Many things are changing in this world. The same goes to the field of medicine. It use to be a so-called glamorous job where no one will question whatever you say. Whatever you tell the patients is considered gospel truth and patients will just swallow it. However, times are changing and doctors are finding it difficult to deal with patients. Patients are becoming more demanding and do not hesitate to question you. Internet is both a gift and a curse. Patients come to you after spending some time “google-ing” their symptoms and ask you various questions which you are not prepared for. I have had patients who walk into my room with a diagnosis in their mind and they just want me to confirm it! It does irritate me but I will always tell them that I will decide what need to be done. But then , there will always be an anxiety at the back of your mind whether you are missing something and the patient might be right. I am still able to control this anxiety but I am seeing many consultants/doctors out there who practise CBM ( Cover Backside Medicine). They order all sorts of unnecessary investigations just to make sure they do not miss something. This was what happened in US when the litigation rate started to rise which subsequently pushed the healthcare cost up the roof. Likely , the same will happen over here , both in private and public hospitals. Mind you, government hospitals are also seeing increasing number of medico-legal cases.
The article below was written in the Malaysian Insider today. I decided to publish it over here as the article do bring up certain issues that are important. I had highlighted some of the sentences for easier reference. In fact, I had written many times in this blog regarding unethical practices and “Cover Backside Medicine” practices in private sector. That’s why I use to say that never judge a book by its cover. Most naive and ethical doctors do not earn much but the unethical doctors may be laughing to the banks. This is partly because, patients tend to believe a doctor who tells them what they want to hear. A doctor who removes an asymptomatic gallstone is good where as a doctor who says nothing need to be done is useless. I believe that patients are partly to be blamed for this.
Coming back to the article below, I personally do not like some of the words used in this article like ” useless doctor” and ” bastard”! This sentence ” “You wonder why we should pay these useless doctors so much when we can find reliable answers online!” is rather annoying. Internet do not really give you reliable answers. I have had many patients who ended up getting anxiety and panic attacks after reading informations in the net. Today, interestingly I even had a patient who diagnosed herself as “bipolar disorder” after reading from the internet!!
But one thing that this article proofs is that patients are becoming more educated, demanding and would not hesitate to take actions against doctors. Gone are the good old days where patients swallow what you say, forgive and forget. The situation is changing rapidly and life is not going to be easy for future doctors. With the deteriorating quality of doctors being produced, the situation is only going to get worst. Many patients are already aware of this scenario of oversupply and under trained doctors. Many of them do go to a few doctors for second opinions.
The rest I will let the readers to read the article below……………….
The sickness of our private healthcare services
OCTOBER 09, 2013
| Lim Ka Ea is a traveller who sees travel as the answer to all the world’s woes. Writing is a grand love. Ka Ea has had NGO and legal experience. |
“If I keep this oath faithfully, may I enjoy my life and practise my art, respected by all humanity and in all times; but if I swerve from it or violate it, may the reverse be my life.”
– The Hippocratic Oath
Mary was entering her mid-thirties when it finally dawned on her that she is reproductively challenged. The thought of her own infertility did play in her mind when she was much younger but her suspicion was only confirmed recently when she was diagnosed for polycystic ovarian syndrome (POS). The strange thing was, the diagnosis did not come from her fertility doctor, who had then been too eager to start her and her husband on the notoriously expensive and invasive in vitro treatment, without first examining their health.
The diagnosis for POS had come up through her own initiative. Once she and her husband decided that they would try to conceive through artificial insemination, Mary thought it would be prudent to go through a full medical check-up, “just to make sure my body is ready for the baby, you know. We’ve read that in vitro is very stressful and we want to make sure that we’ve tried everything possible to make sure that the conditions are conducive,” she said.
When her blood work came back, her thyroid function tests were elevated. Later, it was her endocrinologist who told her that in addition to hypothyroidism, she might be suffering from POS too. He told her that the sudden and continuous weight gain, increased cholesterol level, development of fatty liver, irregular menstruation, and acne are some of the symptoms of POS.
Mary had initially thought that these symptoms were attributed to her bad eating habits and sedentary lifestyle but it now explains why these unflattering conditions remain unchanged even after her vigorous attempts to eat and exercise better.
“The funny thing is, no one told me about it. The GP (General Practitioner) at the hospital where I did the full medical check-up did not alert me to anything after he examined my test results. All he did was to make me feel bad about my weight and asked me to take another test in three months’ time to see whether there are any changes to my thyroid functions. All this while, I had been wondering why I’ve been battling bad skin and weight gain. If only I had known earlier, I would have been less depressed and feeling hopeless all the time,” Mary said.
