We are so vulnerable

We are so vulnerable when there is inequality of power.  Sadly, inequality of power is everywhere.

I saw a patient last week.  He was at a loss with his blood pressure condition.  He was diagnosed with “hypertension” and was given anti-hypertensive by an A&E doctor when he recorded elevated blood pressure after a heated quarrel with his wife.  He took the medicine and felt dizzy, with self-checked blood pressure of 90/60mmHg.  He did a follow-up appointment to GOPC and told the doctor about his hypotensive symptoms and his blood pressure readings.  Despite the confirmation of the reading of 90/60mmHg at GOPC, the attending doctor ignored him, told him nothing, and prescribed the same medication for him for another 6 months.

Inequality in power is the classical description of the doctor patient relation.  The doctor is equipped with the medical knowledge to diagnose and to treat, the skill to operate, and the license to prescribe controlled drugs.  If he so wishes, he is in the position to fully manipulate the patient, who becomes even more vulnerable when stroked with pain, and preoccupied by prognosis of his illness.

Unfortunately, inequality in power is not unique to doctors and patients.  Every time my clinic needs renovation, or when the air-conditioner fails, or when I hire a plumber, or whenever any service with special knowledge or skills is needed, I will have a taste of such inequality in power.

Regulation has been one of the solutions to partially address the problem of inequality in power.  The Medical Council is the regulatory body of doctors.  It fulfills its function by setting standards, maintaining registry, handling complaints and having the power to order disciplinary actions.  On the other hand, the Hospital Authority, as the largest employer of doctors in Hong Kong, regulates its employees mainly through administrative actions.  However, with the creation of such regulatory bodies, there comes a new set of inequality of power between the regulatory bodies and doctors.  

Inequality of power is everywhere.  What is important is to have checks and balances on the power, and proper routes of appeal and redress.  A specialist who is removed from the Specialist Register permanently because of a prescription error can lodge an appeal to the Court of Appeal.  A doctor who is prevented from doing operation by his seniors can write to every possible source and he can talk to the media every day.  We ask ourselves how useful such remedies are.  And we are so vulnerable.

As citizens, the most common inequality in power we face every day is the police.  To enforce law and order, the police is equipped with lethal weapons, and the power to arrest a citizen and to detain him.  The eternal debate, which is still going on, is how to strike a balance between effective law enforcement and abuse of power by police.  Of course, one of the factors for consideration is how much power the police is given by statute.  In September this year, the Government, through the Action Committee Against Narcotics, will launch a consultation exercise for a compulsory drug testing scheme.  Be it Compulsory Drug Testing Scheme, or Community Drug Testing Scheme, or by whatever fancy name the scheme is called, a major and controversial component of the scheme is to greatly increase the power of the police.  It is proposed that a police officer can, upon reasonable suspicion, require a citizen to go to the police station to carry out further testing, which includes a urine test for controlled drugs.  The targeted citizen can have no choice.  His consent is not needed.

The statutory position now is that the police have no power to force anyone for any reason to submit his urine sample for drug testing.  The reasons behind such “lack of power” or more appropriately “prohibition of such power” are manifold.  It protects the citizen against invasive search of his body.  More importantly, forcing (Yes, it is forcing.  The citizen cannot refuse, as he will be charged for failing to submit a urine sample, the punishment of which is the same as positive urine results.) the citizen to provide a urine sample which can incriminate him is against human rights.  

I wonder, what will be the use of compulsory drug testing when we all realize that drug abusers are turning more and more “hidden”?  They take drugs at home or at friends’ homes.  What is the chance of a police officer catching an abuser on the street?

I wonder, when the School-based Drug Testing Scheme is boosted as very successful and millions of dollars are pumped to launch more similar schemes at different schools, why is it necessary to introduce another totally different scheme?

I wonder, how easy it would be to trigger the subjective “reasonable suspicion”?  And, don’t be as naïve as to think that you can challenge the police officer’s findings on you.

I wonder, how can a police officer distinguish between drug abuse and alcohol consumption?  How can a police officer distinguish between drug abuse and psychiatric illnesses?  How can a police officer distinguish between drug abuse and the side effects of common medications?

I wonder, when I am at home, I open the door to answer a police office claiming to look into a complaint about noise, can he exercise his reasonable suspicion on me?

I wonder, how much should I wonder?

Paulo Freire, the Brazilian philosopher, claimed that: "Washing one's hands of the conflict between the powerful and the powerless means to side with the powerful, not to be neutral."  This new drug testing scheme will have drastic consequences on all of us.  We are facing enough inequality in power.  I decide to spend some time to go through the consultation document in detail and to give my comments.  Do you still choose to remain neutral?

(Source: HKMA News September 2013)