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Well, the world is changing! I had written several times in this blog that patients nowadays are not the same as it used to be. This is something that the current budding doctors are totally unaware when they claim that they want to “help” people by being a doctor. Only those in practise will understand what is happening out there.

Today, Malay Mail published several articles regarding ” Dr Belittle“(see below). It was about a Facebook posting which supposedly breached patient confidentiality and made various unwarranted remarks against the proponents of home/natural birth. Actually, I have been watching this ongoing debate among these group of doctors and the supporters of home birth for quite some time now. While both have their own believes , I do agree that certain unwarranted remarks or unacceptable language should not come from professionals like us. We should debate it in a civilised manner with facts rather than emotion. Saying that, I do see a lot of emotional rants in this blog by the younger generations when they don’t agree with my statements. But, do you see me doing the same?

We should understand that patients have every right to accept or deny our treatment. One of the ethics of medicine is “patient’s autonomy”. It is not mandatory for any patients to follow your treatment plan despite all the explanation given. You can scare and scold a patient but they have every right to deny any treatment offered to them. I use to get irritated by these group of patients when I was a junior doctor but after some time I began to accept the fact that our job is just to advise. You advise a patient for mastectomy for Ca Breast but she goes for traditional treatment. 6 months down the line , she comes back to you with metastasis all over the place! Do you scold her? It is her body and her life, you can’t do anything about it! Unfortunately, over the past 18 years, I have one thing which seem to be getting louder by the day. It is the refusal to seek doctor’s advise or treatment. The patient rather trust a traditional medicine practitioner than a doctor, simply because they feel that these practitioners are prescribing and using “natural” treatment rather than chemicals. They refuse to believe that these “natural” treatment are usually adulterated  with modern medicine chemicals such as steroids, NSAIDS and antibiotics. But you can advise till the cow come home and they will not listen to you. They will only listen when complications occur and they come back to you for treatment. I had seen enough Addisonian crisis, Liver toxicity and peptic ulcer disease from patients taking TCM. I had even sent some for analysis and showed them the proof.

What do I do when I see such a patient, nowadays? Basically, I don’t give a damn anymore. I tell them right to their face that since they do not want to take any treatment plan from me, please do not come to see me again for any problems. I rather treat and “help” patients who are willing to follow my treatment plan than wasting my time on patients who are never compliant. And for those who do come back to me, I will give them a piece of my mind before treating them.

Unfortunately, that is the reality out there. That’s why whenever a budding doctor tells me that he wants to help people, I tell them that not many patients nowadays really appreciate your help anymore. The real appreciation nowadays are in rural areas and interiors. Unfortunately, not many doctors would want to work in these areas. Just yesterday, I heard another Gynaecologist being sued in court. Together with him, another 2 doctors will have to be involved as they co-managed the complications that this patient had.

Coming back to the articles in Malay Mail today, I find the articles rather depressing. Firstly to the fact that many “unprofessional’ remarks were made by doctors which is not the right thing to do. NO matter what you discuss openly in any public forum/social media, patient’s details and particular should never be released. I see a lot of such pictures and details being written in Facebook  which is unethical. Anything that you publish that can directly or indirectly point to any patient’s particulars, where it took place etc can be sued by the patient. Also, please remember that a written consent must be taken from the patient for any pictures or videos taken. On the other hand, the article seem to be supporting home/natural birth proponents, blindly. While home birth is nothing new, it should be done by people who are trained medically. Even in some developed countries like N.Zealand, UK etc, midwives do deliver babies at home. However, these are done to low risk cases only. If they pick up anything unusual or feel that the patient might be high risk, the patients are referred to hospital for delivery. Unfortunately, the proponents of such method in Malaysia are mainly non-medically trained people. Majority do not take any responsibility when complications occur. Furthermore, they provide information that are not true and never disclose the complications that had occurred to their clients. No action can be taken against them as well. Remember, even some of the supporters of such methods had died during delivery.

Unfortunately, as a doctor, our job is to treat any emergency no matter who they are. They can be drug addicts, prisoners, murderers, robbers, snatch thief’s, HIV patients or even patients who refused to listen to you before. Your job is to treat them for whatever emergency they come with. If it is non-emergency, in a private sector, you can refuse to see the patient on a basis that you are emotionally not ready to treat such a patient. BUT, in government sector, you can’t, as you are an employee of the government, paid by the government to do the job.

So, if any of these patients who decided to deliver at home come to you with a complication, it is your job as a doctor to treat them. You can complain all you want, but that is your job. You decided to become a doctor to help people. So, just keep quiet and do it no matter how much anger you have in your heart. You have to accept the fact that it will never be the first or the last such case that you will see. That’s when you will ask yourself why I became a doctor when patients don’t listen to me anyway? And when the mother dies, a full report need to be sent to MOH as maternal mortality is a national index. Subsequently, you will be called for the Maternal Mortality meeting to find out why the mortality happened. I feel in such case, MOH should take action against the proponents of home births. BUT do they have the authority/law to do that?

As for the patients, it is their right. If they want to harm themselves, it is up to them. It is their life not ours. I realised this after few years of working as a doctor. BUT they should realise that they should NOT cause any problems to others as well. Don’t run to the hospital when complications occur. Take the people who advised you to do home delivery to task. Sue them or ask them to pay for the complications. Unfortunately, our society are more than ready to sue a doctor but not a traditional medicine practitioner or anyone else who has been advising them all this while. Do you see anyone suing these people? You don’t! That’s the sad life as a doctor. Not only you get sued for everything nowadays but also get called up by MMC for emotional rants, as you had breached professional ethics!

Doctor’s life is never the same anymore………………… so, It’s time for me to take another holiday on the seas….. ……

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Doctors reminded of professional etiquette
By Vanessa Ee-Lyn Gomes
Published: June 3, 2015

PETALING JAYA, June 3 — A government doctor may have possibly breached patient confidentiality by discussing a young mother’s home delivery case over social media, says deputy health director-general (medical) Datuk Dr S. Jeyaindran.

He said the Health Ministry had regularly reminded doctors about Facebook use besides professional etiquette regarding medical discussions over the Internet.

Dr Jeyaindran said a patient’s information was always confidential.

“There is a very fine line because doctors sometimes use social media to discuss a patient’s condition or conduct consultations, but the patient’s name should never be revealed.”

He said there were implications and repercussions from public postings on social media which doctors may be unaware of.

“Unfortunately, a lot of doctors still do not realise that postings on social media may lead to breach of patient confidentiality and ethics,” he said when commenting on a young doctor’s Facebook post which ridiculed a patient suffering a third degree tear following a home birth.

Other medical professionals left mocking comments on the post.

Dr Jeyaindran, who is also a member of the Malaysian Medical Council, said it was inappropriate for medical professionals to post such comments.

“The use of social media to openly discuss patient issues is not appropriate and is definitely not advocated,” he said.

He said the council could investigate the matter if there were complaints from the patient, her family or the public.

