My last blog entry on 17/02/2014 received the highest number of views in a single day since it started, 4 years ago. It achieved 11 195 views in a single day!! This goes to show that there are many who are worried about the situation. I also received few emails and blog comments from students who are doing medicine elsewhere without the minimum requirement introduced by MMC in 2011. It is very sad that our society is still a very ignorant society. Some of them are not even aware of the guideline! Are we leaving in caves?  With the information technology, there is no excuse! I would blame it on our education system!

When I read some of the comments and emails, I realize that there are many who are doing medicine with pathetic SPM results. Majority do not understand what medicine is all about.  With many dubious and mediocre medical schools out there, getting an MBBS degree is as easy as any other course. What you need is just money!! Money talks! How many students who go to Russia ever failed their 5 years medical course?  We have heard and seen many mediocre students doing medicine in Russia as well as in some other universities in Indonesia, China and Eastern European countries. I know one who got 9Fs in SPM but was doing medicine in Ukraine! Some of the comments that I received in my last blog entry just proved the scenario. The poor entry qualification is one of the main reasons why you see graduates with poor quality from Russian universities ( the talk of the town). On another note, there are good students who go to Russia, as they could not afford any of the local medical colleges. These students generally do much better when they start working. I have heard horror stories of what actually goes on in some of the medical schools!! The fact that they do not even know how to take history and examine the patient, tells you a lot. The very basic reason why you go to a medical school !

Many were tricked by agents who promised guaranteed job, similar to what happened to thousands of nurses. They were told that as long as they have a MMC recognized degree, they would get a job when they return. Well, it is true at the moment but not anymore. With limited number of post within the next 2 years, having a MMC recognized degree does not mean anything. Having a degree, which is registrable by MMC, does not mean you will get a job. It is the same in any other country. In Malaysia, job is given by SPA and Ministry of Health. MMC only provides Temporary MMC registration for you to undergo Housemanship.

With so many dubious Foundation programs organized by many universities as a “short-cut” to attract students into their medical school, MMC had no choice but to introduce the minimum requirement based on SPM results in addition to pre-university results (only A level, STPM and few other courses can supersede)!! We are probably one of the very few countries in the world, which do not use a standardised pre-university qualifications as a sole requirement. I would rather prefer if MMC makes a few well-known Pre-U courses as the minimum requirement, such as STPM, A-Level, IB, Australian Matriculation etc etc. As far as I am concerned, Foundation studies SHOULD NOT be used as an entry qualifications into medical course. Not only it is NOT standardized but prepared and marked by the university itself!! Whatever said, you need certain level of intelligence to do medicine. You may not need to be a A-star student but at least the top 5-10% of the cohort.  Medicine is not for any tom, dick and harry. That having been said, you also need genuine interest and passion to function as a good doctor.

Since the minimum requirement was introduced in 2011, all students accepted into local private medical schools have to submit their results to MMC for verification. The universities will do this. However, despite this I have heard and seen many students being accepted into medical schools locally without the minimum requirement.  The students are accepted and subsequently asked to appeal to MMC. When Crimea Medical University was derecognized in 2005, the NOC was introduced. The government noticed that there are students who have very poor SPM/STPMresults, from Arts stream and even those who fail SPM, were doing medicine in Crimea.  Unfortunately, there are still many students out there who are doing medicine WITHOUT NOC. This is simply because, they were told that as long as they have a recognized degree, it is not a problem.

Sad to say, the situation will change soon. Last year’s MMC’s guideline clearly says that those who do medicine in an unrecognized university without minimum requirement, will NOT be permitted to sit for the MQE exams. This basically means that you can forget about practicing medicine all together in this country. You can try to get a job in another country where your degree might be recognized.

When the job market gets saturated, the government will become choosy as any other profession in civil service. Preference will be given to government-sponsored students and local public university graduates. This will be followed, by the rest. With limited number of post available, what criteria will SPA use to offer employment? This is where your NOC will come into force. Very likely that those who do not have NOC or the Minimum entry criteria will be the last choice to be offered a job. You may end up jobless as there will be almost 6-7,000 graduates/per-year by 2017.