“You have most of the POS symptoms. Go home and do a search online. Read up and learn as much as possible about POS and then go see a gynaecologist to seek treatment. You need to solve all this hormonal issue first before you even try to get pregnant. There are other options before you start considering in vitro. Let’s get you fixed up first, ok?”
That was the most honest and reassuring conversation Mary have had with a doctor so far.
After reading up on hypothyroidism and POS on the Internet, Mary discovered that the chances of having a problematic pregnancy would have been high if she had become pregnant either through natural or artificial means. She confessed that much to her disappointment and great horror, she felt that the renowned fertility specialist she saw at a highly recommended infertility clinic in Kuala Lumpur should have informed her of this vital piece of information.
Mary and her husband initially reasoned that the specialist would have alerted them to her condition if only he had bothered to look at their medical records, which they had brought along with them during their first consultation, having thought pre-emptively that the doctor would have asked for it.
“It was going to cost us about seventeen thousand ringgit for the whole procedure and that doesn’t even cover the cost of a second treatment if the first one doesn’t work. With hypothyroidism and POS, the chances of having a miscarriage would have been great.
“Can you imagine how devastating it would have been if we hadn’t known?” Mary asked and added dejectedly, “The thing is, the doctor didn’t even bother looking at our medical records, you know. They just wanted to make money out of us.”
Mary said that on hindsight now, she is not even sure whether the doctor would have warned them of the potential complications if he had known of her conditions. Mary insisted that her endocrinologist is the minority.
“There are definitely good doctors out there, but they are extremely rare,” she said. She revealed that she no longer trusts the medical service and would turn to her trusted online sites for all her medical diagnosis and query.
“You wonder why we should pay these useless doctors so much when we can find reliable answers online!” She laughed scornfully.
Mary is not alone when it comes to being at the receiving end of bad medical services and not trusting our medical practitioners. It would appear that more and more private hospitals are abandoning the Hippocratic Oath for personal gain.
A medical practitioner revealed that the price of medicine at a private hospital costs a lot more than an external pharmacy. He often advises his patients to buy their medicine from external pharmacies because it makes no sense for them to pay “cut-throat” prices for the same medicine. However, when Kelly tried to do precisely that, the doctor treating her apparently did not take it too well.
“Instead of giving me a prescription for six months as he had recommended, the bastard only prescribed me a month’s worth of medication. In other words, he was ‘forcing’ me to go back to him for a follow-up prescription and that would have meant paying him ninety ringgit for just a bloody piece of paper. Can you imagine that?!”
The Department of Pharmaceutical Services at the Ministry of Health informed that there is currently no law to control the prices of medication at private hospitals. However, it is encouraging when the Head of the Medicine Pricing Unit wrote, “As a patient, you have the right to obtain a prescription from your doctor to buy your medicine from any pharmacy even though it displeases the doctor. I believe that empowered patients can change the current bad habits practised by medical professions so that we can all guarantee affordable medication for the people.”
Vikram, another unhappy patient, shared the experience he had with his doctor when he was undergoing treatment for Hepatitis C. He said that he was mortified when the nurse asked about his treatment in front of other patients while he was waiting for his doctor in a clinic. He understood that the nurse probably asked out of customary politeness but he did not appreciate the fact that in the course of her doing so, other people had learned about his medical condition.
He said that patient information management is lacking in many healthcare facilities and was shocked that this clinic is part of a hospital that has received an accreditation from the Malaysian Society for Quality in Health (MSQH), the national accrediting body for healthcare facilities and services.
“On top of that, my doctor failed to inform me of all the side effects of the antiviral medication I was taking. There was no counselling or support for me and my spouse. The repercussions of the medication was so great that I felt as if the treatment had ruined an important part of our lives.
“For each visit, I paid ninety ringgit for a five-minute consultation where the doctor did practically nothing. Thankfully I had a good insurance coverage because the medication cost an arm and a leg. To be honest, I wish I had not undergone this treatment if only I had known of the repercussions. I wasn’t informed properly,” Vikram said regretfully.
As of June this year, 75 percent of public hospitals have received the MSQH accreditation while only 25 percent of private hospitals have. At the international level, only eight hospitals have received the Joint Commission International (JCI)’s accreditation.
The JCI is created by the Joint Commission on Accreditation of Healthcare Organisations, a US government agency, aimed to improve the safety and quality of care in the international community through the provision of education and advisory services, and international accreditation and certification.
