Don't hurt public trust, doctors
Every doctor agrees that continuing medical education (CME) is good and any decision on it should be easy. But money and politics play a part in health care, even for such a fundamental issue.
Specialists, including many in private practice, have been, for years, clocking up their CME credits as required by the Hong Kong Academy of Medicine. Doctors with the Hospital Authority and the two medical schools are in an academic environment where CME is a way of life. That leaves about 4,600 private general practitioners (GPs). Of those, about 2,000 do not complete CME requirements, says the Medical Council. To understand why many GPs are reluctant to take part in CME, we must look at it from a monetary view.
Patients who use private GPs' clinics usually have minor ailments such as a common cold or gastrointestinal upset, and they only go to GPs to get what they want - drugs for a quick cure and perhaps a sick leave certificate. These patients are inclined to clinic-hop and competition among GPs in the same area is keen. A GP taking a few hours off to attend CME may lose patients to a competitor. Not that what they can learn in CME lectures will improve their earnings. Try telling a patient not to take antibiotics for upper respiratory infection and the patient's business may be lost forever. If CME is a prerequisite for renewing the license to practice, it becomes a serious livelihood issue. No wonder the Medical Council's proposal to introduce such legislation triggered a flurry of opposition from officials of the Hong Kong Medical Association and the Hong Kong Doctors Union, whose members are mostly private GPs.
In a medical association study in 2002 on CME, only 616 of 5,443 (11.3 per cent) of members responded to the questionnaire. Of the responses, 550 were against the proposed legislation. There are flaws in the poll because of the low response rate. But could it be that those respondents against the legislation were GPs who never take part in CME and those who did not respond in the survey could not care because they fulfil the CME requirements?
Those who argue vehemently against mandatory CME by claiming that most doctors already do so miss the point - it is the minority, be it 2,000 or 20 doctors who do not participate in CME, that the Medical Council is pursuing. The argument that CME activities do not necessarily help GPs improve their skills also misses the point. If that is the case, then improve the effectiveness of CME and do not scrap it.
Another argument, even among doctors who are CME compliant, is that such legislation symbolises a loss of professional autonomy. Such matters of principle, however, would have public support only if it was not self-serving.
When CME as a prerequisite for license renewal was first debated in the Medical Council in 2001, the only members against it were three (out of the seven) representatives from the HKMA. One member, who has been vociferous against mandatory CME, has recently been elected as HKMA president, Choi Kin, no doubt getting significant backing from GPs who have similar views. Many other HKMA office-bearers have since joined the chorus of opposition.
Dr Choi, in an open letter to the Medical Council, has even compared the legislation with Article 23, implying that doctors can apply the same rationale to revolt. Its analogy with Article 23 erases any doubt that this has become a political issue. But politics is like a double-edged sword. If there were any validation to the Article 23 analogy, it would be that the public might have the final say.
By being too vociferous about not wanting mandatory CME, union leaders risk inciting the public's involvement. If public sentiment backs mandatory CME, then the medical community has no choice but to carry out the mandate. Then the real loser will indeed be the autonomy of the profession.
Feng Chi-shun is a consultant pathologist at St Paul's Hospital