Obviously, there is no law to do this but getting a post in civil service is a privilege and not a must. The only problem in medicine is the fact that if you do not do housemanship, you will not be able to practise as a doctor in this country. Thus, MOH is working on a few formulas to decide on who will get a job in MOH in the future. With the civil service being controlled by almost 90% from a single race, the people as well as the politicians will make transparency and biasness as an issue. So, we need to come up with fair and transparent criteria.

Over the last few months, many suggestions are being discussed at MOH level. The first suggestion is to give housemanship post on contract basis, after which you need to sit for an exit exam. The exit exam as well as your superior’s assessment will be used to decide who will get a MO post. Basically, you need to reapply into government service after Housemanship. What happens to those who fail? Obviously, you may not be able to work as a doctor or may need to redo housemanship.

The latest suggestion, which is seriously being considered, is the common entry/licensing exam or MMLE. Many countries as well as many other professions do this. Even our nursing board has exams similar to this.  The lawyers have CLP but they can still work as legal adviser without CLP. For me, this will be the best option. MMLE should include all graduates including the local public and private universities. It should be standardized and centralized by MMC unlike the current MQE exams. Only those who pass will be able to get a job. This will definitely remove the mediocre ones as long as it is fair and transparent.  Unfortunately, this was suggested by our ex ex DG (Tan Sri Dato Dr Ismail Merican) but was shot down by cabinet due to political reasons!! In Malaysia, education is always politicized!

So, for those students who do not have the minimum criteria, please do some other course. This is my advise to you. Firstly, unless you do well in a well established, standardized Pre-U course, you do not qualify to do medicine. Secondly, with the soon to be surplus of doctors, your chances to get a job in Malaysia will be slim. Finally, do not waste your parent’s money. Put that money to good use. I would also like to advise parents that they should not force their child to do medicine and please do not ask your child with mediocre results to do medicine. You are committing  a crime to the society. I have seen enough mistakes being done by the current generation of doctors, life threatening mistakes that I have hardly seen before. It clearly shows the deteriorating quality of doctors in our community. We do not want to see students with SPM results like below to do medicine. In “real and genuine” medical schools, they will not even survive the first year. I am not saying that all good grade students will become good doctors but you need certain level of intelligence to do medicine coupled with passion and genuine interest.

FYI, the SPM result below is a Russian graduate who applied for Master’s program. A friend of mine who were interviewing them sent it to me!! She got a shock of her life when she saw the result!! Obviously, this student would not have got a NOC based on the current criteria. Obviously, she may not get a Master’s seat, as the competition is getting tougher.

Our ignorant society needs a wake up call……………………

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For a physician in Malaysia, Dengue is considered as a bread and butter disease. Since Dengue was first discovered in Malaysia in early 1900, it had claimed many lives. Unfortunately, to date, there is NO cure for this disease.

The current Dengue epidemic/outbreak, which started almost 11 months ago, somewhere in April 2013, is one of the longest and most disastrous episodes I have ever seen during my 17 years of service. I have never seen such a long epidemic before and it looks like there is no end coming.  Unfortunately, our public who screams when they hear about 3-4 H1N1 cases or Hand Foot Mouth syndrome seems not to be bothered about Dengue. They take it very lightly as though it is a non-fatal disease. For the year 2013, Dengue had claimed almost 94 lives. The number has reached 17 deaths in just 37 days of this year! Remember, majority of these patients are young and healthy individuals. JB hospital is having 1 death every week since November 2013!!

Where are we going wrong? It is a preventable disease and a holistic approach is needed. Our public health officers seem to be overloaded with this epidemic, so much so, they do not even come and interview any dengue cases in the wards anymore. Personally, I feel it is of no value. As long as they are aware the number of patients and where they are from, actions should be taken. Unfortunately, I feel that we are losing the battle. We are still deploying the same strategy since the last 50 years or so, which clearly has failed to control the disease this time around! The actions taken also seem to be rather slow due to shortage of manpower and lack of budget. What is the point of notifying within 24hrs when no action is taken within 48 hours?

