GCF Chan

In this issue, we adopted the speech delivered by our special education expert Ms. Betty Ip. Ms Ip has been devoting her time and effort to take care of children with various learning difficulties for the past 2 decades. The long term care of children with learning disability is an area that most paediatricians, especially those working in the acute care hospital, seldom pay attention to in the past. While many paediatrician colleagues complained that the paediatric population is shrinking in Hong Kong, it is time for us to re-think whether we have been providing adequate care to our children with various chronic disabilities and special needs.

One of the areas with severe inadequacy is the care of children with mental problems. There are only a few paediatric psychiatrists practicing locally. The unreasonable long waiting time, including new cases, has been repeatedly criticized by the community. Even there are plans to increase the number of paediatric psychiatry trainee, the patient to doctor ratio is foresee to remains high and the care will still be grossly inadequate. One alternative option is to upgrade the training of our paediatric colleagues so they can handle the least severe cases. Such training had been organised by the Hong Kong Paediatric Society and the Hospital Authority with excellent feed back but only a small number of paediatricians can be benefited so far. While we would like to continue with such endeavor, the problem due to the shortage in local experienced trainer started to surface. Different solutions have been proposed including the use of expertise from aboard but it remains to be a short term measure. The most essential element in achieving a durable impact is that our health administrators and paediatric professional bodies should have consensus and long term commitment on such direction. Then an organised program can be established and that is the only way that we can solve this problem in the future.

Another areas that require attention are problems related to adolescent and community child health. Both adolescent medicine and community paediatric covers a huge area of paediatric problems. The current paediatric training already includes some of the areas in this aspect such as child abuse, drug abuse, etc.. There are still areas that have not been covered such as non-surgical sport injury, etc. The training should not be limited to junior trainee only but it should also be extended to other practicing paediatricians in the community. Many paediatricians, including myself, have not been taught or train to handle these problems and some update courses or programs should be organised by our local health administrators or paediatric professional bodies so we can fill up this service gap.

With the emergence of various subspecialties or even sub-subspecialties, many paediatric trainee may develop an impression that general paediatricians only taking care of the "left-over" from various subspecialty fields. In fact, this is a wrong impression. General paediatric is the common final path of all subspecialties and general paediatricians should be equipped with the competency to tackle either the initial phase or the long term problems of various subspecialty diseases. One example is that the general health problems of a post-cardiac surgery or oncology long term survivors will be taken care mainly by general paediatricians rather than by cardiologists or oncologists. Therefore, the general paediatricians should have adequate knowledge as of how to manage these patients. The required core knowledge of a paediatric trainee should be regularly revised so they can acquire the necessary skill in handling various paediatric problems related to many subspecialty fields.

With the possibility of having a local Centre of Excellence in Paediatrics (the "Children's Hospital") in the near future, the role of paediatricians should be carefully revisited. The orientation and focus of various existing paediatric training hospitals should also be adjusted. The training of general paediatricians should be strengthened rather than downgraded in order to meet the surging and new challenges of the modern era. After all, while Hong Kong is already considered a developed city, our children deserve better care!