It must be bloggers block! The information incoming is just too great to handle. I have cross-posted about this blog in an editorial I have just written for our magazine. I am revisiting the inquest of a girl that died in a private plastic surgery clinic in Hong Kong. It is not straightforward and an inescapable web of deceit and corruption begins to be revealed. I was introducing this each week with some compare and contrast comments regarding the medical profession in Hong Kong and in the UK.

I have been quite open in my concerns regarding the Medical Council of Hong Kong. It has not changed since the handover and so is modelled on the GMC prevailing at that time. 1997 was not a good time for the medical profession in the UK. Ian Kennedy was beginning his review of the Bristol Children’s Hospital cardiac care scandal and this was followed on by the Shipman inquiry chaired by Dame Janet Smith. Ian Kennedy was very critical of the old-boy network and club culture prevailing in the medical profession at the time whilst Dame Janet’s report was especially critical of the GMC. Specifically, it said that the General Medical Council "was an organisation designed to look after the interests of doctors, not patients."

The GMC in the UK has changed out of all recognition from that anachronistic and dysfunctional institution on which the MCHK is based. It is not surprising that the Medical Council in Hong Kong is now finding itself under grave threat. I am not sure if the medical profession itself actually realises that. When the regular columnists in the local English language newspaper begin to take pot shots at the lying, deceiving and manipulating medical politicians you know that things are bad. It is a question of accountability and responsibility and the MCHK has neither. It protects bad doctors, turns a blind eye to the unsafe conditions in many private clinics, it restricts the access of new doctors into Hong Kong for the purpose of maintaining a closed, doctor-friendly market. This is again not of any benefit to the people of Hong Kong. A recent issue was the inordinate length of time the MCHK took to investigate complaint cases. This promoted a permissive atmosphere amongst many in the private sector with appropriate discipline being almost non-existent. The Government wanted to increase the number of lay people on the Council (by four members) although this would still give a very significant majority of representation to the medical profession itself.

To make this amendment possible new legislation had to be passed and that is where things have ended up in an almighty mess. There is a medical politician amongst the lawmakers, called Leung Ka-lau. He first rose to notoriety / acclaim for destroying the previous Chinese University Chairman of the Department of Surgery, Joseph Lau Wan Yee. Leung was always involved in politics and was involved in promoting a more militant brand of new professionals. He was the head of the Public Doctors Association and when the Chinese University senior management committee had to make a choice between backing the Chairman of the Department (who was trying to instil some discipline into the General Surgical Teams in the university teaching hospital) and Leung Ka-lau (the fearless fighter for the downtrodden and hard pressed public doctors) they sowed the seed whose harvest is reaped today. Joseph Lau is the Head of the MCHK and wants it changed. Leung Ka-lau is a law maker and has been able to use delaying tactics to prevent the bill from being passed during this Legco term. His motives have been justifiably questioned, as the current situation is certainly not in patients’ best interests. The Government has to do something and it is highly likely that a new administration with a popular mandate will push through legislation to make radical changes to the way the medical profession is regulated (more of that to follow).

Meanwhile in the UK, there is the junior doctors’ contract issue, which is still dragging on and likely to become even more divisive. The Government Minister involved, Jeremy Hunt, made such a mess of things that in the recent government shake up, it appears the new Prime Minister could find no one prepared to take on the health portfolio. Initial news of his sacking was met with outpourings of thankfulness on social media but then in a bizarre twist he was not sacked and was insanely stupid enough to taunt the junior doctors. Meanwhile, one of the civil servants he used to support his false and misleading campaign against the junior doctors, Charles Massey, has been appointed as the new Chief Executive of the GMC. Junior doctors are understandably very concerned.

The role of the GMC is defined on their website as thus:

“We are an independent organisation that helps to protect patients and improve medical education and practice across the UK.

  • We decide which doctors are qualified to work here and we oversee UK medical education and training.
  • We set the standards that doctors need to follow, and make sure that they continue to meet these standards throughout their careers.
  • We take action to prevent a doctor from putting the safety of patients, or the public's confidence in doctors, at risk.

Every patient should receive a high standard of care. Our role is to help achieve that by working closely with doctors, their employers and patients, to make sure that the trust patients have in their doctors is fully justified.”

In Wikipedia, the description is slightly different: The chief responsibility of the GMC is “to protect, promote and maintain the health and safety of the public” by controlling entry to the register, and suspending or removing members when necessary.

It is also noted that the GMC is funded by the subscriptions of the doctors it regulates.

The GMC is accountable to the Government but is an independent institution. There is debate as to whether it was responsible for the Chairman of the GMC to express a political opinion regarding the junior doctors’ contract issue. The appointment of Charles Massey is a clear sign that the Government’s intentions cannot be trusted. The lack of trust is confirmed today when the millionaire Hunt tried to use money to prevent a legal hearing about his right to force a contract on doctors.

So, Hong Kong and the UK are both in a difficult position from the point of view of the medical professions. I hope the junior doctors have enough resolve and passion to put the NHS and patient safety first. Meanwhile, in Hong Kong the devious politics and scaremongering of a few scurrilous medical politicians has further tarnished the image of the medical profession. The failure to have the medical registration amendment law debated is being described by the local media as “a pyrrhic victory for Hong Kong doctors”.

Wow. How some things change whilst others do not. I will get back to the inquest in the next blog but this is obviously the time to be addressing professional regulation. The MCHK and the GMC are poles apart but both are exhibiting extreme views and that is not what Medicine is about.

Link to the Kennedy report:

Andrew Burd (Prof)

The Chinese University of Hong Kong.

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