I am sure many of us would have read the article that was published in the Star 2 days ago. You can read it below. This is the first time a title such as that has been published in a main stream newspaper. I had written many times about unethical doctors and how the competitive market is creating more and more of them. It is a known fact, mainly in private sector. Fortunately, the numbers are still small. Unfortunately, the example that this writer pointed out is NOT about unethical practise (at least the first example). The writer obviously do not know how to differentiate between unethical practices and management issues. As for the second case highlighted, it can be. In fact, I had seen many patients who presented with AGE symptoms without any abdominal pain, ending up with an appendicectomy done! However, it is still defendable in the court of law as symptoms can change. MMA has given it’s response over here
Unethical practise is when a doctor does an upper and lower endoscopy in a 16 year old girl presenting with acute gastroenteritis, doing multiple lumpectomy in a 17 year old with lumpy breast, doing upper scope in a patient with neck pain, doing angiogram is a 24 year old with iron deficiency anaemia with no chest pain etc etc! These are the type of unethical practices that we do see, on and off. It is not uncommon as I had written before. Doing further test to rule out any other possibilities/diseases is not unethical. For example, if a middle age heavy smoker comes with chronic cough and left basal pneumonia, you may want to do a CT Thorax to rule out Cancer of the Lung causing proximal obstruction. If not, he may sue you 3 years down the line for missing a cancer. It is a delicate balance between treating a disease and not to miss out something that can be life threatening. The first case is about that, nothing unethical. MMI (Malaysian Medical Indemnity) insurance has just tripled the premium for Obstetrics and Gynaecologist. MMI is a Malaysian based indemnity insurance company unlike MPS (Medical protection Society) which is global society providing indemnity to doctors all over the world, where the rates are much higher. Click on the links to see the rate. This basically shows that the litigation and payout rate in Malaysia is increasing exponentially. BTW, the doctors consultation and surgical fees are controlled by the government and the rate has not changed since 1998 !
Surprisingly, the same newspaper published another interesting article yesterday. It is about finding reliable doctor !. Well, to be frank, due to some bad apples in the profession, the public are now advised to be more vigilant and find a reliable doctor. The public has the right to choose. BUT how do you choose ? How do you know that the particular doctor is good, reliable and trustworthy ? It is interesting to read Dr Alan Teh’s response over here .The enforcement is weak in Malaysia and the enquiries conducted by MMC is troublesome for the complainant. Thus, not many complains are made. Private hospitals on the other hand rarely takes action against a consultant despite unethical practices as the hospital gets money out of it as well. It is a business entity and profit is what matters.
However, the second article do mention a lot about the reality and future of the medical field. Somehow, I feel that all those that was mentioned came from my blog! It has all been explained in this blog with facts and figures: oversupply of doctors, competitive private practise, declining income, limited postgraduate opportunities, venturing into aesthetics, beauty therapy, selling supplements etc etc.
MY advise to budding doctors whose sole intention in doing medicine is for money; please don’t do medicine. It is a long way to go and money is what that drives you to do unethical practices. Money that is earned “illegally” will disappear as fast as it comes. I believe that no matter what you do, if you do it sincerely, work hard and be truthful, you can be successful, live a decent and comfortable life.
Beware of unethical doctors
DIFFERENT SPIN BY SHEILA STANLEY
Public regard for the medical profession has dropped and this is due to greedy doctors who dupe patients into undergoing unnecessary procedures and tests.
Society has always had high regard for medical professionals as they represent our path to a healthy mind and body.
We rely on their opinions and medical advice and tend to take their recommendations very seriously.
Currently, however, regard for the medical profession has dropped a little.
This is due to a small number of unethical doctors who have taken advantage of our trust in them and used it to make more money through unnecessary procedures.
More often than not, this happens in private medical institutions.
A number of anecdotal stories among people I know underscore this. Take for example, a recent story told to me by a 33-year-old woman, pregnant with her first child, who went to a private maternity centre to give birth instead of a government hospital.
Her periodic check-ups went along fine until she was about seven months pregnant.
At that point in time, she was informed by her doctors that her blood tests indicated there was something wrong with the child she was carrying and there was a strong possibility that the child had Down Syndrome.
She was informed that she had to go for a number of different tests – all of which would obviously cost a lot of money.
Although she wasn’t that concerned about the cost, she became very afraid for the future of her unborn child.
So, after speaking to her family members, she decided to go to a public hospital to get a second opinion.
At the public hospital, they conducted a number of tests on her.
These were all free under the Malaysian public health system. After results were obtained, she was informed that the baby seemed perfectly fine and she had nothing to worry about.
She then decided to deliver her baby in the public hospital. When her child was born, it was perfect, and there was nothing wrong. Other stories such as this exist, although probably not as horrifying.
There is another story about an eight-year-old boy who suffered from fever, cough and was vomiting for a day.
He did not have any abdominal pains. His father took him to see a general practitioner who then told him to take his son to a particular surgeon at a private medical centre.
At the centre, the surgeon, when examining, pressed down so hard on the boy’s abdomen that it caused him pain.
The surgeon then insisted that the boy had a perforated appendix and insisted that he undergo an operation that very night.
However, about an hour before the surgery, the father, feeling uneasy, decided to get a second opinion. He asked for his son to be discharged and took him to another doctor.
This doctor found that the son did not have a perforated appendix and instead treated him for an upper respiratory tract infection, something common among children of that age.
I am sure that many other stories like these exist out there and readers have been through similar experiences.
The outrage we feel when faced with such incidents has to do with a betrayal of our trust.
As far as I know, doctors take the age-old Hippocratic Oath when they begin practising medicine.
