Perceptions of professional attributes in medicine: a qualitative study in Hong Kong.

OBJECTIVE. Medical professionalism has been widely discussed in western scholarly literature. However, since Hong Kong has a mixed Chinese-western culture, it remains uncertain whether Hong Kong health care professionals, medical students, and patients see medical professionalism in exactly the same way as westerners. The objective of the present study was to explore perceptions of medical professionalism in Hong Kong. DESIGN. Individual semi-structured interviews. SETTING. Medical faculty preceptors, residents, interns, nurses, and students from the Li Ka Shing Faculty of Medicine of the University of Hong Kong. Subjects were recruited at an out-patient clinic of Queen Mary Hospital. PARTICIPANTS. We interviewed 39 subjects, including six medical faculty preceptors, six hospital residents, four medical interns, eight nurses, eight out-patients, and seven medical students. The interviews were transcribed and coded. Grounded theory was employed for framing and analysing the interviews. RESULTS. A total of 30 primary themes were identified and grouped under three secondary themes, ie 'Expectations of a professional doctor', 'Work values', and 'Patient care'. In general, the primary themes were consistent with recognised professional attributes in western bioethics, such as knowledge and skills, holistic care, and communication skills. A closer analysis suggested that traditional Chinese thought also played an important role in shaping the medical professionalism of Hong Kong. Challenges to be faced by Hong Kong doctors due to recent social changes were also identified. CONCLUSIONS. Medical professionalism in Hong Kong is shaped by both western medical ethics and traditional Chinese thought. The values treasured by Hong Kong health care professionals as well as technological advance, and the city's proximity to Mainland China makes Hong Kong health care unique. It is important to maintain the present work attitudes and at the same time adapt to new social changes.

Perceptions of ethical practices in Hong Kong public hospitals: inter- and intra-professional similarities and differences.

AIM: To investigate similarities and differences in the perception of hospital ethical practices using different seniority of doctors, nurses and administrators, and between these healthcare professionals (HCPs). IMPORTANCE: Intra- and inter-professional similarities and differences had implications for HCPs' morale, hospital ethics climate and quality of patient care. METHOD: HCPs (n = 1.910) with different levels of seniority in 14 Hong Kong public hospitals were randomly surveyed between November 2004 and April 2005. RESULTS: Intra-professional differences in perception between senior and junior doctors or nurses were found in nine ethical themes including: quality of care, patient satisfaction, disagreements among HCPs and between HCPs and patient family, end-of-life care, professional incompetence and misconducts and communication. Inter-professional similarities in perception were also found among different HCPs in senior positions and as a group they differ from the perceptions of junior HCPs. CONCLUSIONS: Significant intra-professional and inter-professional polarizations of perception of ethical practices between senior and junior HCPs were found and they potentially undermine the trusting relationships between HCPs. IMPLICATIONS: As nursing managers were found to align with senior doctors and administrators, junior nurses might feel unsupported, isolated and frustrated, creating a nursing management challenge that must be faced.

The contemporary healthcare crisis in China and the role of medical professionalism.

The healthcare crisis that has developed in the last two decades during China's economic reform has caused healthcare and hospital financing reforms to be largely experienced by patients as a crisis in the patient-healthcare professional relationship (PPR) at the bedside. The nature and magnitude of this crisis were epitomized by the "Harbin Scandal"-an incident that took place in August 2005 in a Harbin teaching hospital in which the family of an elderly patient hospitalized in the intensive care unit (ICU) for 66 days paid over RMB yen6 million. The news was publicized globally and ended in the firing of six top hospital administrators including the hospital president and the ICU director. This paper seeks to show that the Chinese healthcare crisis is ultimately linked to a conflict of interests between patients and healthcare professionals (HCPs), which is inherent in the reformed healthcare system of China. Hence the crisis is, at its core, a crisis of fidelity and confidence that must be restored to the PPR. At the "macro" level, it is simplistic to blame the crisis on the failure of the market system, and at the "micro" level, it is naïve to expect that a contractual understanding of the PPR will effectively restore the confidence of patients. This paper will show that the fiduciary relationship and medical professionalism share similar attributes, with fidelity being the core value of both. It concludes that the loss of medical fidelity implies the dissolution of the PPR and the demise of the medical profession and challenges Chinese HCPs to keep their fidelity as a means to both protect their patients' interests and to preserve their profession's survival.

Attitudes of Chinese couples in Hong Kong regarding using preimplantation genetic diagnosis (PGD) and human leukocyte antigens (HLA) typing to conceive a 'Saviour Child'.

OBJECTIVES: To investigate Hong Kong couples' attitudes and concerns about using preimplantation genetic diagnosis (PGD) and human leukocyte antigens (HLA) typing to conceive a disease-free and tissue-compatible 'Saviour Child (SC)' to save an afflicted sibling. METHODS: Two cohorts of Chinese couples, one with natural pregnancies and the other receiving in vitro fertilization (IVF) services, were studied using a structured questionnaire. RESULTS: Although most couples believed that embryos possess moral rights, they considered it acceptable to reproduce a donor child if it was safe for the child, and tissue transplantation was the only available treatment for the sick sibling. Most couples believed that the donor child would not suffer adverse physical or psychological effects but rather would gain positive psychological benefits, and opined that parents using PGD/HLA-typing suffer sacrificially for their children. In response to one specific question, one-third of the couples agreed to use the donor child as a lifetime organ donor and supported the use of PGD for non-medical gender selection. One-quarter were willing to reject PGD/HLA-typing because of its potential for non-medical genetic enhancement. CONCLUSION: Probably influenced by the Chinese tradition of strong familism, couples in Hong Kong generally show positive attitudes towards using PGD/HLA-typing to reproduce a 'SC' to save a sibling affected with life-threatening diseases amenable to treatment with genetically compatible tissue.