“The doctor has to be present before the disciplinary committee to see what form of patient confidentiality has been breached,” he said.

“It does not matter who lodges the complaint because the doctor’s professional conduct will be examined.

“We will also study what information was shared in the post.”

On home birthing, Dr Jeyaindran said the ministry did not advocate it because of the risks that could lead to complications.

It is understood an investigation will be carried out on the direction of the director-general of health to ascertain if there was a breach of professional conduct and patient confidentiality.

– See more at: http://m.themalaymailonline.com/malaysia/article/doctors-reminded-of-professional-etiquette#sthash.y47COpoB.dpuf

MMA: Patient info not for open discussion
By Ida Nadirah
Published: June 3, 2015 07:32 AM GMT+8

PETALING JAYA, June 3 — Social media has given rise to issues regarding patient confidentiality, said Malaysian Medical Association (MMA) president Dr Ashok Zachariah Philip.

With widespread use of social media platforms such as Facebook, medical practitioners are not excluded from using them to channel their experiences, joys and frustrations.

However, Dr Ashok said doctors were discouraged from using social media as a forum to discuss patient information.

He said doctors in general do not reveal patient details, but would sometimes share information with other doctors for discussion or consultation.

“The problem with Facebook and such, even if something is discussed in a closed group, people can still share the information,” he warned.
He said patient information and histories should not be shared in open forums, and should only be done in traditional channels, such as bulletin boards.

Dr Ashok said the sharing of a patient’s photographs could only be done with the patient’s consent. Failure to have consent would be unethical, even if the patient was unidentifiable.

“If found guilty of breach of confidentiality, the doctor may face action by the association as well as the Health Ministry,” he said.

In reference to the recent criticism on a Facebook post where a mother suffered third degree tears during a home birth, Dr Ashok said it was not right for the doctors to use such crude language.

“We, as doctors, are human as well, and we may be angry over the result of a patient ignoring the doctor’s advice.

“However, we still have to treat the patient in the best way possible, and in no way suggest causing more harm,” he said.

He said it was improper for the doctors to comment publicly about the mother, whose medical history was unknown to them.

He said it was not uncommon for mothers to deliver at home.

– See more at: http://m.themalaymailonline.com/malaysia/article/mma-patient-info-not-for-open-discussion#sthash.X9KmQppk.dpuf

Use lidi and yam roots to stitch tear, doctor advises
BY IDA NADIRAH

Wednesday June 3, 2015

PETALING JAYA, June 3 — A young woman who sought treatment for a third degree tear after home birth has become the butt of crude and distasteful jokes from doctors who latched on to sarcastic comments posted on Facebook by the doctor who was treating her before delivery.

In the general tirade againt home birth by 26 others including young doctors, one even went as far as saying that the patient should use yam roots and a lidi (coconut leaf skewer) to stitch the wound.

If that was not rude enough, he went on to suggest in a similarly unprofessional vein that the first-time mother use glue and aloe vera to heal herself.

A Kuala Krai medical officer who agreed to the doctor’s post, mockingly said: “Yes, please repair naturally. No analgesia (painkiller) please.

Another doctor belittled the woman and patients who supported natural birth, saying “I guess positive vibes, giving birth while standing, lots of hugs, etc can’t prevent third degree tear? Hmmm, maybe because it was not natural enough.”

A third degree tear involves a tear through the perineal muscles and the muscle layer around the anal canal following a natural birth.

The person who started the sordid affair, a house officer at the Hospital Sultanah Nur Zahirah in Kuala Terengganu, had posted this on her Facebook page on Saturday night: “Homebirth. refused everything. Came to hospital for 3rd degree tear. Yes doctor, please repair my tear. Keep calm and continue oncall

To add insult to injury, the doctor also included part of the patient’s pregnancy record book in which the woman had said she would not require any medical attention during delivery at home.

The shocking use of unacceptable language and breach of patient-doctor confidentiality has come in for reprimand from the Malaysian Medical Association and the Malaysian Medical Council which took the doctor who belittled the mother and her fellow medical practitioners to task for bringing the profession into disrepute.

A group of mothers who advocate home birth have also expressed outrage over the manner in which the doctors had treated the woman who went for a procedure that had gained acceptance worldwide.

The photograph of the woman has been circulated widely and found its way into other public Facebook postings despite an attempt to erase the patient’s signature.

The first Facebook posting has been taken down but the author and other doctors continue to discuss the matter openly on Facebook.

– See more at: http://www.themalaymailonline.com/malaysia/article/use-lidi-and-yam-roots-to-stitch-tear-doctor-advises#sthash.67D0nPC8.dpuf

Home birthing is here to stay, doctors told
BY IDA NADIRAH

Wednesday June 3, 2015

PETALING JAYA, June 3 — Doctors have been told to wake up to the fact that home birthing is here to stay.

Hypno-birthing educator Nadine Ghows said the phenomena of doctors criticising mothers who advocate home birth had been going on for some time on social media.

She said the language used by the doctors tended to be patronising and condescending, oreflecting a lack of training on basic etiquette.

“Some doctors still see patients as someone to control … this is partly due to the ‘white coat’ syndrome,” she said.

She said the attitude of some doctors towards patients was unhealthy and they lacked an understanding of their role in the patient-doctor relationship.

She was commenting on the case of a house officer who had posted confidential information on a patient on Facebook which in turn elicited rude and crude remarks from a host of others including doctors.

Nadine, in decrying the actions of the doctors, said basic training on etiquette had to be offered to young doctors especially on the strict rule that they could not share any information on a patient with the public.

She said a medical lecturer from Universiti Kebangsaan Malaysia (UKM) had started a basic etiquette course for young doctors last year.

“Maybe we will not see the results soon now. I hope this course will play a role in ensuring that humanity and respect are brought back to medical care,” she said.

Researcher and engineer Nur Firdaus A. Rahim, 31, said every patient had the right to their opinion on matters involving medical procedures and their requests had to be respected by doctors.

“They should not belittle or insult parents who holds their own opinions on such matters,” she added.

“I am affected by their actions. I had initially planned to give birth at a government hospital but will now chose a private hospital that is more natural-birth friendly.”

Flight attendant Zamzilah Fairuz Kamarul Zaman, 30, said she did not mind doctors sharing their experience “but sharing patients’ records goes beyond the limit.’’

– See more at: http://www.themalaymailonline.com/malaysia/article/home-birthing-is-here-to-stay-doctors-told#sthash.v69ph7lE.dpuf

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Last week, our PM revealed the 11th Malaysia Plan (RMK 11). As usual, a lot of sugar-coating and wonderful plans were mentioned. With the current reputation that our PM is enjoying, it has to be taken with a pinch of salt. The market did not respond well this time around. On Monday, our Bursa crashed. That simply shows that no one believed what was mentioned in RMK 11.

