Medical schools should cater to society's needs
Medical advances notwithstanding, the role of family medicine in the efficient delivery of modern health care is well established in developed societies. But few of Hong Kong's future doctors want to specialise in it and, as we report today, our medical schools are accused of neglecting the teaching of its broad-based skills.
Sadly, family medicine has long been seen as the poor relative of the medical profession. In the eyes of our medical students, it lacks the social and career status and high earning potential of traditional specialties. The time and resources the city's two medical schools devote to it do little to discourage the perception that it is professionally unrewarding. This perception is not unique to Hong Kong. What does set us apart is a comparison with other developed societies, including those where many of Hong Kong's doctors have studied for higher professional qualifications. There, medical authorities and educators have invested considerable resources in promoting the role of family doctors as the gatekeepers of increasingly specialised and complex health systems.
Almost every medical school in the United States and Canada, and two-thirds of those in Britain, have independent family medicine departments. In Hong Kong, the Medical Council's latest five-yearly review of curriculums has warned that both the University of Hong Kong and Chinese University have devoted inadequate training hours and staff to the speciality. The council criticised HKU's medical school in particular over training and for snubbing calls to remedy the curriculum. The Academy of Medicine - Hong Kong's top body for specialist training and accreditation - has also raised concerns about whether the university's medical students have the necessary skills and enthusiasm to practise family medicine. The discipline emphasises treating the patient as a whole rather than specific organs or diseases - and heading off serious illness, or making a timely referral to another specialist. The University of Hong Kong's dean of medicine does not see the council's remarks as suggesting the teaching and training of family medicine in either university is 'in any way inadequate'. But Chinese University, on the other hand, has undertaken to strengthen its family medicine training and discuss the criticisms with the College of Family Physicians.
The academic debate may seem to have little to do with the ordinary person and personal health concerns. But the development of family medicine is at the heart of long-awaited health-care reforms, under which overworked public hospitals will increase their focus on acute and emergency care and the needs of the poor. People will be encouraged to consult specialist family doctors before going to hospital, with the emphasis on preventive medicine and continuing management of health and lifestyle issues. The academy's proposal to shorten the six-year specialist training term for family medicine to increase the supply of specialists is well worth considering, so long as undergraduate training provides adequate preparation for a shorter course.
The growing role of family medicine is a global trend. The practice of it will account for a more important sector of health care in the future. Yet in Hong Kong it remains the last choice of young doctors for specialist training. The medical schools will fail them and society if they continue to cater to perceived status and expectation rather than society's need for more community-based care. They should set the example by treating it more seriously.