The assessment criteria used by the MSQH is quite similar to the one used by the JCI, except the latter provides additional components such as patient and family education, staff qualifications and education, medication management and use, and the assessment and care of patients; elements which seem to be sorely lacking in our own private healthcare services.
Previously, the government has made several attempts to make it mandatory for all public and private hospitals to obtain MSQH accreditation but these attempts have been put on hold thus far. Although having some sort of national or international accreditation by a recognised and credible agency does boost public confidence, alongside minimising and mitigating clinical and safety related risks, these accreditations do not take into account public rating. The application submission for accreditation is done by the hospital in question and the assessment is then carried out by a panel of surveyors appointed by the accreditation agency.
There is no consideration for public opinion on how the hospital has fared.
“As a patient, I would like us to have some sort of a scorecard for all the hospital in Malaysia. Something simple for a start and it can be done by civil society, someone independent and done from the patient’s perspectives.
“What we need is someone who will disguise as a patient to test out the hospitals. So you have this person who goes to several hospitals and says he’s got liver problem, for instance, and then he assesses how the hospitals handle him based on selected key criteria. The problem has to be the same though, so you can compare apple for apple,” Vikram suggested thoughtfully.
Kelly said the hospital’s ability to deal with complaints is something left to be desired.
“No point. I’ve written to a hospital before to express my dissatisfaction over their service. I haven’t received any response from them. This was last year. It’s like as if the hospital doesn’t really care if you’re unhappy with them. They have patients lined up anyway. So why should they care?”
Sumitra, who is married to a doctor, revealed that medical practitioners often tend to close an eye when their colleagues commit a medical error. This culture is deeply rooted on the notion of solidarity akin to “I have your back now so that when I need you, you’ll have mine.”
This makes it virtually impossible to have a doctor testifies against the other, even when a grave error occurs at the expense of a patient’s life.
Perhaps what Malaysia needs is a patients association such as the one in the United Kingdom. The UK’s Patients Association provides a platform for the people to rate their National Health Service (NHS). The association also runs educational campaigns such as the Speaking Up Complaints Project which encourages patients to speak up against poor medical services and the NHS to improve the way it deals with patients’ complaints. The NHS is ranked as one of the top 20 best healthcare services in the world by the World Health Organisation.
Not all is lost. Malaysia seems to be doing remarkably well in the area of medical tourism. A private hospital in Kuala Lumpur is recently recognised by the Medical Travel Quality Alliance as one of the world’s top ten best hospitals for medical tourists. By taking advantage of the weaker Malaysian currency, foreigners from the Middle East, Europe and Japan are flocking to Malaysia to enjoy better medical treatment.
It would have cost the local patients an arm and a leg to receive treatment in these hospitals but Mary said, “If the service is compatible with the amount I pay for, why not? The problem with the private hospitals here is that I’m not even getting the value for my money.”
While our private hospitals continue to nurse tourists with top notch care, in order to stay competitive alongside South Korea, Thailand and Turkey, have they forgot about our own illnesses along the way? – October 9, 2013.
* This is the personal opinion of the writer or publication and does not necessarily represent the views of The Malaysian Insider.
Pagalavan's Avatar 
Frankly I start to wonder if the recent many posts in the papers bashing up the medical fraternity left right and centre, is part of the bigger evil plan of bringing on the 1care. Well, then again, if the public is really asking for it, why not… bring it on, let the 1care begins.
I heard the 1 Care might be delayed once again
The story of Mary quoted in this article is either a made up story or she is trying to blame her fertility doctor for the money she spent. The fact that she got hypothyroidism explained that that is the likely cause of the subfertility and obesity. PCOS is a syndrome, no particular single cause of this syndrome established. A syndrome means a condition where a group of syndrome present in the patient. PCOS patient may have obesity problem, menstrual problem and a significant number will have fertility problem as well BUT all these can be attributed to hypothyroidism as well. The endocrinologist concluded well that the differential diagnosis is PCOS but hypothyroidism must be corrected first. After all in PCOS, there is no specific treatment, the patient can either trying to lose weight or have assisted reproductive technique in order to have babies.__”the price of medicine at a private hospital costs a lot more than an external pharmacy.” That’s because cost of business in private hospital is definitely higher than a pharmacy.__”This makes it virtually impossible to have a doctor testifies against the other, even when a grave error occurs at the expense of a patient’s life.” Unfortunately consumer cannot differentiate complications of disease and treatment and negligence. __”“Instead of giving me a prescription for six months as he had recommended, the bastard only prescribed me a month’s worth of medication. In other words, he was ‘forcing’ me to go back to him for a follow-up prescription and that would have meant paying him ninety ringgit for just a bloody piece of paper. Can you imagine that?!” Ya, in stead of follow up closely the medical condition, the patient only want their doctor to monitor them once per six month and wait till the complication of treatment or disease happen. __This article is not about bad service. It is all about dissatisfaction of price paid by consumer which they think is too expensive. Private healthcare is a business and there is a range of private health care from luxury to community hospital. If you still can’t afford the private care, their is an excellent public service that you can seek. The only trade off is you time in stead of your cash.
