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Archive for the ‘Politics’ Category

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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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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My last blog post received almost 27, 000 views in a single day on 5/11/2014. Numerous comments were made. My comment was very simple, a once well-respected and trusted profession to whom the community looked up upon, has gone to a stage where the authorities have to ask sisters/nurses of the ward to monitor their discipline. Some commented that there are only a few bad apples in our profession BUT let me tell you, for those who are not in the system will not know that it is NO MORE a few bad apples. The fact that the Minister has to instruct and give extra job to the sisters to monitor the discipline of house officers is enough to explain the gravity of the situation. BTW, the topic discussed had nothing to do with insulting the nursing profession. It was all about the deteriorating attitude of OUR profession! We brought it to ourselves.

The same situation seems to be happening in smaller district hospitals and Klinik Kesihatans. I am beginning to hear stories that taking MCs, EL and coming late to work is becoming very common nowadays, despite having more MOs. Sometimes I wonder whether it is better to keep less number of doctors than having more as it is easier to monitor. I always believed in quality than quantity. Recently I heard that 4 MOs did not turn up to work in a KK on the first day of the week! 2 decided to take MC, 1 took EL and another claim stuck in traffic jam! Some MOs were found to be taking frequent MCs (must be immunocompromised I guess!), given to each other by themselves! What will MOH do about this ? I am sure sooner or later, another similar circular will be issued to KK sisters to monitor the situation. Few years ago, there was already a circular stating that MOs can only be given MC by a specialist but no one seem to be following this anymore. What impression does the other staffs of the clinic will have on us? An unreliable bunch of ………..?

Every now and then, I hear that HOs and MOs do not turn up to work because they are busy doing locum in 24hr clinics. Some has been caught before. Let me remind those HOs that doing locum before full registration(aka completing housemanship) is ILLEGAL! MOs are allowed to do locum with permission from the Hospital Pengarah. However, the place where you are doing locum must be written in your APC. As a doctor, you can only practise at the places mentioned in your APC. Practise at any other place can be deemed illegal.

All these years, even after locum was legalised in 2006, MOs/Specialists locum incomes are never properly declared to LHDN(IRB). While the clinic may declare the locum fees paid as an expense, I am not sure how many doctors who do locum ever declare their income generated from locum. Remember, every income that you receive are taxable. We all know that the government is running out of money! The last Budget 2015 and the impending GST are clear indications. The drop in oil and oil palm prices in international market will further reduce our country’s income. So, the government has to fall back upon the people to get the money back! Thanks to the 47% who voted in the last election. The toll prices are going up next year, electricity tariffs may go up in June 2015 and petrol/diesel subsidies are being removed effective 1/12/2014. While doctors who are running clinics cannot charge GST to patients (GST exempt), they have to pay and absorb all the GST charged by their vendors on supplying equipment, drugs and clinic rentals. Thus, the overhead cost will definitely increase which in turn reduces your net income further. ON the other hand, an increase in your consultation fee is limited by the government and the patient’s ability to pay! Patient’s cost of living will also increase after GST implementation.

While GST comes under Customs department and follows a completely different set of protocols, income tax comes under LHDN. Doctors in private hospitals who are generally self-employed are still confused about GST. Negotiation and discussions are still going on, between MMA, APHM, Hospital Managements and Customs.

LHDN on the other hand is going around blocking all the loopholes they have, to generate more income for the government. Coming back to the locum incomes mentioned above, LHDN is sending circulars to clinics making it compulsory to declare who their locums are!! The circular (see below) clearly says that, it is needed for LHDN to collect more MONEY! So, for those who thought can do locum and escape without paying tax, please beware. LHDN may come knocking at your doors one of these days. The penalty can be an additional 20% of the tax not paid! Furthermore, you can be barred from leaving the country!

As I wrote in my Part 1 and 1b of the above topic, life is not going to get any easier for doctors. So many rules and regulations are changing nowadays. If the separation of dispensing rights happens in April 2015, income of doctors will further decline. The medico-legal cases and seeking compensation from doctors are also increasing day by day!

Well, it’s time to take another holiday to clear my mind and release my stress. I will be away and may not be able to answer the comments in this blog from 26/11/2014 till 7/12/2014. It’s time for me to go for another round of thrill rides down under!

Good Day mate!

