As mentioned previously, general surgeons in Hong Kong do more than the common operations encountered in routine practice. They often develop expertise and special interest in particular types of surgery, such as breast surgery, hepatobiliary and pancreatic surgery, colorectal surgery, and vascular surgery.

Within the profession, a surgeon’s area of expertise is usually well known. Informally, colleagues may describe one another as vascular surgeons or hepatobiliary surgeons. Interestingly, although these subspecialty labels are widely used within hospitals and the profession, the Hong Kong Medical Council’s rules limit how such descriptions may be presented to the public. As a result, regardless of a surgeon’s particular operative focus, the title seen by the public is generally that of a specialist in general surgery.

People may naturally ask how they can find the right surgeon for an operation. There is no need for concern in many routine procedures, such as appendicitis, haemorrhoids, gallstones, hernia repair, or gastrointestinal endoscopy, because general surgeons are trained to manage these. For more complex procedures, the current common approach is to seek assessment first from a general practitioner or family doctor, who can then refer the patient to an appropriate surgeon. Surgeons may also refer cases onward to colleagues who are especially experienced in a particular type of operation.

This traditional referral pathway has long existed around the world. The Medical Council also strictly requires that referrals between doctors should not involve improper financial interests, which helps protect patients. The advantage of this system is that several doctors may contribute to assessment, increasing the likelihood that the patient is referred to a suitable surgeon. The drawback is that the process may take more time and may be less convenient.

In reality, medical information is much more accessible today, and online media are now widely used. Members of the public can enter the name of a disease or operation into a search engine and find information about different surgeons. In many Western countries, information on surgical subspecialty interests is already openly available to the public. This appears to be part of an international trend, and Hong Kong’s specialist system may gradually continue developing in that direction.

Author: Honorary Clinical Associate Professor, Department of Surgery, The University of Hong Kong; President, Vascular Health Foundation