Despite the extremely cold weather during the Chinese New Year, the fleeting holiday was still very pleasant to me — doing nothing except eating, sleeping and reading. My back pain was much less annoying. I could enjoy flipping over pages of out-dated magazines which I had no time to open, but for medical journals???

I spotted an article in the December 2009 issue of The Hong Kong Practitioner with much interest. The title was “Is the number of clinical problems per consultation correlated with poorer ICPC coding practices in primary care clinics? A pilot study in two distinct clinic settings." I was not in the mood of doing a critical appraisal. But, one of the statements made in the discussion was "limited consultation time could be one of the major causes of missing codes" which has always been a problem for the GOPCs.

Why would patients complain about the short consultation time and especially doctors spending most of the time with the computer? Part of the reason is probably because of this ICPC coding which our colleagues have to key-in. There is a Chinese saying "gazing without seeing, hearing without listening" (視而不見，聽而不聞). Why is it difficult for trainees to identify the reason for consultation, subtle body or verbal language, hidden agenda of the patients…? I agree with the authors’ suggestion that more educational initiatives be implemented in these clinic settings to enhance ICPC coding practices. If we increase the consultation time, would it be improved? If yes, where is the extra manpower to meet the needs? That is why I choose this title of "Money Talks".

The Financial Secretary Mr. John Tsang Chun Wah announced in the Annual Budget that the total expense for our healthcare system is 36.9 billion, and 33.3 billion is allocated to the Hospital Authority. The lion’s share is mainly for secondary care. What is the percentage for primary care? I presumed the 3.6 billion left over is mainly for Department of Health which covered all the current services under its umbrella. If the Government is really advocating primary care as the foundation in the healthcare system, they should have the mindset of a clear distinction in the allocation of resources for the healthcare system between primary care and hospital care.

There was a newspaper reporting in SCMP on 1 March 2010 that in Mr. John Tsang’s budget, HK$600 million would be spent in the next three financial years to implement healthcare reform and related initiatives. Part of these new resources will be used to set up a 20-strong Primary Care Office, a new structure under the Food and Health Bureau to co-ordinate all the primary care services now provided separately by the Hospital Authority and the Department of Health. I applaud the decision whole-heartedly. I am sure this is a very important and big step forward in the right direction.

If I may refer back to the issue of ICPC code, I think it is time to plan for proper education and training initiatives as suggested in the article, not only for FM trainees in Hospital Authority but also those of us in private practice. I have to admit that I do not have any formal training to use ICPC code except by reading the translated version of the book of our College. I do not know how many primary care doctors in private practice are using ICPC coding in their daily practice. But one thing I know about is that the planning of the e-Health Record Office will incorporate ICPC code in the system, which I fully support and consider as vital. Our College should have a strong participation in this territory-wide electronic health record sharing project. The success of the healthcare reform and the e-HR system is closely related, and it requires the cooperation and input from the academic, public and private sectors.

Dr. Gene W W Tsoi
President

At the time of writing, people are busy preparing for the Chinese New Year, the Year of Tiger. It is a tradition among us that parents buy new clothing and shoes for children, "red packets" are prepared with new bank notes and housewives work overtime for year-end dinners and celebrations.

It is also the time for planning. A couple of things are happening in relation to our College and Family Medicine. We need new ideas for the future development in terms of undergraduate and postgraduate education, nocational training and professional assessment. The Open Forum in January was well attended by members and lots of comments and ideas were gathered. I am very pleased that we can share our experiences and feelings. It is just the begining of a long venture for the College to push through a long awaited new vocational training programme with a new starting point.

The role of our College in the undergraduate medical education is well recognized. Last monthI was invited to present a HKCFP prize at the HKU Medical Faculty Graduation Ceremony to the candidate who has produced an excellent report in his clinical attachment of the FM module. The importance of a strong FM curriculum cannot be over-emphasized. I am sure the two Medical Faculties will move with local and international expextations t5hat Family Medicine is at the core of teaching and training of doctors and healthcare providers.

It is never easy to set standards in any medical specialties and especially for Family Medicine.It  has to strike a balance between the expectations of patients, colleagues of the medical profession as a whole and the policy-marker. Universities have a crucial role to play and their products are the raw materials. Everything is inter-linked in a cycle and each affects one another. If undergraduate teaching in Family Medicine is not satisfactory, it will be hard to convince young doctors to specialize in Family Medicine. If vocational training is not satisfactory, the standards of practice will not be good. As a result, patients, who cannot appreciate the advantage of  good family doctors, will have less demand for the service. Hence, Government is not going to allocate the resources for the provision and development of Family  Medicine in the healthcare system. It will also affect the Medical Faculties of the two Universities in their funding and structing of the medical cirrculum. Forgive me if I am being long-winded, but this is exactly what has been happening in the past decades.

The output of Specialists in Family Mrdicine every year has been monitored. The highest number in the last 10 years was 34 in 2009. The total cumulated number is 248. We are amongst the smallest College in terms of the number of Fellows in the Hong Kong Academy of Medicine. If we tell the Governmnet that primary care services will need 2700 specialists in Family Medicine to meet the demand, we are very far from the target, which may nerver be achievable. We need to re-think and be pragmatic. I do not advocate lowering our standards to meet the demand, but the mindset needs to be changed among sone of us. The attitude of every doctor in his daily practice is dominated by his experience and personal value. Training can provide the required jnowledge and skils, and perhaps modify some of the behavior of trainees. The most deficient area in both undergraduate and postgraduate curriculum is the teaching of medical ethics. I have to emphasize that I am not referring to the medico-legal aspects of medical practice. Criminal offences such as indecent assault of patients are commonly reported. Recently, there was an article in the SCMP about doctors taking rebates of "kickbacks" by referring patients to specialists. Those incidences have a far more damaging impact to the professional integrity and public confidence to our advices. Surely it is a serious matter for all of us, especially medical educators, who should study what has been missing in the making of a good doctor.

I would like to take this opportunity to wish you health, wealth and luck in abundance throughout the year of Tiger.

Dr. Gene W W Tsoi
President