I will not talk about the entire plan as many of it are repetitive issues. I will concentrate on the medical field as attached below. Let’s look at the 1: 400 ratio. This is nothing new. Right from the beginning, the government’s intention is to achieve the ratio by 2020. That’s the reason why numerous medical schools were given license to start. As usual, our government is only interested in quantity rather than quality. We want to achieve everything on paper but in reality, half of it ” tak boleh pakai !!”. First they said that it is WHO recommended ratio, but last year, WHO has made it very clear that they never came up with such a ratio. Interestingly, just last month, MOH said that we are short of post and there are too many graduates coming into the market, but suddenly everything changes. I believe our PM do not know what he is talking about, as usual. Secondly, with the number of graduates being produced now, we will achieve the ratio 1: 400 by 2017. Don’t need to wait till 2020. All our 36 medical schools will be producing graduates by 2017. We have already reached a ratio of 1: 600 in 2013. The statistics for 2014 is yet to be announced.

Whatever said, these ratio does not mean anything as it includes both government and private doctors as well as doctors in administrative jobs. No matter how many beds that you have in the government sector, it will always be overcrowded as 80% of patients are dependent on government hospitals. This brings me to another question of bed ratio; 2.3: 1000 patients that was mentioned in RMK11. This ratio includes both private and government, but only 20% of patients will use the private sector. Unless the government comes up with a National Health Financing Scheme (which was not mentioned in RMK 11), the bed ratio do not mean anything. Everything will look glorified on paper but meaningless in reality.

Now, let’s look at the “so-called” new hospitals that are going to be built. Are they really new hospitals?

1) Hospital Bentong : There is already a 152 bedded hospital in Bentong. So, is this new hospital replacing the existent one?

2) Hospital Baling : Again, a 160 bedded hospital is available in Baling. So, nothing new either.

3) Hospital Kamaman: A 116 bedded hospital is available

4) Hospital Maran : A 60 bedded Hospital Jengka is in Maran, about 40km from Maran town. A 500 bedded Hospital Temerloh is also about 40km. I am not sure where exactly these new hospital is going to be but likely it will be quite nearby to the existing hospitals.

5) Hospital Pendang :This will be a new hospital

6) Hospital Pasir Gudang : Hospital Sultan Ismail, a 500 bedded hospital is just 15km from Pasir Gudang. There are also 3 private hospitals in Pasir Gudang District: KPJ Pasir Gudang, Regency Specialist Hospital and Penawar Hospital. So, do we really need another hospital there? Will it ever materialise. It is an industrial area where most workers are foreigners.

Building an upgraded hospital is good. However, looking at our track record, likely these hospitals will never see the light of the day. Remember, Hospital Shah Alam is yet to complete since RMK 9. Remember, Hospital Sultan Ismail was delayed for almost 3 years? Furthermore, most of these hospitals are only going to replace the existing hospitals with better facilities. It is not going to increase the number of new post very much. There will still be too few of a new posts for increasing number of new graduates.

What about cluster hospitals ? In early 1990s, a concept known as Nucleus Hospital (under RMK6) was introduced. Hospital Manjung, Hospital Sg Siput, Hospital Kulai, Hospital Segamat, Hospital Batu Pahat etc are few of the hospitals that are Nucleus hospitals. A total of 12 was introduced based on a system in Britain. It suppose to be community based hospital which acts as a nucleus for further expansion and upgrading. Unfortunately, many remained as district hospitals with some basic speciality. I got no idea what this cluster hospital is all about. I presume it is sharing of manpower and facilities among hospitals within a district/area. If that is the case, specialist may be running between few hospitals. I remember our Health Minister did mention about this few months ago. It may end up chasing away more specialist from the government sector.

Upgrading of health clinics is a necessity. Unfortunately, many of the current clinics are already facing shortage of funds and expired equipments. I hope the current ones could be upgraded first before selecting a “few” for upgrading work.

Finally, another 165 “1Malaysia clinics” will be introduced. This is a disaster for GPs. Some of this 1Malaysia clinics in N.Sembilan and Selangor is currently being filled by MOs. While it is a good publicity stunt, it will affect many GP’s income.

While everything looks good on paper, many may not happen. With the current economic situation, where will the government get the money? That is the question many economist are asking. Some of these projects will be shelved as usual, or postponed to 12th Malaysia Plan. Many may fail, as happened again and again, countless number of times……… History repeats itself!

 

 

 

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I recently received few emails from medical students involved in the above organisation. It is an organisation of Malaysian medical students both locally and overseas. It is interesting that they have come to realise the issues that need to be addressed for their future. Thus, they are actively organising various events in Malaysia which will be participated by Malaysian students from around the world. Some of them had contacted me to advertise their program in this blog. Their next upcoming event will be in Sg Buloh Hospital next month as attached below. The Event is called MMI MAID – Making an informed choice.

A little introduction on MMI – it is an organisation that has been very actively organizing major events that involve many medical schools in Malaysia.We are a Malaysian-registered medical student organization representing Malaysian medical students both locally and overseas. Our committee comprises of both local (UM,UPM,PMC,MMMC,IMU,MONASH,AIMST etc) and overseas Malaysian medical students

Please feel free to visit page in fb : https://www.facebook.com/mmimaid and website for this event : https://malaysianmedicsinternational.wordpress.com/about-2/what-we-do/ They also have another big event coming up in August 2015 known as Malaysian Medical Student Summit as seen over HERE.

 

details on event

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MY last article regarding the AUCMS loan fiasco attracted some nasty comments from some students. They accused me of insulting them and not understanding their situation. I tried my best to digest what they are trying to say but I simply do not understand what these students really have in their mind. Many don’t seem to understand what I am trying to say. Thus, I thought of putting my thoughts in this article.

3 years ago, I warned many students not to fall into a trap. It was a gentle advise to all those who contacted me and read my blog. Unfortunately, many refuse to listen and decided to go against my advice. When issues happened last year, what can I do? Thus, I said that students being students, they would choose whichever way to achieve their “dreams” without realising the implications in the future. What surprised me the most is the fact that many of them do not know much about the world out there. They don’t read much. One of them said that competition to enter medicine now is beyond Godly? I am still amazed and shocked with the statement. Do they even know what they are talking about? Let me give them the scenario that I went through in my early years of life!

In 1980s, there were only 3 medical schools in this country, namely UM (started 1964), UKM (started 1972) and USM (started 1979). When I achieved 8A1 and 1 A2 in SPM 1989, the only scholarship available was JPA. Unfortunately, we were told point blank straight to our face that JPA scholarship for medicine is only reserved for bumiputera students but we can choose something else. There is NO such thing as PTPTN loan or even bank loan those days. My father was a teacher and my mother housewife, and I am second in my family of three. Just as a reminder, each state will only have 2-3 students scoring 8A1s those days, unlike now where we have hundreds to thousands.

