What are Family Doctors for? And will they be replaced by artificial intelligence?

Martin Roland

HK Pract 2025;47:80-83

* This paper was presented at the 35th Dr. Sun Yat Sen Oration on July 13, 2025.

President Chao, honoured members of Council, Fellows, distinguished guests, ladies and gentlemen. This is my title: “What are Family Doctors for? And will they be replaced by artificial intelligence?”

We get a good clue about what GPs are for by looking at the motto of Hong Kong College of Family Physicians, which is ‘Whole Person Medicine’. But also, I want to draw your attention to the motto of the UK Royal College of General Practitioners and the Royal Australian College of General Practitioners, which is Cum Scientia Caritas, and that means caring with science, two critical aspects of what we do as GPs.

I first want to introduce you to Barbara Starfield, who was described by Dr. Donald Li - a past President of this College as ‘the leading icon of our age’. She was an American family physician who, more than anyone else, demonstrated the value of primary care in producing cost-effective healthcare outcomes. A typical example Barbara's work ranks a number of different countries by how good their primary care is and compared this with their healthcare outcomes.¹ There is a very clear relationship here: the countries with strong primary care like Netherlands and Denmark have both the best primary care and the best health outcomes, with the US having the weakest primary care and the worst health outcomes.

So what are Family Doctors for? I want to talk about this in respect of them being first contact, providing excellent clinical care, providing continuity of care, co-ordinated care, and comprehensive care. These are based on Starfield's ‘Four Cs’,which she described as the defining characteristics of primary care: first contact, continuity, coordination and comprehensiveness to which I have added clinical excellence for reasons I will describe later.

Next I want to ask: Are you entering a static world in which the job of the Family Doctor is clearly defined? No, you are not. Here is Professor Cindy Lam writing in the Hong Kong Practitioner at the end of last year, describing the challenges you will face with “… an ageing population with people living with an increasing number of chronic diseases and years of ill-health ... new health intervention technologies are increasing with the state-of-the-art treatments .... high expectations from the public.... excessive demand for more and better care”. Professor Lam goes on to write: “A shift of more healthcare from the hospital to primary care is the only solution to contain costs and to assure better equity and quality of care. The landscape of primary care has changed from episodic treatments of self-limiting and minor illnesses to the long-term care of people with multimorbidity and complex biopsychosocial problems”.

So the work that you do is going to change and let us think about it in respect of the characteristics of primary care that I previously defined and adding in the question of, not just ‘What are Family Doctors for?’, but ‘Will they be replaced by artificial intelligence?’

So let us talk first about the first ‘C’, first contact care. You will remain as the first point of contact for many patients, but this will change in two important respects. The first is that patients increasingly will have looked at the internet or have consulted a Chatbot doctor before coming to see you. Artificial intelligence programmes will not only interrogate the patient about their symptoms, but also matching to their medical record and analysing photographs that patients may upload. So patients who come to see you will have better ideas than they do now of what is wrong with them and what treatment they expect. And people with long-term conditions, particularly rare ones, may well know more about the condition than you do. So your relationship with your patients is going to change. I don't think this is going to be traumatic and it may not be terribly rapid, but it is going to happen and I think it should be embraced.

The next thing that is going to happen in the consultation is that you will be able to spend more time looking at your patient and less time looking at your computer screen, because artificial intelligence – so called ambient scribes – are going to be taking the notes. What does an ambient scribe do? It listens to the consultation, generates a summary using the existing information in the record including clinical codes, but with output that you can customise. The AI can also generate a summary to send to the patient, write referral letters and book tests. How far in the future is this? Well, the answer is that it is not. It is here now. The National Health Service in England has already published guidance on using AI-enabled ambient scribing products in healthcare settings. And a survey done in March this year in New Zealand showed that 50% of New Zealand GPs are already using ambient scribes to take notes during their consultations.

Let me go on to my next ‘C’, which is clinical excellence. Here, rather looking forward, I first want to take you right back in time to Hippocrates the father of western medicine who lived in Greece 2,500 years ago. In the first documented observation of variation in clinical practice, Hippocrates wrote “In acute diseases doctors differ so much among themselves that those treatments that one gives thinking the best that can be given, another holds to be bad”. And variation in clinical practise exists wherever you look, whatever country you choose, whatever speciality you examine. And variation in clinical practise also means variation in quality of care, with some doctors providing good care and other doctors providing care that doesn’t meet accepted professional standards. Let me give you an example of the sort of study that has now been done in many, many countries.

This example is from Australia. William Runciman and colleagues took 522 quality indicators and applied them to over 1,000 randomly sampled Australian adults, measuring quality of care for 22 conditions and preventive care.² He measured the percentage of patients who were receiving recommended treatment for each condition. For coronary heart disease, 90% of people were receiving recommended care but for COPD, only 70% were receiving recommended care and for atrial fibrillation, only 50% of people were receiving recommended care. For preventive care, only just over 40% of patients were receiving the preventive care that they should have had. I don’t have data on Hong Kong family medicine, but I think this sort of variation is likely to exist simply because it is found in every specialty and every country in the world where people have actually looked.

This College has been pre-eminent in Hong Kong in promoting quality improvement in family medicine with CME programmes, quality assurance programmes, CME accreditation among a whole range of initiatives which this college has promoted for many years. Indeed, it is a central part of what the College does and as David Chao said in his introduction, your awards today aren’t the end of your education, but a stage – an important one – in life-long learning.

The issue is also now recognised by the Hong Kong government. In the Primary Care Blueprint, we read that ‘care quality is going to be ensured by the primary care register’. And read further one, they will ‘require all family doctors and healthcare professionals participating in primary healthcare service provision to be enlisted on the primary care register and to commit to using the primary healthcare reference frameworks’. The government will set training requirements under the primary care register.

