Source: Hong Kong Government special administrative region – 4
Following is a question by the Hon Adrian Ho and a reply by the Secretary for Health, Professor Lo Chung-mau, in the Legislative Council today (July 8):
Question:
Recently, an intern doctor and a resident doctor in public hospitals have been dismissed by the Hospital Authority (HA) due to their serious improper acts, which has aroused public concern. In this connection, will the Government inform this Council whether it knows:
(1) the number of people who completed their internship but were not awarded a certificate of experience or were not registered as doctors in the past five years, as well as the reasons for that; the number of complaints or reports received by HA involving breaches of professional conduct by intern doctors or resident doctors;
(2) whether HA has a regular mechanism in place to monitor the access records of its clinical management system, and has established an internal reporting mechanism for unusual access behaviour; if not, whether HA has plans to enhance the system’s security and confidentiality mechanism, including exploring the introduction of fingerprint, face ID, or mandating doctors to provide reasonable grounds and obtain authorisation from the attending doctors when making cross-hospital enquiries into patients’ medical records, so as to effectively safeguard patient data; and
(3) whether HA or the Medical Council of Hong Kong has plans to draw up guidelines clearly defining what constitutes “professional misconduct” for doctors to follow, and to liaise with the faculties of medicine of the various universities to strengthen medical students’ awareness of professional conduct through their curricula?
Reply:
President,
The medical profession is a core element of the healthcare system. The Medical Registration Ordinance (MRO) (Cap. 161) provides a legal framework for regulation of the registration of medical practitioners in Hong Kong. The Medical Council of Hong Kong (MCHK) is a statutory body established according to the MRO, responsible for various statutory functions relating to the medical profession including the registration of medical practitioners. According to the MRO, to be qualified for full registration as a medical practitioner in Hong Kong, a medical graduate from a local medical school must be engaged in full-time employment and training in the capacity of intern doctors in a public hospital assessed and recognised by the MCHK for not less than 12 months, passed the assessments by the relevant medical school and the Hospital Authority (HA) and obtained a certificate of experience (CoE) awarded by the medical school.
The HA demands the highest standards of professional conduct, behaviour, and discipline from its medical practitioners. All public hospital doctors, including intern doctors, resident doctors and specialist doctors at all levels, must possess both medical competence and conduct themselves in a professional manner, placing patient well-being, privacy, safety, and care as their foremost priority at all times.
In consultation with the Department of Health and the HA, the consolidated reply to the question raised by the Hon Adrian Ho is as follows:
(1) According to the MRO, a local medical school may award a CoE to a medical graduate only if it is satisfied that the graduate has been engaged in medicine and surgery during the 12-month internship employment at public hospitals under the HA and that the service has been satisfactory. Obtaining the CoE is a prerequisite for applying to the MCHK for full registration as a registered medical practitioner. Doctors who have completed full registration may serve as resident doctors in the HA to provide clinical and related services while undergoing specialist training.
From 2021-22 to 2025-26, the HA recorded around 12 to 35 disciplinary cases due to poor performance or breaches of professional conduct involving intern doctors and resident doctors per year. Among such disciplinary cases, three intern doctors failed to complete the internship due to poor performance, misbehaviour or criminal conviction, thus unable to be registered as medical practitioners, during these five years. In addition to the cases above, there are 10 intern doctors who failed to complete the internship due to resignation on personal grounds such as health issues or unable to meet the internship requirements and thus unable to be registered as medical practitioners. The aforementioned cases account for a relatively low percentage of the total intern doctor and resident doctor workforce of around 4 200. Detailed figures are listed in the Annex.
During these five years, all doctors who have completed the internship were actually awarded the CoE and were registered as medical practitioner. This is the response to the question mentioned by the Hon Adrian Ho.
(2) To safeguard security of patient data, the HA enforces strict gatekeeping on the usage of the Clinical Management System across five major dimensions:
(i) Regarding the application for the Clinical Management System account, each staff member must first complete a training course on privacy. Each application for account creation must be reviewed and approved by department head;
(ii) Regarding access to system functions, functional permissions for users of different grades vary according to operational needs. The system retains access logs to ensure traceability and accountability;
(iii) Regarding access and control on patient records, when a user enters a restricted access zone, the system will prompt and mandate the input of a reason for the access, and simultaneously remind the user that such access is subject to audit;
(iv) Regarding regular auditing and monitoring, the HA regularly reviews system accounts, user authorisations and access logs, and receives alerts on abnormal cases through the advanced incident reporting system and the personnel notification mechanism; and
(v) Regarding cybersecurity, the HA will continuously enhance system security to ensure data confidentiality and security.
(3) Courses on professional conduct and medical ethics are compulsory courses for medical students in local universities. They ensure students are acquainted with professional values and standard of good conduct prior to graduation. The MCHK will continue to maintain communication with universities’ medical schools to enhance medical students’ awareness towards professional conduct, through strengthening relevant content during the regular accreditation of medical programmes.
On the other hand, the MCHK has formulated the Code of Professional Conduct (Code) since 1994 to regulate a series of aspects such as the professional responsibility over patients and provides specific guidelines for all doctors on matters including keeping medical records, protecting patients’ privacy, and dissemination of information to the public; and is subject to update from time to time. The latest version of the Code is the “red book” I am holding, which is the revised version of 2022. All doctors in Hong Kong, including intern doctors, have a “red book” which they should be familiar with.
Intern doctors must abide by the “red book”, the Code by the MCHK, and non-compliance of which will result in disciplinary sanctions. Even if they were granted the CoE issued by the medical schools, the MCHK may still order not to register them as medical practitioners according to the MRO. Despite the nature of the Code as a guideline, the Government has submitted an amendment Bill to the Legislative Council which recommends empowering the MCHK to formulate and promulgate codes of conduct, granting the codes of conduct statutory status. The relevant amendment will further strengthen the authority and binding effect of the Code in favour of regulating the practice of all doctors including intern doctors and enhancing professional conduct.
On the other hand, to ensure staff compliance with ethical standards, apart from the Code by the MCHK, the HA also has the HA Code of Conduct, the “green book” I am holding. The HA Code of Conduct emphasises that staff have a duty to protect the HA’s and the patients’ information, records and property against improper or negligent disclosure, misuse, or unauthorised usage. The HA and the Committee on Teaching Hospitals communicate regularly with university medical schools on matters relating to the training of intern doctors and medical students, and the Central Internship Committee has been set up to monitor and enhance matters relating to internships.
President, we will continue to work with the MCHK, the HA, and the two universities to foster excellence in training, stringently enforce the regulatory mechanism for medical practitioners to assure the professional integrity of doctors, and safeguard the rights and interests of patients.
Thank you, President.