So, what you do then? Most of us had no choice but to proceed with Form 6 as it is the only way to enter public university aka medical schools. Please remember that there was NO such thing as Foundation studies, a short cut to do any degree programs nowadays. It’s either STPM or Matriculation. Matriculation was ONLY reserved for Bumiputera students. It was only after 2003, 10% of the slots were given to Non-Bumiputera students. So, we studied another 2 years and sat for STPM exams, which was considered one of the toughest exams in the world. Public universities practiced quota system based on population ratio. Sixty percent for Bumiputeras, 30% for Chinese and 10% for Indians. So, to get into a public university medical school, you either need to score 5 or 4As in your STPM. Some Indian students could manage to enter with 3As as they need to fill up the quota. The total medical student intake was 180 for UM, 150 for UKM and 110 for USM(Total 440 students). Since I was the only Indian student to score 5As(out of 71 students) on that particular year, I did not have any problem to enter UM medical faculty. That was how tough it was to enter a medical school those days, which obviously the students nowadays do not know anything about. The fact is, it is very much easier to enter medical school now than during my time (late 1980s to late 1990s). Once you are in the public university medical school, you will be given JPA scholarship and bonded for 10 years with the government.

Would I have done something else if I did not get the results needed to do medicine? Yes, I would have. My parents would not be able to send me anywhere else. There were hardly any private colleges except for some offering law degree and no such thing as PTPTN loan either. I would not have burdened my parents with loans. Some did go to India to do medicine, as it was the only place affordable at that time. You must also remember that the economic situation of this country was much better than. Inflation was lower and our currency was much stronger with RM2.50 for 1 US dollar and RM 1.20 for 1 Singapore dollar!! The cost of living was way lower.

As I had said many times before, passion is one thing but living a life is another. Some feel that they should achieve their dream and passion at whatever cost but, from economic point of view, it is being insane. I had said that if you think you have true passion in medicine and feel that you can put up with all the work life challenges that had been listed in this blog, you could go ahead. BUT I also said that you should NEVER take huge loans to do medicine, as it does not make any economic sense! Life starts after you graduate. When you are student, you are still supported by your parents and thus you do not understand the need to work to earn a living and the burden of debt. Medicine is a noble profession but the world is not the same anymore.

When I graduated, I had NO debt! I worked “like a dog” during housemanship with a salary of RM 1695/month (yes, I can still remember this pathetic figure). “On Call” Allowance was RM20/call. You can’t even afford to buy a car. I bought my first car (Proton Wira) during my first year MOship by using all my savings acquired during my housemanship, subsidized by RM 34K government car loan. Woolah, now you realise that RM 500/month goes to pay your car loan for the next 6 years! I drove this car for 9 years. Thankfully, we did not have mobile phones those days and Internet were dial-up service, which does not cost much. Computers were not a necessity yet. Your annual increment was RM72. Then you get married and began to have kids while you are planning for your postgraduate education. You live in a rented house, which would take another RM 600/month with no proper furniture! By the time I finished my MRCP Part 3 (all paid in British pounds : Rm 5.50 to 1 pound), I had a credit card debt of RM 12K which took me almost 4 years to settle. My salary was RM 2200/month after 5 years of service. I told myself that I would not continue with my MRCP if I fail my attempt as I could not afford it anymore with 2 kids need to be fed.

It is during these times, you will realize that passion is one thing but living a life is another. After some time, it is just a job to earn a living. What matters most is how you are going to feed your children and live a life. Only after I pass my MRCP, I decided to buy a house, which I am staying till today. The house will take another RM 1100 of your salary/month for another 30 years. I am still paying till today.

What I am trying to say is, trying to achieve your passion/dreams by taking huge loans will hunt you in the future. Imagine, the day you graduate, you have a loan of RM 300-500K to settle. This does not include the upcoming car loan, house loan etc. Many parents feel that their children are going to earn tons of money immediately after they graduate. Thus, they feel that the loans are worth taking. As I told one of the students who commented that they are from poor family who could not afford to do medicine without the AUCMS loan:  Are you going to be any better after you graduate? You are going to be poorer than your parents!

Would you do medicine if I tell you that you will not be paid? Would you do medicine if your starting salary is going to be the lowest among all profession? With all the passion that you have, would you still do it? I still see many grouses about housemanship, mostly about their working life and bullying. I also see many who request the salary to be raised! Where is your passion? Basically, once you start working, you are paid for your work, not for your passion. Would you work 24hrs a day if not going to be paid overtime allowance? (BTW, for those who don’t know, On-Call allowance only started in 1994. Prior to that, you do work for free). As for salary of doctors, in government service and private sector, please read my earlier articles.

I also get comments like “ I want to help people” as the reason for doing medicine. How are you going to help people when you can’t even help yourself? I just replied to a girl who wanted to be a doctor, as she wants to give free treatment to people. She feels that many people are dying because they can’t afford medical treatment and the government sector is too long of a queue for patients to get proper timely treatment. No matter what consultant you are, if I throw you to a place where you do not have any medicines or equipments, you are as good as anyone else standing there! There is no way you will be able to treat anyone without medications/equipment. To do this, you need money! That’s why only less than 20% of hospital bill belongs to a consultant. The rests are for the hospitals to cover the cost of medicines, equipment, consumables etc. Unless you are from a rich family, you cannot run a free service. There are many ways you can help people. Most philanthropists are not doctors. Imagine how many people can you help with the RM 300-500K you are spending to do medicine? How many houses can you build for homeless people? I know many who became rich without even having a degree and helping other people via foundations etc. Do you see any doctors running free clinics? Whether you like it or not, everything needs money nowadays. It is a capitalist world!

I hope I am getting the points across. Passion is one thing but living a life is another. That’s why I had always said that education should NEVER be commercialized. The best and qualified students should be given scholarships or absorbed into public funded universities. Unfortunately, commercialization of education in this country is making each and every student poorer. We are creating a future generation of people in debt.

The government is also heading towards bankruptcy, I guess. Imagine not getting a job to even start paying your debt! Ministry of Health had slashed its budget and streamlining allowances this year as reported over HERE. I heard IJN referrals will not be entertained anymore. All cases can only be referred to MOH hospital’s cardiology centres. Today, I received a report from a whistleblower site that NO NEW government post will be created with immediate effect from 22/04/2015. The letter sounds genuine. Again, what I have been saying all these while is becoming a reality. As a country with the highest number of civil servants per-capita population, it is not sustainable. Eventually, it will collapse as what happened to Greece. As a medical graduate, whatever you had spent will become meaningless if you can’t do your housemanship as you will never be able to practice medicine without it.

The world is changing. I would not have done medicine if I could not get into a public university. I would not have become a specialist if I had failed my MRCP Part 3. I worked hard and finally succeeded. BUT I did not have a huge loan to start with. I did not have to spend on so many necessities as nowadays. I had a wife who supported me by living a simple life: no jewelries’, a rented house with no furniture other than a bed, dining table, TV and fridge, no maid and no parents support. The only debt I had been a car loan and credit card debt which did not even exceed RM40K until I passed my MRCP and decided to buy a house.

I can’t imagine how a student who is graduating with a debt of RM 300-500K ever going to live a life. Passion is one thing, living a life is another! I leave the readers to ponder upon!

