As time goes by, the year 2010
marks the 90th Anniversary of the HK Medical Association. There will be a series of activities to
celebrate this big event. The Charity
Concert on July 31, 2010 will mark the beginning of these activities while the
Annual Ball on December 31, 2010 will be the finale. Other activities include sports events (the
HKMA 90th Anniversary Cup), singing contests, public education
events, recreation and cultural activities, and the production of souvenirs. It is my
honour to be
responsible for the production of the Commemorative Publication. If you have any documents or photographs
related to the history of the HKMA and would like to share with others,
please kindly send them to the Secretariat (Ms. Candy YUEN).
Your precious memories might appear in the Publication.
As time goes by, this is the
third year I have been serving on the Action Committee Against
Narcotics (ACAN). The medical profession
and the HKMA have always been supportive in beat drugs activities. In response to the need to consolidate beat
drugs activities organized by the HK Medical Association, the Beat Drugs Action
Committee (BDAC) was formed in March 2010. It aims at strengthening the role of doctors
in the team work of prevention and management of drug abuse problems in Hong
Kong. Activities organized by the BDAC
include school talks, public education, CME lectures and workshops for doctor
training, group therapy programme with drug abusers, and cooperation with other
organizations and professions in the prevention, treatment and rehabilitation
of drug abusers. Another piece of good
news was that the BDAC had successfully applied to be the beneficiary of the 90th
Anniversary Charity Concert.
As time goes by, it is becoming
more and more difficult to be a doctor. It
is becoming more and more difficult for a doctor to realize, to understand, to
accept and then to follow the decisions of the Medical Council so as not to
find himself being charged misconduct in a professional respect. The recent area of concern is the prescription
of steroids. In this issue of the News, the
Special Feature section from JSM talks about the pitfalls in the use of
steroids. I think this article is in
response to a recent decision of the Medical Council. The agreed facts of the case were that a
family doctor diagnosed an adult patient having acute bronchitis and gave him
three days of celestamine (one tablet four times a day). He was found professional misconduct not
because of his failure to justify the use of steroid. The charge was that he prescribed to the patient celestamine that
contained steroid without informing the patient of the fact that celestamine
contained steroid.
It was a strange charge. It stated that if you gave steroid to a patient,
you must tell him the fact that steroid was given. It did not matter whether the patient asked
for it or not. You must volunteer this piece of information.
Otherwise, it was professional
misconduct. And this was exactly the
case. Apparently, the patient did not
ask anything about the medication. He
just disappeared after receiving the medication and then complaint to the
Medical Council. Then the outcome was
that the doctor was found professional misconduct.
Steroid is a potentially harmful medication.
There can be very serious side effects
to the patient especially when used in high dose and in prolong use. Doctors have the duty to explain clearly to
the patient about the indication, the side-effects, the precautions and the
alternatives to the use of long term steroid. This is the respect of patients’ rights to
choose and to have information before consenting to treatment. This should apply to all kinds of treatment. The more serious the side effects are, the
more information should be given and more time should
be spent on
discussion. The relevant
provision in the Code is Section 9.6, which stipulates “Where a drug is commonly known to have serious side effects, the
doctor has the responsibility to properly explain the side effects to the
patient before prescribing the drug.”
Having stressed the importance of
patient protection and the respect of patients’ rights, one must also agree
that misconduct in a professional respect is a very serious allegation to the
doctor. Being found professional
misconduct would certainly affect the doctor’s good name. The guilty doctor can also be removed from the
general register and his livelihood being affected. He might have difficulties in his application
for restoration to the register. He is not
eligible for the election to be a council member of the Medical Council. In this case, it should have been the duty of
the Medical Council to prove that the use of three days of celestamine with the
said dosage on an adult patient could cause serious side effects to the extent
that the doctor was obliged to volunteer information concerning its use. However, it seems to me that the judgment
imposes a strict liability on doctors to volunteer information including
side-effects on steroids whenever they are used irrespective of circumstances
and justifications. Naturally, many
questions would arise in doctors’ mind. Is
this good development in the control of doctors’ practice and conduct? What are the harmful effects of three days
steroid on an adult? How about other
medications such as antibiotics, NSAIDs, hormones and symptomatic treatments? Do doctors need to volunteer information on
the use of these potentially harmful medications? What make steroids single out in medications? How about the omission of the use of steroids
when there is an indication for their use? Do doctors need to volunteer information for
not using steroids?
As time goes by……
(Source: HKMA News April 2010)
