It Is Not Easy

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)