No more vacancies — Putrajaya confirms hiring freeze
Tuesday May 5, 2015
KUALA LUMPUR, May 5 — The Public Service Commission (PSC) has confirmed that the government is no longer recruiting for any positions effective April.

PSC chairman Tan Sri Mahmood Adam told Sin Chew Daily that the government was not taking in any more people into its service, but declined to explain the rationale for the decision.

Mahmood told the Chinese-language newspaper that 15 agencies, including the police, army and Education ministry, have already received notice of the freeze.

He insisted, however, that agencies that needed emergency replacements could still apply to do so via the Public Service Department.

According to Mahmood, the moratorium does not affect recruitment for vacancies that were advertised prior to the April 22 directive.

His remarks confirm a report by whistleblower website Sarawak Report across the weekend that said Putrajaya was no longer hiring, based on a leaked copy of the memorandum from the PSC.

Malaysia’s civil service force currently costs some RM60 billion in wages annually, accounting for a third of total government spending.

Malaysia also has one of the highest public workers to population ratios in the world.

Putrajaya was forced to reduce its operating budget for 2015 owing to a sharp drop in oil price since last year.

– See more at: http://www.themalaymailonline.com/malaysia/article/no-more-vacancies-putrajaya-confirms-hiring-freeze#sthash.alzCumz1.dpuf

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So, after 5 years of me starting this blog and almost 10 years of voicing out my concerns, finally the government has acknowledged the situation. Almost all that I had said in this blog over the last 5 years were clearly mentioned in today’s Star headline. The time has come for the government to admit the mistakes that they had committed. Unfortunately, do they have the political will to change the situation?

As a country with the highest number of medical school per capita population in the world, in a truly Malaysia Boleh spirit, we had allowed countless number of shop-lot medical schools to flourish. Thousands more go to overseas universities either sponsored or self sponsored. We are creating a generation of people who are going to be in debts for years to come. I had always said that you should not take huge loans to do medicine. It does not make any economic sense and do not forget the many more debts that will come along away. Basically, you are starting your life with a RM 500K debt which will only accumulate further.

Today’s Star’s headline discussed several issues. Debts to be paid and huge investments that are going to waste, as the country is unable to provide housemanship post for at least 6 months to a year upon graduating. This waiting period will increase further when all the remaining medical schools (50% of them) start to produce doctors at their maximum capacity from next year onwards. I understand that they have started the e-housemen website.

Another issue was the issue of quality which I had written several times before. The figure that 1 in 5 housemen are quitting their job was rather surprising to me as I had expected a much lower figure. As the Deputy DG said, most of them just go missing in action(MIA) without any resignation letter. In government service, if you leave without a resignation letter, it will take almost a year for disciplinary action to be taken to remove you from the service. During this time, no one can occupy your post! THUS,  for those who intend to leave, please put in your resignation letter. This will benefit the newly graduating doctors in reducing their waiting time. I have said many times before, being  a doctor involves hard work and lost of social life. Working long hours is a norm in many countries including in many developed countries. It’s the healthcare system that wary. Each country will have their own problems. In Malaysia, the public healthcare system is as such that working long hours is sometimes  inevitable. WE need an integrated healthcare to improve this. Being part of civil service, it is very difficult to take disciplinary action against a civil servant. That’s the reason why you may see a lot of deadwood doctors in civil service. That is also the reason why bullying and intimidation will never stop!

There were again suggestion to introduce a common entry exam/MQE. The last time I spoke to a senior MMC member early this year, the obstacles to this idea are the politicians and local public universities. My question is, if you think you are producing competent doctors, why worry about the exam? I am all for a common entry exam. It is the only way forward to maintain the standards. It is impossible for MMC to monitor all the medical schools locally and overseas. That’s the reason why many countries switched to a common entry exams. I hope the politicians and local public universities will lower their ego for the betterment of the future generations and the country.However, I am sure you know the answer!

So, for future doctors and for those who made insulting remarks over the last 5 years in this blog, the time has come to wake up and face the reality. Never do medicine for wrong reasons and I will also add, never do medicine if your intention is to migrate. It takes great passion to overcome the obstacles that you will face as a doctor. Do not forget the numerous laws and regulations that you need to abide to. We have Medical Act, PHFSA, Poison’s Act, Dangerous Drug Act etc. A traditional medicine seller has very much less rules and regulations to follow! The complementary medicine practitioners are laughing to the banks but we doctors are fighting tooth and nail to prevent dispensing separation. Oh, and not to forget the GST which doctors are supposed to absorb in the name of “untuk rakyat”.

On the other hand, we are facing more and more demanding patients. Medico-legal cases are increasing by leaps and bounds. Just recently, a patient sued a government hospital and was awarded RM 3 million in damages. Not to forget a male doctor being charged for molesting a male patient! These are some of the frustration that doctors are facing day by day. The younger generations are still leaving in their past. I attach 3 out of 4 articles that appeared in the Star today.

Housemen do not complete training stint for various reasons
PETALING JAYA: One in every five doctors undergoing training as houseman in Malaysia quit each year, an alarming rate of drop out, considering the high cost of studying medicine.

IMG_20150330_144800

It may cost up to RM500,000 to study medicine in Malaysia and up to RM1mil if it is completed abroad.

Many newly qualified doctors also quit because of the longer wait to be posted as housemen.

Those who left abruptly have been found working as waiters and even running pasar malam stalls and there has also been a case of a trainee doctor taking up a job as an air stewardess.

Deputy Health director-general Datuk Dr S. Jeyaindran said about 1,000 of the 5,000 housemen employed each year do not complete the two-year training stint.

Among the reasons for housemen to leave the service include unsuitability for the profession as they were pressured to study medicine by their parents.

Having a totally different perception of a doctor’s life, inability to work long hours and suffering from burnouts are the other causes.

He said the rise in numbers of housemen quitting had been growing over the past three years.

Dr Jeyaindran said as housemen were hired by the Public Services Department (PSD), the termination process was tedious and could take up to several months to more than a year.

“Until the person’s service is terminated, the vacancy cannot be filled and those who replace them have to wait for their turn to start,” he said in reply to questions submitted by The Star.

He said many of the housemen who left did not tender official resignation letters.

The large number of medical students graduating each year is another reason for the long wait for postings as a houseman, especially under the new e-houseman system, which allows for newly qualified doctors to choose the place of their posting.

While the average waiting time is about six months, it can be longer for the more popular postings in urban hospitals including the Kuala Lumpur Hospital.

“With 10,000 housemen in all the 45 training hospitals nationwide, these hospitals have varying degrees of waiting periods except for hospitals in Sabah, Sarawak, Kelantan and Terengganu,” Dr Jeyaindran said.

He said the ministry must explore other ways that allow for greater flexibility in employing housemen to replace those who had left.

He said the proposal to have a common entry or fitness to practice examination as proposed by the Malaysian Medical Association (MMA) was among the steps being considered.

Another was a longer induction period for housemen to have better understanding of their work.