Considered a rite of passage, the oath hinges on the duty of the doctor to practise medicine in an ethical manner, in the best interest of his or her patient.
When faced with stories like these, one can’t help but wonder what has happened to the Hippocratic Oath?
Do doctors these days, especially those in private medical institutions, no longer take this oath?
Or does the making of money trump any public duty they hold to practise their profession in an ethical manner?
It is clear that we have to be aware of our rights as consumers when it comes to doctors as well. In fact, the Malaysian Medical Association (MMA) has procedures where a complaint can be filed against any doctor practising medicine in Malaysia.
To file a formal complaint, the MMA requires the person making the complaint to submit the full facts of the case, clearly stating the allegations against the medical practitioner.
The Consumer Association of Penang also advises consumers on their rights under the Private Healthcare Facilities and Services Regulations 2006.
These regulations provide patients with the right to request and receive information on the estimated charges for services provided as well as other unanticipated charges for routine services.
The public also have the right to complain to the hospital or medical centre in question about any issues they may have about their treatment at the hospital.
In such cases, the private hospital must establish a patient grievance mechanism which includes the appointment of a Patient Relations Officer to act as a liaison between the patient and the hospital.
It is clear that we have to be more aware of our rights when it comes to private medical practitioners.
In many cases, it would involve doing some independent research into the symptoms of the illness and the appropriate care required.
Also, getting a second opinion when doubtful seems to be the best course of action.
Do you have any stories to share on bad encounters with private medical practitioners?
If you do, share them with me, and in my next column, I will share your stories.
It is time we start being more aware of our rights as patients.
> Sheila Stanley is a writer, TV producer and PR/media consultant based in Kuala Lumpur. You can share your thoughts with her on Twitter @sheila_stanley or via e-mail firstname.lastname@example.org.
Finding reliable doctors
BY FOONG PEK YEE
CHAN was bleeding profusely from his left nose after he tripped and fell in front of his house in Gopeng.
The nearby general practitioner (GP) whom he sought treatment from told him to go to the Ipoh Hospital (Hospital Raja Permaisuri Bainun), but refused to give him a referral letter.
At the hospital about 30km away, the doctor there told him his blood pressure was 120\80 and the reading was perfect, and that he can go home.
However, his nose was still bleeding then.
When met at his house recently, Chan, in his 70s, said he felt the left side of his body had been weak since the episode.
Over in the Kuala Lumpur Hospital, a young doctor told the sister of a patient, “I have so many patients and some are dying.”
This doctor, who was sitting on the nurses’ counter in the accident and emergency ward and shaking his legs, said this when the woman asked him about her brother’s condition.
She reported the case to the Health Ministry director-general, who also heads the Malaysia Medical Council (MMC).
Any doctor must be registered with the MMC before he can practise in Malaysia.
I believe the two cases are just the tip of the iceberg because victims either do not know how to complain to the MMC or they are afraid of doing so, one reason being the fear of retaliation from the doctor or doctors.
While having a perfect score, like 4 for CGPA (cumulative grade point average) may qualify an STPM student academically to do medicine, it certainly takes more to become a good doctor.
I am not saying that this is reason for the government to reject top scorers who wished to pursue medicine in local public universities.
But I feel it will be good if those wanting to study medicine are aware of what it takes to be a good doctor.
And what is the purpose of their desires of being a doctor.
If one is induced by the perceived earning power of doctors, it may be good to do some research on the situation.
These high income doctors are medical specialists in disciplines in demand, like cardiology, obstetrics, gynaechology and eye surgeons to name a few.
They usually are very skillful, have a good track record and reputation and are attached to big private hospitals.
I do not know the remunerations for specialists in local public hospitals or teaching hospitals.
Apart from that, it is not easy to specialise as there are limited places locally if one somehow could not do it overseas.
Besides being expensive to specialise abroad, it is also very competitive in terms of getting a good place to do so.
The country does face a shortage of specialists, for now.
However, its capacity to train specialists is limited because the requirements for training facilities are very stringent.
Well, if one somehow is contented to just become a doctor or general practitioner, the market out there is also increasingly competitive.
In June 2010, MCA president Datuk Seri Dr Chua Soi Lek said there would be an oversupply of doctors in five to six years’ time.
The former health minister, who is a doctor by training, said the country, produced some 4,500 doctors a year starting 2011 and would see the 30,000 doctors in 2010 doubling to between 55,000 and 60,000 doctors by 2015 or 2016.
Even if the government somehow can absorb the doctors in local public hospitals, I supposed the doctors must be prepared to be posted to wherever their services are needed.
And I will not be surprised when a time will come, likely in the near future, that doctors who wish to join government service will need to be shortlisted for interviews first, and no longer wait to be posted.
It is a situation of supply more than demand, and, not surprisingly, doctors could join the ranks of the jobless through oversupply.
There is also a bright side, though.
Assuming meritocracy is in place, the patient care and the country’s healthcare standards stand to gain when there is a big pool of doctors to choose from.
And some arrogant or rude doctors will think twice if they think they are a cut above the rest.
For those who want to be a GP, the market is very competitive, if not saturated.
Private clinics are usually set up in towns and cities where the demand is there.
It seems GPs also have to seek to be panel doctors to boost their business these days.
The mushrooming of 1Malaysia Clinics in urban and rural areas is also another concern for GPs.
I heard there are also GPs who diversify their business, like selling health food and supplements.
A friend of mine told me a husband-and-wife team of doctors from Malacca are no longer practising medicine, but using their titles to peddle expensive health supplements in the name of disease prevention.
I have heard that many doctors are also going into aesthetic medicine and peddling skincare products to their patients.
With supply more than demand for doctors, there will certainly come a time when more and more doctors have to find alternative jobs or business to survive.