A Day in the Life of Dr. Shiu Yuen Kwok
Opthalmologist and "Ethnic Surgeon" in Chinatown, San Francisco

"Learning is a life-long process. This same principle applies to the focus of medical practice on a subgroup of a population. There, the doctor has to deal with the social issues of a subculture as well as those of the science of medicine," asserts Dr. Shiu Yuen Kwok, a comprehensive ophthalmologist in solo practice in the San Francisco Bay Area.

Dr. Kwok's medical practice is divided between work in his office and in nearby hospitals. He spends 70% of his time delivering office-based care and the other 30% in hospitals performing conventional eye surgeries, such as cataract, glaucoma, and blepharoplasty (eyelid surgeries). He also spends a portion of his time in clinical research and teaching.

Since Dr. Kwok's office is located in Chinatown, the majority of his patients are Chinese. Many of these patients travel to his office from all around the San Francisco Bay Area, even from as far as San Jose and Sacramento. Furthermore, many of his patients are not fluent in English. Most of Dr. Kwok's patients are elderly and have federal Medicare coverage. However, some of his patients are new immigrants who do not qualify for Medicare and do not have the financial means to purchase private health care plans, so they are only provided for by Medi-Cal, California's Medicaid program.

"I think any physician can decide how much time to put in his or her work," says Dr. Kwok. Dr. Kwok maintains a 9 AM - 5 PM daily schedule during the week and continues with his work on the weekends reviewing patient records, analyzing test reports and drafting consultation letters. Throughout the week, his schedule frequently includes various conferences.

San Francisco is a very dynamic community for doctors. Dr. Kwok believes that as one of the oldest cities on the West Coast, San Francisco is blessed with the effective combination of having "the most organized and established medical community," and of being "supported by many excellent hospitals and two prestigious medical schools, namely UCSF and Stanford." These two institutions "provide leadership in many areas of medicine." Also adding to the San Francisco community is the constant stream of immigrants, which is not only a source of new patients, but also, in Dr. Kwok's experience,"poses challenges to the medical community," showing not only "uncommon diseases" but also "unusual presentations of common ones."

Regarding the challenges in treating and caring for San Francisco's population, Dr. Kwok asserts that "this issue is not inadequate access to medical care, but rather, patients' reluctance to seek medical advice as they are under the influence of their diverse cultural backgrounds and beliefs." For example, "many new immigrants still cling to the folk medical concepts from their old countries. Alternative medicine is too common. Proper medical care is not sought until the disease is very advanced." He adds that adequate treatment is also challenged by the failure of patients to adhere to the required treatment regimens. In meeting such challenges, he asserts that "education is perhaps more important for this group of people," and that "emphases on the understandings of public health issues as well as specific health issues are needed." However, Dr. Kwok also optimistically notes that "the San Francisco medical communities are offering classes on many of these issues to the public through several hospitals' and health plans' outreach programs." He has observed that these classes "are beginning to be noticed... subscriptions to the classes are on the rise."

In the past, Dr. Kwok has referred to himself as an "ethnic surgeon," strongly focusing on cultural sensitivity and trust-building with patients. "Many patients," says Dr. Kwok, "are turned off once they hear the word 'surgery.'" Consequently, surgeons "ought to be willing to spend the time to understand the patient, to explain the issues to, and to discuss, in detail, the pros, the cons and the other [available] options with the patients."

One unique aspect in Dr. Kwok's background is that he has obtained three advanced degrees: M.D. (Doctor of Medicine - medical degree), Ph.D. (Doctor of Philosophy - research degree), and J.D. (Juris Doctor - law degree). "The multiple degrees reflect my interests," Dr. Kwok explains, "I am always curious of things and want to learn," and that "degrees, per se, are not as important as the interest." He believes that while "there are certain advantages with [having] knowledge in different disciplines, it all depends on one's interest level in the different disciplines."

As the practice of medicine increasingly appears to require interdisciplinary understanding, Dr. Kwok also emphasizes the human component in medicine, noting that "clinical medicine still thrives on the practical skills of the practitioner. The practice of medicine is an art as much as a science. It needs the heart as well as the brain." He advises those aspiring to be doctors that the same principle that applies to other careers also applies to the practice of medicine: "The best doctors devote their lives to their careers."

"Medicine is so vast. Every doctor would eventually find one or more areas of focus" with which the practitioner feels comfortable, and which captures the practitioner's interest. "The focus may shift with the change of time," but Dr. Kwok also expresses that "the challenges never end. There is always interesting work no matter if one is prepared or not," thus medical practitioners should accept life-long learning. Not merely regarding scientific knowledge, Dr. Kwok remarks that the principle of life-long learning "applies to the focus of medical practice on a subgroup of population [where] the doctor has to deal with the social issues of a subculture as well as those of the science of medicine." He emphasizes that "patience and understanding are the keys - this is where the art of medicine comes into play."

Serene Chen is a Writer of the Next Generation and a member of the Harvard College Class of 2008.

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