Opening “Klinik Kesihatans” up to 10pm is not going to solve any problems either. Our Health Minister announced before the Chinese New Year that KKs would be opened till 10pm in Dengue Hotspot areas to reduce the congestion at Government Hospital emergency departments (ER). I think the more important issue is to educate the public that emergency department is for emergencies and not for cold cases. In 2003, MOH introduced outpatient clinics in Emergency Department with a rate of RM 40/hour. It was open to all doctors in the hospital. It failed. Subsequently, with the same reason of reducing ER patient load, most major KKs were asked to open till 9.30pm with a locum rate of RM 80/hour since 2008. Again, did this reduce the ER department patient load? The answer is NO. What we need is “public-private” integration, which will make our GPs as part of the primary health care system supported by a National Health Financing Scheme. This is what 1Care “suppose” to do but due to the current political situation, it has been postponed once again.

Now, with the excuse of Dengue, all KKs in hotspot areas are being asked to open till 10pm. Likely, even after this epidemic settles (hopefully), the opening hours of these clinics will remain, with the excuse of “ receiving good response from the public” as the 1Malaysia clinics supposedly did. The GPs nearby these clinics will definitely be affected. Eventually, MOs in KKs will be asked to work shift duties in order for KKM not to pay the “overtime allowance” of RM 80/hour. A pilot project of shift duty was conducted in KK PD last year. With close to 15 MOs in major KKs, it is not impossible to introduce shift duty. It will come, whether you like it or not. The only problem will be safety issues especially for female doctors and lack of support staffs despite having enough doctors.

What are we lacking in the preventive measures for Dengue?  Firstly, we are still going after the Aedes mosquito after the incidence has already occurred (chasing from the back). Fogging and house inspection are only done almost 2-3 weeks after a case is reported in a particular area. By this time, the mosquito would have bitten hundreds more and would have laid hundreds of eggs all over the place. Should we think about detecting Aedes mosquito breeding area before it even starts to infect people with the Dengue Virus? During the 2003 outbreak, the then Johor state Pengarah Dr Prethapa Senan came up with a good idea.  He decided to place a half cut mineral water bottle(small), on a wooden stick, pricked to the ground every few kilometers in a hotspot area. The health inspector will periodically check these bottles and immediate fogging and cleaning of the affected area with residence help is done, if an Aedes mosquito larva is detected. I found it rather interesting and  although it involves a lot of work, it did bring down the number of dengue cases and the epidemic was over in just 6 months. Another issue that I always wonder is to what happened to discussions between MOH and researchers and academics from our universities?? I am sure many academics are involved in Dengue research and their expertise may be useful in controlling the disease.

As far as I am concerned, this Dengue outbreak should be considered as a National Disaster and a proper disaster plan should be developed for an all out war against Dengue. BUT I don’t see it happening from our political masters who are more interested in making “jokes” everyday in public. I don’t see any massive adverts to “scare” the people in the mainstream news, papers as well as alternative medias. This disaster should send chills through the spines of every resident so that the people will get frightened and do the needful to help the authorities. The Ministry should work hand in hand with the residence rather than working on their own. There is no point having mortality meeting after a death has occurred and only after that, inspections are done at the deceased house and surroundings to “prevent” another death!! Whatever said, Dengue is a public health issue and not a clinical issue.

There is NO cure for Dengue. IT is your own body’s immune system that kills you. That’s why the complications occur after the fever settles as your immune system starts to produce antibodies. It is also the reason why a secondary infection is more fatal than the primary infection. Many patients have the idea that early admission to hospital can cure their Dengue but frankly, the body cures itself. The only thing that doctors do is to keep you well hydrated and treat the complications, hoping that your body will over come it’s own immune system’s assault. Thus, there are also many Dengue cases that can be managed on an outpatient basis. The most important thing is that the patients need to be monitored by an experienced doctor. From my experience, when complications occur, many will die no matter what we as doctors do! You survive purely by luck!

Whether anyone realize it or not, this outbreak is a huge public health burden and draining huge amount of money. The insurance companies are bleeding billions of ringgits due to huge amount of admission to private hospitals. Many of these admissions may not be necessary but the fact remains that a patient can only use his medical card if he/she gets admitted. Thus, there are many unnecessary admission to private hospitals simply because the insurance companies do not cover outpatient treatment. I would suggest that insurance companies should make some adjustment during this outbreak to cover outpatient treatments of Dengue. This will definitely save a lot of cost for them.

