Yeung, CY

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Title Family medicine and paediatricsAuthor(s) Yeung, CYCitation Hong Kong Practitioner, 1998, v. 20 n. 4, p. 169-171Issued Date 1998URL http://hdl.handle.net/10722/45228Rights Creative Commons: Attribution 3.0 Hong Kong LicenseThe Hong Kong College ofFamily Physicians8th Floor, Duke of Windsor Building,15 Hennessy Road, Hong Kong.Tel : 2528 6618 (3 Lines)Fax: 2866 0616Website:http://medicine.org.hk/hkcfp/journal.htmEDITORDr. Lam Tai PongDEPUTY EDITORSDr. David V.K. ChaoDr. Wong Hung WaiBOARD MEMBERSDr. Cynthia S.Y. ChanDr. Chan Wai SunDr. Stephen ChenDr. Rudolph W.M. ChowDr. Julie CohenDr. Mina GoyalDr. Kwok Kon HungDr. Augustine T. LamDr. Cindy L.K. LamDr. Lam Tai KwanDr. Lam YuenDr. Bernard W.K. LauDr. Frederick C.T. LeeDr. Peter C.Y. LeeDr. Lawrence K.C. LeungDr. Ronson C.T. LiDr. John MackayDr. Charles C.Y. NgDr. Ng Chun BorDr. David OwensDr. Raymond WM. PauBUSINESS MANAGERDr. Betty K.M. KwanEDITORIAL EXECUTIVEMs. Teresa LeeEDITORIAL ADVISERSProf. Cindy S.T. AunProf. Helen ChiuProf. Jim DickinsonProf. Tony DixonProf. Wes FabbProf. S.T. FanProf. A. HedleyProf. Walter WK. KingProf. C.R. KumanaProf. C.P. LauProf. PC. LeungDr. Mak Ki YanProf. C.W OgleProf. Wilfred C.G. PehProf. Grace TangProf. Mark TsoProf. C.A. Van HasseltProf. Jean WooProf. Wong Tze WaiProf. C.Y. YeungProf. R.T.T. YoungSTATISTICAL CONSULTANTSDr. Joseph LauDr. Ian LauderThe Hong Kong Practitioneris indexed in Excerpta Medica(EMBASE).ISSN 1027-3948Printed & Designed ByPrinthouse Production CenterHong KongFami ly Med ic ine AndPaediatricsThe nature of the two disciplinesThe closeness and similarities between family medicine and paediatricsare well-known. Both disciplines are general medical specialties which dealwith a wide spectrum of medical conditions ranging from delineation ofnormalities through minor deviations from the norm to major structuraldisorders and multiple functional derangements of the human body. Bothdisciplines stress the importance of holistic patient care and examine in detailthe interaction between the patient and his immediate environment.As a general clinical discipline, paediatrics emphasises the importance ofthe interaction between functional and structural disorders and the processesof growth and development. As the child is often the "presenting symptomof the parents' illness", the paediatrician always assesses the relationshipbetween the child and his parents and other immediate family members witha view to finding out whether they have contributed to the child's medicalproblems. Besides provision for cure and alleviation of pain, paediatrics alsoputs equal if not more emphasis on the prevention of diseases and promotionof health. The discipline provides complex technologies needed for the cureof the critically ill child often based in institutions but is also heavily involvedin community services aimed at preventing children from utilizing thesetechnologies. Thus paediatricians tend to promote health in the communityto minimise the utilisation of their services by sick children, often at theexpense of reduction of their income.In many ways, family physicians are now being trained along similar linesas paediatricians. They are however involved in providing care for a full agerange of people, not only children. The basic approach to the deliverance ofcare in family medicine shares many aspects in common with paediatrics. Itis therefore of paramount importance that family physicians should be offeredsufficient training in the paediatric discipline. This will not only provide thetrainee with exposure to the unique problems of the child population but alsothe opportunity to train in the philosophy of holistic patient care.The clinical practiceThe pattern of clinical practice in Hong Kong is uniquely different fromother places. It has been guided by the former colonial government policy on169EditorialEDITORIALhealth care. It is influenced also by strong Chinesecultural belief and background. Although there has beengreat effort attempting to reform this pattern in recentyears, it will probably take a long time before significantchanges or improvements occur. The government 'semphasis is on providing a tertiary backup of medical carefor the very ill child also. Since the early 50's, a well-organised maternal and child health service has been ableto provide a number of programmes which have beensuccessful in preventing deaths and disabilities from manyinfectious disorders and malnutrition among infants andyoung children. Primary medical care is generally left tophysicians and traditional Chinese medicine practitionersin pr ivate practice or government general c l in ics .Graduates from the medical schools are medico-legallyexpected to be "all rounders", able to look after the wholerange of medical and health problems inclusive of internalmedicine, surgery, obstetrics and gynaecology andpaediatrics.To select the right doctor in private practice to see asick chi ld can be a problem. A large variety ofpractitioners ranging from self proclaimed Chinesetraditional medicine practit ioners through qualif iedherbalists, medically qualified general practitioners tohighly trained medical subspecialists may be involved.Under the free market system, the child could be seen bya totally inexperienced