Let's make a rule to control doctors' attitude, why not?

When I read in newspaper that an organisation had proposed to the Medical Council of Hong Kong (MCHK) “to set up a body to re-educate physicians with poor attitude to patients”, I considered this a joke and told my friends about this. Those who were not doctors shared my viewpoint. Some of them thought this might be a satirial work, like 1984 of George Orwell, written to mock at tyranny.

However, this joke soon turned into a nightmare when my colleagues told me that this idea had been discussed in the MCHK for several years in the form of a Professional Performance Committee (PPC). As said by the spokesman: “The Medical Council has the power to discipline doctors for professional misconduct by imposing punishments - from warnings to suspension of their licence. However, poor attitude is not regarded as professional misconduct and the council has no mechanism to deal with such complaints.” "The Medical Council should do more. Attitude should be classified as one of the professional performance standards and doctors below the standard should be re-educated," he said. Some of my colleagues even reassured me that just like mandatory CME, PPC was on the card and it would not go away no matter what you thought.

I did not think that I had attitude problem, and I was quite sure that I would not be complaint of in the future. So why did this mightmare haunted me for this whole week? After analysis, it was this “Why not” attitude of rule making that disturbed me- the MCHK should not make rule, or consider making rules, lightheartedly.

I understood the frustration of the MCHK or the Preliminary Investigation Committee (PIC) when they faced complaints and found that they did not have the power to act on. However, I thought they might sit down and think whether the result that they had no power to act on such matters was because such matters did not need to be acted upon. To classify "attutide problem" as problem that needed the MCHK to look after was itself a problem. To present it in a high brow manner in newspaper and to suggest re-educating doctors would only remind me of the Mao times.

The MCHK was given power to make rules to control doctors. Each rule would carry far-reaching effects and cause disturbance to doctors. It was very important that the MCHK should not misuse this power. For a rule to be made, all of the following questions needed to be answered in the affirmative:

1. Is there a problem?

2. Does this problem need to be controlled?

3. Does this problem need to be controlled by making rules?

4. Is making rules an effective control?

5. Are the rules made able to control the problem?

6. Are the rules made precise and not controlling other areas that need not be controlled?

The onus was on the MCHK to convince doctors that these tests were satisfied and any lighthearted decision would be deemed misuse of power. For this issue, it was very doubtful that it could pass the first 2 tests. Even if the MCHK could convince us that there was a problem with doctors’ attitude, the problem was far from serious and there was no danger posed or forseen. As quoted by the spokesman, 19 complaints (of which some might not be substatiated) were received against [10000 doctors x 50 patients/day x 300 days] per year.

The suggested way to control was even more problematic. The punishment was out of proportion to the "guilt". Many cases of misconduct in a professional respect ended up in warning letters. But the attitude problem would end up with "re-education", which was in fact disturbing to the doctor and he might again be put the burden to convince the MC that his mind was sound then. What would happen if the doctor did not want to be re-educated? Would he be removed from the general register?

I sincerely hoped that this “attitude check and re-education” stuff would not be the road to tyranny. Decision of rule making should not be a game of show-hand (by claiming that if we didn’t do it, someone else would do it anyway, and in a more unpalatable way), nor should it be a game of showing hands (voting-“Those in the Council who agree, please show your hands”).