community and Family Medicine of The Chinese University of Hong Kong (CUHK).

Upon retirement from Presidency of College, he was appointed Chief Censor.

Dr Natalis Yuen, utilised his personal experience of studying in Australia and attainment of FRACGP to share with us how a college of General Practitioners could be found. He was an important pillar in forming our College 40 years ago.

The last person I would salute to is Sir Professor David Todd.

Professor David Todd graduated from the Medical Faculty of The University of Hong Kong (HKU) in 1952. He was a classmate and good friend of Dr Peter Lee. He, as the professor of Medicine in HKU was the most respectable figure in the local medical profession.

In 1984 when the College started its local Fellowship Examination, to add credibility to the examination, Dr Peter Lee invited Professor Todd to be the Chief Censor to supervise the local Fellowship Examination from 1984-1986. As Chairman of Board of Examinations, I experienced how serious and righteous Professor Todd was in administering the examination.

In one of the Board meetings to consider the result of the candidates at Robert Black College of HKU, Professor Todd had a heated discussion with the external and local examiners on the standard of passing the candidates. I remember that meeting which I was chairing, lasted till 2:00 am in the morning. This exercise is important as the successful candidates of the 3 years of local fellowship examination have paved the way to make our College being recognised as a specialty college.

When the HKAM was established in 1992, Professor Todd was the Chairman of the Preparatory Committee. In the working party responsible for establishment of the HKAM in 1990, a great deal of discussion, sometimes acrimonious, centred around the status of the various colleges. Disagreements arose over what types of doctor could be referred to as ‘Specialists’. Some Committee members felt ‘General Practitioners’ could not be considered specialists because their remit was general. The case was persuasively argued that the new type of trained General Practitioners or Family Physicians was quite different from the older generation of General Practitioners in that they possessed a special core of knowledge and skills relating to the whole person, rather than to age, sex, or a single part of the body.

It was also pointed out that they related to family and society rather than to a single person, which made family medicine unique among clinical disciplines and that they needed a broader magnitude of knowledge in order to treat an individual effectively, otherwise they would simply be referral clerks passing on patients to specialists even in the case of minor complaints and illnesses.

A lot of discussions was centred on whether General Practice should form a College. Nevertheless, all parties concerned never lost sight of the broader implications of their deliberations and usually managed to arrive at a consensus. Observers credit Professor Todd with being instrumental in promoting this consensus, and that without losing his temper too often. On May 1993, the HKCGP was admitted to the Academy with a total number of 79 as the first batch of Academy Fellows. Our College was renamed as the College of Family Physicians in 1997.

Professor Todd has been always in my mind when I am preparing this oration.

While celebrating the 40^th anniversary of the College, we would never forget Professor Todd’s enthusiasm and contribution in the growth of the College.

Sir Professor David Todd was conferred Honorary Fellowship of the HKCFP in 1993, Honorary Fellowship of HKAM in 1997 and in 1995, he was awarded the Sir status by the Hong Kong Government for his profound contribution to the medical profession locally and internationally.

15 years ago, in celebrating the 25^th Anniversary of the College, our Founding President Dr Peter Lee spelt out in his ‘Vision and Mission’ for the College by elaborating 4 main objectives which I would elaborate.

The 1^st objective was to secure formal recognition from the Medical Council of Hong Kong that the postgraduate academic degree of HKCGP/HKCFP is a quotable qualification. This was achieved in 1990 and the Fellowship of our College became the first and only locally granted postgraduate medical degree to be so recognised at that time.

The 2^nd objective was to secure Specialty Status for the discipline of General Practice / Family Medicine. This was partially achieved in April 1990 when the Government appointed a Preparatory Committee which was set up to plan the establishment of the Academy of Medicine. This decision was made with the intention of ensuring that the discipline of General Practice / Family Medicine would in future require the same stringent training and achieve the same high professional standard as other specialties in Hong Kong. When the Hong Kong Academy of Medicine Ordinance was enacted in the Legislative Council on 25 June 1992, the Hong Kong College of General Practitioners was listed as one of the constituent Colleges of the Academy and our specialty status was thus enshrined in the Laws of Hong Kong.

The 3^rd objective is to continuously improve and elevate the standards of Continuous Medical Education and Vocational Training Programmes and to achieve academic excellence in the discipline of General Practice / Family Medicine and to enhance the professional status and prestige of its fellowship degree. The successful launch, together with the RACGP of the Conjoint HKCFP/RACGP Fellowship Examination in 1987 authenticated the standing and reputation of our fellowship degrees which are henceforth internationally recognised.

The last objective was to persuade and assist Government to transform the health delivery system of the Government of the Hong Kong Special Administrative Region (HKSAR) from the existing hospital-based one to a community-based system.

Dr Lee said the last objective was a lengthy uphill struggle.

Development of high quality primary care system to take care of the health of people of Hong Kong has been the main agenda in formation of the College.

I am pleased to say that the Chief Executive of Hong Kong in her maiden report on health policy has stressed ‘A comprehensive and coordinated primary healthcare system will enhance overall public health, reduce hospital re-admission and rectify the situation where accident and emergency service is regarded as the first point of contact in seeking medical consultation….We will set up a steering committee on primary healthcare development to comprehensively review the existing planning of primary healthcare services and draw up a development blueprint…’

I wish all these would help to fulfil the 4^th objective of the College.

Now I would like to spend a few minutes to elaborate –

What evidence we have to stress the significance of Primary Care in health delivery?

Professor Barbara Starfield, a leading figure in primary care medicine, reviewed the evidence of significance of primary in health care delivery:

1. Studies of the supply of Primary Care Physicians
2. Studies of people who identified a Primary Care Physician as their regular source of care
3. Studies linking the receipt of high-quality Primary Care services with health status.

Outcome:

1. Health is better in areas with more Primary Care Physicians
2. That people who receive care from Primary Care Physicians are healthier
3. That the characteristics of Primary Care are associated with better health.

These statements have been verified all over the world. Countries with the best health index have a robust and well-founded Primary Care system. Qualified Family Physicians are the cornerstones in development of a high standard Primary Care system.

I wish, in this occasion of the 40^th Anniversary of the HKCFP, our Government and Health Authority would share our vision to develop a sound community based health system for the good of the citizens of Hong Kong.

I am most fortunate and proud to be connected with the HKCFP since its inception 40 years ago. I see the College as an important part of my career and my life. I am proud that the growth of the College fits in very well with the theme of this year’s (2017) scientific conference: “From Seedling to Forest - Ever Enriching Primary Care.” In this great and loving family, my life has been enriched by my acquaintance with the distinguished figures I mentioned today.

“To build the future, you need to know the past”. This is the sentence engraved in the wall of the Museum of Anne Frank in Amsterdam where I visited this June. Mr Otto Frank who wrote this sentence was the father of Anne Frank, who was the author of the famous book, “the Diary of Anne Frank”. Anne Frank died at the age of 14. Her Diary depicted how her family hid in their house which was the museum, to avoid prosecution by Nazi during their invasion of Holland. By knowing the history of our College, I wish our younger generation of Family Physicians would work together to paint a bright picture of our College in future.

Thank you.