The turning point for Family Medicine development

A Lee 李大拔

The recent Severe Acute Respiratory Syndrome (SARS) crisis in Hong Kong has added strengths and opportunities to our development of Family Medicine. During that period, many of our family physicians participated actively in helping the community to fight against SARS. Some of our colleagues were giving voluntary services. Many of our colleagues formed networks of doctors in different districts giving support to schools, elderly homes and community centres. If the system of interfacing between primary and secondary care could be well set, family doctors would act more effectively as gatekeepers of the hospitals. They could follow guidelines and protocols laid down by the expert authorities to triage patients, so that the burden of hospitals would be relieved.

There is a large overlap of symptoms and signs between the clinical manifestations of SARS and that of upper respiratory infections. All symptomatic cases could end up being admitted to hospitals. If the primary care doctors can have direct access to basic diagnostic procedures such as chest x-rays, blood tests and direct communication with hospital teams managing SARS, the primary care doctor would be better equipped in selecting suspected cases for secondary care.

Even the role of family physicians was not limited to that of gatekeeper alone at that time: their contributions in various types of community services highlighted the many roles of family doctors in the community. In an acute crisis such as SARS, public doctors will be heavily loaded with the work of surveillance, development of treatment protocols, management of large numbers of cases in hospitals, monitoring of the situation, and public health planning. Private doctors would play the roles of giving community support, public health education, participating in the surveillance system, and empowering the community to adopt various preventive measures. SARS now poses a new public health challenge as many control measures are seen to lie outside the hospitals.³ Family doctors are the key persons in the primary health sector and the nature of their job involves working across not only different disciplines, but also different sectors. Family doctors are very resourceful members of the community. The work of our doctors in the community during the last SARS event has highlighted the role of family doctors as "frontline" health-care workers in the community.

The main weakness pointed out in a previous paper was the lack of training posts for and recognition of general practice as a distinct specialty.² There are now more training posts in the Hospital Authority and the Department of Health. Although Family Medicine is now established as a distinct specialty, there is a feeling that it is still not enjoying the same status as the other "conventional" specialties. The practical solution is to move from advocacy to action. The actions taken by our colleagues during SARS have demonstrated that family doctors are willing to, and would also play a significant role in community-based care. A submission has been made to the SARS Expert Committee to take this opportunity to re-examine the entire health-care system and also the need for quality primary health-care.⁴ It was suggested that preventive services and services for some special "client" groups should be integrated into the realm of practicing family doctors rather than setting up provision for compartmentalised services.⁴ This is more cost effective and also enhances efficiency. Both Universities have developed many good postgraduate programmes in Family Medicine, to meet the local needs despite the small size of their academic staff. Local academics have also initiated various innovative projects which are gaining international recognitions. The development is promising but it has also brought with it big challenges.

There would be many new initiatives in community-based care opening the opportunities for practicing family doctors to be more involved in developing a new era for Family Medicine.⁵ In fact, networks of community doctors have already evolved out of the SARS crisis in some districts to facilitate closer working relationships with different sectors in the community. Positive action is a concrete step to overcome the weakness and combat threats. The current climate is a good turning point for the development of Family Medicine in Hong Kong and we have great potential to put our efforts into action.