“It is not to control numbers as proposed by MMA, but to ensure a minimum standard of competence. The common entry examination is already in place in some Asian countries, the United States and Australia and it might become necessary to ensure safe medical practice especially once there is a liberalisation of trades and services,” he said.

He said a houseman’s workload in Malaysia was lighter than those in other countries, adding that on average, housemen in Malaysia took charge of between four and six patients in a ward compared with eight to 12 in Singapore, Australia and the United States.

“Moreover, house officers in these countries work an average of 80 hours compared with the average of between 65 and 72 hours for Malaysian housemen,” he added.

New docs may have to wait a year for housemanship
PETALING JAYA: Newly qualified doctors must now wait longer – up to a year after their graduation – to take up their stints as housemen at certain training hospitals instead of the previous period of six months.

Malaysian Medical Association (MMA) president Dr Krishna Kumar said that with medical graduates now being given the choice to choose the hospitals to be trained in under the e-houseman system and the long waiting lists in some hospitals, the waiting time could be longer.

Prior to the e-houseman system, which was introduced this year, the average waiting time was about six months.

“The waiting time is getting longer and longer, especially in the more popular urban hospitals, including the Kuala Lumpur Hospital.

“We must have an entrance examination to screen medical graduates for the best candidates,” he said, adding that the bottle neck was reaching a “critical stage”.

Last month, Deputy Health Minister Datuk Seri Dr Hilmi Yahya announced that housemen could choose the hospitals for their internships through the new system.

Dr Krishna said with one in five applicants requesting for specific postings, the ministry decided to let the applicants see the limited spots available for themselves.

He said at the current rate of 5,500 medical students graduating each year, all 45 training hospitals in the country had difficulties in coping with the numbers.

Dr Krishna cited two hospitals as an example. At the obstetric and gynaecology (O&G) department in Seremban Hospital 65 housemen have come under the supervision of two consultants and five specialists while the Kuala Pilah Hospital O&G unit only had one obstetrician overseeing about 30 housemen.

“We are a small nation but we are generating so many doctors and causing a bottle neck in training hospitals,” he said.

He also expressed concern that some might not get postings as medical officers in the future, adding that their career path too would be limited because scholarships for Masters programme were only offered to between 800 and 1,000 medical officers each year.

Five years ago, The Star highlighted the massive number of medical students graduating each year, putting pressures on the limited number of training hospitals. The problem has since worsened.

Dr Krishna attributed this to the lack of political will to resolve the issue and urged the Higher Education Ministry’s moratorium on new medical programmes be maintained and the brain drain among specialists be addressed as it was difficult for a small number of senior doctors to keep tabs on housemen.

Universiti Malaya medical faculty dean Prof Dr Adeeba Kamarulzaman said that there was no waiting list at the Universiti Malaya Medical Centre for housemen but the entry level for medicine course at UM had been raised to 5As for Sijil Pelajaran Malaysia results.

Deputy Education Minister P. Kamalanathan said the five-year moratorium imposed on new medical programmes in 2010 would remain.

Long hours and lack of work-life balance prompt one doc to quit
PETALING JAYA: One doctor decided to opt out of her housemanship training after realising that it was not the life she wanted.

The 32-year-old woman, who only wished to be known as Dr MH, said she decided to stop her housemanship after 14 months of training because the long hours were stressful and there was no work-life balance.

“I was on-call every other day and I realised that even after becoming a medical officer or specialist, the schedule would still be heavy. I didn’t want that kind of lifestyle,” she said.

Dr MH, who is now a medical adviser for a pharmaceutical company, said as a houseman in a training hospital in the Klang Valley then, she worked from 7am to 5pm and would be on-call duty from 6pm to 7am the following morning before continuing with the normal working hours the next day.

“During on-call duty, there are usually patients to attend to. We get little sleep in between and have to wake up at 5am to take blood samples of patients before the senior doctors come in,” she said.

She said her late father was horrified when she resigned and even asked relatives to persuade her to change her mind.

She admitted that her father had wanted her to do medicine although she had wanted to do actuarial science.

“Money was not a factor for leaving the profession even though pharmaceutical companies pay better. I am more satisfied with the stable working hours,” she said.

Asked what advice she would give to students wanting to pursue medicine, she said they must have the passion and good grades because the course was intensive and the work demanding.

“They should not be influenced by their peers or their parents for choosing medicine,” she said.

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For 3 weeks I am battling with a virus. Started with an Upper Respiratory Tract Infection just after CNY which subsequently led to severe pharyngo-laryngitis causing me to almost lose my voice a week ago. While I am still recovering from this massive viral assault, with my voice still not back to normal, it has been work as usual. Being a private practitioner with own business to run, you have to work no matter what happens. It is a one man show. Appointments had been given and on-calls has been arranged. As long as you can walk and talk, work goes on. That’s the life as a doctor.

As per the years before, there will always be a surge in the number of visitors to my blog after the SPM/STPM results are announced. As expected thousands of students have scored straight As, close to 11 300 students. Despite being less than last year, it is still a huge number. I can’t imagine the number of students who would have scored at least 5Bs to be eligible to enter medical school. I was made to understand that MMC is in the middle of revising the minimum entry requirement and should be announcing it anytime soon , hopefully.

Again, I will be asked the same questions again and again by these budding doctors. Despite this blog having full of information written over the last 5 years, somehow the current generation of students do not READ. As per our education system, they prefer to be spoon-fed all the way. For those who are interested to do medicine, please spend a couple of days READING ALL the information written under ” For Future Doctors” page.

My advise for budding doctors has always been the same: NEVER DO MEDICINE FOR WRONG REASONS! Life as a doctor is never easy. Even in UK, doctors are struggling with work load. Many of their own doctors are migrating to other countries especially Australia. I had written enough about this in all my previous posts.

I had also proven many times in this blog, even before the Minister confirmed it last year, that we are heading towards surplus of doctors. The 5 years moratorium for new medical schools which was imposed in 2010 is coming to an end this year. I heard the moratorium will be extended. I also heard from reliable sources that MMC has asked some of the universities to slowly terminate some of their twinning programmes to cut down the intake of students. We also know that AUCMS has closed shop last year, reducing the number of medical programmes by 5. I also heard that UniKL’s Vinayaka Mission University twinning program may also be terminated by the college. We heard the withdrawal of John Hopkins collaboration with Perdana University last year. However, they manage to get a new collaboration with University of California, San Diego. Hopefully it won’t end up with the same problem. Our healthcare system is completely different than the US. Even their “suppose” to be ready private teaching hospital has not taken of the ground yet. Almost all other private universities which wanted to build their own teaching hospital have abandoned their plans (Monash, UCSI, MMMC, AUCMS). The career pathway is also not the same as in the US which is clearly shown on their website. PUGSOM is a graduate medical school which is the way forward in many developed countries. The students are more matured and know what they are getting themselves into. However, you will end up doing housemanship at an older age(roughly at the age of 30) and will have to compete for post graduate post at the same level as your juniors, by age. By the time you become a specialist, you will be in your 40s. The only advantage of PUGSOM for time being is the full JPA scholarship!

