A debate over the right of patients to see primary healthcare professionals such as physiotherapists without a doctor’s referral is shaping up as a thorny issue for Hong Kong’s new administration. Physiotherapists and patients’ rights campaigners said doing away with doctors’ referrals would empower patients, give them swifter access to treatment and rejuvenate the primary care sector. But doctors – especially orthopaedic surgeons – have warned that such a move could put patients at risk if it delayed diagnosing their serious health conditions. The two sides locked horns over the issue for years before a primary healthcare reform package proposed by physiotherapists was rejected in 2019. But their disagreement resurfaced after former city leader Carrie Lam Cheng Yuet-ngor indicated in last year’s policy address that there was a need to amend the law to “allow patients to have direct access to healthcare professional services (e.g. physiotherapy and occupational therapy) without a doctor’s referral so as to avoid delay in treatment”. After internal meetings in a working group, the opposing parties appeared to have narrowed their differences to one key issue – whether direct access to physiotherapists should be allowed only if the patient had a pre-existing diagnosis by a doctor. More recently, the city’s new administration signalled it intended to press ahead with primary care reforms, which could include amending the Supplementary Medical Professions Ordinance covering physiotherapists, occupational therapists and radiographers, among others. Secretary for Health Lo Chung-mau would only reveal that the reform blueprint was ready and would be published later this year. An amendment to the law is expected to go before the Legislative Council in October. How a lack of community-based primary health care doomed Hong Kong Welcoming change, Professor Marco Pang, president of the Hong Kong Physiotherapy Association, told the Post he expected demand for direct access to increase, especially from coronavirus survivors with “long Covid” symptoms. “Many more patients may look for physiotherapy to optimise their physical conditions with cardio exercises if they suffer from lingering lung problems, or seek muscle training to rebuild their fitness level,” he said. “Hongkongers have also become much more health-conscious, with many people going to the gym nowadays compared with 10 or 20 years ago.” Pang urged the government to seize the opportunity to promote primary health, allowing people to make positive lifestyle changes and avoid burdening the hospital system unnecessarily. Urging caution, Dr Wilson Li, president of the Hong Kong College of Orthopaedic Surgeons, said his specialist group agreed to allow “limited direct access” for patients with a pre-existing diagnosis and recurrent symptoms. But he warned that some pain symptoms could mask more serious conditions, including cancer, and require doctors to carry out a “holistic assessment”, including imaging and the use of drugs. In some cases, the symptoms could be caused by psychological factors. “Policymakers will have to bear the political responsibility if they push ahead without a consensus. Our job is to point out what is in the public interest and the best interests of the patients,” Li said. The issue is expected to dominate next month’s meeting of the Supplementary Medical Professions Council, the self-governing body for physiotherapists, occupational therapists and some other primary care workers. The Patients’ Alliance on Healthcare Reform, representing more than 30 patients’ groups, said it had proposed a system involving community, NGO and private physiotherapy providers without needing a doctor’s pre-existing diagnosis. The proposal included telling patients at the start about the treatment aims, risks and their rights, requiring physiotherapists to refer clients to a doctor for diagnosis if they do not improve after 30 days of physiotherapy, and storing all medical records in a government database. “The right to choose is a fundamental right of a patient,” said alliance convenor Tim Pang Hung-cheong. “Direct access can shorten waiting times of patients by removing the need to consult a doctor first, and save costs especially when many low-income patients have little money to spare.” Physiotherapist Pang said his research showed that direct access had been implemented in more than 80 jurisdictions including Australia, Canada and most of Asia, and a United States survey in 2018 demonstrated it lowered patients’ costs significantly. In terms of health outcomes, patient satisfaction was higher by some 10 per cent, according to a 2011 study in Australia involving a group given direct access, he said. Pang was confident that physiotherapists had sufficient training and education to spot “red flags” and refer those who might have underlying medical issues to doctors. Orthopaedic specialist Li said that while patients had a right to choose, they ought to make an informed decision. “We should not encourage patients to go for symptomatic treatment without a full medical treatment plan first,” he said. While accepting that most patients would be receptive to direct access to physiotherapists, he worried about the minority who might end up delaying diagnosis and treatment for serious illness. Hong Kong athletes given best support in sports science and medicine Cleaner Hung Chi-wan, 71, said she wished she could have seen a physiotherapist right away when she suffered acute shoulder pain from long hours of manual work. She ended up waiting 10 months in 2019, first to see a doctor for a referral and then to see a physiotherapist. “My legs almost went numb in an MTR train once,” she recalled. While she waited for treatment, the pain was sometimes so intolerable that she would lash out at family members. Her condition improved after she began seeing a physiotherapist. “My pain only eased after doing some exercises on a machine,” she said. A Health Bureau spokeswoman said that “depending on the progress of discussions in the sector”, the government hoped to begin the process to amend the law within this year.