My last article on this series was written on 12th November 2011. The article was about how private hospitals are managed in this country and what is happening lately in private sector. Consultants in private hospitals are NOT employed by the hospital as many presume. You are self-employed and your income depends on your charges. Generally, a consultant fee is only about 20% of the total fee that you pay when you leave a private hospital as a patient. Out of this 20% that the consultant earns, the hospital will take 10-15% as their administrative fee. So, you work to make the hospital rich!
Towards the end of my last article, I mentioned that the incomes of many specialists in private hospital are gradually dropping due to stiff competition. That is the reality and you can see many consultants jumping from one hospital to another in Klang Valley. Same scenario will soon happen everywhere else.
When the competition gets tougher, unethical practises will become a norm. Some consultants want to maintain their income and thus indulge themselves in unethical practises by cheating patients. In fact, some go into private practise just to make money at whatever cost, making use of our ignorant society. Many may not like what I am going to write in this article but the truth has to be told. I received this interesting email quite some time ago:
“I would like to bring to the attention of the public the unethical practices of some doctors in private practice.
An 8-year-old boy was brought to see me by his father after suffering from fever, cough and vomiting for 1 day. He DID NOT HAVE ANY ABDOMINAL PAIN. He was initially seen by a general practitioner who insisted that the father bring him to see ‘Surgeon G’ at a specific private medical centre in Kuala Lumpur. The father at first refused and had wanted to bring his son to the medical centre where he was born but relented when the medical practitioner said that ‘Surgeon G’ will order some blood tests and will send his son home with some medications.
However, when he brought his son to see ‘Surgeon G’, the surgeon examined his son’s abdomen and pressed so hard that he elicited pain. Then the surgeon told the father that the son had a perforated appendix and insisted that he be operated the same night. The father was baffled because his son did not have any abdominal pain prior to that excruciating examination but he reluctantly agreed upon insistence by the surgeon. About 1 hour prior to the surgery, the father suspected that something was not right and he asked for his son to be discharged. He then brought his son to see me.
The first thing I noticed was that the boy had a slight cough but he was very active. His father told him to jump to prove that he did not have any abdominal pain, which he did with great enthusiasm. After a thorough examination, I was convinced that the boy did not have appendicitis and definitely not a perforated one. I treated him symptomatically for upper respiratory tract infection and sent him home with some medications. The father was outraged with what happened to his son earlier but he was relieved that his son was saved from an unnecessary surgery. Professionally, I could not tell him that ‘Surgeon G’ may have tried to cheat him but, in my heart, I knew that was the case because I knew ‘Surgeon G’ very well and had inherited a few of his patients whom he operated upon and had botched the surgeries.
The next day, ‘Surgeon G’ called me and asked what happened to the patient. I told him I was certain that the boy did not have a perforated appendix but he insisted that the boy was very sick and had rigors (severe shivering) when he first saw him. Surgeon G said the boy improved tremendously after one dose of antibiotics. In my years of practice, I have not come across one case where one dose of antibiotics can cure a case of perforated appendicitis. IT IS JUST NOT POSSIBLE! He also said that the boy’s father was a liar and had lied about his son not having any abdominal pain. Well, dear readers, I am a parent too. No father will lie about his son’s health because he would have wanted the best treatment for his son.
I suspect ‘Surgeon G’ is giving kickbacks to many general practitioners to send patients to him to operate. In return, he would pay these general practitioners for each patient referred to him. He would cooperate with the general practitioners to convince the patients that they need urgent surgery. I have personally worked with ‘Surgeon G’ and I know that his skills are questionable. He told me once that it is alright for a patient to have a recurrent disease as a result of his incomplete surgery because he would then refer the patient to another surgeon to tackle the problem. He had caused one death from a thyroid operation and at least 2 cases of complications after galbladder surgeries which he refused to admit fault. In his clinic he has medical books with pictures of dangerous diseases which he uses to scare his patients into accepting surgery.
I am writing this to alert the public that there are doctors who are out for money only and are unethical in their practices. It breaks my heart that there are such individuals practising freely and fleecing off unsuspecting and vulnerable patients and giving this noble profession a bad name. The only defence patients have is to be knowledgeable about their own illnesses and not be afraid to ask questions. All patients have to right to a second opinion and no doctors should coerce their patients to accept treatment against their will. The only consolation I have is that most doctors, both in public and private practice, are still ethical and are sincere in helping their patients.
