Prof Chak-sing Lau, the Immediate Past President of the Hong Kong Academy of Medicine (HKAM), and a renowned clinician and professor with a storied career, was invited by the Hong Kong Medical Journal to reflect on his career and share some thoughts for the future.

Prof Lau doesn’t like to see himself as a leader; despite being Chief of Service at the Department of Medicine at Queen Mary Hospital, he sees himself as a member of the team, no more important than any doctor under his team. Everybody has a role to play in the community, and he only seeks to do his job to the best of his ability.

Prof Lau has inevitably experienced many of the challenges that the recent COVID-19 pandemic has brought upon the Hong Kong community, and especially the healthcare system. He still firmly believes that increasing vaccination rates are imperative to reduce morbidity and mortality from this pandemic. However, while he remains optimistic, he admitted underestimating the difficulty of city-wide vaccination, and also overestimating the ability of the healthcare profession to persuade people to get vaccinated.

While the sentiment towards COVID-19 in the hospitals has not changed significantly, Prof Lau’s personal views about the strategies that people employ to cope with COVID have seen some changes. Doctors have learned to live with COVID-19 on a daily basis; although no single strategy is superior (in Hong Kong, or internationally), the important thing is for everyone in the community to work together to return the world to some normalcy.

One of Prof Lau’s key concerns is the ageing population in Hong Kong. He remarked that there are few incentives for new doctors to train in geriatrics, along with a lack of manpower in nurses, allied health professionals, and caretakers within the public system. Hong Kong’s COVID-19 situation has only exacerbated issues; for example, some of the current restrictions mean that many elderly inpatients cannot have visitors, which may exacerbate mental health issues that are already prevalent in this demographic.

Despite the added strain that COVID has placed on the public healthcare system, Prof Lau expressed admiration for his colleagues’ staunch hard work during the pandemic. He felt touched that even colleagues who work in the private sector have reached out and volunteered to help the strained public services. In this way, he remarked that COVID has driven people apart, but in some ways it has brought people together through adversity.

Another pressing problem facing public healthcare services that concerns Prof Lau is the high attrition rate among doctors. Many departments are understaffed, and the only source of manpower is fresh graduates. Many of these junior colleagues are overwhelmed by the workload, and the steep learning curve can also be extremely discouraging. Ultimately this is detrimental for both doctors and patients, resulting in a poor impression of public healthcare services from both perspectives. Prof Lau thinks that a key way to correct this is to show doctors that they are appreciated; having a say in what happens and seeing the results is a great way of improving morale. By building a culture of belonging and fraternity, doctor retention and satisfaction will certainly be helped.

Prof Lau has much to say on the past, present, and future of medical education. He lamented that medical students these days have too much to learn; he recognises that it is impossible for students to know everything, and teachers’ expectations might need to be regularly revisited in this context. He thinks that the key to effective education is training teachers to assess students reasonably, which he notes is a far cry from his own medical training. He recalls that his medical school professors were top clinicians or researchers, but did not know how to match expectations with students’ abilities. Over his own time as an educator, he has noted a shift towards mindful consideration and realistic expectations of students, but there is still a disparity between teachers’ expectations and reasonable ability.

Regardless of the limitations in the education system of his time, Prof Lau said that he paradoxically misses the stresses of it. He fondly recalled frantically copying notes from professors’ lectures and trying to memorise everything possible. However, he cautions students that this is not the optimal way to learn, and now encourages students to understand rather than rely on rote memorisation. He also expressed disappointment that the pandemic meant many medical students were deprived of clinical teaching hours and patient exposure and stressed the importance of patient interaction, emphasising that everything he knows was learned from his clinical encounters. He sympathises with new graduates who may find it extremely tough to begin practice.

The level of burnout among healthcare workers has reached an all-time high in recent years. The key to preventing burnout is to “love what you do”, says Prof Lau. When interviewing candidates for medical school, Prof Lau always tries to work out whether they will love medicine, and he hopes to nurture a love of medicine in his students during their time in undergraduate medical education. Passion for the profession has helped Prof Lau’s motivation persevere; he recalls how despite the overwhelming workload, he drew inspiration and ambition from his colleagues. Despite loving what he does, he knows that burnout is unavoidable and there are still times when he feels stressed. Therefore, Prof Lau places a great emphasis on finding a good work-life balance. Outside of work, he enjoys long distance running, playing basketball, spending time with his friends and family, and he never misses watching any of Liverpool’s matches.