They say curiosity killed the cat, but it was precisely this interest in the human mind that lead Dr Tsang Fan Kwong, the senior medical officer and specialist in psychiatry at Castle Peak Hospital, to decide to enter the profession at a relatively early age.
"I visited the old Castle Peak Hospital when I was about 17 years old with a group of friends," he explains. "I left the main gate and told myself, 'If I have the opportunity to become a medical doctor, I will go into the field of psychiatry'. Why? There are many patients, but few medical staff here."
Indeed, relatively small numbers of medical graduates entered the field of psychiatry in the mid 1980s, partly because training was very limited at undergraduate level. In addition, psychiatry is regrettably perceived as a second-class position: "[People] don't think talented physicians will go into this field."
Only the few
"You know your strengths and weaknesses - that's the most important thing that keeps you going"
Dr Tsang, however, was determined to live out his dream after obtaining a basic medical degree at the Faculty of Medicine at the University of Hong Kong (HKU). "At that time, of 150 classmates, maybe 148 didn't want to go into psychiatry. But there are a lot of mental patients and there must be somebody to treat and take care of them," he explains.
As no local training was then available, he took his professional examinations abroad. Today, potential Hong Kong psychiatrists can qualify locally and become practicing specialists after six years' training with the Hong Kong College of Psychiatrists and admission as a Fellow of the Hong Kong Academy of Medicine (in Psychiatry).
"The Hong Kong Training Scheme (Psychiatry) is the only overseas training scheme approved by the Royal College of Psychiatrists in the UK and Ireland for Part I and Part II membership examinations," he explains. "We're also entitled to practice in the UK if we register with the General Medical Council as a specialist in psychiatry."
An interest in people
What qualities does a successful psychiatrist need? "You must be curious and interested in the human mind - and you must have enthusiasm and know how to be concerned. But this can be learned," says Dr Tsang. "Under training, we learn how to communicate, observe and deliver a message."
He adds that, above all, psychiatrists should be interested in people, very patient and tolerant, due to the high levels of frustration in this profession. "Some patients won't say thank you, but ask, 'Why are you taking me into hospital, doctor?' even if you're trying your best to help him or her and show some progress. Sometimes even relatives are against you. If you can't tolerate this, you might get burnt out and leave the profession."
However, the upside of a psychiatric training is the chance to learn about oneself. "You know your strengths and weaknesses - that's the most important thing that keeps you going."
Dr Tsang emphasises that, in addition to offering psychotherapy, a psychiatrist prescribes medication. In his clinical work, he sees the patients in inpatient, outpatient and community settings. Community psychiatry is a developing area: "A psychiatrist goes out to visit patients, either in crises, alone or accompanied by a social worker, community psychiatric nurse or even a member of the police if someone is mentally unstable and a danger to himself or others. We also pay regular visits to rehabilitation facilities such as half-way houses or workshops, [where] we meet the staff and tailor-make individual rehabilitation plans for our patients."
Psychiatrists also need to be familiar with the Mental Health Ordinance, with regard to admission into psychiatric units and patients' different legal status and rights. Finally, good teamwork is imperative, as a psychiatrist usually works alongside a social worker, psychiatric nurse, clinical psychologist and occupational therapist.
As mainland China has a different medical system and different training, Dr Tsang believes that Hong Kong psychiatrists are not yet able to practice there, due to the lack of mutual recognition.
However, times are changing. "The majority of the treatment diagnosis in the field is more-or-less the same, except in the sense that [on the mainland] they are more American. Many [mainland psychiatrists] train at different places, in Russia, Germany, the UK, Germany and even Japan. They have a very smart younger generation of psychiatrists, so they will do very well in future."
Currently, opportunities for Hong Kong psychiatrists only include work with foreign private teams and private hospitals, although some management posts could exist in clinics in major cities such as Shanghai or Beijing.
In terms of research, opportunity could exist for cooperation with mainland psychiatrists. "Some colleagues are honorary lecturers on the mainland and they send delegates to our hospitals frequently."