On 16th August 2005, there was a whole page cover in Ming Pao on “No body care about the Anti Obesity Agents left in clinics”. In contrast to the proposal of Health Care Reform by the Secretary for Health, Welfare and Food, the report did not stir up too much concern from the public except the Department of Health.
The story went back one year ago when a private colleague was an employee of a clinic. On the day of reporting duty to the clinic, he was forced by his boss to advocate body slimming and to offer Intense Pulse Light (IPL) therapy to his clients so as to boost up the clinic income. His boss is, of course, not a registered medical practitioner but a pure businessman. And his boss’s behavior in the clinic would not be governed by the medical professional code and conduct.
Worse still, the poor colleague does not know anything about IPL therapy and on the fear of losing his job, he has to experiment the IPL with his clients until one day he gets sick of doing IPL and of not practising what he has learned from the medical school and the one year internship. Thereafter, he refused the unreasonable demands from his boss until one night he was fired. On that night, he was not even allowed to pack up things from the clinic under the scrutiny of 4 tough guys with eyes widely opened and arms crossed at the front door of the clinic.
The question is who should be responsible for the dangerous drugs left behind. The poor colleague tried to seek help from the Department of Health several times but failed. When the clinic closed down later, nobody cared about the dangerous drugs left behind. When the story appeared in the headlines of Ming Pao two weeks ago, the Chief Pharmacist of the Department of Health was very much concerned about the laissez-faire attitude of his staff as reported. According to him, the right thing for the poor colleague to do is to call the police to seize the owner of the clinic for the final destination of the dangerous drugs. However with the aforesaid description of how the poor colleague is fired, it is difficult for the poor colleague to disclose the detailed information since his life would be at stake. The story ends here, without any follow up on where about of the drugs unless and until some citizens are hurt.
This is just one of the three stories that I would like to share with you, especially those who are green to the private medical service.
The next story went back two years ago to a young doctor. The employee doctor was employed with the terms of working 12 hours a day and 7 days a week without rest days. The employee did not dare to report to the Labor Department for lack of rest days. He was even required to work in various clinics all over the territory and his clinic hours used to end up 1 to 2 hours later than the agreed working hours. Until one day he was so fed up with his boss that he refused to write down any medical notes except treatment regimes on a few medical records after consultation. His boss seized the medical records and threatened the poor employee by reporting to the Medical Council of Hong Kong for poor record keeping. He finally asked for help. He was advised to memorize the notes of the few patients and recorded down on a few blank sheets in case of investigation from the Medical Council of Hong Kong (MCHK). Luckily, he has changed to a new job without being investigated by the Preliminary Investigative Committee of MCHK.
Another story is about unfair conditions in the contract for the employee doctor. His boss is a registered medical practitioner who is running a chain of clinics all over the territory. The doctor feels threatened by the nursing staff who actually had persuaded the patients to complain to the MCHK for wrong drug labeling. According to the doctor, he believed his boss orders the nursing staff to change the drugs in the labeled drug bags before dispatching to the patients after being checked by the employee doctor himself. Then the nursing staff persuades the patients to complain against the employee doctor. We have informed the Labor Department about the unfair conditions laid down in the contract. Here is a list of the said unfair conditions:-
Unequal Period for termination of contract – the employee has to inform of his intent of termination for a period much longer than that for his employer;
“Gratuity sum” – half of the promised salary becomes company loan which has to be returned if the employee could not complete the period of contract;
Restricted practice – on termination of contract, the employee is not allowed to practise within certain kilometers of the clinic premises for certain number of years.
The Labor Department promised that they would look into such unfair terms in the contract and we hope that we can help this poor colleague soon. However, these are just a few examples of those fresh graduates under employment in the private market. We do not know the exact number of young doctors being ill treated in such manners.
How about private doctors who have been in the service for years? Most of them are self employed. With such poor business nowadays, there are HMOs planning to buy some of their clinic businesses so that the HMOs can be successfully listed in the Shares and Stocks Market. The only motive of these HMOs is huge financial gain through investment techniques. The term of offer, as I understand lately, is up to 49% of shares being transferred to these HMOs for a return of a lump sum of money roughly equal to 2.5 years of net average profit of the clinic. After the acquisition, the clinic’s income and expenditure will be under strict control by the HMOs through web cam and even through the internet for instantaneous report. For those colleagues who are interested in such a deal, please look at those terms carefully and consult your lawyer before succumbing to that sum of money from the HMOs.
So you see, it is absolutely unnecessary for the Secretary for Health, Welfare and Food in his health care reform to advise us on how to form group practices. There is always a strong market force behind. The most important thing is whether we would choose money or dignity in our practice at the end of the day.
For the interest of doctors serving contract medicine, we have sent a letter to a number of HMOs inquiring on the issue of fee transparency in accordance with our Professional Code and Conduct. And we shall report to you the outcome when ready.
Dr. Yeung Chiu Fat Henry