practitioner or a highly qualifiedsubspecialist of a non-paediatric discipline or by a wellq u a l i f i e d paed ia t r i c i an . The outcome of thesemanagements must necessarily be highly variable. Thisis complicated by the unfortunate misunderstanding andwrong expectations of parents demanding a "promptresponse of symptoms to t reatment" ra ther t han"appropriate treatment of the disease". Many practitionersare tempted to provide only prompt symptomatic reliefrather than aiming at long term cure. This can result in asick child moving around from practitioner to practitionerlooking for instant relief of symptoms and inviting manyundesirable and probably unnecessary therapies. Ascommunication means advances many catchy malpracticeheadlines have occurred in the media. Unnecessary andincreasing distrust of doctors have been engendered by thisunhealthy system of health care deliverance.The College of General Practitioners was probablythe first group of doctors in Hong Kong who had thevisionary outlook to organise an examination systemrequiring practitioners to acquire a certain level ofexpertise in the discipline, including of course adequateskills and knowledge to manage heal th problems inchildren, before acquiring the qualification. This servesnot only to enhance the standard of health care deliverancebut also heightens the public awareness of the need to seekqualified practitioners.Interphase between family medicine andpaediatricsAs pointed out earlier, both paediatrics and familymedicine are general disciplines, there is bound to beoverlap in the way medical practice is conducted by theprofessionals in the two disciplines. Both groups ofprofessionals would ensure holistic health care deliveranceto the child from birth through adolescent to adulthood.Both groups of physicians aim at providing preventivehealth care besides curative care for the sick. When "thefamily physician's duty stops and the paediatrician'sbegins" is never a sharply defined demarcation. Howeverwhenever secondary and tertiary health care needs havearisen, the paediatricians, by nature of their backgroundt r a in ing and expert ise , should takeover the mainresponsibilities. For example, there is absolutely noreason why a child with a febrile i l lness due to anintercurrent upper respiratory tract infection could not bemanaged by the family physician. The same child whodevelops a secondary bacterial pneumonia could warrantthe increased expertise of a paediatrician for his careunless the family physician is also highly trained and veryexperienced. If he has developed additional complicationssuch as empyema, the family physician should not hangon to the child's medical care without resorting to theexpertise of the tertiary backup paediatricians who aremainly based in well organised/established institutions.Similarly a healthy newborn could be looked after byeither the family physician or the paediatrician. But when170Hong Kong Practitioner 20 (4) April 1998he develops significant jaundice necessitating closemonitoring and management, he should best be put underthe care of the paediatrician. And when exchangetransfusions are indicated, his care should only beconducted by those paediatricians or neonatologists whohave been trained in providing such tertiary level of care.Through hol is t ic approach to pa t i en t care ,paediatricians tend to command good rapport from theirpatients and their families. Many members of the patients'families tend to seek medical advice and treatment fromtheir befriended paediatricians. Some paediatricians mayhave to provide medical service to patients beyond thepaediatric age range to increase their c l inical load bynecessity also.Under ideal cond i t ions , as pract ised in mostdeveloped communities overseas, paediatricians shouldprovide mainly secondary and tertiary medical care forchildren. Upon completion of such medical care for thesick child, the paediatricians should refer them back to thefamily physicians for primary health care. In the currentfree market scenario, parents often elect to bring thesechildren back to the paediatricians rather than the familyphysicians. If family physicians are able to develop agood rapport with the families, most parents wouldprobably prefer to bring their children back to theminstead. This pattern of practice can only be achievedwhen sufficient mutual respect and agreements have beenreached to develop a system of cross referrals. Of courseit would also necessitate an adequate level of publicawareness to abide by the system. The traditional practicein Hong Kong so far has not been emphasising family-centred medicine but rather only general practicemedicine. The majority of the practitioners in the privatesector tend to be unfamiliar with the health conditions ofthe families, parents therefore would prefer to "shoparound for the most effective doctors". Until the patternof family-centred medical practice can be put in place, Isuspect there wi l l still be a continued overlappingpractising pattern between the family physicians and thepaediatricians for sometime in Hong Kong. •Yeung Chap-yung, FRCP(C), FRCP, FRCP(Edin), FRACPProfessor,Department of Paediatrics,The University of Hong Kong,Queen Mary Hospital.171

Family medicine and paediatrics

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