Phone-surgeon row puts bedside manner on hold

AS FAR AS SURGEON Tung Hiu-ming is concerned, the controversy that almost wrecked his career is over. The hospital doctor, who took a call on his mobile phone while performing an operation, was cleared of misconduct by the Medical Council.

But Wednesday's verdict, in one of the most high-profile hospital complaints cases in recent years, marks the beginning of a new debate about the credibility of the Medical Council.

Dr Tung received the call on a hands-free device while carrying out keyhole surgery on taxi driver Gary Chung Chi-cheong at Queen Mary Hospital on May 12, 1999.

Mr Chung, 47, was shocked to hear the surgeon talking on the telephone during the operation on his large intestine. He claimed Dr Tung discussed buying a car during the call and that the doctor's lack of attentiveness caused him to suffer a perforated bowel which required an emergency operation.

The Hospital Authority's Disciplinary Committee and its Public Complaints Committee last year found the surgeon's behaviour to be 'serious misconduct'. The three-member disciplinary committee barred Dr Tung from having any promotion or pay-rise for five years.

But the Medical Council reached a different conclusion. Its ruling, by seven doctors and one lay member, cleared Dr Tung of misconduct. It decided he had not intended to receive the call and had quickly taken steps to end it. The patient's perforated bowel was not caused as a result of the doctor receiving the call, it decided.

The Medical Council ruling has come under fire from patients' rights activists and has been cited as another example of how the council protects the interests of doctors while disregarding the views of patients.

Critics have renewed their calls for an independent medical ombudsman to be set up, arguing that the Medical Council can no longer be trusted.

The ruling raises several important questions. Are the standards a doctor is expected to meet confined to his medical skills? To what extent should a doctor's respect for the personal feelings of his patient be a concern? Is it the case that as long as an operation is performed well, it does not matter whether the doctor receives a phone call, or for that matter plays mahjong, during surgery?

The council defines professional misconduct as behaviour of a doctor which will be 'reasonably regarded as disgraceful, unethical or dishonourable by his peers'. Does the ruling therefore mean that the taking a phone call while conducting surgery does not fall into any of these categories?

Council chairman Dr Lee Kin-hung has answered all these questions in the negative. He described public reaction to the decision as 'irrational and not based on facts.' He said although the council had noted that doctors often had conversations with each other during medical procedures, it had not taken the view that it was acceptable for such a conversation to take place on a phone. It also expects doctors to be sensitive to patients' feelings.

But in the case of Dr Tung, the council was not convinced by the evidence that he intended to receive the call.

Dr Lee said Dr Tung had made the mistake of failing to make sure his phone was turned off during the surgery, but that the call had been received inadvertently.

'We have taken into consideration that Dr Tung did make an effort to stop the telephone conversation; he urged the caller to hang up,' said Dr Lee.

The council also found evidence from the complainant, Mr Chung, highly unreliable because he was under the influence of sedatives and pain killers.

During the hearing, council members challenged Mr Chung's recollection of the event. For example, Mr Chung failed to correctly remember the colour of Dr Tung's gown. He said it was white, when in fact it was purple.

Dr Lee said the public should study the evidence instead of making irrational and sensational accusations.

He also revealed that while adjudicating the case behind closed doors, members were all well-prepared for the tide of public criticism they knew would greet any decision which cleared Dr Tung.

'The situation now is what we expected. It takes courage for the council to make such a decision. It would have been easier for us to find him guilty to please the public, but we choose to be fair and just,' Dr Lee said.

But, once again, the council has failed to clearly convey its message that it does not accept doctors talking on the phone during operations. The council, while explaining why it cleared Dr Tung of misconduct, did not warn against the use of phones in operating theatres, which may risk interference with medical equipment.

Dr Lee's 'evidence-based' argument also fails to convince Reverend Chu Yiu-ming, a member of the Hospital Authority's Public Complaints Committee. Reverend Chu said the Medical Council's ruling had again disappointed the public.

'How can the council clear the doctor when the Hospital Authority has already issued guidelines banning the use of mobile phones in the medical wards and the operating theatre?'

Reverend Chu said the function of the Medical Council was to uphold professional standards as opposed to protecting doctors. 'Ironically, the council has protected a doctor but has, at the same time, compromised professional standards,' he said.

Dr Tung is regarded as a 'rising star' in the hospital's surgery department. He has the sympathy of colleagues and more than 300 patients and staff signed letters of support.

The Medical Association, which represents the professional interests of doctors, wants Dr Tung to appeal against the punishment imposed by the Hospital Authority's disciplinary committee. The overwhelming support for Dr Tung from his colleagues and local medical figures illustrates the great discrepancy between what the medical profession and patients expect in a doctor's bedside manner.

Dr Chu Kin-wah, Dr Tung's immediate boss at the Queen Mary Hospital and also vice-president of the Medical Association, cannot see why talking on the phone during surgery should be regarded in such bad light. He said chatting among medical staff during a lengthy operation is not uncommon.

'Doctors are just human beings, and operating on a patient for hours and hours is not an easy task; it is even boring sometimes. Medical staff chat with each other to relax. What's wrong with that?'

Dr Chu added that some doctors like to listen to light music in the operating theatre. 'It is quite a common practice in the United States or Britain. The music helps to refresh the doctors.'

He said people had been misled by the whole event. 'All the comments are too emotional. We are not saying it is appropriate for Dr Tung to bring his mobile phone into the operating room, but whether it amounts to professional misconduct is a separate matter.

'We [the Medical Association] question why the two bodies have come out with two different rulings. The Medical Council held a more credible and fair hearing, it cross-examined both sides and legal representation was available.'

The association is to ask the Hospital Authority to explain the discrepancy.

'Many doctors supported Dr Tung, we think the five-year punishment was too heavy,' Dr Chu said.

The patient, Mr Chung, plans to sue Dr Tung through civil proceedings. He said the case, which has been dragging on for more than a year, has taken a toll on him.

'I have been under intense stress. Now it is over, at least for a while. But it is not the end of the world.'

Ella Lee ([email protected]) is a staff writer for the Post's Editorial Pages