Happy New Year

It’s December.  Merry Christmas and Happy New Year.

You will find a Christmas and New Year gift going with the HKMA News in this issue.   It is a diary and log book from the CME Committee tailor-made for doctors.  It contains useful information like hospital telephone numbers, and practical tips for safe practice from the Medical Protection Society.  Most importantly, there is a schedule of CME activities for family doctors for the upcoming year, featuring the newly introduced family medicine seminars on a Sunday of each month.  You will surely find these seminars very interesting and useful.  At the end of 2009, you will also find yourself one big step nearer to get a Certificate of Family Medicine.

It is tradition to review events of the past year.  The following are some major medically related events that come across my mind:

Dr. KWONG Kwok Hay v. the Medical Council of Hong Kong

On January 24, the Court of Appeal handed down the judgment and confirmed that some of the sections of the Code of Practice were against basic human rights.  This had great influence on the dissemination of information by doctors including advertising, and the investigation and inquiry for professional misconduct by the Medical Council.

Health Care Reform

On March 13, The Food & Health Bureau published a Healthcare Reform Consultation Document entitled “Your Health Your Life” to seek public views on the healthcare system and financing arrangements.  The first stage of public consultation ended on June 13.  The community generally agreed that increased resources should be best utilized to enhance healthcare services.  However, there were contentious and skeptical views about the supplementary financing options. 

Sichuan Earthquake

On May 12, a magnitude 8.0 earthquake occurred at 14:28 in Sichuan province of China: the “Great Sichuan Earthquake”.  From official figures, 19,065 school children died, and there were more than 90,000 deaths or missing.  The Hong Kong Medical Association and the Hong Kong Medical Association Charitable Foundation Limited launched fundraising appeal without delay.  Many doctors of different specialties also volunteered to work at various sites.

2008 Olympic and Paralympic Equestrian Events

Hong Kong was privileged to be a co-host city for the Beijing Olympics in August.   Led by the Director of Health, Dr. P Y Lam, who was also the Chief Medical Manager of the Equestrian Event, a 2000-strong medical professional team fully supported the events.  The medical team had set up contingency plans to deal with various emergencies like infectious disease outbreaks, poisoning, mass casualties and disasters.

2008 Legislative Council Election

On September 7, the election battle finally ended after months of campaigns and forums.  Dr. K L LEUNG was elected for Medical Function Constituency.  He received 2,217 votes for approximately 33%, defeating the other three nominees.

Melamine Scandal

On September 11, Mainland’s Sanlu brand of infant formula was found to be contaminated with melamine.  Screening reviewed over thousands of babies across the country who developed urinary problems after consuming tainted milk powder.   On September 20, the first case of renal disease associated with contaminated milk product was reported in Hong Kong.  On October 11 & 12, affiliates from the Hong Kong Medical Association visited Guangzhou and Jiangmen to examine the conditions and to study the management of children suffering from renal stones.

 

World Economic Turmoil

Starting with the federal takeover of mortgage finance giants Fannie Mae and Freddie Mac in early September, there were unfavourable occurrences all around the world.  Lehman Brothers filed for bankruptcy protection and the mini-bonds issued were affected.  Doctors themselves suffered financial loss and some might be emotionally disturbed.  At the same time, we need to look after patients and addressed effects from the economic turmoil.

Policy Address 2008-2009

The Policy Address 2008-2009 was delivered by our Chief Executive on October 15.   Under the heading of “Healthcare Reform”, there were four main categories: consultation, promoting the development of private healthcare, district medical facilities and enhancing primary care services.

Influenza Vaccination Subsidy Scheme

On November 1, the Government launched the Influenza Vaccination Subsidy Scheme.  This was the first implementation that the government roped in private doctors to help in prevention measures of the community.

Avian Influenza

On December 8, the Food and Health Bureau confirmed that up to 60 chickens died from H5N1 viral infection in one chicken farm in Yuen Long.  Again, we will have no chicken for New Year.   

