Family medicine, cross road - where are we?

Stephen KS Foo 傅鑑蘇

HK Pract 2021;43:1-2

The Hong Kong College of Family Physicians has been in existence for 44 years with the objectives of training qualified family doctors as the cornerstone in primary care to provide primary, continuous, comprehensive and whole person care to the community. The establishment of the Conjoint Fellowship Examination with the Royal Australian College of General Practitioners in the past 34 years has enabled Fellows to provide a high standard of family medicine care to citizens. The fact the Hong Kong College of Family Physicians was incorporated as one of the constituent foundation Colleges of the Hong Kong Academy of Medicine in 1992 has reinforced the Specialist status of the Academy Fellows of our College.

We have as up to the time of writing a total of 805 Fellows of the College, of whom, 521 are specialists in family medicine. The majority of them are working in the public sector taking care of about 30 % of the population of Hong Kong. Most of the primary care doctors in private do not possess higher qualifications in family medicine and they are taking up the major roles of providing 70% of primary care in our community.

Having served the local community in private capacity in primary care over the past 50 years, sometimes I wonder, is the standard of primary care improving commensurable with the growth of the College and the increase in number of our College Fellows. Personal experience tells me that it is not. There is great improvement in service provided by the public sector as these clinics are training grounds and our trainees are required to go through the training programs designed by the College. Most trainees are employed by the Hospital Authority to serve in the Outpatient Departments after training. Of course, there is a lot to improve in provision of standard care to the community in the public sector but most of the defects are in the system of delivery of primary care by the health authority. On the other hand, I cannot see much improvement in care provided by primary care doctors in private sector. Many practicing in private sector, especially those with postgraduate training in family medicine, are doing very well, exhibiting care, concern and empathy towards with good skills in problem solving for their patients. Still quite a number of primary care doctors in private have not demonstrated the standard of care required of in the practice of family medicine. Hence a lot of frustrations, dissatisfaction, complaints and even lawsuits occur in the doctor-patient consultations. They may not be providing the adequate primary care including whole person, comprehensive and anticipatory care to our patients, resulting in enhancing the morbidity of our patients and increasing demand in hospital admissions. Sometimes I wonder why the delivery of primary health care in the community is so heterogenous despite our effort invested in training family doctors. Most of the college fellows after training work in the government sector. However, the majority of service is provided by doctors in private sector. I wonder what is the quality control of these doctors as service providers. Doctors after acquiring the basic qualifications should be able to deliver a reasonable standard of service to the patients. With the fast escalation of medical knowledge in medicine and the rapid advances in medical technologies, we should not be complacent with what we have learned in the medical schools. We owe our patients a disfavor if we are not doing the best for our patients. There is no regulation that primary doctors who are not specialists should be equipped with continuing medical education, continuous professional development activities, training or any post graduate qualifications to serve the primary care. The College is tasked with the responsibility to ensure a standard of care to our patients through education, training and assessment in family medicine. The execution as to how our community is well protected to be entitled a reasonable primary care is to be decided by the health authority

Unless there is a balanced cooperation between the health authority and the College to see how the health of our people can be enhanced, through a better medical service provided by the primary doctors in Hong Kong, there is not much point in continuing the College’s efforts in producing more qualified family doctors.

The College has done her part. It is up to the health authority to consider how to regulate and upgrade the standard of primary care medical service to the community. Apart from the provision of the Fellowship Examination to members, the College has provided different courses of training in family medicine to all doctors in Hong Kong, like the one year course of Diploma in Family Medicine which is a quotable qualification by the Hong Kong Medical Council. I think some guidelines should be imposed by the Medical Council to the fresh graduates who would like to enter into primary care service in Hong Kong.

Passing the basic undergraduate medical examination is only the first step in the medical career. We need more than a basic medical degree to better serve our people. Life long learning and acquisition of postgraduate training is a must in the delivery of a satisfactory service in primary health care.

I strongly urge the health authority to seriously consider why the primary health care standard in the community is not proceeding with time.