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