ContentsThe Presidents Message
ASM in Anaesthesiology 99
Basic Science Course
Certificate Course for Anaesthetic Assistants
At the first meeting of the new Council held on 3rd June, 1999, new office bearers were elected. I am very honored to be elected President of our College. I am also pleased to report that Dr. John Liu and Prof. David Chung were elected Vice-Presidents. The other office bearers are Drs. P. T. Chui, Jacobus Ng Kwok Fu, Theresa Hui and Tom Buckley as Hon Secretary, Assistant Hon. Secretary, Hon Treasurer and Assistant Hon Treasurer respectively. I wish to take this opportunity to thank the outgoing President, Dr. C. T. Hung, and his Council for their leadership and dedication that has brought the College to the present state.
There are some changes in the Boards and Committees. Prof. Yang has resigned from the Chair of the Pain Management Committee. Due to his hard work in the last two years, our College has established a training programme and examination leading to Diploma in Pain Management. I wish to express our gratitude to Prof. Yang and wish him every happiness in his retirement. Dr. P. P. Chen has been appointed Chairman of the Pain Management Committee.
Dr. Andrea O'Regan has resigned from her position of Training Officer. She has single- handedly looked after the training records of all the trainees. The number has grown to around one hundred. Her contribution to the smooth running of the training programme is much appreciated. She will be succeeded by Dr. Chow Yu Fat of Queen Elizabeth Hospital. Dr. Chan Wing Sang has designed a computerised database for the trainee records.
As I was elected President of the College, it would be preferable for me to step down form the Chair of the Education Committee. Dr. C. T. Hung has kindly agreed to be the Chairman to continue to look after the education matters of the College.
This year is the 10th anniversary of our College. Celebration activities are organized by the committee lead by Dr. John Liu. They will coincide with the Annual Scientific Meeting to be held in November. Representatives from Australian and New Zealand College of Anaesthetists, Royal College of Anaesthetists and the Chinese Society of Anaesthesiologists will honor this occasion. A CD-ROM and a souvenir book will be produced. There will also be public education activities. This would hopefully enhance the public image of anaesthesiologists in Hong Kong. The College is grateful to the Society of Anaesthetists of Hong Kong for their donation of HK$ 100,000 for the celebration activities.
The College has gone a long way in its first 10 years. However, there is no reason to be complacent. We will be facing a number of challenges. Hong Kong had one of its most difficult times in the last two years. It is not clear when we will come out of the economic downturn. The medical profession, as part of Hong Kong, is inevitably affected. There are a number of issues that will affect the medical profession directly. The Harvard Report will have great impact on the medical system in Hong Kong. This may pre-empt a major overhaul of the medical system. Pressure on the medical profession is already evident even before the period of consultation is over. Public opinions are being rallied to support the concept that those who can afford will have to pay for their medical treatment. At the same time there is pressure to reduce expenditure. Colleagues working in the Hospital Authority are familiar with initiatives to reduce expenses and to improve efficiency. In the private sector, there is the fear that HMOs or insurance companies might control doctors' fees. There are adverse reports in the media of private practitioners allegedly charging excessively high fees. The Medical Council had recently made it its business to adjudicate on private doctors' fees.
The Harvard report raised concerns about variable standard amongst medical practitioners. The specialists in Hong Kong have made efforts to upkeep their standard by CME. This is not only to satisfy the legal requirement to stay on the specialist register but also to ensure that we update our medical knowledge. Despite some initial hiccups, we have completed our first three-year CME cycle. While the Medical Council intends to make CME compulsory for all medical practitioners, the Academy will introduce continuous professional development (CPD) rather than just continuous medical education. It is likely that some voluntary quality assurance activities, such as outcome audits and peer reviews, will be introduced from early next year. As a constituent College of the Academy we will work closely together to make CPD a successful programme.
The Harvard report concentrated on finance and organization of the health care system. There was no provision of resources for training and CME. We believe that this would in the long term jeopardize the standard of specialist medical practice. After deliberation at the Council, a submission was sent to the Health and Welfare Bureau to express our concerns.
Finally, I would like to conclude by informing you of the good news that Medical Council has given the approval for our Fellowship in Intensive Care and Diploma in Pain Management to be quotable as FHKCA (Intensive Care) and Dip Pain Mgt (HKCA), respectively.
