During the holidays I went to
Chimelong Amusement Park in Guangzhou again. Yes, again.
As I like that Park. You can walk
along in the Zoo and have close contact with quite a numbers of animals. You can get a very close look at twenty odd pandas,
a much closer look than in the Chengdu Panda Base, though you cannot pay 2000
dollars to take pictures with them. You
can also visit the 3 newborn panda triplets. Maybe they are not quite happy with their
funny new names, they are asleep most of the time. For other animals, you can get into contact
with them. There are elephant rides, koala
petting and animal feeding. I like feeding
giraffes most. They fancy a certain type
of leaves. You can attract them by
waving that kind of leaves only. While
it grabs the whole branch with its long tongue, you have ample time to take
close-up pictures of its long eye-lashes.
During night time, there was nothing
else to do except watching the International Circuit show. Actually the show was great and well
organized. You must not miss it. However, it might not appear as interesting
after you had watched it a few times. So
in the intervals between pop corns and whatsapp messages, I began to notice
some not-as-big-and-interesting events in the show. There were athletes jumping from a wall and
then bouncing back from a trampoline repeatedly. That looked like cartoons and was quite funny.
My sister thought that there was no
difficulty in it. I recalled my high
school days when I struggled clumsily on a trampoline and nearly broke my neck.
Many things are easier watched
than done. General practice is no
exception. I have been in general
practice for more than 2 decades. Academic-wise,
I am not as bad as my trampoline skill. I
still find general practice far from easy. Laymen, or even some colleagues, might think
that general practice is seeing URTIs. Well,
yes. General practice involves many
URTIs, especially in Hong Kong. However,
among the URTIs, there are a few lung cancers, a few serious pneumonias, a few
heart failures, and more asthmas than you expected, and once in a while, even a
fatal syndrome we have never encountered, which was later named as SARS. And sorry, I have to correct you that general
practitioners are not seeing URTIs. We
are seeing patients with URTIs. We see
patients. Among the patients with URTIs,
there are patients with hypertension, patients with diabetes, patients with
hidden colonic cancers, patients with depression, and once in a while, a
patient with a rare disease that the professors in the 2 Universities have
never encountered. The scope of general
practice is too large. We are expected
to know a bit of everything. But that “a
bit” is the essential bit to recognize early sinister conditions, to keep our
patients healthy, and to relieve their immediate sufferings.
People like to talk about the
importance of primary care and general practice. Do they realize that general practitioners are
fighting a deem-to-lose battle everyday? Each and every of our patients will eventually
develop one of the diseases that we are assumed to prevent. There is no end point in preventive medicine.
How about the government which
has been the biggest lip-service provider in primary care? Do the officials know primary care? Do they have a fair and accurate assessment of
the importance of general practitioners? Hong Kong is proud of the longevity of its
citizens. This fact often serves as
evidence of the success of the Department of Health and the Hospital Authority.
The role of general practitioners is
never mentioned. It is estimated that
general practitioners are seeing around 100,000 patients a day. Some of them are working 7 days a week, and most
of them more than 350 days a year.
On the contrary, the importance
of general practice is often undermined, and general practitioners are openly
attacked. Vaccination is considered a
purely mechanical procedure and can be done by non-healthcare personnel with
minimal training in injection technique. For a proper consultation, explanation of
vaccination, consent signing, injection of vaccine and the taking care of any
adverse reactions, a fee of $50 is paid by the government. It has been hinted that it is a generous sum.
Another example: the Healthcare
Voucher Scheme. I am not going to repeat
how absurd it was to focus on accusing general practitioners overcharging
without any solid evidence. No one was
interested in investigating such matter. No one was found overcharging and punished. But the names of general practitioners were
not cleared either. What I wanted to
remind you was the stated objective of the Scheme. It was announced at the beginning and then
reiterated in the first review that the Scheme served to encourage routine body
check. General practitioners were
frowned upon for not achieving this mission impossible. While most of the elderly were struggling with
acute anomalies, they were expected to use the minimal sum of $250 for body
check. There was no added resource or facility
to cater for those screened positive.
General practitioners are trained
to modify behavior. The gist of primary
care rests on behavior modification. People
are encouraged to live health life styles, to vaccinate, and to look for early
signs and symptoms of serious illnesses. Behavioral modification is never easy. The government has spent lots of money to promote
vaccinations, to promote smoking cessation, to encourage regular exercise, and
you name it. It is hard to say any one
of them is successful. It is sure that
sitting in the ivory tower and trying to modify the behavior of people over 70
with $250 will never succeed.
To young general practitioners
and to my colleagues: don’t forget that in the course of modifying others’
behavior, our behavior is being modified too. Our physical health might deteriorate because
of the long working hours and the lack of exercise. We might become more pessimistic and less
compassionate because of repeated frustrations. Have the government done anything to help?
(Source: HKMA News January 2015)
