Interfacing between primary and secondary care is needed

Editor—Straus et al highlighted the impact of severe acute respiratory syndrome (SARS) on professionalism and gave several examples of strained professional behaviour.¹ Research in Hong Kong showed anxiety among general practitioners who, despite worries, demonstrated willingness to do their duty as was expected from a highly professional workforce.² Altogether 82.3% of general practitioners in the study wanted more involvement in the management of SARS: 74.6% as educators and 68.4% as gatekeepers.³ However, the primary care system in Hong Kong is less well developed and most general practitioners work in the private sector, whereas most hospital care is given in the public sector, with little interfacing and collaboration.⁴

Primary care is the gatekeeper to hospital care. The fear and panic caused by SARS made it difficult for patients with symptoms to be managed in primary care without a close working relationship with and support system from hospitals. If general practitioners had direct access to basic diagnostic procedures and communicated with the hospital team directly, they would have more confidence in screening out suspected cases. They can also be useful health educators to minimise panic, which would also decrease unnecessary admission.

Measures must be taken to avoid overloading the hospital system and putting further strain on frontline doctors in a public health crisis. This would ensure that professionalism was not eroded. General practitioners are useful partners but not fully used. In facing new public health challenges, governments should take the SARS crisis opportunity to strengthen the primary care system and ensure appropriate mechanisms for partnership and interfacing with secondary care.⁵