There is a lot in there which I can’t unpack in this talk, but I think that you can see the beginning of more formalised quality assurance programmes in Hong Kong. Indeed Dr. Stephen Pang, Hong Kong’s Primary Healthcare Commissioner, said at the Primary Care Conference this morning that money would be ringfenced for family doctor education. So as more money from the Hong Kong government flows into private family medicine, I think we can see the government being increasingly interested in ensuring that high quality care is being provided.

Artificial intelligence is undoubtedly going to influence this by changing medical education which will become more personalised, with learning resources tailored to your needs, and increasing use of simulations adapted to the things you need to learn. AI will also help clinical decision making in your routine care of patients. There are a rapidly increasing number of AIbased clinical support systems being developed for primary care. The benefits of these are that they can give you efficient up-to-date synthesis of evidence in a way that you could not possibly do yourself and the ability to incorporate the patient’s history, test findings, image analysis, etc into your decisions. The cautions are that generative AI is a black box. It is often very difficult to see how the decision-making is made and the data sources and evidence behind the models are rarely traceable. So you don’t know if there are biases in the training data of the AI model you are using, for example, in relation to age or ethnicity, and you don’t know if the models are using poor quality or out-ofdate data. Family doctors urgently need help from our professional bodies and governments to indicate which AI tools we can reliably use. The whole business of how AI support systems in healthcare are going to be governed is one of very active discussion and something in which we will see a developing field over the next few years.

Next, I want to talk about continuity of care. I am not talking about informational continuity which is largely about access to key information in the medical record or management continuity which is about consistent application of clinical guidelines. Rather I want to talk about interpersonal continuity because interpersonal continuity of care in many, many studies across the world has been shown to lead to better patient satisfaction, better doctor satisfaction, improved health outcomes and reduced costs. One example – from Scandinavia – shows how the longer a patient has known his doctor, the fewer out of hours calls are required, the fewer acute hospital admissions are needed, and indeed the lower the risk of dying. Now Hong Kong people have always had and still have the ability to go from doctor to doctor, but the Hong Kong government has recognised the benefits of interpersonal continuity of care by introducing family doctor pairing. And if I read again from the Primary Care Blueprint, “I will have a self-selected family doctor with continuous follow-up who knows my needs best … and for the public, we will propose registering the family doctor as one of the prerequisites of joining CDCC and EHVC schemes”. When I visited a District Health Centre recently, I was able to observe family doctor pairing in action, with patients presented with a screen showing them a range of details of local doctors with some information about the services that they provide and able to choose which doctor to be paired with.

Finally, I want to talk about co-ordination and comprehensiveness because in this changing world, these are going to be challenges. The vision for the Hong Kong government is that District Health Centres are going to be the coordinating bodies for the wide range of professionals. This is an important new part of Hong Kong’s developing healthcare system but Family Doctors have and will continue to have an important part in co-ordinating the patient’s care.

As I come towards the end of this oration, let me mention four visionaries. The first is Sun Yat Sen after whom the oration is named. In 1892 he was one of the first graduates of the Hong Kong College of Medicine for Chinese which later became part of the University of Hong Kong. He only practised medicine for two years before he became a revolutionary, taking part in the overthrow of the Qing dynasty and he is now regarded as one of the fathers of modern China. A true visionary.

My second visionary is Dr. Peter Lee, founding President of Hong Kong College of Family Physicians, sadly no longer with us. I want to quote to you from the very first Sun Yat Sen oration which Dr Lee gave in 1989, called the ‘Human Face of Medicine’. If I may quote from his oration, you will see that his precise words could just as well have been spoken today. He said: “The age in which we live is unquestionably the age of high technology .... We have grown dependent on all manner of wizardy which our mothers and father would have struggled in vain to comprehend. The technological assistance readily at our elbows must not be allowed to diminish our appreciation of the whole patient as a subject calling for our human skills rather than an object for the employment of medical technology. The doctor who sees his patient as a whole person – who has known him in health as well as in sickness – is better placed to point out to him the road to recovery, to take his hand and even accompany him on his journey”.

My next two visionaries are more up to date and indeed both are in the room today. The first is Professor Cindy Lam. I have already quoted from Professor Lam’s description of the challenges facing Hong Kong doctors. In the same article she goes on to write “The traditional primary care team of doctors and nurses must expand to become a transdisciplinary team that includes physiotherapists, occupational therapists, dieticians, pharmacists, social workers, clinical psychologists, community volunteer workers and others, who can be readily accessible by the patient when a need arises. The team members need not work under the same roof, but they must have effective co-ordination and continuity of care.”

My final visionary is Professor William Wong, also from the Department of Family Medicine and Primary Care at the University of Hong Kong, a department with which I have the honour of being associated. Professor Wong, also writing the Hong Kong Practitioner – the College’s own journal in 2023 “Family doctors must ride on this unique opportunity to work together with the government to deliver the primary care reforms that will work for the people of Hong Kong. There may be many hurdles on the way, but I firmly believe family medicine and primary care will have a bright, brilliant future ahead”.

These are exciting times for Family Medicine in Hong Kong and I share Professor Wong’s optimism. But returning to the subtitle of my talk, artificial intelligence is going to change the ways in which you practice medicine. Looking again at the mottos of the UK and Australian Colleges of General Practice, Cum Caritas Scientia, AI is going to help you become better scientific doctors but will not replace the need for the care which we show to our patients every day. I think the AI-enabled doctor will, in Professor Wong’s words, have a bright and brilliant future.

References

1. Starfield B. Primary Care. Balancing health needs, services and technology. New York: OUP. 1998.
2. Runciman et al. CareTrack: assessing the appropriateness of health care delivery in Australia. Medical Journal of Australia 2012; 197: 100-105.