Speech to Hong Kong College of
Anaethesiologists 6.11.99
On the occasion of the 10th anniversary
celebrations of the Hong Kong College of Anaesthesiologists, I wish to convey
most hearty congratulations from the Academy of Medicine. Throughout the
formative years of the College, from the Board of Studies for Anaesthesia and
Intensive Care in 1984, to the incorporation of the College in 1989, to the
admission of the College as an Academy College in 1992, the inaugural
intermediate examination in 1994, the final examination in 1995, and admission
of the subspecialty of intensive care in 1997, I have watched your leaders
with great pride and admiration. You have chosen dedicated, resourceful, and
wise Councillors whose insight, appeal, and diligence have established a
perpetual system ensuring high professional competence, and goodwill both here
and abroad that guarantees successful growth well into the next millennium.
Most of all, they have all been great friends of the Academy, lending mutual
support when we both were growing up.
Today, out of 3284 Academy Fellows, 182 are in anaesthesiology and 12 are
in intensive care. This is out of 8695 medical practitioners on the resident
list, and 1108 on the overseas list, while 123 are under limited registration.
The ratios are one anaesthetist out of every 46 doctors, or one to 33505
population. While there is a general impression of an oversupply of doctors,
at least at the post-registration year, the manpower situation looks far from
saturated in your particular specialty. While I was working in a general
hospital, it took the greatest of efforts to set up a trauma list, and old
ladies with fractured hips routinely waited for up to 2 weeks for surgery.
That situation has greatly improved in the past 5 to 10 years, so that I
seldom see acute hip fractures having to be transferred to private hospitals
where anaesthetists seem to be always ready to start a case for their surgical
colleagues. Yet, barring the recent withering of surgical cases in this
adverse economic environment, I have observed that even in the private sector
there may be room for further growth, for some anaesthetists there do not
appear to have sufficient time to pay a preoperative visit to their patient.
Nevertheless, their tremendous experience and efficiency continues to amaze
me. But I may be entirely incorrect in these impressions, for what can I
possibly rely on for evidence to support the assumption that we must train
more anaesthetists for the foreseeable future?
And that brings me to remind you of the importance of careful manpower
planning. The Government's Health and Medical Development Advisory Committee
relies on the Academy for advice on specialist manpower. Even though manpower
planning is far from an exact science, the Academy does try to produce a
pragmatically based assessment of current and future needs. To such end the
medical manpower planning committee chaired by Dr CH Leong has conducted a
pilot study of actual detailed workload and predicted manpower needs for
expected services across the sectors for one selected specialty, orthopaedics
and traumatology. The study suggests that a similar approach can be used for
more evidence-based predictions in other specialties. I hope that your College
can take useful reference from the methodology in arriving at the manpower
needs for anaesthesiology for say the next 15 to 20 years. It will be the
Academy's responsibility to negotiate with the Government for any
consequential funding. Although the current economic climate remains overcast,
when major reforms are put into place-and they will-the sun that is hiding
behind the dark clouds will once again shine on us. That is provided we
conscientiously ensure that standards of competence are meticulously nurtured
through not the least letup in training and continuous professional
development.
In closing, I wish to pay special tribute to a few of your leaders without
whose selfless devotion you will not have todays celebrations. They are Andrew
Thornton, Ivan Houghton, Mike Moles, Teik Oh, John Lo, Ronald Low, CT Hung,
and of course currently T W Lee. Every Fellow of the Academy joins me in
extending our very best wishes for the HKCA. I am sure that you will have the
greatest success in your endeavours, beginning with the annual scientific
meeting, AGM, Congregation and celebrations today. Thank you.
Dr David Fang
6.11.99
Speech to Hong Kong College of
Otorhinolaryngologists 23.10.99
President Prof W Wei, Fellows of the HKCORL,
distinguished guests,
It is a great pleasure and honour for me to attend this honorary Fellowship
conferment ceremony, particularly when you are honouring the President of the
Royal College of Surgeons of Edinburgh Professor Arnold Maran, who is such a
great friend and supporter of the Academy, and who is so close to many of us
that he is affectionately known as Arnie. As I am sure you will be duly
informed of his achievements and attributes, I would like to speak to you on
the subject of the Academy's public standing.