Please circulate this article to your friends and loved ones and let’s hope no one will suffer in the hands of surgeons like ‘Surgeon G’. Also, beware of the general practitoner who insists that you see a particular specialist in a particular hospital because he could be working hand-in-hand with that doctor.”
Unfortunately, due to survival, many doctors are doing what is mentioned above. I even hear jokes at times that people around certain particular hospital got no appendix! This is because everyone who goes to this hospital with abdominal pain, vomiting or diarrhoea will have their appendix removed!! Few years ago I had a 16 year old girl who went to a private hospital for vomiting. She had an appendicectomy. She was still vomiting after discharge and was brought to government hospital 2 days later. When I asked her whether she had any abdominal pain, she clearly denied. It seems the consultant pressed her abdomen so hard that she had pain. It turns out to be that she was pregnant!! A simple history of LMP and a UPT would have given you the diagnosis. It’s all about money!
I have heard colonoscopy being done on a 16-year-old teenager who gets admitted for diarrhoea, which is just a simple acute gastroenteritis. Any patient with abdominal pain will have an Upper and Lower endoscopy done automatically if not an appendicectomy! Some doctors do not even examine the patient before ordering these investigations!!
It is very sad that the medical profession has gone so low just because everyone wants to make money. This is the reason why I keep saying that if you do medicine for money, eventually you will be carried away and unknowingly do unethical practices to sustain your income. Your motto of “saving lives” will remain a motto only. I will say this again : there is no money in medicine!! I have personally known specialist who are paying GPs to refer cases to them as mentioned in the email above. That could be the reason why certain GPs only refer their cases to a particular consultant in a particular hospital despite that consultant is not a sub-specialist in the field that is needed. That’s how desperate the consultants in private hospital have become.
I have had SLE patients with gross edema due to nephritis but the consultant in the hospital refuse to refer the patient to a nephrologist for a renal biopsy. Indeed, he was treating the patient with immunosuppressive agents without a renal biopsy (which is the standard practice)!! How unethical, but it happens. They rather take care of their pocket than the interest of the patient. Even though the specialist is not an expert in a particular field and the patient is still suffering from the illness, they still do not refer the patient to an expert! And they got no insight to the harm they have done to the patient. A good doctor will know his limit and would refer his patients out for the best level of care, whether to the government or another private hospital. He will not keep the patient to make money!
Also, don’t assume that all specialists in private hospitals are skilful. I have seen surgeons who can’t even do a simple hernia surgery but yet practicing in a private hospital. Most of the smaller private hospitals do not even have an ethics committee and what they want is just money. Whatever mistake or unethical practices that the specialist do, the hospital is not bothered as the hospital will just wash their hands off when the consultant gets sued (the hospital has already made the money!).
Do unethical practises occur in government hospitals? Rather unlikely but what I hated most when I was in the government service was when different and expedited treatment is given to VIPs! The VIPs were treated immediately and everything gets done fast. CT scans can be done the same day when general public have to wait for 3 months. I had always refused to entertain VIPs when I was in government service and my HOD was well aware of this.
I would say that partly the society is to be blamed for these unethical practices. Our society still has a lot of trust in doctors that they still feel that the doctor is doing the best for them. Fortunately, most still do but we are seeing more and more doctors who are cheating patients day by day. Unfortunately, our society believes that a doctor who says that nothing needs to be done as a useless doctor where as a doctor who removes an asymptomatic gallbladder is a good doctor! The public needs to be educated to do their own research and seek 2nd opinion when necessary before making a decision or they should ask for clear-cut evidence.
Sooner or later, the public will lose trust on doctors and the litigation rate will reach a very high level indeed. As you can see, the litigation rate is already going up day by day in major towns, especially in Klang Valley. Due to some bad apples, everyone will suffer one day………………….. and with the current quality of doctors being produced, the situation will only get worst………………
Pagalavan's Avatar 
Hmm.. Ur story almost made me cry. I have heard of stories as such and I’ve seen a few cases where I study. Only I’m not an internist like you so I’m raw with my observation.
I really hope doctors don’t do this for money. Its about saving lives. That itself is a huge satisfaction. I guess its good that I’ve always trusted gov hospitals (even for my family I always insist they go to a gov hosp). Its kinda obvious in private hospitals with the trend of doctors or ‘kind’ of doctors that work there. Also, a bit hard to trust a doctor who wears too much colongne or extremely high heels.
