The many facets of a medical multi-tasker
Dr Fanny Wai San Ko (Croucher Fellowship 2000) is an internationally renowned respiratory physician, trainer, researcher, and collaborator who, by necessity, has developed the skills of a professional multi-tasker.
Ko is heavily engaged in bedside clinical treatment of patients, medical research into chronic respiratory diseases, management of care models, and training of junior doctors. She also serves as a science committee member of the Global Initiative of Asthma, helping to draft international guidelines and seeking to reduce its prevalence, and on several other professional bodies to inform healthcare professionals and the public on airway diseases.
“I am multitasking all the time. It’s very tiring but very rewarding too,” Ko said.
Ko’s primary motivation for performing such a multitude of medical roles was surprisingly simple, being drawn to a career in medicine after witnessing her father being treated for tuberculosis as a young child. “I can’t say I made up my mind to be a doctor then. But it did put the seed in my mind that being a medical professional means you can help people,” she explained.
Ko entered The Chinese University of Hong Kong (CUHK) Faculty of Medicine in Form 6 from St Paul’s Convent School in Hong Kong as part of an early admission scheme. After graduating from Shaw College as the top student in Medicine in 1994, she started her medical career at the Prince of Wales Hospital as an intern. Once there, she quickly developed an interest in research into respiratory medicine, asthma, and chronic obstructive pulmonary disease (COPD), in particular.
COPD is a life-threatening progressive lung disease characterised by a persistent reduction of airflow resulting from chronic inflammation in the lung and remodelling of small airways. In Hong Kong, the disease accounted for 1,223 registered deaths in 2017, representing 2.7 per cent of all registered deaths. The comprehensive Global Burden of Disease Study, funded by the Bill and Melinda Gates Foundation, estimated that 3.2 million people died from COPD in 2015, an increase of 11.6 per cent compared with 1990.
A Croucher Fellowship in 2000 allowed Ko to undertake research at Woolcock Institute of Medical Research at the University of Sydney in Australia in 2000-01, an opportunity she highly appreciated.
“The Croucher award meant a lot because the experience was eye-opening for me,” she said. In Hong Kong, she noted, she was a clinical doctor learning from seniors and reading publications. But in Australia, she saw research undertaken in the laboratory and was exposed to different types of fieldwork and lab settings.
“When I returned to Hong Kong, I wanted to do more research and my supervisor [Professor David Hui Shu-cheong] was very supportive but I had no funding, no staff to help me, and very little time available,” she recalled. Despite this, she persisted, using the spare time she had to continue. Since then, she has published more than 150 peer-reviewed papers and estimates she still spends about 15 per cent of her professional time directly engaged in research.
“Sometimes you can combine clinical treatment and research if you can recruit your patients into a study,” she said, rejecting the notion that there could be a conflict between undertaking research and delivering patient care.
One of her early research projects revealed local air pollution as an important and significant factor in exacerbating symptoms in both COPD and asthma patients. By examining and undertaking matrix data modelling on air pollution index values over periods of time, she discovered a direct correlation with hospital admissions, but with a two-to three-day time lag.
“The lung inflammation of patients worsened until it became intolerable for them as their symptoms were exacerbated and they sought medical treatment,” she said.
Ko has also undertaken clinical research on airway diseases, including their epidemiology (prevalence of airflow obstruction, relationships of air pollution and infection with airway diseases), pathophysiology (exhaled breath biomarkers for assessment of airway inflammation), standards (lung function and exhaled nitric oxide references in Hong Kong), and disease management models (rehabilitation and comprehensive programmes for COPD patients). In addition, she has assessed the different factors that will affect pulmonary rehabilitation, such as physical exercise and drug optimisation.
As such, her research focus remains closely related to multidisciplinary and comprehensive care models involving doctors, nurses, and physiotherapists. Randomised controlled trials have shown positive results with this strategy, which has improved hospital care over recent years. Her work on the service model for COPD patients, for example, has brought tangible improvements to their well-being. “I want to help advance the standards of medical care,” Ko said. In 2007, she was awarded a Doctor of Medicine (MD) degree for her research.
Her research team is now working on the overlap between asthma and COPD patients, who are currently treated differently despite some common symptoms between the two conditions. For example, sometimes a patient is diagnosed with asthma but they also smoke and have COPD symptoms too.
“We are looking at patient behaviours, investigating how different the patients are with both sets of symptoms, and looking at improved care outcomes,” she said.
Another study is exploring asthma biomarkers in exhaled breath, which indicate the degree of eosinophilic airway inflation. Healthy subjects in Hong Kong with normal lung function have a higher level of exhaled nitric oxide than healthy Caucasians and Ko is looking at asthma subjects to assess their measurements at different levels of asthma control and to compare them with the Caucasian population.
Of her many accomplishments in improving care outcomes for patients with respiratory diseases, Ko said it was the invitation to join the Global Initiative for Asthma (GINA) in 2016 that was probably her proudest achievement to date.
Founded in 1993, GINA is a medical guidelines organisation drafting asthma guidelines for worldwide use. It works with public health officials and healthcare professionals globally to reduce asthma prevalence, morbidity, and mortality. There are 15 members of the science committee and Ko is the only Asian woman.
Ko was also invited to join the Lancet COPD Commission in 2018. The commission works on strategic documents to inform the medical community as well as policymakers, funders, and healthcare planners about the need for novel approaches to the prevention, diagnosis, and management of disease.
“This work makes a global impact on the way the disease is treated and managed so that’s very satisfying,” she said.
Dr Fanny Wai San Ko is a specialist respiratory physician, currently holding the position of Consultant in the Department of Medicine and Therapeutics, Prince of Wales Hospital, in Hong Kong. She has been Deputy Chief of Service of the Department since 2017. Dr Ko is also an Honorary Clinical Associate Professor in the Faculty of Medicine at The Chinese University of Hong Kong. Dr Ko is a past president of the Hong Kong Thoracic Society and former vice-president of the Hong Kong Institute of Allergy. She is the medical advisor of the Hong Kong Asthma Society and programme director of the Specialty Board of Respiratory Medicine, Hong Kong College of Physicians. Dr Ko joined the Global Initiative of Asthma (GINA) Scientific Committee in 2016 and Lancet COPD Commission in 2018. She is also Senior Editor of Respirology journal. She received a Croucher Fellowship in 2000.
To view Dr Ko’s Croucher profile, please click here.