My Big Ten might not go with yours.  Year 1 students might find their admission to the Medical School memorable.  2008 is the year for more than two hundred new housemen and new registered doctors.  Some doctors passed part or all of their fellowship examinations.  Some doctors got married.  Some gave birth to children.   And sadly, some of us had to separate with our beloved ones.

The biggest event for my signature bear is the co-organizing of the Certificate Course in Family Medicine with the Chinese University of Hong Kong.  The kick-off seminar will be held on January 18, 2009.  Your diary will also serve as a log book for recording your attendance of the family medicine core seminars together with other CME activities.

 (Source: HKMA News December 2008)

Keep the Change......

A great change has come to America in November.  On November 6, 2008, Barack OBAMA was elected US President.  OBAMA, a first-term Democrat, defeated his Republican rival, John McCAIN, with 52.5% and 46.2% votes respectively.  The President Election day attracted a voter turnout of 64%, a high level unseen for a century.  And, OBAMA was the first black man elected US president.  “It’s been a long time coming, but tonight, because of what we did on this day; in this election, at this defining moment, CHANGE has come to America,” said OBAMA in his victory speech.

Ever since OBAMA announced his candidacy for President of the US in February 2007, it had been addressed by the press and the media that, “Something is happening.”   During the movements for the past 21 months, OBAMA’s platform rested upon tremendous change in the United States and the establishment of a new path for the American government.  His election campaign, his speeches and his weblog were all highlighted on change: “It’s About Time… It’s About Change…”  As reported by the New York Times, he identified the issues of rapidly ending the Iraq War, increasing energy independence and providing universal health care as his top three priorities.  

Doctors might be a bit more interested in health care issue.  On January 24, 2007, OBAMA spoke about his position on health care at Families USA, a health care advocacy group.  He said, "The time has come for universal health care in America…. I am absolutely determined that by the end of the first term of the next president, we should have universal health care in this country."  OBAMA cited cost as the reason why many Americans did not have health insurance.  He proposed to provide affordable health care for all Americans.  This would be paid for by insurance reform, cost reduction, removal of pharmaceutical patents, and requiring employers to provide insurance coverage or to contribute to a new public plan.  For those not insured through employment, he proposed a National Health Insurance Exchange that would include both private insurance plans and a government-run option.  Coverage would be guaranteed regardless of health status, and premiums would not vary based on health status.  Mandatory health care insurance for children would also be provided.

In Hong Kong, we also face changes in the medical environment.  The first stage of the public consultation on healthcare reform ended on June 13, 2008.  Chapter one of the Healthcare Reform Consultation Document entitled “Your Health Your Life” spelled out “The Need for Change”.  Correspondingly, the ending of this chapter emphasized that “the time for reform is now….”

On June 13, 2008, Dr. York CHOW, Secretary for Food and Health, said in the press release that: “The consultation showed that the public generally supported the healthcare reform proposals, including enhancing primary care, promoting public-private partnership, developing electronic health record sharing, and strengthening existing public safety net.”  However, healthcare financing was not mentioned, except that: "To the public, a major concern is what kind of healthcare protection they can gain by contributing to a financing option."  Regarding service reform, Dr Chow reported that there were three areas drawing great public concern: “how to further upgrade public healthcare service quality, resource management and cost-effectiveness to ensure the public healthcare system can continue covering the public's basic health needs, particularly the disadvantaged; how to ensure fees paid by the public for private healthcare services and health insurance are value for money, including upgrading the private sector's charging mechanism's transparency and boosting service quality monitoring; and, how to ensure both the software and hardware of the healthcare system can meet future rising demand, including training of healthcare professionals.”

Another important document which talked about changes was the Policy Address 2008-2009.  This was delivered by our Chief Executive on October, 15 2008.   Unexpectedly, the focal point of discussion was the introduction of a means test for candidates eligible for the raised Old Age Allowance.  The public reaction was overwhelmingly negative.  Around 60% of respondents fought against the means-testing option.  On October 24, 2008, a week after the delivery of the Policy Address, our CE modified his original proposal by shelving the idea.  Again, as doctors, we might be more interested in medical related issues of the Policy Address.  It seemed that the focus was on “Healthcare Reform”, which was one of the three titles under “Care for the People”. “Healthcare Reform” covered four areas: “Consultation”, “Promoting the Development of Private Healthcare”, “District Medical Facilities”, and “Enhancing Primary Care Services”.