 

LHDN 2

 

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IN my last Post, I mentioned a little about the increasing waiting period for Housemanship. Over the last week, I received few more information regarding this “waiting” period. I was informed that the UKM, IMU graduates had to wait for 4 months to get their postings, UCSI took 5 months and PMC graduates are still waiting for their posting since June 2014. I was told that some will get their posting in October and some may need to wait even longer. So, guys, it is time to start the waiting game for your housemanship…………..

Today, a JPA scholar wrote to the Star regarding this issue. Surprisingly, being a JPA scholar does not seem to have any advantage when it comes to housemanship posting. However, the only guarantee that they may have is that the government MUST provide them with a job since they are bonded. From the letter, we can see that he has been given a job in civil service but it is the posting that is being delayed. The posting is done by Ministry of Health. Unfortunately, the situation seem to be getting rather critical in MOH.

MOH just released their Health facts 2014, which summarises the health situation of the country for 2013. I use to write this under ” The Writing is on the wall” series over the last 2 years. One thing is for sure, we are 3 years ahead of our target. The initial plan for our “quantity” government is to achieve a doctor:population ratio of 1: 600 in 2016 and 1: 400 by 2020. Unfortunately due to our generous medical school licensing “program”, with close to 33 medical schools and thousands more returning from overseas, we have already achieved a ratio of 1: 633 last year!! BRAVO !Based on MMC report, we had 4472 new doctors doing housemanship for the year 2013. The numbers will continue to increase as 50% of the 33 medical schools are starting to produce graduates from this year onwards till 2016. As I predicted almost 5 years ago, the number will hit 6-7000 by 2017. I wonder how MOH going to deal with this number, by then.

As of 31st December 2013, we have 46 916 doctors with 75% (35 219) in government service. ONLY 25% are in private sector! This is total opposite to what it use to be 10 years ago. WE only have 141 government hospitals in this country, not all of them are housemanship training hospitals. So, where are these graduates going to be dumped to do their housemanship? That’s the reason why the waiting list is being created.  Until the government introduces a common entry exam, they have to provide Housemanship training for all. The waiting time will only get longer from now onwards.

There is another problem coming soon. The MO post are also getting saturated. What will happen then? I was informed that soon, Housemanship may only be given on contract basis. Upon completion of your housemanship, you need to reapply for a permanent MO post in civil service. There is no guarantee that you will get a job. Compulsory service may be removed. You can be sent anywhere where the post in available. You can’t be choosy anymore. This in turn will reduce the issue of maldistribution of doctors in this country.

AS what the Minister said last month, we are heading for a complete restructuring of our healthcare system. Once our hospitals are corporatised, every graduate have to apply for a job to the respective corporate hospital. It is no more a civil service employment. It is also no more a permanent and guaranteed job. Many countries practices the same system. IT is also a way to get rid of the “non functioning” doctors in the system. Only those who are genuinely interested to work as a doctor and competent enough should be given a job.

Back to the letter below, since you are bonded, unlikely you will be released. That’s the reason why JPA has stopped sponsoring students for medicine. It is interesting to note that she gave the answers to her own query!

So, the waiting game continues………………………..

 

Give JPA scholars postings or free them
MY nephew is a Public Service Department (JPA) medical scholar. He came back in the middle of July.

He attended the JPA interview in early August and was given a job offer letter but until now he is still waiting for his posting. He and his friends called JPA to ask when will they get their postings and the answer they got is to wait till December 2014, if not early 2015 – another two months or later!

I am wondering why the Government spent hundreds of thousands of ringgit sending them to study overseas and yet keep them waiting doing nothing for months.

These scholars came back to Malaysia to honour their contracts to serve the Government.

There are two reasons I can think of why the Government cannot post them as soon as possible:

1) All the Government hospitals are loaded with doctors.

2) The Government cannot afford to pay them.

If either of the above is correct, then the Government should release them from their contract so that they can get to practise their profession in other countries where they will be grabbed.

I hope the authority will look into this matter seriously.

LOH GEOK SUAN

Alor Setar

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418: The Verdict !

Well, the circus has finally ended. In my last article I wrote that something is not right about the magic number of 418. The number simply do not tally with the number of public medical schools. Following the ridiculous statement by a Deputy Education Minister, not only MMC but even MOH as well as the Minister of Education (2) came out with interesting statements denying that MOH or MOE gave any instructions to reduce intake of medical students! This is truly a Bolehland!

