Building trust with patients

PUBLISHED : Tuesday, 02 August, 2005, 12:00am
UPDATED : Tuesday, 02 August, 2005, 12:00am

One of the health-care reforms proposed by the Health and Medical Development Advisory Committee is to train more family doctors.

The concept of family medicine is not new. As shown in old Hollywood movies, the family doctor would be there in the home during all important occasions, including the birth of a child, the death of a family member and even at Christmas.

However, a doctor as a family friend is alien to Hong Kong culture. When I was a medical student, it was not uncommon to witness hot-shot doctors stridently scolding patients for not following instructions, and letting patients kneel before them begging to be saved. Those were signs of the times, and it is heart-warming to know that doctors nowadays are more down to earth.

According to newspapers, one young doctor plays tennis with his diabetic patients to encourage exercise, and another says that all her patients are her friends. But these examples are few and far between. In general, patient-doctor relationships in Hong Kong are far from genial.

It is laudable for the advisory committee to envision 'every family or citizen of Hong Kong under the continuous care of a named doctor of his/her choice' in future. One of the weaknesses of health-care delivery in the city is the lack of a personal touch. For example, in government clinics, patients are assigned haphazardly to whichever doctors are on duty. In private practice, patients are inclined to clinic-hop whenever a quick cure is not in sight.

But training more doctors in family medicine may not be enough to change things. Promoting an ideal such as rapport between patient and doctor is like promoting love - commendable but not enforceable. First and foremost, doctors need to gain patients' trust.

In general, patients have more trust in government doctors - despite the curt and snappish bedside manners - because patients know they are not working just for the money. But they have less trust in private doctors: it is hard to trust someone whose every word and action comes with a price tag.

And many of the charges are unreasonable: blood tests with a built-in 'processing' surcharge sent to a laboratory partly owned by the doctor; a $500 charge for providing a two-page copy of a patient's record; or a kickback for a referral to a surgical specialist who might not even have been trained in that particular area of expertise.

Further, trust has been eroded over the years by a continual stream of scandals: the use of a mobile phone during a colonoscopy; an error in dispensing a diabetic drug in a general practitioner's clinic; and many private doctors' failure to continue their medical education.

Training a lot of doctors in family medicine does not mean doctor-patient relations will improve overnight. Cultivating trust takes time.

A good start would be a change in the medical school admission policy - do not enrol students excelling only academically, but rather choose well-rounded individuals showing traits of compassion and civic awareness.

The medical curriculum should focus more on ethics and bedside manners. Young doctors should be trained to practise medicine as a profession, not a business.

The Medical Council should stamp out all unethical practices instead of waiting for formal complaints to act.

We may not see family doctors being invited over for Christmas any time soon, but we hope that in the near future, at least patients will begin to call on them for help without having to worry about being ripped off.

Feng Chi-shun is a consultant pathologist at St Paul's Hospital, Causeway Bay