Readying watchdog for major surgery: Joseph Lau
Professor Joseph Lau says unpopularity comes with the job of Medical Council chairman - and a big overhaul is set to mean more controversy
When he was offered the chance to take over as chairman of the city's much-maligned doctors' watchdog, the Medical Council, Professor Joseph Lau Wan-yee's wife had a warning for him.
"When I first considered taking up this job, my wife told me I should be prepared to be hated by some people," Lau recalled last week. "Doctors would not like me as there is a conflict of interest; the public would not like me either as my work might not be understood by many people.
"But I still feel the job is an honour," said Lau, whose day job is an expert on surgery of the liver, pancreas and biliary system at Chinese University.
The council has long been under scrutiny. It is accused of being too protective of doctors, being too slow and reactive when it comes to disciplining them and punishing them too lightly for the public's liking.
Major surgery is expected to be announced by the government later this year, at the council's instigation, with measures to speed up the complaints procedure and restore public confidence anticipated. The council's problems were highlighted by the case of singer Peter Cheung Shung-tak and his wife, former actress Eugina Lau Mei-kuen, whose nine-year battle for justice over the death of their newborn son in 2005 ended in June with a two-year ban for an obstetrician.
Lau last week presented another demand for reform. He wants a central system to handle all complaints about doctors from patients under a unified standard.
It would mean the Hospital Authority, which has long been criticised for its lack of transparency in handling doctor-patient disputes, would lose the power to conduct investigations.
At present, the authority can punish public hospital doctors for blunders itself, often without making the decision public. The authority can refer cases to the council, which has the power to ban or suspend doctors from practising, but did so just four times in the five years to last year.
Lau admits his proposal is likely to prove controversial, as public hospitals would have their own reasons for not referring cases to the council.
"It may be very difficult to put forward my proposal, as the issue is very sensitive. But this is something I have believed I should concentrate on doing since I took up the job." Lau told the Post.
"I am not a person who is easily dismayed or frustrated. I am actually rather persistent."
He will meet authority chairman Professor John Leong Chi-yan to discuss his proposal, which he said he would consider submitting to the government after he presented his idea to other doctors for comment.
Lau also proposes creating a mediation system to encourage settlements on minor issues without formal disciplinary proceedings, for example, in cases of overcharging or accusations that a doctor had been impolite.
Controversy is nothing new for Lau; he knew he was taking on a hot potato when he took over the chairmanship from Professor Felice Lieh Mak in 2012.
He was an experienced council member before the appointment, having chaired its preliminary investigation committee for six years. The committee, now led by former Medical Association president Dr Gabriel Choi Kin, is responsible for investigating professional misconduct claims and deciding whether a case is "substantial" enough to warrant a disciplinary hearing.
"Being a doctor is a job with huge responsibility, as the actions of a doctor can determine the life or death a patient," Lau said. "When society has given a doctor so much power, the doctor has the responsibility [to perform professionally].
"To me, it is difficult to accept 'inexperience' as a doctor's excuse for his or her mistake. And I would not protect doctors on this," Lau said.
As firm as that stance might sound, the medical veteran also cautions against being overly harsh on medics. Doing so would, he says, promote "defensive medicine" - in other words, putting physicians off attempting risky procedures that may have huge benefits for patients in order to protect themselves from consequences.
"There is such a trend of defensive medicine in Hong Kong, but the situation is not serious," Lau said.
"If the public is to sue the doctor for every single mistake, it is foreseeable that the doctor would refuse to treat high-risk patients. If patients who had a 10 per cent chance of survival after surgery decided to take their chance, no doctor would dare take the risk.
"When doctors start to become defensive, in the end the patients suffer."
Lau says many people misunderstand the concept of professional misconduct in relation to medical practitioners.
A doctor commits professional misconduct when their performance falls below normal expectations. Having a bad attitude, getting into a row over charges or anything else that makes patients unhappy is not regarded as misconduct.
Whether a misstep in a medical procedure is considered misconduct would depend on whether the mistake could have been avoided.
"Not every mistake made by a doctor is professional misconduct," Lau stressed.
Additional reporting by Cannix Yau
Education: University of Hong Kong, Chinese University
Specialty: liver, pancreas and biliary system surgery
1972-80: surgeon at various public hospitals
1989-present: senior lecturer, reader and then professor, department of surgery, Chinese University
2002-04: president, International Hepato-Pancreato-Biliary Association
2012-present: chairman, the Medical Council