While MMC made a press statement saying that they never instructed the universities to reduce their intake, Minister of Education(2) said that the quota was set by MMC !! The circus was really going wild. After close to 2 weeks of entertainment, finally it is out. As I predicted, the number 418 was only the intake via UPU (STPM and Matriculation). Another 501 was taken in directly by universities via Asasi etc, making a total of 919. Another 100 intake will follow  after a “directive” from cabinet. So, the total intake will be 1019. University Malaya’s intake this year was 124, out of which ONLY 50 were taken via UPU. The rest (74) were from their own asasi program.

It looks like our Ministers/Deputy Ministers simply do not know what they are talking about. Our Education Minister aka DPM says that all university graduates need to pass an English test to graduate. I wonder what MUET is for ? As far as I know, all university students will have to sit and pass MUET exams. Sometimes I wonder whether they are simply reading a script written by someone else or are they really that *****d! Unfortunately, there is no such thing as apologising or taking responsibility, among our politicians.

Personally I do not agree that public university should cut down their intake. The government should ask the private universities to reduce their intake or close down the below par universities. From the information I received, there were no such instructions given to private universities. Frankly, a private university would not be able to sustain a medical school economically if the intake is below 100-150. They will never make profit or even get their return of investment. Since the introduction of the MMC’s minimum entry requirement in 2011, the number of students enrolled into private medical schools had reduced drastically over the last 3 years.

However, there is still a question on those who go overseas for medical education without the minimum requirement. I have a strong feeling that MOH/MMC may not provide you with a job upon your return as the number of post will be limited OR there may be a common entrance exam.  Let’s wait and see what happens.

The entire fiasco started due to poor planning almost 10 years ago. Now, the good students have to suffer. However, I still feel that it is not enough to reverse the situation within the next 5 years. Oversupply will happen and waiting list will have to be created. WE should also not forget that the Malaysian Healthcare system may soon undergo a major restructuring after GST is in force. Our Health Minister has already made the statement last month(see below). Once the hospitals are corporatised, jobs will never be guaranteed and it will be on contract basis!

 

 

Health services poised for radical overhaul, minister
BY AUDREY EDWARDSAUGUST 17, 2014

 

PETALING JAYA , AUG 17 — In what could prove to be a controversial move, the government is looking to have a mixed source of financing to merge public and private healthcare delivery services.
Health Minister Datuk Seri Dr S. Subramaniam said this would be done through a single non-profit public third party payer.

He, however, did not elaborate on the plan that was announced during his keynote address during the Apec high level meeting on health and economy in Beijing.

Dr Subramaniam said besides fostering a greater public-private partnership, the government is also drafting a health transformation agenda that took into consideration the country’s challenges and needs.

He said that in the future, the functions of the ministry would be concentrated on stewardship and policy making, governance, public health services, research and training.

“Service delivery will be devolved to enhance responsiveness and flexibility in a more competitive integrated environment,” he said in the speech.
The last time the subject of a healthcare financing scheme surfaced was more than two years ago with the proposed 1Care for 1Malaysia. The criticisms that followed saw a road-show being organised to gather public feedback to draw up a blueprint.

The idea was first mooted more than 30 years ago and there were two attempts previously, with 1Care encompassing three components: transforming service delivery, financing and organisational transformation.

However, as in the past, it was the financing bit that had people riled up although the ministry at the time insisted that nothing was cast in stone.

More recently, the ministry’s director-general Datuk Seri Dr Noor Hisham Abdullah said under Health Transformation, the concept was to strengthen existing services and integrate the public and private health sectors.

Dr Subramaniam said the ministry was reviewing the treatment fees for foreigners to eventually cover actual costs.

“This may also help shift some workload to private hospitals regarding foreign workers who have employment-based health insurance,” he said.

He said a key focus was to strengthen primary healthcare as the population and current system did not foster the development of family doctors to manage the health needs of the individual over their lifetime.

“Malaysians are more likely to go doctor-hopping and there is an over-focus on curative care,” he said.

“This situation is far less effective to tackle long-term chronic illnesses.”

Dr Subramaniam said in the future, Malaysians would have their own family doctor to manage their health needs from womb to tomb.

He said this was to manage health issues better by having a long-term relationship between the healthcare giver and recipient.

– See more at: http://www.themalaymailonline.com/malaysia/article/health-services-poised-for-radical-overhaul-minister#sthash.fczIcESC.dpuf

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Every year, around this time, there will be hue and cry in the medias by politicians regarding failure of top students getting into critical fields in local public universities. At the top of the list will always be medicine. However, this year, there was a big twist to the story! Few days after some young students revealed that they failed to get into medical course in local public university despite scoring 4As etc, one of our great politician came with one of the best statements of all time. He claimed that only 418 students were offered medical course this year to avoid oversupply of doctors !!