Public universities were also asked to reduce their intake last year. Remember the magic number 418 which turn out to be a “moronic” statement by a deputy minister? The total intake for public medical schools last year was about 1100 students. However, personally I feel that the government should not limit the intake of public medical schools. Unfortunately, the selection process to public universities are never fair! MMC on the other hand should concentrate in reducing the intake into many of the dubious local and overseas private medical schools. How can we allow “shop-lot” colleges to run medical schools? Only in Malaysia! The truly Malaysia Boleh style.

Once again, I would advise those who intend to migrate that doing medicine is the worst decision you will make! I had written enough regarding this over the last 1-2 years. However, I still get emails and blog comments on intention to migrate with an unrecognised degree obtained locally. Please spend some time reading THIS and THIS blog entry. All the answers are there. I just received the following email from an Indian citizen:

Sir I am an indian citizen , did my medicine in china graduated in 2011 and ever since I have been on constant run from exams after exams I cleared my USMLE with 247 in part 1 and 258 in part 2 applied to more than 400 surgical programmes and got turned down…

With Australia and UK almost shutting their doors to foreigners, even after passing their entrance exams (AMC/PLAB), getting into US is also not easy. I know many who spent huge amount of money sitting for exams (USMLE etc) and never got any residency post. Only very few lucky ones manage to get it. Your chances of getting a job overseas is better if you graduate from one of their own medical schools. With the current political climate in this country, almost every non-Bumis that I talk to have intention to migrate, especially for their children. Unfortunately choosing medicine is the worst thing you can do. As my Ophthalmologist friend  said “doing medicine is a trap, you can’t move anywhere!”. I just met a couple who are succesfull GPs and has 3 clinics. They are NOT sending any of their 2 children to do medicine. Of course, their intention is also to let their children migrate.

Thus, I would advise budding doctors to open your eyes and READ…………….. Don’t get glorified with statement like, doctors are needed everywhere and you can work anywhere in this world. There is NO such thing! There are so many information in this blog. Please spend some time READING it. There is NO short cut to life. The more you read , the more successful you will become. Knowledge is key to success and the only way you are going to achieve it is by reading. Enough of spoon feeding in your schooling days! It is time to wake up and face the reality out there!

Please READ…………….

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It has been almost 3 weeks since I last updated my blog as I was very busy. The above topic had 3 parts written before over HERE, HERE and HERE. I discussed how the medical profession is gradually changing with introduction of many new rules and regulations. A recent meeting between MMA president and Ministry of Education had yet again confirmed the fact that we are heading towards oversupply of doctors and unemployment (Berita MMA January 2015). The Ministry officials admitted the fact and are considering to increase the entry requirement to 5As in SPM. I will not elaborate any further as I had written enough.

In July 2014, I wrote the 1st part of the above topic. One of the issues discussed was about dispensing separation (DS). It was announced that the dispensing separation would begin in April 2015. Over the last few weeks, this is the hottest topic being discussed among the medical fraternity, especially among the GPs. It was informed that the Pharmacy Bill would be tabled in Parliament this March, which suppose to move the dispensing rights from doctors to pharmacist. This will have great impact to the GPs. As I had written before, most GP’s income comes from the sale of medications. If they were to survive by just charging consultation fee, most GPs may not earn enough to even maintain their clinic. They may have no choice but to increase their consultation fees, which in turn will increase the overall cost of medical care and chase away their patients.

I must agree that in most developed countries, doctors are not allowed to dispense their own medicines. However, are we ready for such practice over here? The best people to answer this question will be the public themselves. Is the public ready to pay consultation fee to the doctors and then go to the nearest pharmacy to collect their medications? I am sure the one stop center that is currently being practiced is a much better option. However, the patients have every right to request to buy their medications from elsewhere. We cannot deny that fact. The patients also have every right to know what medications they are taking, aka name of medicines. No doctors can refuse to inform the name of medications to the patients. In fact, under PHFSA, all medicines must be labeled.

Over the last 1-2 months, multiple letters were published in newspapers, even RTM had invited a pharmacist representative to talk about it, and last week, most major newspaper carried topics regarding dispensing separations. One issue that I noticed during these few months is the fact that the pharmacists are more united in supporting this change. What happen to the doctors? Sorry to say, we are the most disunited profession in this country! We had MMA as the sole representative of doctors in this country till a few years ago. MMA is the only body that the government communicates with, officially. Some felt that MMA is not representing them enough and not vocal enough. MMA, as a professional body and not a union will have to settle any issues with the government via diplomatic way. Unfortunately, many out there, who are NOT even a member of MMA and do not even know what MMA is doing, will only know how to complain without contributing anything.

Few years ago, social media aka Facebook was used to start a new organization known as Malaysian Primary Care Network aka MPCN. The main agenda is to unite all doctors. The group grew in size and subsequently registered as an organization. I am also a member of this Facebook group and supported the call for unity. I have been a member of MMA since I was a houseman and had been active with MMA since then. I have been a committee member of MMA Johor since 2000, SCHOMOS Chairman of Johor for 3 years and National SCHOMOS Treasurer for 2 years. Currently I am the CME Chairman since 2013. While I support MPCN’s call for unity, I always felt that they should work with MMA and all their members should also become MMA members. Only with total strength we can fight.

Unfortunately, doctors are far more divided than before. Not only we have MPCN, we also have GPs united and don’t forget the race and religion based association such as Persatuan Doktor Islam Malaysia (PERDIM), Muslim GPs united and even Kumpulan GP Melayu etc etc. IT is very sad to see that after almost 60 years of achieving independence, we still want to fight a course by differentiating ourselves along racial and religious lines. While all of us are doctors through western education and sworn to help human beings irrespective of who they are, I wonder how differentiating ourselves along racial and religious line will help mankind. These include backstabbing each other etc.

We must not forget that we are all in the same ship. We leave in symbiosis. If one falls, everyone falls. Frankly, our ship is sinking! Politicians will find whatever way to keep their power and thus, the increasing rhetoric on protecting race and religion. We, the so-called most educated people in this country should be the uniting factor. Unfortunately, day-by-day, I see the most educated people believing in conspiracy theories and prefer to hold on to their race and religion cards. Sad indeed.

I see each of these groups organising separate forums and agendas to fight the dispensing separation (DS). The only unity I see is the fight against DS. Why not we merge into a single group and fight the battle together? Why must we fight separately? Is it because, everyone wants to become a hero of their own group? I see sincerity in MPCN’s boss Jim Loi. Being in an organisation for almost 17 years thought me one thing: backstabbing is common. There are many armchair critics and keyboard warriors who will only talk but will never help you when the need arises. There will be many who may be nice to you but will say the opposite behind your back. I have seen and heard enough. A person who you thought is your best friend may have a totally different agenda behind your back. This is becoming more common as our politicians use race and religion to their benefit. Many minds are being polluted with multiple conspiracy theories. Even a sincere help is considered as a conspiracy to “take over” the country, convert people etc etc!

