SARS and family medicine

D V K Chao 周偉強, D Owens 歐德維

The success in fighting SARS has been the result of a concerted effort by members of the community as well as frontline health care workers in both the public and the private sectors. The World Health Organisation (WHO) removed Hong Kong from the list of areas with local transmission of Severe Acute Respiratory Syndrome (SARS) on 23 June 2003. Now is a good time for reflection, an opportunity to look back and learn the lessons of the past in order to better plan for the future.

The contribution and cooperation of the community was essential in the control of the SARS epidemic. Frontline community doctors were usually the first ones to meet patients suffering from the illness. They needed to be up to date with infection control measures, be able to recognise suspected cases as early as possible and refer them to hospitals for confirmation, and immediate management in order both to improve their outcome and to prevent the spread of the disease within the community. During the training of a family physician, the role as a gatekeeper for the hospital is fundamental to the daily routine. This expertise is critical at times like the SARS outbreak. Not only does the family doctor play the role of a clinician, he also serves as an essential link between the community and the hospital.

The versatility of family medicine has been proven again in the SARS epidemic. At the onset of the SARS outbreak, the emergency departments and the public hospital wards were filled with SARS or suspected SARS cases. Family medicine doctors were requested to help out in these pressure areas. They bravely did an excellent job. They were also amongst the first to volunteer help for the general outpatient services as well as the elderly homes when the community was being severely affected. The experience of family medicine doctors achieved whilst rotating through many specialties as part of their training programme was essential in dealing with patients with problems across specialty boundaries.

Despite the fact that the SARS epidemic is now under control, it has cost many lives, both of the public and of health care professionals. It has also brought much suffering. Now is not a time for complacency. SARS may come back again or be replaced by other health threats to our population. We need to be better prepared and equipped for the future.

SARS provides a focus for reflection. It is a time to look back over the last 25 years of family medicine in Hong Kong. The local development of our specialty owes a great deal to the proactive approach adopted by our predecessors who have dedicated a great deal of time and effort on behalf of the Hong Kong College of Family Physicians. They have strived hard over the last quarter of a century to establish the principle of formal training for future generations of family physicians. Importantly, it is also a time to look forwards to the next 25 years. This year sees the launch of the Diploma in Family Medicine organised by the college. The first intake is fully subscribed. The Fellowship examination will also change format in 2003/2004 in line with other international standards. Every year we are seeing an increase in the number of examinees sitting for the examination. The change towards lifelong learning and a greater emphasis on Continuing Professional Development (CPD) epitomised by the work of the Quality Assurance and Accreditation Committee, the Research Committee and the Boards of Education and Examination will ensure ample opportunity for individual and professional development for all members of our college.

Over the last few months, Hong Kong has demonstrated the strength of her health care system. We have a solid foundation on which to build a well trained and well organised primary health care system. We must look back and learn the lessons of the past but now is also a time to focus positively on the opportunities and challenges for the future.