Hi, Poor doctor, why don’t you feedback your opinions to Malaysia Insider on this ‘Mary’, as it is no points we just talk about here ourselves and others (not reading this blog) being ‘misled’ by the writer’s real intention. Even if it is meant for the purpose of 1Care as claimed, the public should not be just misled by this types of article. I hate it.
Already tried but comment deleted immediately
why complain about rm90 if you can go to public hospital. Its her choice to go there so dont complain of expensive thing lo..lol
Exactly
Dr Paga,
Are consultation fees and other charges imposed by allied private healthcare practitioners eg physiotherapists, orthotists and podiatrists regulated by MOH? Some of them are charging quite exorbitant fees, even more than a private medical practitioner for a 10 minute consultation! As I am aware of, private medical practitioners and hospital charges are quite regulated.
Nope, they are not regulated as far as I know.
Unfair article, very much one sided! The author is writing what the public wants to read. How about writing how many patients a doctor save? How many doctors neglect their personal life for the sake of patients? And I really do not appreciate the way she put down ‘bustard’ and ‘cover up stuff’. I say this because the author going to gave the reader unfair/bad reputation of doctor. How a doctor going to treat a patient if there is no trust from the patient from the beginning.
Agreed. Nobody sees things from the other side of the fence. Another issue is that nowadays that there are websites where patients can rate doctors. Although this seems fair enough to source a good reputable doctor, but I am sure that doctors who abide to the patients wishes would definitely score higher in ranking.
Well, to be fair, there are a few rotten apples out there in private practice out of desperation to finance their luxury lifestyles. But not all are like that. many times when private O&G does prefer to advocate for in vitro as the charges are much higher without examining the basic few things such as the general condition of both spouses as well as the male’s semen analysis. Of course, the article is one sided as it was from the view of the author. No one gets PCOS suddenly, but PCOS patients do have certain traits recognisable than hypothyroidism which includes hirsutism and behavioural changes which may present as lack of tact or inappropriate masculine behaviour (just from my observation and not proven..:P). But PCOS can be a clinical suspicion most of the time and this should not be missed by the O&G specialist as clomid treatment prior to in vitro or IUI has a higher risk of ovarian hyperstimulation syndrome in PCOS patient. Furthermore, symptomatic treatment for PCOS such as metformin for its increased insulin resistance has proven to be initial effective strategy for fertility treatment (Which was one of the many reasons metformin was tested for safety in pregnancy). Perhaps metformin is just too cheap a drug.
http://www.lubinandmeyer.com/cases/caselist.html If this were to happen in Malaysia, healthcare cost will triple. There is only one way to survive in medical field in near future – DEFENSIVE MEDICINE.
http://www.thestar.com.my/News/Nation/2013/10/13/When-doctors-cant-even-afford-a-Proton.aspx
Impending disaster mentioned by Dr Paga is coming really soon
The related article … http://commonhealth.wbur.org/2013/10/why-i-left-medicine-a-burnt-out-doctors-decision-to-quit
I dont have to read this article to know there are good doctors and useless doctors. I have experiences with doctors in malaysia abuse their position to hurt patients, from both the gov and pvt sector. The only reason I have never complained is because I have family members who aren’t able to afford to fly to another country for treatment. the most common complaint is that doctors in the private sector only want money, and yes, to a certain extent, it is true. I have a friend who was given wrong medication from a dr in a private hospital, causing his condition to worsen. The dr he consulted after from a general hospital told him the medication he was prescribed from the 1st doctor was detrimental to his condition and the possibility of the 1st doctor being profit driven was high. That being said, consider yourself lucky the only thing you can complain about is a high bill. Try having a dr instruct nurses to turn off your drip because she’s not happy with you or have a house officer who was told off by her superior to take it out on you or having the wrong organ operated on. I honestly think doctors should accept the fact that they can do wrong and patients should not blindly agree to everything they say. Of course patients should not be rude idiots, but after having family members left scorned by doctors and nurses, I can never 100% look up to all doctors ever again. Not saying we, the general public do not appreciate doctors, but we have the right to be weary.