Well, enough of my rant. Coming back to the DS story, our “MIC troubled” Minister issued a statement yesterday that DS is still in discussion stage and the government has not decided anything yet! Hah? There will never be smoke without fire !. Remember PHFSA in 1998? Before we knew, it was tabled in Parliament and passed!

Somehow I feel DS is inevitable as the government prepares for the next major restructuring after GST. It will be the health care system. The government will never be able to sustain the current public healthcare system. It will have no choice but to introduce a National Healthcare Financing Scheme. Whether it is for good or bad, we must be prepared for it. The future landscape for doctors will change. The only people who can challenge this will be the public……………

 

Gong Xi Fa Chai…………………. May the year of Goat bring us good luck.

 

Doctors meet to diagnose ailing industry
By Haresh Deol
Published: February 6, 2015 07:05 AM

 

KUALA LUMPUR, Feb 6 — As the debate for separation of the roles of doctors and pharmacists lingers, general practitioners (GPs) are racing to safeguard their interests in the wake of impending losses and additional costs imposed on them.

More than 50 doctors will gather in a closed-door meeting in Kuantan tomorrow to discuss the implications of:

• Separating roles of doctors and pharmacies;

• Implementation of the goods and services (GST) tax;

• Upgrading equipment involved in treating foreign workers;
• Growing number of clinics folding up;

• Over 4,000 private doctors who have quit in 2013 alone, mostly due to losses.

The disgruntled doctors insist these factors will impact their practice come April 1, leaving them little choice but to charge their patients more.

They cited rising cost of living and “bullying tactics” adopted by third party administrators as among the reasons for closure of more than 500 clinics between 2012 and last year.

But Health Ministry insiders claim, while nothing has been confirmed, the doctors are kicking up a fuss as they stand to lose their side-incomes from selling drugs.

“Dispensing separation will hurt the people not only in terms of more financial burden but other things like waiting time and other inconveniences,” said Medical Practitioners Coalition Association of Malaysia president Dr Jim Loi Duan Kong.

“The inconvenience of driving around for another parking space and paying for another parking coupon … that will happen if clinics no longer dispense medicine. What about the elderly? It’s just more troublesome for the man on the street. We’re not ready for it.”

Dr Loi admitted doctors would be able to “cut corners” if they continued to buy and dispense medicine.

“It has nothing to do with GPs enjoying kickbacks. It’s pure economics as doctors get to balance their accounts. We don’t dare to charge more than RM25 for consultation for a common flu or fever. We can’t hike prices of medicine as people know how much a strip of paracetamol cost. But many members insisted if the dispensing of medicine is taken away, then they would be forced to charge higher consultation fees.”

When told talk of dispensing separation has made its rounds since last year, he insisted: “This time it’s going to happen and it’s going to start in April.

“Right now will be what has been termed as the hybrid period where patients will be allowed to choose to either buy from the clinics or pharmacy. The dispensing of medicine will be phased out by April next year,” he said.

He has also received complains members have not received their dues from third party administrators on time.

“According to our statistics, there were 11,240 private doctors in 2012. The number dropped to 6,675 in 2013. In 2014 there were 6,865 private doctors nationwide. So many have quit as they cannot sustain.”

Another doctor from Jerantut, who declined to be named, said the introduction of dispensing separation will kick-start the 1Care for 1Malaysia health transformation plan — which mirrors the national health care service of developed nations including US and UK.

“But if you study the US and UK health care service, they have plenty of woes. It is not perfect. It is now even a top issue in Britain ahead of the May elections,” he said.

He said the rental of clinics and other administrative and operating matters were not exempted of the GST.

A Malaysian Medical Association top official said they have received numerous queries pertaining to the issues.

“There’s just so many elements disrupting doctors, especially those running their own clinics. Yes, many had quit and intend to quit. Some thought they could earn a steady income by becoming associated with companies through third party administrators but have instead been incurring losses. They also worry of the GST.

“But the dispensing of medicine is the final straw. It will be difficult for both doctors and patients. Let’s be logical, you’re already sick and the last thing you would want to do is to go in circles finding a pharmacy to buy medicine. Doctors will eventually hike their consultation fee as the current regulation states GPs can charge consultation fee of not more than RM120. So if a doctor used to charge RM25, if the dispensing separation kicks in, he or she could now charge RM35 or RM40.”

“Doctors face many woes and often suffer the end rot of it.”

– See more at: http://m.themalaymailonline.com/malaysia/article/doctors-meet-to-diagnose-ailing-industry#sthash.vdpE6cZW.dpuf

 

Pharmacies to dispense medicines if proposal accepted

BY CHRISTINA CHIN
PETALING JAYA: Instead of getting their medicine from private clinics, patients will have to obtain it from pharmacies if the Health Ministry accepts the proposed “Doc­tors diagnose, pharmacists dispense” system.

While the system may cause some inconvenience to patients, pharmacists say it will help bring down the prices of medicine and give doctors access to many more drugs to prescribe.

It is learnt that doctors and pharmacists have held several discussions on the issue over the last year and they plan to meet the Health Minister soon.

They are represented by the Malaysian Medical Association (MMA), Medical Practitioners Coalition Association of Ma­­lay­­sia, Islamic Medical Association of Ma­­­laysia, Malaysian Pharmaceutical So­­ciety (MPS) and Malaysian Community Phar­­macy Guild (MCPG).

According to MCPG president Wong Sie Sing, the five organisations had, at their last meeting on Nov 8, agreed in principle that dispensing be left to pharmacists.

Representatives of pharmacists later met Health Ministry director-general Datuk Dr Noor Hisham Abdul­lah on Nov 26.

He said the two professions met to work out a timeframe to introduce the new system, adding: “I hope we can implement it by April.” Debate on the issue has been going on from as far back as 2008.

“If pharmacists are allowed to dispense, doctors would have access to 10 times more drugs to prescribe than what they have in stock. This will benefit the patients,” Wong said.

MCPG represents more than 2,000 community pharmacies employing some 2,500 pharmacists.

MPS president Datuk Nancy Ho said patients would receive further counselling from another group of well-trained healthcare professionals if pharmacists were to dis­­pense medication.

“The check-and-balance reduces prescription and dispensing errors. Dispensing separation is about professional medication management and only pharmacists are trained in this specialised practice. We know everything about a drug’s healing value and possible harm,” she said.

MMA president Dr H. Krishna Kumar confirmed that the associations had met on the proposed new system but said nothing had been agreed on yet.

Dr Noor Hisham confirmed meeting representatives of pharmacists, and said they discussed about integrating and consolidating the Pharmacy Act.

Stating that nothing had been decided on, he stressed that the ministry’s main priority was to ensure quality and safety.

Universiti Sains Malaysia (School of Phar­maceutical Sciences) Assoc Prof Mohamed Azmi Ahmad Hasalli said a 2013 study of 40 clinics and 100 pharmacies in Penang found that doctors dispensed more medicine and antibiotics and charged more than pharmacists.

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