tim's experiment

One of my friends consulted a GP the other day about a puzzling ailment and was told to make an appointment to see a specialist in the nearest public hospital. So she went to the Prince of Wales Hospital, where the specialist clinic brandishes the name of Mr Li Ka-shing. I think Mr Li should ask for his money back, because this is not doing much for his reputation. The first thing you see when you get into the appointment-making area is a sign, which so stunned my friend that she took a picture of it. This tells you how long you should expect to wait before the day of your appointment comes up, depending on the type of specialist you need to see. Thus your appointment for a “general medicine” specialist will be in February. Look closer: that is February 2016. If your problem is cardiac, then April of the same year. If you need Geriatric care they make a special effort to fit you in before you join the Monty Python parrot. Your appointment will be in November … next year. Something illegible which might be Renal beats that by a month. No doubt some of these ailments proceed slowly, but I felt a twinge of sympathy for respiratory customers, who are apparently expected to hold their breath until March 2016.

Now I accept that everyone concerned is working hard and doing his or her best. I am sure also that waiting periods at other public hospitals are as bad if not worse. But asking people to wait for 18 months to see a specialist is not providing a public health service; it is just drumming up business for the private sector. Consider the scenario: you see your doctor. He confesses some puzzlement. Don’t like the look of that; think you should see a specialist. You go to your specialist clinic and discover that you have to wait somewhere between 15 months and two years to have your first encounter with a specialist.  This is not a wait for a bed, or for an operation, it’s just the wait for a chat with someone who will tell you whether what you’ve got is serious or not and what needs doing about it, if anything.  Clearly at this point in the proceedings, unless you are down to your last cent, you are going to go private.

Interestingly, there are lots of private specialists. In fact in recent years it seems that in those buildings where lots of doctors flash their names on the lift board, everyone is a specialist. A cynic might, indeed, suppose that it is rather easy for a private doctor to become a specialist, which makes an interesting contrast with the extraordinary obstacles facing doctors who qualified in perfectly respectable medical schools overseas and wish to practise in Hong Kong.

It may be, of course, that doctors have a different sense of time to the rest of us. This is certainly the kindest explanation for the report last week that the Medical Council, which regulates the profession with a gentle hand, had decided to suspend a doctor for an error she made more than nine years ago. This is not quite in the same class as the old 19th century Court of Chancery. It is generally considered that Charles Dickens was exaggerating in the account of its proceedings which he gives in Bleak House. But there is in existence a perfectly genuine recorded judgment by the then Lord Chancellor which starts with the ominous phrase “Having considered this Will for 15 years…” Indeed the Medical Council’s effort is not even a record for Hong Kong. The legendary Yaqub Khan’s case against the Hong Kong Government for unfair dismissal lasted 11 years, no doubt helped by the government’s desire to see him reach retirement age before they lost, as they did. Still, nine years is a long time. It suggests that it might not be very rewarding to complain if your doctor cuts the wrong leg off, because medical careers only last 40 years to so. By the time the Medical Council gets round to your problem there is a one in four chance the offending doc will have packed in the game anyway.

A spokesperson for the council did not help matters by parading an unusually limp set of excuses – difficulty in getting people together, finding rooms for meetings, etc. This suggests that the council does not approach some of the matters in its remit – like disciplinary proceedings – with a great sense of urgency. Part of the problem is that the council is too big. It has 25 members. No useful meeting has every been held between 25 people. The corresponding UK body has 12 people on it. Half of them are not doctors. a feature which Hong Kong has not copied.

Another problem is that the Council, and indeed the Hong Kong Medical Association, are dominated by private practitioners. This gives rise to a suspicion, which is hard to dispel, that the local profession is mainly interested in a most painful medical procedure: the amputation of the patient’s wallet. No doubt the profession would like us all to hold it in high esteem, while continuing to ensure that hospital carparks display an admirable crop of recent-model Mercedes equipment. These two objectives may not be entirely compatible.