The Harvard report pilloried the medical profession for variable standards,
but acknowledged the role of the Academy, which required all its Fellows to
undertake continuing education, while no such requirement existed for general
practitioners. To be sure, the Academy must relentlessly pursue her goal of
ensuring the highest possible standards of specialist training and continuous
professional development. We are coming to the end of the first 3-year cycle
for most Colleges and the results at the end of 2 years show a compliance rate
of 82.4% for otorhinolaryngologists, compared with 86.2% for surgeons, 94.7%
for physicians, and 100% for ophthalmologists, pathologists, and
paediatricians.
Dental surgeons, however, are at 52.8% and anaesthesiologists, 70.4%. But I
am reliably informed that their figures have not been completed and are still
coming in. Overall therefore we should be reasonably satisfied that our
Fellows have seen it necessary and useful to adhere to what the law requires
of specialists.
On the other hand, there is little room for complacency because we know
only too well that CME in its present state can give no assurance of
professional competence. Starting from the next CME cycle, the Academy hopes
all Colleges will introduce elements of Quality Assurance (QA) into specialist
practice. The components of QA, or more correctly continuous quality
improvement, will not be stereotyped but will rather follow the needs of the
specialty. They may for instance include outcomes audit and peer review
processes, or improvements in clinical and information management. All of
these processes, including CME, are appropriately described as continuous
professional development, CPD.
To encourage participation, Council has very wisely decided that QA
measures will be voluntary but will be accreditable for CME points next year.
At some time in future, probably the third CME cycle, the law will be amended
so that specialists will have to fulfil the requirements for CPD as determined
by the Academy. In parallel with the Academy's initiatives, the Medical
Council has also established a committee on quality assurance. It looks
certain that CME will be compulsory for all medical practitioners, and CPD
will follow at a later date.
If we look to our overseas counterparts, many of us may wonder why none of
this is required in for example the UK. The reality is that the days of
relying on GPs and specialists to remain competent on their own initiative may
be over. The indications are that compulsory recertification processes will be
in place within 2 years. Still, one might argue that in Asia we are the first
to set such high and rigid standards. The answer must be that we should pride
ourselves in being the leaders to set standards which eventually all developed
Asian nations will surely follow.
One of the most important tools for CPD that have emerged in the past
decade is the Internet. Indeed, it has been said that information networking
as achievable through the Internet will change the way we practise medicine
forever. The SAR Government sees the development of information technology as
essential for our economy, and the Academy also recognises that we must
harness all that MIT has to offer if we are to remain at the forefront of
medical training and professional development.
The Harris Poll reports that over the past year, 60 million people surfed
the web for disease-specific information, and over 90% said they found what
they wanted. Most visited sites...
Most frequently researched diseases...
US Physicians' Median Gross/Net Incomes, 1998
Note: Gross = individual share of receipts before professional expenses and
taxes. Physicians who are new to the Web report these anticipated uses of the
technology...
Source: Chi-Lu BI and Durkin RM. JAMA. 1999;282:633-4.
Dr David Fang
23.10.99
Source: Medical Economics, September 20, 1999, pg. 178.
In anticipation of increased usage of the Internet among all doctors, the
Academy has entered an agreement with CWHKT to develop an International
Intercollegiate Network for specialist training and CPD. The system will be up
on the Internet by mid-December of this year, in time to celebrate the new
millennium.
Speech to Hong Kong College of Pathologists,
20.11.99
President, Fellows and guests,
It gives me great pleasure to address the Eighth AGM of the Hong Kong
College of Pathologists, whose fellowship falls within the centre of the
Academy numerically. It is the eighth largest College, with 157 Academy
fellows among a total of over 200 college fellows. Since its inauguration in
October 1989, the number of trained pathologists has more than doubled. Six
specialties have been recognised under the College, providing clear guidance
on subspecialisation for the profession and the public. Training programmes,
and intermediate and exit examinations have all been successfully implemented.