14th August 1999
Mrs. Katherine Fok, OBE JP
Dear Mrs. Fok,
Re: Harvard Report
After studying the report of the Harvard Consultancy group on the health care system of Hong Kong, the Hong Kong College of Anaesthesiologists would like to submit the following comments and suggestions for your consideration.
Lack of Commitment to Training
2. We are one of the constituent Colleges of the Hong Kong Academy of Medicine. Our responsibilities include training of specialists, setting of standard, and continuous medical education. At present, majority of training of specialists takes place within the public health system. Resources allocated for training are scarce. These may be in the form of extra manpower to allow for study leave, additional staff for supervision of trainees, funds for attending courses, etc. Likewise, resources for continuous medical education for specialists are limited.
3. While the Harvard report deals with the financing and organization of health care in Hong Kong, its recommendations, if implemented, may have far reaching impact on the training of specialists in Hong Kong. There is the concern that adoption of the "money following the patient" concept leads to direct competition between the private and public sector. In fact, it was proposed that public hospitals may be asked to bid for allocation of budget for certain services against private hospitals. In order to contain cost, the public health system may be forced to limit the already inadequate resources for training even further. Afterall, these are resources that do not directly contribute to patient management. In the short term, there may be cost savings. However, in the long term, training of specialists may suffer. This may eventually lead to a lowering of standard of medical practice in Hong Kong.
4. We would therefore suggest that the requirements for training should be considered whenever any restructuring of the healthcare system is planned. In considering the integration of primary care and specialist service, there should be long term planning to establish the right number of specialists required. It may then be possible to have more efficient allocation of resources for this purpose.
5. The Harvard report rightly pointed out that there is poor integration between primary and tertiary care, and between the public and private sector. Sharing of information is relatively easy to achieve. With advances in information technology, it is now technically much easier for information to flow between different sectors. This may reduce the need for redundant investigations and delays in diagnosis and treatment. What is required is coordination between the different sectors. There is naturally the need to safeguard privacy and confidentiality of patients.
6. Integration of other aspects of patient service may require much more radical overhaul of the present system. The need for integration of primary, secondary and tertiary care is quite obvious. So is the need to integrate preventive, curative and rehabilitation services. Registration for Chinese Medicine practitioners is imminent. However, the integration of Chinese Medicine into the present predominantly Western Medicine based system was not addressed by this report. There was a long history of the two system systems co-existing in the Mainland. Their experience could be very useful.
7. Integration of the private and public sector is much more problematic. According to the recommendation of the Harvard report, the distinction between public and private hospitals will slowly blur and may eventually become the same. Together with the "money following the patient" concept, we must be careful to avoid unhealthy competition.
"Money following patient"
8. We agree that those patients who can afford should pay for their medical treatment. However, as pointed out by the Harvard team, a safety net should still be in place for the needy. For the patients to be able to make informed choices on physicians, hospital, modality of treatment and drug, much more effort have to be put into their education. Although the Harvard team admitted that "international experience has long shown these conditions do not exist in the health care market", formation of an Office of Patient Education was recommended. Even if it would eventually be possible to educate patients to that stage, it will take a long time. In the mean time, patients would still have to make their choices based on their level of knowledge or rely on patient advocates which may be HMOs or insurance companies. We have to ensure that some of these commercial bodies will not interfere with autonomy of the medical profession to act for the benefit of the patients.
Standard of medical practice and quality assurance
9. At present, all medical specialists are required to upkeep their standard by satisfying CME requirements of the Academy. The Medical Council will require the same for all medical practitioners. These efforts notwithstanding, we agree that these may need to be supplemented by better quality assurance activities to monitor the quality of healthcare provided to our patients.
10. We think that there is considerable degree of transparency in the handling of complaints. There is always room for improvement. It would be better to build up on the existing system rather than to appoint a separate medical ombudsman. This would not only increase administrative cost, but the potential for increasing antagonism between the public and the medical profession may not be in the best interest of all parties involved.
