Family Medicine beyond Hong Kong

Donald KT Li 李國棟

HK Pract 2016;38:75-76

The Hong Kong College of Family Physicians (HKCFP) celebrates her 40th Anniversary next year. Over the last four decades, the HKCFP has established the specialty of Family Medicine in Hong Kong. Family Medicine (FM) is a departure from the general practitioner or "General Practice" (GP) who used to only see mainly coughs and colds. Nowadays, even the GP who has not received formal or vocational training (because FM training was not available before 1987) is doing a lot more for patients at the primary care level.

Specialist Family Medicine doctors are not claiming to be elitists, but simply enhances what a primary care doctor can do. Patients now know how to self-care and self-medicate for minor ailments so the newgeneration of family doctors can focus more on providing innovative and comprehensive primary care including anticipatory care, management of chronic diseases, and mental care, just to name a few.

The specialist status and recognition is a great incentive for devoted medical graduates to practise Family Medicine. Yet issues and challenges remain globally. All over the world, countries experience challenges in financing their health care systems and putting resources into primary care. Administrators are influenced by both political and commercial imperatives. In the face of growing health care expectations and needs, with unstable economies and poor workforce planning, many governments are preferring to employ non-medical teams in the community and there is continued dominance of hospital specialists to make medical decisions. To address these challenges, influencing government and politicians on health policies and healthcare financing, resource allocation and manpower planning are important. But more importantly is the upscaling and upskilling of primary care as advocated by Prof Amanda Howe in her keynote address to the Taiwan Association of Family Medicine recently in Taiwan. WONCA advocates that countries need to invest in Family Medicine as part of the strong primary care providing team, which can provide comprehensive care over time and that the care should be accessible, acceptable, accountable and thus is also affordable. The care needs to be cost effective for the patient and government. Yet even in some countries where there is already FM, we are seeing counter arguments and questions whether there is sufficient evidence and research to really support the effectiveness of Family Medicine in health care systems.

The free market system in Hong Kong allows family doctors to provide quality primary care in private practice. The best incentive for quality is reward and Family Medicine doctors are rewarded with decent remuneration. China has revolutionised GP in the past few years ever since the top down order for China's health system to "go primary care" in 2009. Indeed the development of General Practice in China is growing at a rapidly high speed, with the number of GPs amounting to 145,000 at the end of 2013, increasing by 35,000 compared with that in 2012. Although GPs are still often strangers to patients and families in China, they remain the ones being most familiar with the health of the family members they serve. These "most familiar strangers" will sooner or later become a member of the family providing family medical care. Since last year with the introduction of specialist referral system or triage（分級診療）and registration of patients with a fixed GP, a GP system with the proposed incentives is emerging.

Throughout the years, there have been a lot of sharing of experience, interaction and teaching of Family Medicine by the HKCFP to help the development of the discipline in mainland China. Those who frequent China will realise their GPs and GP teachers and specialists are nowadays quite sophisticated and well versed in FM knowledge and skills. Yet areas we can further assist is the instilling of proper attitudes. The humanitarian approach through appropriate communication, attention, and body language will further enhance the building of trusting doctor-patient relationships: the essence of Family Medicine. Sharing our experience in practice management and establishing private practice will also be the way ahead as I see the future of primary care will rely on well trained General Practitioners with the confidence to open up their private practices in the community in mainland China.

I applaud colleagues at the HKCFP who have devoted time in teaching our mainland colleagues. My experience over the past 20 years has been most rewarding as I get to learn, interact and explore Family Medicine beyond Hong Kong. Our local FM specialists are also ready to reach out into the international arena and show the world what we have learnt and consolidated over the years.