On October 16, 2008, a meeting was held by the HKMA with Dr. the Hon. LEUNG Ka Lau to discuss the Policy Address.  Much concern was expressed on how the government was going to enhance primary care services.  According to the Policy Address, a “Working Group on Primary Care” would be set up “to introduce basic primary care service models focusing on preventive care and a primary care register based on the family-doctor concept.”  A primary care delivery model -the “community health centre”- would be explored “to coordinate the efforts of different service units in the delivery of primary care services.”  Would these lead to further expansion of services provided by the government against the private market?  Would these policies favor HMOs and large group practices?

Are changes always necessary and good?  Well, it’s about time; and it’s about change……

(Source: HKMA News November 2008) 

Some thoughts in Black September

The two pieces of breaking news in September were the collapse of Lehman Brothers and the melamine-tainted milk scandal in China.

On September 15, Wall Street bank Lehman Brothers filed for bankruptcy protection.  Then Merrill Lynch sought refuge by selling itself to Bank of America.  Subsequently, insurance giant AIG called for emergency funding from the Federal Reserve Bank of New York.  On September 28, European bank giant Fortis was partially nationalized.   This was followed by the nationalization of the mortgage lender Bradford & Bingley in Britain the next day.

These stunning series of global financial turmoil had great influence on us.  Apart from the “free-fall” in the stock market, thousands of retail investors, many of whom were ordinary citizens, were at the edge of losing their lifelong savings through holding the so-called low risk “mini-bonds” issued by Lehman Brothers.  Another event showing the shaky emotion of Hong Kong citizens was the bank run on September 24 after rumor was spread via Internet and mobile phone messages about the financial stability of a local bank.

Some citizens had query on the fundamental philosophy of saving and investment.   There was growing mistrust in banks and insurance companies.  Could fund managers or investment banks look after our wealth better than we did while investment banks like Lehman Brothers could go bankrupt?  How did “wealth managers” in local banks be ensured to discharge their fiduciary duties when they lived on commissions from selling “mini-bonds”?  What would people who joined the bank run do with their lumps of cash?  Could anyone say that he was wiser to invest in “mini-bonds” than the conservatives who put their cash or gold bars in moon-cake tins in the old days?  Should citizens be forced to invest through Mandatory Provident Fund Schemes?  Should our newer generations be allowed to keep money notes inside cookie tins?  What would be the impacts on the forthcoming Supplementary Healthcare Financing?

On September 11, Mainland’s Sanlu brand of infant formula was found to be contaminated with melamine.  Chinese babies across the country developed urinary problems, mainly stones in the urinary tracts after consuming tainted milk powder.  Screening reviewed over thousands of babies being affected.  There were young victims with renal stones after consuming tainted milk powder for as short as two months.  Then, many other brands of milk powder and products with milk-derived ingredients were detected to contain melamine.  Melamine is an industrial chemical used for the production of melamine resins.  It was postulated that melamine was added illegally to the milk products so as to past the quality test for protein content after the milk was diluted with water to increase profit.  In this issue, we have reports from the Association’s delegates who visited Guangzhou and Jiangmen to study the conditions and the management of children suffering from renal stones.

In Hong Kong, the Centre for Food Safety (CFS) was closely monitoring the situation.   Batches of dairy product samples had been collected for melamine tests throughout the weeks.  Dreadfully, unsatisfactory samples of dairy products (frozen confections, chocolates, milk beverages, cakes etc) had been announced one after the other.   Apart from condemning the malpractice in China, this incident was an illustration of the importance of food hygiene and food safety.  Suddenly, a wild thought came across my mind.  Would it be advisable for the Food and Health Bureau to consider providing hygienic and healthy food to the public at minimal cost with heavy subsidies from the government?  Would this better guarantee the quality of food supplied to citizens?  Should public canteens be built to serve guaranteed and nutritious breakfast, lunch, snacks and dinners to all Hong Kong citizens at perhaps two dollars per meal?  No one would then be deprived of the availability of quality and hygienic food.

