A senior Hospital Authority executive was booed as he sought to explain the rationale behind a set of new proposals to streamline the structure of public doctors at a meeting among doctors late last month. Disgruntled with what they deemed as a plan to cut starting salaries, more than 1,000 doctors united to defend their interests and threatened to take more drastic action if their voices were ignored. The authority's leadership was quick to cool the temperature by promising a three-month consultation before a decision. Defending the reform as an attempt to rationalise the structure for better services, the authority's chief executive William Ho Shiu-wei said the row had reflected the large number of changes as well as challenges dawning on the medical sector. Work pressure on staff had been building up under the enhanced productivity programme for the public sector. Waiting time for outpatients has to be shortened. Starting salaries will have to follow civil service guidelines. Medical blunders and misconduct, meanwhile, have made frequent headlines. Dr Ho said: 'Colleagues felt pressure under these circumstances. Over the past two years, doctors have faced a lot of pressure from the media and public. 'Many were asking why [the changes were being proposed] while they followed the established rules and practices and why there was an atmosphere of trial by media. 'The world has changed and values have changed. As the management, we are obliged to give a clear vision and work out strategy in order to boost morale and work together for common objectives.' Formerly the Kwong Wah Hospital's chief, Dr Ho succeeded Yeoh Eng-kiong as head of the statutory body in September. The authority manages 46 public hospitals and a staff of 50,000 with a total budget of $20 billion. Mr Yeoh is now Secretary for Health and Welfare. Dr Ho, 40, maintained that the authority has been able to entrench in its working culture a commitment to improve the use of resources. On the other hand, he reckoned the public had surging expectations on health care. 'Trust of patients towards doctors has become weaker. 'We see experience in foreign countries such as the United States which shows doctors are so worried that they adopt so-called defensive medicine. It is, after all, public money and there's no harm doing all possible tests to play safe. '[But] as far as how resources are best used, this might not be good for the whole society. 'I'm worried about whether Hong Kong will follow the same path,' he said. Calling for a 'fair and objective' assessment on their work, Dr Ho said letters of praise from patients have outnumbered those of complaint. The medical staff, he said, should learn to deal with the inherent risk involved in the process of treatment and 'not blindly believe in advanced technology'. More important, Dr Ho pointed out it was imperative for doctors to communicate well with their patients to understand their needs. 'Traditional training emphasised medical technique, not communication skills and teamwork. 'Times have changed. Relations will get tense if doctors take the voices of their patients as a challenge to their authority. We have to understand the sentiments of patients who might lay blame for their misfortune on doctors. It's not the case that doctors have always made the mistake [alleged]. In many cases complaints are found to be groundless. 'I see the complaint mechanism from the perspective of relations-building, for health workers to understand more about the needs of patients and to avoid recurrence of problems.' Negligence and poor manual skills of some doctors aside, Dr Ho attributed some medical blunders to the lack, if not breakdown, of communication among medical workers. That has become more important with increasing sophistication in medical treatment processes and techniques. 'They are not really matters relating to the areas of competence of doctors and nurses.' Nevertheless, the hospital chief underlined the importance of streamlining the structure of public health to face future needs, noting the disputed two-tier structure proposal was mooted about two years ago. The authority has proposed restructuring the system from three-tier - medical officers, senior officers and consultants - to one made up of only residents and specialists. 'We need to flatten the structure by giving full recognition to specialists and good training for residents. After [training], they will become specialists and form the prime workforce for the delivery of health care. 'Ideally, the number of specialists will gradually increase to give better direct care to patients. I'm convinced that's the direction we should work towards.' Describing it as a two-tier accountability, Dr Ho said speculation and suspicions about the proposal were inevitable in view of the drastic changes to the overall environment. 'Many have linked it with the government drive to boost productivity and suspected it was an attempt to cut costs. We have said it is cost-neutral and the crux of it is how to make best use of the money.' There has been better mutual understanding through contacts, he said, adding 'I hope the [medical] sector will show professionalism and come up with the best way to deliver services.' Dr Ho, whose appointment was greeted with claims he was too young for job, admitted his responsibilities were much heavier than before - although by no means different in nature. 'There are big challenges . . . we face dilemmas and high public expectations. But I knew it was going to be tough when I applied for the job. 'If you look around the world, Hong Kong does have a good system ensuring cost-effectiveness. Although the public have different views about the system they by and large agree it is sound. 'We should feel proud of it. That doesn't mean we should feel content; and we should continue to make improvements. 'Yet we hope there will be a fair and objective judgment,' he said. Chris Yeung is the Post's political editor