While he admits that we are heading to that direction, the statement did not make any sense to most of us. The figure 418 simply do not tally. There are 11 IPTAs offering 13 medical programs in this country. IT is VERY UNLIKELY that each university only took 50 students on average!! I was informed that UM only wanted to take 120 students this year as the intention is to make UM as a premier university for medicine. I contacted some of my friends from the universities and I was told that the figure is likely only for the STPM/ Matriculation intake. It did not include asasi students intake. It was interesting to note that in his statement, he said that this reduction in numbers were made after consultation with MMC and MOH (see below).

Interestingly, today I received a press statement issued by our DG aka Chairman of MMC denying the fact that such a decision/directive was made/given by MMC/MOH (see below). So, someone is talking nonsense as usual.

If at all the government wants to reduce the number of graduates, I feel it should start from the private colleges and NOT the public universities. Public university intakes should be maintained and should be allocated to the best students who have genuine interest in medicine. Unfortunately, private universities are a business and the government cannot close down businesses!!

Whatever it is, the number 418 still remains a mystery……………………. By early next month, hopefully I will be receiving further info on the exact number of students who were accepted into some of the public universities.

 

Limited Offers To Study Medicine To Prevent Flood Of Doctors – Kamalanathan

KUALA LUMPUR, Aug 18 (Bernama) — The government has offered places to only 418 brilliant students to take up medical studies (first degree) at public institutions of higher learning for this year’s intake.

Deputy Education Minister P.Kamalanathan said the limited number of offers was meant to control the number of new medical graduates and avoid a flood of new doctors in the employment market.

“A total of 1,163 students with a Cumulative Grade Point Average (CGPA) of 4.00 applied to do medicine, but offers were only made to only 418 of them and the selection was also based on interview results.

We made this decision following discussions with the Health Ministry and the Malaysian Medical Council (MMC),” he told reporters here today.

He said the others who were not offered medical studies were offered other courses, but related to the field.

He said this in response to complaints by students with CGPA of 4.0 in the Sijil Tinggi Persekolahan Malaysia (STPM) and matriculation who failed to get offer to study medicine.

Kamalanathan advised those who failed to get places at IPTA to appeal to the Education Ministry online at upu.moe.gov.my before Aug 23.

“A total of 37,467 students have received offers at IPTA, there might be some students who are not happy with their course.

“For them I suggest they accept the course and register first, then put appeal in writing directly to the university concerned,” he added.

The ministry, he said, made sure that all students with CGPA of 4.00 received offers at IPTA for the 2014/2015 academic session.

— BERNAMA

 

Press Statement MMC : No directive to reduce intake of medical students
Posted on August 23, 2014 by pejabatkpk
PRESS STATEMENT : MALAYSIAN MEDICAL COUNCIL

 

1. I refer to the article published in the New Straits Times, on the 19 August 2014, Page 9 – “Drop in intake for medical degrees”

2. The Malaysian Medical Council (MMC) would like to clarify that all accredited medical schools in Malaysia have been given approval for a specific quota in terms of number of students to be enrolled every academic year. The quota is determined by their teaching capacity, and takes into consideration among others the lecturers to student ratio, and also the students to hospital beds ratio to ensure that students get adequate clinical teaching.

3. For the public medical schools in Malaysia the total size of the approved quota is 1,550 student intake annually, and is distributed among the 11 Public Universities with 13 medical programs (UM 180, UKM 200, USM 300, UPM 100, UNIMAS 120, UIA 140, UMS 90, UiTM 230, USIM 80, UNIZA 60, UPNM 50). The approved quota was decided based on their ability to comply with the accreditation guidelines for medical programmes.

4. MMC has never give any directive to any of the public universities/public medical schools to reduce their intake of the medical students. They are free to enroll the students in accordance with the quota approved for them, provided they are in compliance with the accreditation guidelines mentioned above, especially in relation to the students lecturer ratio and also the ratio of students to the hospital beds.

5. The issue of oversupply does not arise as long as the public universities comply with the approved quotas and the accreditation requirements, which is important in ensuring the quality of medical graduates so that patients are provided safe and quality care.

Datuk Dr Noor Hisham Abdullah
President
Malaysian Medical Council

23 August 2014

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