Readers might immediately disagree with this suggestion, as foreseeable harms would much outweigh foreseeable benefits.  A large bureaucratic body needs to be created.  There would be high administration costs for running this specific governing body.  The operation costs, together with the subsidy for food and running costs, would place heavy burdens on taxpayers.  There may also be an increase in wastage by users due to the perceived minimal cost.  Moreover, unfair competition may lead to a gradual decline in the number of private restaurants.  The most essential point is the fact that the government’s public canteens will still encounter the same problem of quality control and food safety as before.  Hence, the only outcome is to replace free market by a distorted monopolized market.

Then what do you think about a hospital authority that insists on looking after nearly all kinds of health problems of the public at minimal cost?  You can read about the thoughts of Dr. CHOI Kin, Dr. SHEA Tat Ming and Dr. SHIH Tai Cho on this problem from the interviews in this issue: The 3 Ex.

(Source: HKMA News October 2008)

From the Editor

For the past few months, over hundred nominated candidates vigorously fought for 60 seats in the Legislative Council for a four-year term of office from 2008.  After copious numbers of election campaigns and canvassing efforts over a long period of time, the battle finally came to an end on 7 September 2008.  Dr. LEUNG Ka Lau won his seat in the Medical Functional Constituency.  He received 2,217 votes for approximately 33%.  (Dr. HO Pak Leung - 2,138 votes; Dr. KWOK Ka Ki - 1,869 votes & Dr. YEUNG Chiu Fat - 580 votes).  For other doctors taking part in the election, Dr. PAN Pey Chyou was elected uncontested in one of the three seats of the Labour Functional Constituency.  Dr. SHIH Tai Cho and Dr. LO Wing Lok, two nominated candidates from Hong Kong Island geographical constituency, did not succeed in the election.

As the new Editor, I mentioned in the last issue that I would like to add some new elements into the HKMA News.  Here, I am going to get started with a special feature: “Interview with Dr. LEUNG Ka Lau”.  Based on the new insight about the functions of a bridge, I intend to provide readers a chance to view Dr. LEUNG from a different angle.  I invited Dr. LEUNG for an interview straight after the Legco election.  Preparation time was very short (3 days).  My original plan was to allow interviewees to choose the restaurant and food they felt affection for, as I believe in the old saying “You are what you eat”.  However, the prior arrangement of this interview was so tight.  I then decided to dine with Dr. LEUNG in the Association (Wanchai) Club House.  This was surely a good choice, as it provided an opportunity to promote our Club House.  Arranged by Mrs. Yvonne LEUNG, our Secretariat CE, a special menu was designed for Dr. LEUNG so as to feature Chef WONG’s signature dishes.  A special note of thanks should also be given to Dr. Amy PANG, an award-winning professional photographer, to take photographs for us.  

Initially, I planned to give my “signature bear” to Dr. LEUNG as a souvenir.  My bear’s hands were tied by a stethoscope, signifying the constraints faced by family doctors in the practice of medicine in HK.  After the interview, I changed my mind.  I took away the stethoscope and wished that Dr. Leung’s hands would not be tied in the coming four years.  And a bear with the wordings “More Than Words” on its foot was chosen to reflect our wishes.

Another observation after the interview was that there was much room for communication between Dr. LEUNG and family doctors, and we should put more effort in this aspect.  It was clearly brought up in Food and Health Bureau healthcare reform consultation document “Your Life Your Health” that Family Medicine should be promoted.  However, we have great uncertainties about what will be done.  Concerning this matter, the HKMA CME Committee is working on a new task.  We are restructuring our “Continual Medical Education Programme for practising doctors who are not taking Continue Medical Education programme for specialists”, the official name that I hate to refer to.  Let’s refer to it as CME for family doctors.  Core module with seminars and workshops on family medicine would be provided.  Participants are encouraged to take all the seminars and workshops in the core module in a three year cycle.  Together with other activities concerning different specialties attended, these CME records are kept in a portfolio provided by the HKMA.  This serves as evidence of CME activities and some basic training in family medicine.  

