| The Hong Kong College of Emergency Medicine
(HKCEM) will celebrate the 10th anniversary in Oct 2006.
We have called our specialty a “young” specialty
for years. It is time we review our future direction and
consolidate the position of our specialty in the medical
profession.
In Hong Kong, Emergency Medicine (EM) service is basically
monopolized by government through the fifteen Accident
and Emergency Departments (AEDs) under the Hospital
Authority. The traditional hospital service budget will
only provide marginal resource to maintain the service,
and there was little provision for training or specialty
development.
After being admitted as one of the fifteen constituent
colleges of the Hong Kong Academy of Medicine (HKAM)
in 1997, under the able leadership of our past presidents,
Dr. Chin-hung Chung and Dr. Tai-wai Wong, fellows of
the College united with continuous effort to gain recognition
and respect from other medical colleagues. The exemplary
success of the AED doctors in fighting against SARS
and other infectious diseases further strengthen our
role in the health care system of Hong Kong . We seemed
to have started this initial phase of the EM development
in Hong Kong quite well. However, comparing with other
countries, we are still far lagging behind in development.
In the States, Emergency Physicians (EP) have subspecialized
in areas such as resuscitation, traumatology, paediatric
emergency medicine, toxicology, ultrasonography, sports
medicine, forensic emergency medicine and pre-hospital
care. In Hong Kong, we have yet to establish our own
subspecialty, but we have organized various structured
training courses in Basic and Advanced Cardiac Life
Support, Paediatric courses and Advanced Life Support
Courses in Obstetrics. We have also successfully introduced
the Toxicology courses into Hong Kong and assisted in
the establishment of the Hong Kong Poison Information
Centre (HKPIC), with our Fellow, Dr. Fei-lung Lau appointed
as the Director of HKPIC. It is expected that more advanced
toxicology training will be established in collaboration
with HKPIC. Along the line of subspecialization, several
interest groups were formed within the College and various
courses have been started in the past few years, namely,
Forensic Medicine, Sports Medicine, Evidence Based Medicine
and Ultrasonography. At present all of them are in the
initial phase and future development will need concerted
effort from Fellows and Trainees.
The road ahead is full of challenge. Amid patients
with urgent life threatening medical conditions, we
are flooded with demanding patients who attend AEDs
for convenience. The desire to intensively manage the
critically ill patients often crashes with the realistic
need to tackle the patient load efficiently. A lot of
emergency physicians find that they do not have the
time to practice the knowledge and skill that they possess..
The demand from hospital administration for decreasing
hospital admission and specialty out-patient referrals
and the lack of time and resources for working up patients
imply that we have to take risk in our daily practice.
With the constraint of time and resources, and the large
bulk of patients being non-urgent, emergency physicians
in Hong Kong can at best act as an efficient diagnostician,
while many do not find enough job satisfaction during
this “routine boring” daily clinical work.
Some EP even do not view their own clinical work as
important or as “specialized” as the other
specialty colleagues, and some administrators and colleagues
of other specialties still consider EM specialists as
gate keepers, or even worse, ‘admission officers’.
The problems listed seem to be insurmountable in the
present socio-financial situation, and I am afraid we
have to live with it for quite a while. However, an
efficient and accurate diagnostician with sensible utilization
of limited resource is an important asset of the society.
An emergency physician in Hong Kong certainly should
concentrate his/her effort mainly on those with serious
medical problems like acute myocardial infarction, major
trauma or other life threatening emergencies, he/she
should also treat those apparently simple minor cases
with respect. Experienced EPs would certainly have encountered
cases with non-specific dizziness and were eventually
diagnosed to be massive gastrointestinal bleeding, acute
myocardial infarction, acute myocarditis, or encephalitis.
The dedicated EPs would obtain job satisfaction when
making a correct diagnosis timely, carrying out prompt
and appropriate urgent treatment within the limitations
of AED.
EPs have the privilege of attending patients with various
presentations in the most acute phase. Our target is
to solve the problems within the shortest time while
reducing the mortality and morbidity, or minimizing
the suffering of the patient. Some procedures e.g.,
reducing dislocated shoulder or rapid sequence intubation,
are not difficult or sophisticated, but the success
will depend on physician’s skills, knowledge,
experience, and good medical-nursing teamwork. While
we are building the base of a pyramid, we should also
continue to construct the top part of it.
The future of the College will rely on the support
from the Trainees and Fellows. I will work with the
Council to encourage and assist development of interest
groups in related sub-specialties with the view of establishing
our own sub-specialties within the field of Emergency
Medicine. United we will survive and mature from the
first phase of a “young” specialty into
a strong and responsive specialty earning trust and
respect from both the medical and non-medical personnel
in the community.
Dr. Chor-chiu LAU
President
HKCEM
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