The landscape of family medicine

King-hong Chan 陳景康

HK Pract 2015;37:1-2

The landscape of family medicine (FM) is changing rapidly. With its development as a specialty since 1993, we step into the 21st year as a member college of the Hong Kong Academy of Medicine (AM) this year. We have over the past years mounted up approximately more than 400 AM fellows, increasingly more trainers than trainees, and progressively more conjoint examiners. Changes in patient landscape are not limited to demographics. In particular, access to medical knowledge is at patient’s fingertips, patients can google for answers as we doctors speak. Younger doctors too differ from the past, veering for a balanced lifestyle rather than having to work for long hours. We are now seeing more part-time doctors than ever before. While family physicians are becoming more qualified and deeper in their knowledge, are we preparing our next generation FPs for the coming future?

Indeed, what is the future of family medicine in Hong Kong? One learning point from GP14 held in Adelaide in October 2014 last year may provide some hints: some typical areas of service development in Australia are 1) preventive medicine, 2) acute exacerbation presentation, 3) chronic disease / multi-morbidity care planning and management, and 4) palliative care conditions. If we in Hong Kong are also seeing an aging population, increasing burden of chronic conditions & multi-morbidity, and a rising population of cancer survivors, perhaps we should look into similar lines as in Australia.

Taking common chronic conditions for a start, we have developed care-models for hypertension, diabetes and COPD in recent years. As these care-models on stabilised chronic conditions become well established, we have an unfulfilled role to play in enhancing care on acute exacerbation of these conditions. As majority of primary care patients with chronic disease have multi-morbidities, so we will have to develop primary careled models to improve multi-morbidity care planning to avoid siloing of care, poly-pharmacy, adverse drug reactions and heavy treatment burden for patients. Turning to cancer care as another example, we have an increasing important role to play in its detection, diagnosis and treatment. As cancer screening improves, we move on in facilitating uptake of cases, which can be enhanced using office prompt system and augmented by audit and feedback systems. As cancer symptoms become better understood, we have risk models to identify patients requiring investigation and fast track referrals. As treatment is becoming more effective, developing primary care-led follow up of breast and colonic cancer survivors, patient may be better cared for in the community and healthier gatekeeping to hospital service may be achieved.

GP with specific interest

If we would follow the steps of the Australian college close enough, we too could develop care models and a body of knowledge within primary care, with our new generation family physicians more apt to the evolving landscape of family medicine in Hong Kong. “GP with specific interest” is becoming a common language within the Australia system. Albeit a different healthcare structure, it stands to reason that heading in the same direction is a matter of time in Hong Kong.

The landscape of family medicine in Hong Kong is indeed progressing rapidly, the challenge would be for each of us, our current family physicians, to get prepared, and more importantly for the College to take up the pivotal role of directing the preparation for our next generation family physicians for the age to come.