Circular No. 2034, 8^th August 2001

President’s Message - What do they want to achieve in mandatory CME and CPD?

I read with interest the President’s Message in the Academy Focus (summer 2001) entitled “Medical Council Reform – Public Aspiration balancing Professional Autonomy”. Among other suggestions to the future Medical Council, it said “ The Medical Council must, therefore, move towards quality assurance for each registered medical practitioner. As a first step, compulsory and stringent Continuing Medical Education (CME) as a prerequisite of renewing registration to practice is perhaps an easy issue to take on board to show the public that each and every doctor has been subjected to a minimal predetermined dose of quality education. Other criteria must, of course, follow.” … “The Academy of Medicine, with its well earned experience in running and accrediting CME, has a ready made system that can extend to support doctors who are not yet specialists. This the Academy has pledged to do."

The Medical Council (MC) decided several months ago to implement voluntary CME for non-specialists for a trial period of 3 years. The Secretary for Health & Welfare also supported the above decision of MC in front of over 450 colleagues in our CME Symposium of 22.4.2001 and he said that the issue of voluntary CME for non-specialists would be reviewed only at the end of the 3-year CME cycle. His message was simple and clear, and would not be mistaken by the audience and guests, among whom was the President of the Hong Kong Academy of Medicine (HKAM).

In the Meeting of 20.7.2001 held by the Education and Accreditation Committee (E&AC) of MC, a HKAM representative insisted that HKAM should be the only body which could grant CME accreditation to non specialists. That representative even claimed that he did not know anything about those guidelines on voluntary CME for non-specialists set up by MC several months ago. His remarks showed clearly the intention of HKAM to monopolize the CME accreditation to non-specialists and his ignorance of the decisions of E&AC on voluntary CME. Fortunately, I am glad to learn that the E&AC was finally able to defend her rights of CME accreditation to non-specialists by allowing not only HKAM, but also Hong Kong Medical Association and Hong Kong Doctors Union to grant CME accreditation to thousands of colleagues in general practice.

From the first paragraph of this article, it is clear that the pressure for Mandatory CME will never stop. You will not be surprised to see that the battle for voluntary CME for non-specialists will continue in the coming years.

Now, I would like to share my views on the following topics with our members.

Continuous Professional Development

As pointed out by the Government, there is marked imbalance of patients’ distribution between the public and private medical services in Hong Kong nowadays. In the long run, it will be detrimental to the development of Professional Standards in both sectors of the health service community. Medical practitioners in the public sector are forced to work long hours on patients and this has limited their time of studies and their chance of sharing experiences with other colleagues. On the other hand, colleagues in the private sector are managing less and less patients, say less than 10 patients per day. With such limited clinical experience, I wonder how many colleagues in private practice will benefit from the Continuous Professional Development (CPD) Programme which aims to upkeep the standards of medical practitioners. I strongly believe that the CPD Programme can succeed only if private practitioners have more patients to see everyday and have more opportunities to put the theory into practice.  In view of the present situation, it will be putting the Cart before the Horse if MC implements the CPD Programme now.  I think that the problem of imbalance of patients’ distribution between the two sectors should be solved before deliberating any plan on CPD. AND the CPD should be implemented only if and when it is fully supported by the whole profession.

Quality Assurance

As regards the upkeep of quality of all medical practitioners in Hong Kong, I suggest to make the following regulations, which are more important than compulsory CME, to safeguard the interests of the public, and which are not exhaustive, for the consideration of MC:

1. Only doctors in a particular specialty should be allowed to practise in that particular field of medicine.
2. Doctors who work as medical administrators only and are not in clinical practice should not be allowed to prescribe medicine and treat patients.
3. Elderly surgeons should have their health, eyesight etc. checked regularly in order to prove that they are fit to operate just like medical examinations for those elderly people who want to keep their driving licenses.

Of course, all suggestions should be thoroughly discussed by the medical profession before any decision is made.

In the Editorial of "The Hong Kong Practitioner, Volume 23–July 2001" published by the Hong Kong College of Family Physicians, Dr. D. Owens pointed out that "……If our goal is to improve the quality of healthcare we need to move away from a system which defines targets based on CME points.……."

In his communication to all Fellows of HKAM on 5^th August 2001, the President of HKAM urged all doctors “to reflect the true caring face of the professions”. I think it will turn out to be another laughing stock if we only do WINDOW DRESSINGS IN THE REFORM OF THE MEDICAL COUNCIL JUST TO PLEASE THE PUBLIC OR THE CHIEF EXECUTIVE OF HKSAR. Indeed, we should make more efforts to safeguard the health of our patients and ensure our Professional Autonomy.

Linking CME with Annual Practising Certificate

We are fully aware that many doctors who have been convicted of professional misconduct were only penalized with a warning letter. I think it is absolutely unfair if a doctor is deprived of his right as a medical practitioner just because he has no recognized records of CME, especially if he has shown competence in his work and has not been convicted of any professional misconduct. I do not agree to the views of some Council Members of MC that linking CME with Annual Practising Certificate is the most convenient way to enforce compulsory CME.

