tim's experiment

When I was aged six it was decided, in accordance with the medical consensus at the time, that my tonsils served no useful purpose and should be removed. This is now regarded as a sort of scientific variation on Female Genital Mutilation, doing nothing for the patient’s health because the tonsils are in fact useful. Never mind. The gentleman who amputated my tonsils in accordance with the prevailing medical wisdom was called an “Ear, Nose and Throat specialist” and the place where he worked was called the Ear Nose and Throat Clinic. But you will not find such a specialist, or such a clinic, in Hong Kong, where the specialists in this area announce their field as “Otorinolaryngology”. Readers who suffered Latin at school will recognise this as being constructed from the Latin words for ear, nose and throat, capped with the word for an area of study. It seems the ear, nose and throat people feel naked unless their professional title is cloaked, like the naughty  bits of Gibbon’s “Decline and Fall of the Roman Empire”, in the “decent obscurity of a learned language”.

No doubt the medical profession is aware of the placebo effect of a bit of mumbo-jumbo, the reassuring rustle of a white coat, the appearance of relaxed omniscience. What is the difference between God and a doctor, goes the old joke. God knows he isn’t a doctor, is the answer. This is all very well, and may even be therapeutic, but it causes problems when doctors as a group emerge in the political arena. Suddenly we have the Legislative Council’s medical representative engaged in a one-man obstruction campaign — no doubt known in the profession as a “filibusterus medicus” — to head off a government proposal to reform, or at least to change, the Medical Council. The council  regulates the profession by vetting qualifications and adjudicating on complaints. Suddenly it seems this profession, largely composed of Mercedes drivers judging by the contents of their reserved spaces in hospital carparks, is having sand kicked in its face by the government. In retaliation Legco is paralyzed. Two other bills (whose importance has no doubt been exaggerated, but still…) will die if legislators do not finish work on them before the summer break.

The government wishes, we are told, to add four lay members to the Medical Council. The council currently has 28 members, 24 of whom are doctors. The idea, or so we are told, is to deal with the public suspicion that the council takes a rather indulgent view of professional misconduct, and that when it does undertake disciplinary proceedings they proceed very slowly. The first point is propelled by a widespread belief that a doctor has very little to fear form the council unless he rapes a patient or sells her kidney to a mainland hospital. The second point was highlighted by a recent case which was decided nine years after the events complained of. This is a long time, even by the standards of the regular courts. The legendary Yacoub Kahn’s unlawful dismissal case took seven years, leading many people to suspect that the government’s lawyers were under instructions not to lose it before he reached retirement age, and consequently could not be reinstated. The quote invariably wheeled out at this point is “justice delayed is justice denied”, which is usually attributed to William Gladstone (19th century prime minister and inventor of the bag) but can be traced back to the 17th century. Well quite. Part of the Council’s disciplinary musings involves a Preliminary Investigation Committee which (I quote its website) “always includes a lay member”. All four of the existing lay members are available for this purpose but no doubt they are busy people. It may be that a larger pool of lay members would enable the committee to meet more often and get a move on. It is difficult to believe, though, that this is the only, or even a major, cause of the leisurely pace which characterises the council’s investigations.

Anyway there we have the case for the prosecution. The Council is dilatory, slow and biassed in favour of doctors. Reading the pamphlet it produces for the information of potential complainants I did detect a certain wistful hope that the number of complaints would be quite small. There is a section on “the nature of medicine”, which starts with the admission that “medicine is not an exact science” and goes on to say that errors of diagnosis or bad outcomes are not necessarily a sign of misconduct. There is a lengthy list of “categories of complaint we are unlikely to take forward” and a daunting section on what may be required of you if your complaint survives: evidence on oath, appearance at public hearing, cross-examination by counsel for the accused… Clearly doctors, like policemen, believe that their work involves special challenges which the lay person does not understand. I sympathise, though it is difficult to accept the council’s claim that it is regarded as anti-doctor by doctors.

