穝 籇 の そ ㄆ 叭 News Department
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の 畗 ㄘ 键 現 竒 琍 戳 せ .
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...........................................................
Dear Friends,
Just woke up in the morning (01/05/99), turned on the radio and listened
to the "politics and Economics on Saturday" at Commercial Radio (讲 ゅ
绊 の 畗 ㄘ 键 現 竒 琍 戳 せ .). The guest of the show was a
doctor representative by School of medical and specialists
(?), chairman
Dr Fong(よ 瑉 ネ).
He mentioned things in his message that really make me angry.
He is so defensive, the basic message is: The medical profession is do
very well and the patients are well protected by the profession in HK.
I do not able to agree with him. In a public section , public hospital,
the service is OK. But the quality and the quantity (consultation time)
of the private medical service vary a lot , and some of them are highly
undesirable. This has become our daily experience with private doctors,
which was also confirmed by the Harvard Report (which the practice research
was actually done with the Medical Society of Hong Kong!!)
The host of the radio show presented to him a personal experience with
his private doctor. When the host saw the doctor for a cold, the private
doctor prescribed him 3 days of antibiotic (let's not asking why
the doctor did not take any throat culture for identification before he
prescribed any antibiotic!!!). The host then demanded a complete course
of treatment (thanks to the Harvard report, the patients now know they
should complete the antibiotic treatment course!) The private doctor did
not tell him any reason, (with a long face) and suggest he had to pay double
the bill to obtain a full course of medicine (i.e. money that matter!).
Dr Fong in the show said the intention for a 3 day treatment is good, because
the doctor wants the patient return to examine the adverse effects and
effectiveness of the drug treatment after 3 days. And follow on saying
there are many effective antibiotic treatment that do not have to administer
5 or 7 days, and some effective antibiotic can be administer as 1 dose
in pediatric treatment.
The information provided was really misleading. I don't disagree it is
necessary for a careful monitoring of the adverse effects of the treatment
(More the concern, always the better), provided it is free and it is working.
If the revisit to the doctor office is free (monitoring, right? Should
be included in the medical bill of the first visit!) I do not have any
objection to it. However, if we need to spent another hugh sum of medical
bill for just a observation or obtain 2 more days of treatment, I suspect
many of us would not want to spend valuable time and holiday
to wait in doctor's office for 6 more capsules!
In most case, the antibiotic should work and remove the symptoms in 1 or
2 days if it is a suitable antibiotic for a bacterial infection. The reasons
to complete the treatment course in 5 or 7 days is to prevent reemerge
of bacterial drug resistance that bad for both the patient and the community
as a whole. So if the symptoms has gone, the patient would most probably
not return for an reexamination, especially you have to face a fee again!
So the treatment course will not be completed, and the drug resistance
developed in the community.
In other western county, where the medical bill are paid by the insurance/government
an/or the no of visits that the doctor allowed is limited, the patient
always be prescribed the complete course of treatment (5/7 days normally).
3 days treatment can only be found in HK. If there is no money involved,
I suspects most doctors are willing to prescribe the complete course. Agree?
So I strongly agree with Dr.Fong that the intention is good, but the reality
is it is not working and that harm the patient pocket and waste valuable
time. Alternative can be arranged, such as prescribe the complete
course and allow free telephone counseling or free revisit, and retail
pharmacist are always a place to provide a free medical advice.
Lastly, I am sure MOST of the antibiotics prescribed today MUST be prescribed
in at 5 to 10 days treatment course! I never come across that antibiotics
for a systemic bacterial infection can be cured by taking 1 or 2
doses!
Doctors, please be honest to yourself!
Concerning the separation of prescribing and dispensing in HK. Dr Fong
suggested HK doctor's dispensing system is doing fine. Such a separation
only make more trouble because the patient have to spent more time in retail
pharmacy to wait for prescription to be dispensed. And many
countries that have the dispensing and prescribing separated has faced
a tremendous objection, such as Taiwan.
I don't want to waste more time to argue with you about all these.
please see http://www.acad.polyu.edu.hk/~bchcwu/iss_separ_hk.htm
The first thing I want to mention is that, there was tremendous objection
experienced in Taiwan, but they are mainly organized by the doctors! And
do we willing to sacrifice our pharmaceutical service (professional dispensing
and medicine advice...) to a short wait!
Doctors, please have a willing heart (and a smile) to let the patient choose!
Concerning the complaint procedures. I would like to know how many cases
has actually successfully to be put on trial and the successful to complaint
ratio. I suspect it would be very small. If the medicalcouncil are really
serious about the matter (I am glad the Dr Fong is
actually encouraging us to make complaint if there is a case), I
suggest the medical council should set up a fund and a free consultation
service to help all the patients in need to fight against all odd!
I am certainly willing to hear about your opinions and correct my mistakes.
We can have further healthy discussion here HK MediNet News Group
news://news.medi.net.hk/hk.mediNet.news
A registered pharmacist in HK