False Diagnosis

There is no bigger fan of the quality of medical care in Hong Kong, including in our public hospitals, than yours truly. Around a year ago my life was saved by being admitted promptly to hospital, on my GP’s insistence, to deal with a mystery infection: the first blood test was for necrotizing fasciitis, commonly known as flesh eating disease, luckily for me negative. And 15 years ago when my unborn son was diagnosed in the womb with a life-threatening illness, an emergency caesarean operation followed 20 hours after birth by brain surgery rescued him from a disabled future (or in the worst case, no future at all). You should see him now.

So naturally when the subject of reform of the Medical Council was discussed on a radio show I co-host every week on RTHK, I came into it from an angle basically supportive of the doctors. But after a thorough debate on the matter, characterised by civilised discourse and mutually respectful remarks, I realised the story is not so simple.

The membership of the Council at present comprises 28 persons, 14 elected and 14 appointed by the Chief Executive. Of the 14 elected, all are doctors, of whom seven come from among members of the Hong Kong Medical Association (in essence, the doctors trade union) and seven from among others in the profession who are not in the HKMA. A private Members Bill, proposed by Tommy Cheung from the catering industry functional constituency, which the government has decided to support, proposes to add four more lay members to the Council.

At first sight that seems to be unfair to the doctors as it upsets the balance between elected and appointed members and indeed the HKMA representative claimed this would undermine professional autonomy. But on closer inspection it turned out that no fewer than 10 of the 14 appointed members are themselves doctors, and the CE does not actually get to choose them. Five organisations each have the right to nominate two persons. The five are Hong Kong University and Chinese University (which each have a medical faculty), Hospital Authority, Academy of Medicine and the Department of Health. The key point here is that all 10 must be doctors. Therefore even if the proposed changes go through, this will not put lay members in charge of professional standards, it will simply alter the current ratio of 6:1 to 3:1 with medical personnel still very much in the majority.

In deciding to support the Bill, the government said it wanted to improve the mechanism for complaint investigation and disciplinary inquiry. There was also a case for reviewing how the council approaches the issue of non-locally trained doctors. These are two sore points as far as the community at large is concerned. There is a perception -- possibly an unfair one – that the council takes too long to investigate complaints and is in general over protective of doctors’ interests. There have been some high profile cases reported in the media which took years to reach a conclusion. The additional lay members will help cases be dealt with more quickly. Most doctors would prefer to see the delay issue addressed so that it does not reinforce the impression of institutional bias.

It is the second aspect which catches the eye, and which led Cheung to introduce his Bill. He has been quite open about his interests and has declared them publically: he has a daughter and a son-in-law who both qualified as doctors in the USA and both practice there. They want to come back to Hong Kong to work here, but have run into the buffer of the protectionist wall that the Medical Council has thrown up to deter (not prevent) them, and others like them, from doing so. We don’t need to go into the detail about how this is done, suffice to say it is the result of present policies and procedures. At a time when Hong Kong is suffering from a shortage of medical personnel, it is clearly wrong to be obstructing professionals coming from some of the toughest jurisdictions in which to qualify. A doctor who could treat President Obama is certainly qualified to treat Madam Wong from Wongtaisin. A review is long overdue.

Sorry doctors, much as I respect you all, your opposition to the changes does you no credit. You have misdiagnosed this one: open wide and take your medicine.