I respect you for refusing VIP treatment. I see it where I study. Its dusgusting. Makes me sad for the average and the poor. Like they don’t have the rights to fall sick.
I hope your blog reaches more people. We need more awareness to create a better world. Doctors who malpractice (even signing up with pharmaceuticals to sell expensive drugs) are disgusting sick people in spirit. They seriously need help.
About surgeon G though, perhaps its sublimation. He’s really into blood n murders so he chose to be a surgeon. May he get well soon.
Amen!
Government hospital have their own set of problems as I have written in this blog before. The poor quality of doctors being produced lately is only making the situation worst. Not all private doctors are bad and only want money but you need to choose the best and the most trusted ones.
A very good article Doc BUT if you do not mind I like to put my thoughts here so that we can do something to stop this rot.
Yes I do agree that today it is all about profits nothing else that is the reason why I tell my friends please do go to Govt Hospital and not private as these are money making factories.
My cousin once ate something and had food poisoning and he always complains about govt hospital so he went to a popular private hospital they told him to admit he was not happy but still got admitted when he got discharged & when he asked for the bill he saw 0.80 cts for glass of water .
With regard to the consultant who in your opinion is not suppose to be there I hope you make a formal complain to MMA to look into his operation..
Regarding your statement that VVIP gets special treatment in Govt Hospital well sir if say a private hospital A if the CEO OR ITS FINANCE MANAGER were to go in for treatment you mean to sat he has to sit along with other patients I do not think so .
Doctors who cheat the patients should be brought to the book
Yes, in my clinic everyone need to wait. I don’t care who he is. Even when I go to a clinic etc, I just Q up as others. Infact I don’t even tell them that I am a doctor!
Both private and government hospitals have pros and cons. I have also seen enough number of cases being misdiagnosed and mismanaged in gov hospitals. It is depends on your luck of getting the right good doctor.
Now, talking about MMA and MMC? That’s a whole new chapter to talk about!
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Why no complaint lodged against “Surgeon G”. Basically you are abetting “Surgeon G” in commiting crimes. You should be charged! You have a duty to protect the public from these kind of crooks!!!!.
You should direct this to the person who sent me this email.
You are rights. Can I have his/her particulars. I would like to lodge a complain against a gyn in a private hospital (she runs her clinic in other hospital too!) where upon peapsmear she insist that D&C be done for further investigation!!!!!!!
About the D&C, you need to find out what is the real problem first. Did she have Vaginal bleeding etc…….
Abnormal PAP smear MAY need D&C especially when there is glandular cells abnormality or changes as the abnormal cells may come from the uterine wall. In private practice, the problem is there is no peer monitoring as in gov hospital so if one do something out from the norm, it is easily being found and be criticized. In private, if the doctor have a good communication skill, he may be a bad doctor but he can sell anything to the patient and the patient WILL buy the story and pay for it. I personally seen a well known senior consultant did something like ‘radical cauterization’ (this term doesn’t exist) for patient with cervical CIN 3 putting the patient at risk of developing cervical cancer and difficulty for future monitoring. Best of all he can charge a bomb for a 15 min job.
When come to the private practice, I would like to highlight that beside unethical private specialist. Do not leave out with the private MEDICAL CENTER (not hospital) as well. Private medical centers are mushrooming in KL. Private medical center normally offer health screening where the price can be ranged from RM1200 up to RM5000, with MRI brain (is it indicated?) or Total Body Scan (imagine the radiation) can reach up to RM8000/patient. These type of practices is no less mercy than the ‘knife’ of the above mentioned private specialists.
http://medicine.com.my/wp/index.php/2010/07/26/be-aware-of-health-screening-risks/
The uncontrolled situation also thanks to the insurance agents who used to claim that how good their medical insurance package and some even published their claimed cheque in their own blog. So it is like when you are sick, you also can make money with your sickness by staying in the private hospital.
I am sure all of you or your friend buy insurance but the problem is whether is it POSSIBLE to claim it? Please refer to the below links
http://thestar.com.my/news/story.asp?file=/2012/1/27/nation/10550354&sec=nation
From my point of view, if you fulfilled the criteria set by the insurance company for the 36 critical illness e.g. Heart Attack – most probably you are dead. For stroke – most probably you are paralyzed.