For your information, there are altogether five functional groups under the Working Group on Reform of the Medical Council. There are officially at least two representatives of HKAM in each functional group. The rest are representatives from the Accounting profession, Journalists, Commercial Companies, Social workers and Patients’ Concern Groups. So the Working Group will receive a lot of input from various professions in Hong Kong. What we hope for is a new system which should be friendly not only for the people of Hong Kong, BUT for OUR profession as well!Dr. Yeung Chiu Fat Henry

會長通訊：強制性延續醫學教育和強制性專業發展目標為何?

二零零一年夏季香港醫學專科學院（醫專）通訊中院長的訊息標題為"醫務委員會（醫委會）改革 ─ 平衡公眾的冀望與專業自主"一文的確發人深省。除了其他對醫委會改革的建議外，文章提及"故此醫委會須要邁向每個醫生的品質保證。第一步是推行強制性嚴謹的延續教育作為換領行醫執照的先決條件，可說是容易實行，亦可以向公眾顯示每個醫生均已接受過起碼的優質教育，自然其他條件會一併實施。" … "醫專對舉辦延續教育和頒發積分富有經驗，現存系統亦能夠發展去支援非專科醫生的延續教育之用。而醫專現已作出此項承諾。

"數月前醫委會已決定給予非專科醫生為期三年的自願參與延續進修的試驗期，衛生福利司亦曾於2001年4月22日我會的一個學術研討會上面對超過450位同業對以上建議作出支持，他更說三年試驗期滿後才需對非專科醫生的自願性進修作出檢討。我相信在場的醫專院長不會誤解這個訊息。

反而在2001年7月20日醫委會轄下的教育及評審委員會的一個會議中，醫專的代表卻堅持醫專是全港唯一能夠頒與非專科醫生進修積分的機構。對於數月前醫委會頒佈非專科醫生參與自願進修的指引，這位代表竟然說一無所知。他這番說話清楚地顯示出醫專要獨佔主辦非專科醫生延續進修的意圖，和對教育及評審委員會所作出決定的無知。可幸地，教育及評審委員會最終能夠保障她對非專科醫生延續進修的權力。她不單批准醫專，更批准了香港醫學會和香港西醫聯會頒發進修積分與數千名非專科醫生。

由本文第一段可清楚見到強制性延續進修的壓力將會接踵而來。對於自願性進修的鬥爭將會持續好幾年，亦請勿覺驚訝。

現在我想把我的觀點跟大家共同切磋。

延續專業發展

如政府指出，現在病人使用公共與私家醫療服務的分佈存有嚴重不平衡。長遠來說，對公立與私家醫療服務的專業發展均不利。公立醫生要長時間照顧病人，大大局限了進修和與同僚切磋的時間，另一方面私家醫生生意淡薄，甚至少於每天十個病人，臨床經驗如斯缺乏，我不禁懷疑以確保醫生水準的延續專業發展計劃（續專發展）能會幫助到多少個醫生。我堅信「續專發展」計劃是需要醫生每天能照顧多些病人和能學以致用才會成功。在現行的社會環境之下，若醫委會推行「續專發展」計劃便是本末倒置。我相信要先解決公家病人過盛而私家病人過少的問題才可以談任何「續專發展」計劃。而且亦要得到全體醫生的支持才可以推行。

品質保證

關於確保香港醫生質素，我提議為保障公眾利益而由醫委會考慮以下比強制性延續進修更重要的幾點：

1. 只有專科本科醫生才可以於本科行醫、例如骨科專科醫生只可以服務患有骨科病的市民；
2. 做行政管理工作的醫生不准處方開藥和行醫；
3. 年老的外科醫生要像年老駕車人士一樣，要經過視力等健康檢查証實合格才可以施手術。

的確，我們要努力去做多點工作去保障病人，尤其是當歐德維醫生(Dr. D Owens) 在香港家庭醫學學院的2001年7月院刊 “The Hong Kong Practitioner, Volume 23 – July 2001” 中社論指出延續醫學教育不能夠提高醫生質素。當然，以上及一切建議要經整個專業深入徹底討論過後才可以實施。

醫專院長最近於2001年8月5日給全體院士的通訊中勸勉全體醫生”把業界真正關懷的一面反映出來”。我認為若我們只是為了取悅公眾和特首、而要在醫委會改革中粉飾窗櫥將會貽笑大方。其實我們理應實實在在地去做多點工作去保障病人健康及確保專業自主。

每年行醫執照與進修掛勾

我們知道不少被判犯了醫療失德的醫生只是收到警告信作為懲罰，若醫生只是沒有被承認的進修紀錄便被剝奪行醫的權利是極不公平，尤其是若然醫生工作稱職妥當和並沒有犯了醫療失德的錯誤。我絕不贊同某些醫委會成員說把進修與行醫執照掛勾是實施強制性進修的最佳方法。不講不知，改革醫務委員會工作小組屬下有5個功能組別。每個組別中起碼有兩位醫專的代表，其他成員來自會計界，記者們，大公司老闆，社工和病人權益團體。故此改革醫務委員會工作小組將會收集到不同專業的意見。而我們最希望見到的是一個嶄新制度，不單止要對病人，亦要對我們為數一萬位醫生一樣友善。楊超發醫生