Andrew Burd: Moments of madness

Andrew BurdThree months in prison for a kiss on the back. Weeping in the dock with the realisation of the implication. A moment of madness. And that is the point. Madness is not the same as badness. A 45 year old male GP from Wanchai was examining a 25 year old female. She was lying face down on the examination bed and he loosened her bra and kissed her back. The case was reported in the English and Chinese press last week. According to the local radio the girl was complaining of back pain and the GP was examining her.  Sometimes terms are lost in translation, at other times they gain in meaning and implication, and in English the word “massage” has been used in the context of the translation of said examination. Whatever the case the key issue was that the doctor did not have a chaperone. The reason why, has not been elaborated but in many cases it is economic i.e. the saving of another salary. The report describes a middle aged father of two young children who does good works for his local church.

In the pursuit of finding out a little more background I searched for the doctor’s name and found two with the identical combination of family and given names. One is an orthopaedic surgeon who has undertaken training in the UK. The other is a doctor who graduated from a mainland medical school and came to Hong Kong in 1999. He took and passed the licensing exam set by the medical council of Hong Kong. This has entitled him to full registration.

There is a current irony in this. The licensing exam is the focus of some heated debate and specious argument. As a direct result of a reduction in medical student numbers after SARS in 2003, public hospitals are desperately short of junior staff. They have come up with a plan to recruit overseas trained doctors on fixed term contracts to help out with the manpower crisis. Whilst described as foreign doctors in many of the reports, most, if not all of the current potential applicants are Hong Kong residents who have trained overseas. There are other stipulations: they must be at least three years post qualification; have a post-graduate qualification from a recognised specialist college, and they cannot occupy any training position. Of note it is proposed that these doctors do not need to take the licensing exam and will work with limited registration, limited to the duration of the contract. And there is the rub. Some senior local doctors who are prominent in the medico-political arena are claiming that allowing these overseas trained doctors into Hong Kong without taking the licensing exam is a threat to patient safety. Indeed they describe the licensing exam as the gold standard for ensuring that doctors are up to standard. It is evident from the reports that the doctor who kissed his patient was working under full registration because he had passed the licensing exam. Oh dear!

Further discussion, also described as hot and controversial debate, has focused on the content of the licensing examination. Indeed in the most recent report from the Hong Kong Medical Council there is an explicit acknowledgement that it is not “fit for purpose.”  It focuses on the ability to recall facts and demonstrate a measure of clinical competence. It does not assess professionalism, ethical behaviour, life long learning skills and other essential attributes of the 21st century physician.

I was once told a good blog is short and focuses on a single message.  This blog is gaining in length and has multiple layered messages. How can I extricate myself?

I am not being patronising here but it may be quicker for me to outline the threads which I have already begun, in a tabular form.

(1) No matter how pretty, alluring, or seductive your patients are do not kiss them. Well at least not in Hong Kong. You will be sent to jail. This contrasts with the UK where you can have a full blown sexual affair with your patient and a high court judge can say words to the effect, “No big deal.”

(2) Always, always have a chaperone present when you examine a patient. Unless of course you are having an affair with them, in which case the chaperone may be not too wise.

(3) Can regulatory authorities please differentiate between madness (momentary) and badness?  The courts obviously cannot in the context of a kiss on the back. But wait, we have doctors who have been sent to prison for a very slick, deliberate, premeditated series of frauds. These are bad people. Strike them off for ever, or make them start all over again.

(4) If you want the public to be safe, find some better way of assessing the medical profession.  Recall of facts is the least of the concerns. Attitude, honesty, and decency added together with a touch of compassion, care, selflessness, and a facility to use a computer attached to the internet with the training to verify the veracity of medical knowledge is what is needed. Wow. That is a paradigm shift.

Andrew Burd is professor of plastic, reconstructive, and aesthetic surgery at the Chinese University of Hong Kong. His major clinical interests involve paediatric burns care and the role of plastic surgery in the palliation of advanced malignancy. Academic interests include pragmatic ethics related to the practice of medicine including research and publication.