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About HKCFP > President’s Message

February 2018

Recently I received a letter from the Social Welfare Depar tment on “Obser vations by the Child Fatality Review Panel on Promoting Careful Prescription of Codeine for Paediatric Patients”. In br ief, the fatal case concerned a 17-month-old girl presented with upper respiratory tract infection. She visited a private medical practitioner and revisited the clinic again attended by a locum doctor as the former doctor was on leave. Two days later, she was found unresponsive while taking a routine afternoon nap in a nursery.

Although the girl appeared to be normal in the morning, she passed away in the same afternoon. Autopsy and toxicological examination did not reveal much significant findings and the cause of death could not be ascertained. It was during the death inquest that came to the attention of the locum doctor that Codeine was contained in the Actified syrup preparation prescribed and dispensed while another bottle prescribed by the locum doctor also contained Codeine!

Though the cause of death in this case could not be ascertained, the Child Fatality Review Panel has concern over the prescription of cough suppressants containing Codeine to children under 12 years old. Codeine is an opioid prescribed for pain relief but is also combined with other medications,such as cough and cold medicines. However, there is lack of evidence to support an effective role for Codeine in children with acute cough, and in light of potentially harmful adverse effects, Codeine should not be indicated as an antitussive medication.

Codeine is converted by the liver into morphine, but genetic differences between people can prompt the liver to create too much morphine in some and too little in others. Children who rapidly metabolize Codeine into an overdose of morphine can experience severely slowed breathing rates and may even stop breathing and die as a result. It should not be used even as analgesic in children because it is too unpredictable. The American Academy of Pediatrics has recommended against prescribing Codeine to children since 1997!

Another letter that I have received was from the Hong Kong Red Cross Blood Transfusion Service. The Medical Director had presented to the Council of Hong Kong Academy of Medicine back in November 2017. An alarmingly high donor deferral rate (12.3%) among prospective donor in 2016 was mainly due to low preonation haemoglobin and mostly due to iron deficiency. As expected, the problem is worse in female donors but also happens in new donors as well. Of course we are at the frontline to raise the awareness of iron deficiency  anaemia and its management. We can certainly work on the following few areas. Firstly, improve the health of general public through better diet education on iron absorption and better managing iron deficiency anaemia especially among the menstruating ladies who are potential blood donors to bring their iron store back to normal. Secondly,pport the blood donation through active participation and correction of myths in the general public. Thirdly, participate actively in different Patient Blood Management initiatives to drive better patients’ outcome at reducing transfusion rate.

Hong Kong Academy of Medicine has done a survey on “Eligibility to Stand and Nomination Mechanism for Election” to potential seats in the Hong Kong Medical Council. A total of 7,572 questionnaires were sent out and 1,906 (25.2%) replies were received. 24% of our AM fellows in Family Medicine have responded and their views are very similar to the overall figures. I will certainly act according to the majority view of our Fellows.

The purpose of the survey was to collect views from Fellows on three aspects:

1) Eligibility to stand for election- A majority of Fellows (75%) agreed that no prerequisite requirements or conditions would be needed for the two seats.

2) Nomination mechanism- The majority (83%) considered that the candidates should be nominated by all Fellows directly, not via the Colleges nor by other means.

3) Means of election- Most of the respondents (93%) agreed that the two additional seats should be elected by all Fellows, but not via the Academy Council nor by other means.

Lunar Year of Dog is fast approaching. Dog is the eleventh of all zodiac animals. Dogs are loyal, honest, amiable and kind, cautious and prudent. Having a strong sense of loyalty and sincerity, dogs will do everything for the person who they think is most important. All sounds very familiar of Family Doctors doing the best for their Patients. Kung Hei Fat Choy and a prosperous and rewarding Year of Dog!

Dr. Angus M W CHAN