These are all vicious cycles.
Currently in my practice, I will screen through the private specialists before I refer. Currently I have blacklisted some of the GENERAL SURGEON (senior) for their bad attitude to my patienta, ORTHOPEDIC SURGEON for their bad management (imagine a simple low back pain bill was RM4k+ with 12 types of medication and neurontin (most expensive med – he prescribed for 3 months) – this is totally absurd and unacceptable. Imagine you are taking 12 types of medication just for low back pain. and others specialist as well.
This kind of specialist is worse than the average GP I would say.
These unethical screening packages have also began to appear in PUBLIC hospitals in Singapore because the govt there has semi-privatised the public hospital – i.e. they have to show they are making some money for the govt. At least we are better than that little red dot in that respect.
Agreed.Actually, even a lot of private hospitals have started this type of “health screening” programmes. Total body MRI etc is being done all over the place and some even offer one year membership card for unlimited number of health screening ( the card cost about RM 3K+/year). AS you have clearly said, the hospital is just trying to make as much money as possible.
Thank god, the hospital I work in do not do this type of things except for basic health screening with consultation with specialist.
quote :
http://medicine.com.my/wp/index.php/2010/07/26/be-aware-of-health-screening-risks/
coke says:
July 26, 2010 at 4:31 pm
This unethical culture has been practising very common for years in the large city like KL, penang and JB. So many medical centers in KL has prospered and some even plan for KLSE listing and building their own building after several years of this called ‘health screening’ practise in the country.
I strongly believed that the situation will get worsen overtime especially when ours lovely Health Minister is promoting the medical tourism. What else is medical toursim, it is all about $$$$. Bear in mind that Kuala Lumpur has the highest density of CT scan machine in the world.
When you go for health screening in the private medical center. RM1000 is the cheapest and actually the package includes all sort of nonsense screening test from Groups of tumor markers test can cost about RM400, unnecessary angiogram despite CAC shows a very minimal calcification <1.
Beware when you are approached with unknown call saying that you have been selected for the discounted 'health screening' test in Malaysia. The nightmare will begin when you go and sign up for the package which includes CT brain, CT lung, CT neck, CAC scores and many many others. The marketing team will try their best to scare you that you are about to get cancer, chronic disease and heart attack if you are not going to sign up.
Some customers (water fish) even signed up for the medical package for 5 to 10 years programme and paid in advance 20K to the medical center.
Some doctors who is success in setting up the medical center got interviewed by the local TV channel and saying how he started business and how difficult he got to it. Back to the fact that, the money all come to the innocent customers (water fish) who has been brain washed or scared by the heartless marketing personal. They get fat bonus everytime a customer signed up the package and the water fish think they were lucky and was put on the table for them to scan this and that and bleed their wallet with at least RM3000-5000. After found out eveything is normal (almost 98% cases), they even thanked the medical center for doing that to them. See how innocent the patient especially from our nearby country one.
One of the top marketing personal can earn up to RM100k/month (more than anyone of you). They can promise you that anything can be cured as long as you sign up the screening package. By screening 8 patients a day with all scan done, the medical center can easily earned RM40k without risk compares to a cardiothoracic surgeon undergoing a triple bypass which cost around RM38k in private.
Pagal,
I completely agree with you. I see many unethical practices on a daily basis. However, after being in private practice for more than a year, there are many challenges for the private specialist/GP. Patients are increasingly becoming more demanding and sometimes whatever you do, it is not enough
Let me illustrate :
I was called by the casualty MO at 2am to inform me regarding a patient who was brought in drowsy. On further questioning the MO, i realised the GCS of the patient was only about 8. I ordered for a CT brain immediately and I came to see the patient at 2.30am
When i examined, the GCS was 8 and the sugar was normal and the Sodium was also normal (previous patient of my hosp under the cardiologist). I had no ICU/CICU/HDU beds available. I called 2 nearby hospitals myself and they had no beds either. I explained to the family in detail that I could not admit her to my hospital and I advised them to take her to the govt hosp immediately. I spent about 45 mins with the patient. I did not even charge consultation. And yet, 2 days later, the family wrote a nasty letter complaining that i refused them admission. It is really frustrating to deal with such people
2nd instance :
Patient came with epigastric pain and jaundice. CT showed a CBD stone. I counselled the patient and her husband and I offered to send them to the govt hosp for ERCP. They wanted me to do it and i tiod them the cost. Unfortunately I could not remove the stone and I had to put in a stent. I explained this to the pt and her husband and I reassured them that for the next ERCP, i will refer them to the govt hospital if cost is an issue. Then that night, after the patient was discharged, the husbands sister called me and shouted on the phone and accused me of not referring the patient to the govt hospital. This happened at 9pm and it took me 15 mins to explain to her that I had already done that but her brother was the one who refused. She did not know that and was shocked when i told her that. She thought I was jsut trying to fleece her brother. I actually told her that I really dnot like doing procedures on patients who cannot pay because they always seem to want to find fault with something once it is done and then demand a discount
Yes, AB, I have written about this in some of my blog postings before about how ungrateful and demanding some of the patients are, nowadays. In private sector, you will definately be scolded by some patients every now and then. As long as we have done the right thing in the best interest of the patient, we should not be worried. Sometimes, working in a smaller hospital is a better option!! ha ha…………
Hi Dr Pagal, one and all,
Yes, we all have horror stories to tell.
