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On the eve of the official release of Star Wars Episode 8, I thought of writing something new, since I had not updated my blog over the last 3 months. Medicine has a long history, going back to the time of Hippocrates(460-370 BC). He is known as the Father of Medicine. Hippocratic oath was one of the most widely known Greek medical text. It forms the basis of medical ethics.

Medical profession is the most widely regulated profession in this world. Degree recognition, disciplinary actions and standard setting is part and parcel of medical life. Our ancestors decided that medicine can be easily misused and thus a proper regulatory body must be formed to prevent any ethical abuse. I had written enough about these issues since 2010. Unfortunately, as I had written in my previous post, the commercialisation of medical education and healthcare system had led to “prostitution” of medicine. Doctors sell their soul to businessman for profit. Some say it is a “win-win” situation but to me, the day a doctors charges a fee for service, the nobility of being a doctor disappears in the eyes of the public. The businessman uses that to do business and the private healthcare is born to squeeze the people. There are 2 things that a government should never commercialize: health and education! The day these 2 sectors are commercialised, that’s the day you will see deterioration of the system. Almost all countries that commercialised these 2 sectors are seeing the outcome of such move. That’s why most developed countries other than US maintain their healthcare and education system under their government’s control. One of the major side effects of commercialisation, is litigation! And when litigation increases, who takes the brunt of it ? Not the hospital but YOU!  The businessman will just wash his/her hands off and disavow any knowledge of your existence!

Medicine is regulated by multiple rules and regulation. It all started with the Medical Act 1971 which regulates registration of doctors, recognition of degrees and disciplinary actions against errant doctors. The Poisons Act 1952 regulate the import, possession, manufacture, compounding, storage, transportation, sale and use of Poisons. Many doctors still do not follow what the poison acts has mandated them to do, like labelling of prescribed drugs etc. Dangerous Drugs Act 1952 specifically regulates the import, export, manufacture, sale and use of opium, dangerous drugs and related materials. This act is more related to opiates and benzodiazepines. Many doctors have been caught selling these dangerous drugs over the counter.

In 1998, the infamous Private Healthcare Facilities and Services Act (PHFSA) was passed. The regulation came into effect in 2006. Prior to this act, any doctors can open any shop-lot to run their clinic/provide service. With the enforcement of the act, anyone who intend to open any medical services clinic have to comply with the rules and regulations stated. The size of the doors, mandatory equipments, storage of medicines etc all all regulated since then. Together with PHFSA Act 1998, the fee schedule was made into a law! The 13th Schedule determines the maximum fee a doctor can charge to a patient for consultations and procedures. Unfortunately, it DOES NOT control the fees charged by the hospitals! The last review of this fee was in December 2014 after 1998! Again, we lost to businessman!

IN 2012, the Medical Act 1971 was amended. The regulations came into force in July 2017 which mandates compulsory registration of specialist, compulsory CPD points for renewal of APC and NSR as well as compulsory indemnity insurance. I had written about this over HERE. The APC fee increased to RM 100/year and there is also a RM 1500 specialist registration fee every 5 years. The doctors also have to pay PHFSA fee for registration and renewal of their clinic license. Just recently, few of the local councils have mandated that clinics must also pay the business license fee to local authority which was deemed exempted before. Not to forget waste disposal fee, minimum wage for staffs etc etc. IRB on the other hand is going after all the doctors to collect more taxes. As long as you sign an agreement under your name, all payments must be declared under personal income tax and not under your company’s tax.

On the other hand, the world of medicine is changing. The beauty of medicine is in making a diagnosis via clinical examination and interviewing a patient. I use to tell my students that interviewing a patient is like a police interrogation to find evidence to charge a criminal. This will be followed by clinical examination which together, will give you a diagnosis almost 80% of the time. Investigations is just to confirm your suspicion and diagnosis. This is called the Art of Medicine. Unfortunately, with increasing use of technology and rising litigation rate has created something known as CBM: Cover Backside Medicine. Why do you need to sit and take a history of headache or cough when you can do a CT Brain and CXR is a few minutes? What is the use of auscultation of the heart when you can ECHO anyone, anytime? For matter of fact, is stethoscope really necessary in this era? Has it become a mere symbol to say “I am a doctor” and that’s it? I have seen doctors who hardly take 4 lines of history and orders a battery of test to exclude whatever diagnosis he can think of. What is the difference between you and a technician? If that is so, why do you need 5 years of medical school? We see private hospitals promoting their latest gadgets to the public to make money. The public now beliefs technology more than a doctor!

Gone were the days when a doctor can palpate an abdomen and diagnose Appendicitis. Now, we need to prove to the patient that it is appendicitis. So, every patient gets a CT scan! If CT scan is normal, insurance may decline the case and patient may refuse the surgery. Interestingly, the Radiologist get pressured and reports it as appendicitis! It is a “win-win” situation I guess. The day medicine was commercialised which in turn caused litigation to rise freely, the pressure builds up for the doctors to prove everything. Unfortunately, in medicine, not everything can be proven by blood test or radiological investigations. At the end, doctors become technicians who orders investigations no matter how accurate his diagnosis is.  The trust is gone. Matters are made worst by article such as THIS. All these issues are affecting doctors all over the world. Depression among doctors, burnt out phenomenon are common in many countries. A recent article in BMJ ” Why has Medicine become such a miserable profession?” says it all!  ” The Dark Side of Doctoring” by DR Eric is also worth reading on how doctors are being used by businessman for profit and why he feels miserable. We have become a glorified prostitute to sell ourselves to businessman. Even US hospitals are feeling the pain of physician burnout. Probably we should also come up with a  “Drop Out Club” like HERE.

Will AI take over medicine one day? My answer is YES. Technology is going into healthcare. I predict radiologist will be the first to extinct. Already Ultrasounds are being done by ultrasonographers in many countries. THIS article talks about the 3 latest advancement in AI. The rise of the machines is coming! THIS article on “AI vs MD” is a long and interesting read. We will one day become like Star Trek and Star Wars where AI will diagnose the condition and even administer the medications. Doctors will merely become a technician. IBM Watson is already revolutionising the oncology treatments.

As Episode 8 of the Star Wars saga (The Last Jedi)  opens tomorrow, it may be the end of the Jedis. The title of the Movie reminds me of the fate of physicians. The Art of Medicine is dying. The beauty of medicine is dead. What is there left in medicine for everyone to be screaming to do medicine? Do people really need us when even now, most do not even listen to our advise? Most do not trust what you say and rather buy thousands of ringgit of supplements, but refuse to pay RM 90 for a consultation?

May the Force be with us……………………… Are we the remaining Jedis who will surely go extinct one day, not long from now………..