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Hong Kong Med J 2010;16:106-15

Although Hong Kong people are famous for 'shopping around' for healthcare, most would prefer to see a family doctor as their first point of contact, according to a study published in this month's edition of the Hong Kong Medical Journal.

The study, "The concepts of family doctor and factors affecting choice of family doctors among Hong Kong people', aimed to determine how the Hong Kong public views the concept of a 'family doctor', including what patients want and expect from family doctors and how they themselves behave when seeking health care for different types of conditions.

After conducting a telephone survey of 1204 Cantonese-speaking residents, the researchers, from the Hospital Authority and The Chinese University of Hong Kong, found the three most important features patients looked for in a family doctor were "Clearly knowing my physical conditions", providing "fast-acting and effective treatment", and being a "doctor with friendly and sincere attitude".

Surprisingly, cost was not a major consideration with 'low consultation fee' ranked as one of the least important factors involved in the choice of doctor. Patients were also unlikely to base their decision on the doctor's gender, rating "doctor's gender is the same as me" as the least important factor.

While most respondents said they would prefer to see a family doctor, not many of them actually did so. Only 35% regularly visited the same doctor, while 45% said they sought out different doctors whenever they had a flu-like illness.

Hong Kong Med J 2010;16:145-8

Bisphosphonates, a common treatment for osteoporosis (thinning bones) have been linked to osteonecrosis (bone death) of the jaw in people being given large-injected doses to treat cancer. However, a report in this month's edition of the Hong Kong Medical Journal describes two cases where women taking bisphosphonate pills for osteoporosis developed osteonecrosis in their jawbones.

Both cases involved elderly women who sought help from dentists for jaw pain and wounds that had not healed after tooth extraction. Both had been taking bisphosphonates for osteoporosis for over 3 years. In both cases the bisphosphonates were ceased and the dead bone was successfully managed with surgery.

The report's authors, dental and orthopaedic surgeons from the Caritas Medical Centre, point out that although osteonecrosis is rare, there are certain risk factors doctors and patients need to consider when using bisphosphonates. "Perhaps the most important risk factors are invasive oral treatments involving bone exposure (eg tooth extraction, subgingival curettage, periapical and periodontal surgery), trauma (e.g. from ill-fitting dentures) and poor oral hygiene".

In the authors' opinion, the significant positive benefits bisphosphonates offer to patients with osteoporosis outweigh the relatively small risk of developing osteonecrosis of jawbones. The optimal approach is to have a complete dental checkup and regular dental care for patients starting bisphosphonates. "Stopping smoking, limiting alcohol intake and maintaining good oral hygiene with or without regular dental cleaning should be emphasised".