The case for the defence is that after all medicine is difficult. With the best intentions and greatest care there will still be cases where the outcome is unfortunate, for which read tragic. A doctor doing his best and following the accepted tenets of the profession may still, say, excise a perfectly healthy set of tonsils. It would be unfair to jeopardise his ability to work in the profession because of a bit of bad luck. Only doctors understand what other doctors go through so it is appropriate and necessary for them to be the overwhelming majority of judges of professional conduct. Cases take a long time because they are complicated and adding lay members will not help.

All this hardly explains the passion which the government’s rather modest proposal has aroused. The problem seems to lie in a harmless-looking phrase, “appointed by the Chief Executive”. This phrase, and its predecessor “appointed by the Governor” used to denote a constitutional ritual. A specialised unit in the Home Affairs Branch kept a register of potential officeholders.  For many years I was regularly asked to update my entry in it, though the only invitation it ever produced was to the committee which vets personal number plates: fun but badly paid. Posts on councils, consultative bodies and such like were filled by the branch after nomination by an outside body, some consultation with the relevant department and maybe the chairman of the body concerned. They were not vetted for political propriety. However it is now widely believed that such appointments are used to reward the government’s supporters, which would be bad enough, and worse to pack the bodies concerned with people who can be depended on to support some government project or objective.

Nor is there an absence of evidence for this view. Come with me to the official list of members of the Legislative Council. This is confusingly presented in “order of precedence”, thereby making it very difficult to find any particular councillor. On the other hand it does mean the councillors are more or less in order of arrival, so that you can see how much legislative toil it takes before honour descends in the form of a Bauhinia Star (BS) of one colour or another or a Justiceship of the Peace. Justices of the Peace in the English system are lay judges who sit in court with a lawyer (the Clerk) to advise them. All they do in Hong Kong is polite inspections of prisons, so this is basically an adornment for your business card.  Looking down the precedence list you have Tsang Yok-sing, who is first becausse he is chairman; he has the BS  and JP. You then come to three very senior and undecorated democrats. Then you meet your first DAB man, who has everything, and next comes another democrat, again undecorated. Then there are two Laus: Wong-fat is lavishly decorated, while Emily is only a JP from pre-Handover times. Next comes a block of government supporters, all of whom have the full BJ except for the FTU’s Wong Kwok-hing, who for some reason is not a JP. Then we come to the undecorated Ronny Tong, and so it goes on. Of course this may not all be CY Leung’s fault. But if you look only at the members who joined the council in 2012 the message is the same. A total of 11 BS have been awarded. Not one to a democrat. The story with JPs is similar. The DAB has 18 per cent of councillors and gets a third of honours. Your work in Legco will only be recognised if it is work on the same side of the fence as the DAB. What used to be a civic honour has become a political reward. Appointments to other bodies may have more obviously toxic results. You have to wonder, for example, why the MTR was in such a tearing hurry to order fleets of trains from a Chinese manufacturer who is the rolling stock equivalent of the people who sold melamine-laced milk powder.  Then there are the university rows…

So what is bothering the doctors is the thought that the four lay people to be appointed by the Chief Executive will be chosen for their willingness to pursue some particular policy beloved of the CE. Recognising the qualifications of mainland doctors would be a hair-raising example. The Chief Secretary, Carrie Lam, will not have soothed these fears by suggesting the other day that the change to the council would help to solve the shortage of doctors in public hospitals. How does that work, one wonders?

Whatever you think of the doctors’ case, this controversy is a symptom of a wider problem. Appointments by the government used to be almost universal. And it was almost universally accepted that the major consideration in such appointments was the interests of the body or activity involved. No doubt some people were black-listed for a variety of reasons but the system was not used as a form of social welfare for grassroots supporters, or as a way of packing councils and consultative bodies with proponents of a particular point or policy. Times have changed. It is now widely accepted that appointments and honours are used to reward, to bribe, and to provide a well-grassed retirement pasture for the Boxers of our local Animal Farm. Whether things changed gradually or CY Leung is entirely to blame is not relevant. Trust, once dispelled, is not easily restored. On the whole we still rely on doctors to do the right thing by us. We cannot, alas, say the same of Mr Leung. His successor will have a lot to live down