At the end of August, the Beijing Olympics 2008 ended with massive viewership.   China’s Olympic tally (51 Gold; 21 Silver; 28 Bronze; 100 Total) solidified its status as a sports powerhouse.  In this issue, we have several articles talking about the Beijing Olympics.  Our Past President, Dr. CHOI Kin presented his unique view on the closing, while our Council Member, Dr. LI Sum Wo reported on the opening.  Dr. CHAN Man Kam, also our Council Member, shared with us his feelings on the Olympics in poems, joining the increasing number of poem-writers in the News. 

(Source: HKMA News September 2008) 

From the New Editor

It is my pleasure to be appointed Editor of the HKMA News for two years.  Interestingly, the first batch of things that come across my mind are the Emergency Council Meeting and another midnight meeting in a hotel lounge to discuss the threat of suing the Editor for defamation, and reprimanding the Editor for disclosing confidential information by the Medical Council respectively.  I can reassure readers that it is just coincidence to find both the new Editor and Deputy Editor law degree holders.

The next things I think about are the functions of the HKMA News, which directly relate to my role as the Editor.  I always think that the HKMA News serves as a bridge between the Council and our members.  A bridge is basically a structure spanning and providing passage over a gap or barrier.  It might not be the shortest or fastest route, as internet can now serve this purpose better.  But it is one of the convenient routes which can provide large flow of important information.  The bilingual Message from the President contains unique viewpoints from our president on important issues, and usually stirs up echoes and heated debates.  Council Section reports news from the Council, which includes activities attended by Council Members (Busy Month) and questions answered by our Duty Council Members.  Committee News always features beautiful pictures and reports from our various committees.  Upcoming events and activities of other medical organizations are found in Notice.  Members Section updates the status of our membership.  Much information is also provided by the Classified Advertisement and Membership Reminders.  Forum is the section looked for by most members when they receive the News.  It contains viewpoints contributed by our members, some of which you have never thought of.  Leisure Corner is relatively new.  It contains articles, photos, drawings, etc from members which are not as serious as those in the Forum.  Three other relatively news sections are Special Feature from JSM writing on medical legal issues (I love this section!), Legislative Councilor’s Monthly Report from our diligent Legco Member, Dr. Kwok Ka Ki, and the HA Section, which only shows up sporadically.

But that’s now all for bridges.  During my visit to RCGP in UK, I came across many bridges, both in London and in Newcastle Upon Tyne. One of them gave me new insight into bridges.  This was the Kew's Rhizotron and Xstrata Treetop Walkway in the Royal Botanic Gardens, Kew, London.  It is 18-meter high in the sky, among the trees, to provide visitors chances to get a closer look at the treetops.  Thus a bridge can serve another function of providing a chance to look at things from a different angle.  I am thinking about to develop a new section in the coming issues featuring interviews.  I am sure it can provide readers an objective way to look at people familiar to them from another angle.

Moreover, bridges are seldom unidirectional.  A more convenient way of communication from readers to the Editorial Board is now in place.  You can e-mail to us at editor@hkma.org for any comment on any section of, or any issue concerning, the News.  I shall try my best to look into them or to publish some of them in the following issue.

Finally, one cannot leave without talking about the upcoming 2008 Legislative Council Election (while our President and Immediate Past President both write on this topic).  What directly relates to us would be the one member returned from the Medical Functional Constituency.  There are four candidates and 10606 registered electors.  No matter who is elected, I foresee than he will have a hard job.  Apart from facing the difficult (and eternal) issues of imbalance between HA and the private sector, the healthcare system reform, HMOs, the increased number of medical students…., he needs to work very hard because he has got a very good precedent.  In the past four years, Dr. Kwok Ka Ki has been very diligent and doing very well as our Legco Member.  Please remember to vote on September 7, to give KK another chance to continue his performance, or to give a hard job to the one you choose to represent us. 

(Source: HKMA News August 2008)