A member complained in our Princess Margaret Hospital Sunday Afternoon Symposium on 16th October 2005 on the restricted distribution of Isotretinoin by drug firms to only Specialists in Dermatology and Venereology and holders of Diploma in Practical Dermatology (DPD) (
The story goes back to a letter issued by the Pharmacy and Poisons Board dated 30 September 2005 to United Italian Corp (HK) Ltd. advising the company not to distribute the said drug to doctors who are not Specialists in Dermatology and Venereology OR who are not holders of a qualification in dermatology which appears in the list of Quotable Qualifications maintained by the Medical Council of Hong Kong (MCHK). In the last bulletin, we have announced the message from the MCHK that DPD (
I have phoned up the Director of Health on this issue and the reply from the Department of Health was it was not their decision BUT the decision of the Pharmacy and Poisons Board even though the Director is Chairman of the Board. We raised our strong objection to such Government act in depriving the prescription right of a drug from most of the doctors in the profession.
In 1983 when Roche first launched the said drug in Hong Kong and according to their commercial decision, they would only supply the drug to certain doctors whom they thought are competent. This is way long before the establishment of the Specialist Register in 1996. Now, on mere consultation with a few Dermatologists including a private one, the Pharmacy and Poisons Board unilaterally restrict the use of Isotretinoin to certain sector of the profession. THIS IS TOTALLY UNACCEPTABLE. The Specialist Register, when enacted by legislature in 1996, is a register for indicative purpose and NEVER restrictive. Only those who have acquired certain professional standard and who are willing to apply for admission and being accepted into the Specialist Register would deserve to have that specialist title with the condition of mandatory CME if he wants to remain in the register. Otherwise, NO single doctor should be debarred from any drug prescription right or any procedural right EVEN THOUGH he is not in the Specialist Register.
We strongly support the following arguments in DPD (
ˇ§... We had been using the drug very cautiously. We only prescribe the drug when it is really indicated and we follow the guidelines closely and explain clearly to patients and we make consent with them before treatment. We monitor, revise or discontinue treatment whenever necessaryˇKˇ¨
ˇ§ˇKIt is certainly not a good practice to ask the patient to stop treatment abruptly or to change doctor and interrupt the continuity of care and doctor-patient relationship. Many of our patients cannot afford seeing dermatology specialists and the waiting list of the government dermatology clinic has always been longˇKˇ¨
ˇ§ˇKwe cannot recall any ordinance restricting the use of such drug or any other drug of similar or even more serious teratogenicity!ˇKˇ¨
I have already voiced out in October 1997 issue of EDA Editorial entitled ˇ§Premature Launching of the Specialist Registerˇ¨ that ˇ§ˇKShould a surgeon be deprived of the right to treat medical problems, such as hypertension and diabetes mellitus after the Specialist Register is implemented? Similarly should a general practitioner be deprived of doing minor operations or even D/C in the operating theatres? Should we, at the end of the day, aim at the ideal situation of "Strictest Division of Labour" where the territories of each specialty are clearly defined? Should we be able to convey to the public which lists of doctors would be the experts in treating such and such diseases. All these questions are difficult to answer.
Unfortunately, even though our Honourable Dr. C H Leong has repeatedly stressed that the introduction of the Specialist Register is just for indicative purpose, there are already measures taken recently by some private hospitals to remove the operating theatre admission rights from those doctors who have not got surgical or O&G higher diplomas even though they have been operating on cases in these hospitals for years without patients' complaints and without any mistake reported. I am worrying whether there would be similar measures of depriving the rights of surgeons in admitting and treating patients with medical conditions in private hospitals. Or even worse, the insurance company would not reimburse the medical expenses incurred in managing certain diseases of the patients which are not within the boundary of the specialty that the attending doctor belongs toˇKˇ¨.
We have noticed one medical insurance company is already refusing to reimburse professional fees to colleagues not in the Specialist Register but who have provided professional service to the satisfaction of the patients. We have received such complaints from colleagues who have been practicing anesthesia for years but not in the Specialist Register. The drawback of such practice, as I have learned, would be against the interests of patients, especially for those who are admitted to private hospitals in the middle of the night and suffering from emergency conditions. Such culprit play by the insurance companies is only FOR ONE REASON - to save money and to increase profit for the company without caring for the health of patients.
Your council is very much concerned on the captioned and has written letters to defense the rights of our colleagues by raising our strong objection. (Please refer to Page xx and Page xx of this Bulletin for details) If their replies were not to our satisfaction, we would bring the matters to the press pointing out how the Government and the Commercial Enterprises have intervened our Professional matters and have done things against the interests of the citizens.
Lastly, we have also sent a letter to the MCHK asking for the reason why DPD (
Dr. Yeung Chiu Fat Henry