Proposed options of financing healthcare
11. The Harvard team favours their proposed option D ( Medisage and HSP) and Option E (Competitive integrated health care). There is very little information that their long term sustainability can be maintained. Bearing in mind the strength of the existing system we agree with the recommendation that any changes should be introduced slowly and be "implemented gradually over an extended long period of time".
In conclusion, we agree that we should take this opportunity to overhaul the finance and organization of our health care system before the present system becomes unsustainable. Strength of the present system should be retained while ensuring changes are introduced with adequate consultation and executed with extreme care. Requirements for training of specialists should not be overlooked.
Tsun Woon Lee
The Intermediate examination was held in February/March 1999 (written on the 26th
February and oral 16/17 of April. Fourteen out of twenty seven passed the examination
(Pass rate 50%).
Dr Chan, Lim Sun Derek PWH
The Prize of the Intermediate Fellowship Examination has been awarded to Dr Ng, Ka Lai. The College is grateful to Dr. David Wilkinson of RCA, and Dr. Peter Roessler of ANZCA for their assistance as External Examiners during the examination.
The FHKCA Final examination was held in March/April 1999 (Written 26th March and Oral
23/24 April 1999. Five out of fourteen candidates were successful in the examination.
Dr Chan Pui Lan, Rowena TMH
The Prize of the Final Fellowship Examination was awarded to Dr Judith Shen. The College is grateful to Prof. Brian J Pollard of RCA and Dr. Tony Weeks of ANZCA for their assistance as External Examiners during the examination.
New Hospital Appointments
Dr Lim Jin Ai, Jean Marie SMO (PYNEH)
Dr Cindy Lai - SMO (UCH)
ADMISSION OF NEW MEMBERS AND FELLOWS
16 July 1999
12 August 1999
Fellows in Anaesthesiology ad eundem
Dear Fellows and Members,
On behalf of the 10th Anniversary Celebration Committee, I would like draw your attention and seek your support for this meaningful and exciting event of our college.
This year our College is ten years old. Thanks to the effort of the founding members and through your continuing support the HKCA has established itself from the budding stage to a college now flourishing with colours. It is time to take a pause, look back and perhaps plan for the future.
To commemorate this important event in the history of our College our committee is charged with the responsibility to make it a year for all colleagues to remember. The main celebration activities will take place concurrently with the Annual Scientific Meeting 1999 in November and will consist of opening ceremony, media meetings,10th anniversary dinner, press releases and public exhibitions ( MTR and public hospitals) to improve our image and enhance public understanding. Anaesthetic simulator sessions will be held, and some sessions will be open to the public. A CD-ROM and a 10th Anniversary Publication are also being actively prepared. Leading figures from anaesthetic colleges around the world have been invited to come and join us. Education pamphlets will be distributed to the public.
We seek your support, both morally and financially, to make this event a success. The College belongs to all of us. Let's join hands to celebrate the event and move into the next millenium with confidence.
John T C Liu
Register for individual
Deadline for registration 15th September 1999
Cheques made payable to "the Hong Kong College of Anaesthesiologists"
Completed application form and cheque to Dr KF Ng, Department of Anaesthesiology, Hong
SCIENTIFIC MEETING IN ANAESTHESIOLOGY 1999
"Safety and Risk Management"
on 5-7 November 1999
at Sheraton Hong Kong Hotel
Professor James B Eisenkraft, USA
*For details, please contact Conference Secretariat:
The Federation of Medical Societies of Hong Kong
Chairman of the Organising Committee: Dr PP Chen
The Hong Kong College of Anaesthesiologists is going to organise a certificate course to train anaesthetic assistants from late January 2000. The course will be conducted on a part time basis with lectures and workshops on most Saturdays. The duration of the course is about 12 months. The students will consists of Nursing Staff working in the area of anaesthesia and Operating Theatre Assistants.
Anaesthesiologists interested in teaching are most welcome to contact course co-ordinator Dr A Kwan ( UCH Tel:2379 4250, Fax:23794245, or E-mail:firstname.lastname@example.org.)
To be held in November 1999 for trainees who are preparing for the year 2000 Intermediate Examination
Lecturer : Dr Peter Kam
For details, please contact Course Oganiser, Dr Steven Wong, Department of Anaesthesia, Queen Elizabeth Hospital