Winds of change

Kathy KL Tsim 詹觀蘭

HK Pract 2023;45:62-63

On 19^th May 2023 we celebrated the World Family Doctor Day with the theme, “Family doctors: the heart of healthcare”, with the slogan “Build a healthy life, engage a family doctor”. This slogan is in line with the change in healthcare that is and has been happening in Hong Kong for more than the past decade.

With easy access to comprehensive primary care in mind, the Primary Care Directory was first launched in April 2011 for the general public to directly search for and access their choice of Family Doctors, Dentists and Chinese Medicine practitioners. It also has a vice versa role of letting Family Doctors search and join forces with similar minded primary care providers. The number of Family Doctors who have enrolled in this scheme have seen an increase with each passing year. With the roll out of the Primary Healthcare Blueprint in Dec 2022 and the introduction of the “Family Doctor for All” concept, the numbers have seen a further increase to over 3,100 earlier in May this year.

Before we go any further let us first define who or what a Family Doctor is. In certain countries, like Australia and United Kingdom the term General practitioner is used while in Hong Kong the Family Physicians is used. This issue of terminology has long been debated on since our College had its name changed from the Hong Kong College of General Practitioners to the Hong Kong College of Family Physicians in 1997.¹ I shall not attempt to go over old ground. However, to me, I believe that WONCA with name says it all.

The shortened name for WONCA is the “World Organisation of Family Doctors” but its full name is an acronym comprising of the first five initials of the World Organisation of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians. So General practitioners and Family Physicians are used synonymous with each other. I shall therefore treat it as the same, meaning Family Doctors include both General Practitioners/Family Physicians.

In his discussion article, Dr. Wun² made the point that “a general practitioner is a physician who personally provides whole-person health care to individuals and families in their living environment” emphases being on the “personally”, “whole-person care” and “in their living environment”. It is the delivery of comprehensive and continuous care to persons and their families over time taking into context their living environment.

The world we are living in is ever changing and at times challenging, so as Family physicians we too need to evolve. The single-handed Family Physician will find it more and more demanding to take on this fight alone. As we can see with the most recent COVID-19 pandemic, our role as Family Physicians in healthcare has become ever more important. It has brought to light the multifunctional role/responsibility of our specialty. We were there in the front-line combating against the unknown, connecting with the person in our communities, sharing our skills delivering much needed care, reassurance and resources. Our role seemed to have expanded beyond our individual clinic setting. We were working together as a team with other allied health providers to bring about the core value of “whole-person care” living in our communities.

The “Family Doctor for All” concept has never been more timely and appropriately instituted. In our present ever-changing world of AI, machine learning, smart hospitals, viruses, epidemics and pandemics, nothing will replace the art of “caring” that we do. As Dr. Libby Lee in her Dr. Sun Yat Sen Oration rightly pointed out “We are in the era that is full of contrasts”.³ Through working together with other primary care providers and connecting with the persons in our locality, we will be able to reduce the fear and insecurity that these contrasts might bring. This is especially so for the increasing population of elderlies who are not mobile enough or secure enough to leave the comfort of their known community. The government with its health reform and the establishment of District Health Centers have taken a closer step of making this connection possible. Empowering patients in their own community is starting to become a reality.

Empowering Family Physicians to be anchors in support of their patient in their journey through life is just as important. As Prof. Poon pointed out, we are now in the post COVID period where we and our patients are facing with the illness entity “Long COVID”.⁴ Knowledge and evidence for this entity is still to be fully understood but with proper training and co-operation between health providers we are making good progress on how to approach this condition with our patients.

As we in Family Medicine know, we are in terms a generalist having medical knowledge on a wide array of subject matters. That is where we shine. Although we might not be a specialist in one specific field, we know and are dedicated when we work in a multidisciplinary team for the betterment of our patients.⁵ We have an important role to network with our community partners, to facilitate social and care services, team building, coordinate integrating care and being a leader within a multidisciplinary team. Our strength in this matter can be seen in Dr. Chan’s retrospective case series analysis where a dedicated team led by primary care physicians significantly improved the health outcome for their osteoporotic patients.⁶ Our strength comes from knowing our patients and letting them know where to find us when they need to and connecting with them and our team of other primary health providers.

Change is an inevitable way of life, whether be it in our world or our healthcare system or our way of living. By keeping connected with like-minded professionals we can be the Family Doctor that is there for the individual living in our community. Being the stable dependable person that they can come to count on to help them weather these changes. I personally interpret the “Family Doctor for All” to have this significant meaning.

Let me end with the 1945 Broadway musical “Carousel” lyric “You’ll never walk alone”. This more than applies for ourselves and each person in our community when we decide to connect with a Family Doctor who will “have our backs” at all times.

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