In this country, we do have a private Healthcare Facilities and Services Act 1998 and Regulations 2006. Kickbacks and hospital oversight committees are all prescribed in the Act and Regulations. A 15% “admin fees” is high and could be deemed as a form of “kick-back”. There is also the Medical Act 1971 which spells out the duties and role of the MMC. All alleged wrong doings should be reported, investigated and wrong doers published. We all have a duty to do that, so that the public is protected. Not reporting wrong doers is abetting the crime.Telling nice, sob stories, bring’s you personal satisfaction, but does not solve the problem . Please speak up, report the wrong doers with your facts and see that justice is done. Besides treating patients, it is also our duty to protect them. Not reporting them is taking the easy way out.
Of course, there are malpractice problems in public hospitals too. Perhaps fees and profit is less of an issue there but wrong things are also being done there.
Anyway, I do hope that Dr Pagal, you and the rest of us will be prepared to be “whistle-blowers” and try to maintain the good image of the Medical Profession..
The best person to complain will be the patients. Many doctors feel uneasy to make a complain to MMC about their “colleague”. Even if we do make a complain, the process is just too long with multiple travels to Putrajaya for enquiry. I have also seen complains being made by public to MMC but despite clear evidence, no action was taken.
“All that is necessary for the triumph of evil is that good men do nothing.” (Edmund Burke)
Yes, I do agree but I hope MMC can be more proactive with complains. Once my wife made a complain(written) to MOH regarding racist remark made by a pengarah but she did not even receive a reply!
As a surgeon to be in a matter of few months, I am completely disgusted with what i have just read. How can a surgeon/physician or even a human could do such thing? A small simple surgery like an appendectomy, can also cause severe complications and that could ruin someone’s life. I am essentially speechless. To be honest, Dr Paga, the more i read your blog, the more i feel sad with the current healthcare system in Malaysia. At the same time, it also make me feel that it is getting more unlikely for me to go back to malaysia after my training in Canada (not government-sponsored).
In the current healthcare system, patient’s unreasonable demand and lack of trust in doctors along with other multitudes of problems, this is certainly not a healthy environment for a doctor to practice. I have to say, for me to end up studying medicine and completing my training in Canada is a blessing in disguise. Canada has no private healthcare and everything we do here are on the government budget which is essentially up to us to order any test/investigation/procedure that is required to diagnose/treat a medical problem, very much according to textbook/guidelines/evidence based medicine. The fee schedule here in Canada, do not based the experience/years of service, it’s similar to the way private practice doctor billed. Junior doctors can earn as much as a senior doctor if they do the same amount of job.
Anyway, most of your blog entrees are eye opening to me in most ways. I will pray that one day we will have a government who will clean up this mess.
The main problem is the health care structure in malaysia. Everyone wants to make money as much as possible by using our ignorant patients. I hope, the time will come when this will end. The government is also earning a lot of money from the private healthcare as most of these hospitals are GLCs!!
Dr Paga,
After reading so many complaints on the poor housemans/junior trainees performance, will these not-fit-to-be doctor get a true fail and not allow to progress further? (i.e, not allow to complete housemanship and get full registration)
In Malaysia, it is rather unlikely as it is difficult to remove a civil servant
It has been my longstanding belief that some things should never be privatized – the police, army (Blackwater anyone?), and healthcare.