Moreover, the latest figures indicate that CME compliance for the first 2
years is 100%. These are achievements, which the Academy take great pride in
acknowledging. Further challenges lie ahead and I hope the College will
continue to work closely with the Academy so that we may achieve a high
standard of continuous professional development.
The Chinese Medicine Council of Hong Kong is a statutory organisation set
up under the Chinese Medicine Ordinance to regulate the practice, use,
manufacture and trading of Chinese medicine. The Ordinance was passed by the
Legislative Council in July this year. Members of the Council are drawn from
different Chinese medicine sectors and also include representative from other
sectors of the community and the Administration to ensure that public interest
will be fully reflected.
Mr Leung also announced today the appointment of the Chairman and Members
of the Chinese Medicine Practitioners Board and the Chinese Medicines Board,
which underpin the work of the Council. The Practitioners Board is responsible
for regulating the practice of Chinese medicine, while the Medicines Board is
responsible for controlling the use, manufacture, and trading of Chinese
medicines. Mr Cheung Tai-chiu, a reputable Chinese medicine practitioner, has
been appointed as Chairman of the Chinese Medicine Practitioners Board. The
Director of Health is the Chairman of the Chinese Medicines Board as provided
for under the Chinese Medicine Ordinance. Members of the Council and the two
Boards will serve for a term of 3 years.
The HKAM, in response to the consultation on the Chinese Medicine Bill, did
raise concern over the lack of definition of the scope of practice of
Traditional Chinese Medicine (TCM) practitioners. We received no official
reply, although I have been reassured by the Department of Health that overlap
and duplication would be insignificant. Albeit the scope of work now falls
under the jurisdiction of the Chinese Medicine practitioners board which will
produce a code of practice. From personal contacts with influential TCM
practitioners, it seems highly unlikely that they will try to limit the
practice to TCM only. The reason given is that Chinese medicine also needs
modern scientific methods for research, education, and development. Back in
1986 when the HKMA submitted a paper supporting the regulation of TCM, there
was genuine belief that TCM and Occidental medicine were clearly demarcated.
In the eyes of the public at least, it remains relatively well demarcated. Our
profession cannot be so narrow-minded as to exclude scientific methodology
from other health care professions, yet there clearly needs to be a dialogue
with the Chinese Medicine Council in order to reach an understanding on our
obviously separate and different roles.
The question of inclusion of the TCM professional within the Medical
Functional constituency is an even more contentious one. Modern TCM training
involves 5 years of university education, including 2 years of basic sciences.
On that basis, the two professions can easily communicate and even integrate
to provide the widest choice of treatment to the patient. After all, we must
admit that there are strengths in TCM, which can mitigate the shortcomings of
western medicine.
However, the ordinance also recognises TCM practitioners who may have no
qualification apart from 15 years of full-time practice. We cannot presume
that they will have common interests, nor can we assume that the interests of
the whole TCM profession can be catered for in a functional constituency that
looks certain to be dominated by the medical profession. Until such time that
their profession have proven that they are responsible, disciplined, hold the
interest of the public above their own, and can work harmoniously with us, it
is premature to share a common constituency. The government is therefore wise
to hold the proposal in abeyance until these uncertainties are resolved.
On a more fundamental question of the integration of western medicine and
TCM, I have always held the view that medicine knows no boundaries. As men and
women of science, we cannot afford to close our minds to any methodology. So
long as the method conforms to ethical principles and can scientifically be
proven to be efficacious, we are duty-bound to explore, research and utilise.
The corollary must be that scientific medicine will prevail and ultimately
absorb so-called alternative medicine. It behoves all of our profession to
adopt a visionary attitude, or the consequence could be steady erosion in our
own capabilities as well as the trust of our patients.
Dr David Fang
20.11.99