It is rather sad to see young patients dying from a tiny virus and a mosquito. Many at times, we just watch this patient’s die right in front of our eyes as we stand helpless! May this epidemic come to an end soon………………

National dengue alert

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Since my last post on 1/12/2013, I received numerous insights on what is being planned for the future. Just few days after my post, there was a symposium held in UM regarding this issue. One of the recommendation that was proposed was  for a common entry exam known as MMLE (Malaysian Medical Licensing Exam), similar to USMLE. The 1st Part of this exam can be sat when you are a student. As I had predicted long time ago, there will come a time where this will be inevitable. The government will not be able to provide job to everyone and thus some sort of screening test must be done. It is either a common entry exam or a common exit exam after housemanship. The only problem in Malaysia is transparency ! Being in Malaysia, we are so used to being influenced by political masters to artificially implement a quota system. What will happen to JPA scholars, MARA scholars and public university graduates? Will they be given priority or will they be in the same boat? Even though I support such a move to eradicate the poor quality students, transparency is always my concern. Who will conduct these exams and how will it be conducted remained to be seen.

When I was admitted to UM Medical Faculty in early 1990s, every single one of us will be given JPA scholarship. It is up to us whether we want to accept it or not. Over the last few years, the students were given an option whether to choose JPA scholarship or PTPTN loan. The latest news that I heard was that many students this year were not offered JPA scholarship at all. Many of those who applied were also rejected. This was across the board for all universities. Is this a prelude to the fact that jobs are not guaranteed in the future ? Being a JPA scholar means the government must provide a job for you as you will be bonded for 10 years. I was also informed that JPA has stopped giving overseas scholarship for medicine.

Many people do not realise the implication of oversupply of doctors. Many are just talking about quality which I had written many times. Introducing a common entry or exit exam will overcome the issue of quality (hopefully) but what will happen to the rest? Many would have spent almost RM 300-500K not knowing that they will become unemployed. Likely they will venture into selling products either pharmaceutical products or supplements. The public will be convinced with what they are selling as they are “doctors” on paper. It has already started. I know a few who had quit housemanship and working as “medical consultant” for companies selling supplements and health products. It is a business and capitalist world out there, where everyone wants to make money out of our society’s ignorance, similar to our many medical schools in this Bolehland.

And for those who completed housemanship but could not get a MO job in government service, they may end up opening GP clinics or venturing into complimentary medicine like Ozone therapy, chelation therapy, homeopathy etc etc. Unethical practices will become a norm and cheating public will be a daily affair in the name of survival. You can already see it happening when GPs are selling supplements, traditional medicines and venturing into aesthetic medicine, anti ageing etc etc. I know one GP who wanted to give growth hormone injection and hydrocortisone tablets to a 75 years old lady to make her “younger”!!

I spoke to one GP who is doing law. He told me that when he opened his clinic, it was the only clinic for surrounding 8 Tamans. Now, each Taman has about 3-4 clinics, fighting for the same pool of patients! Thus, he decided to do law and soon to become a medico-legal lawyer! A good move I must say as looking at the current situation, the number of medico-legal cases will definitely increase in coming years. As for the GPs, their income will gradually decline to the extend that they will end up closing shop or end up doing what I described above. Overall, it will be the public who will be at the loosing end………….

Well, I will be going on leave again from tomorrow till Next Thursday. So, I may not be able to answer any comments till I am back. The dengue epidemic has drained me enough over the last few months, Thus, for the first time, I will be taking my family not overseas, not to a land but “on the sea” ……………Welcome to Starcruise………………

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While in Malaysia we are talking about the entry qualifications to do medicine, a more interesting but rather sad incidences are happening in other parts of the world. I had talked about increasing litigation rate, declining income of doctors, doctors closing shops due to high maintenance cost and declining income etc etc, but in our neighbouring country as well as in UK, laws are being created to send doctors to jail!.

In Indonesia, there was a recent uproar by the O&G community when 3 gynaecologist were sent to jail for negligence. I do not know the real story behind this event except from what was reported over here and here.  Indonesian health system is still developing and due to their poor control of the medical education,poor accessibility of healthcare and a huge area to cover,the quality of products/healthcare is questionable. Singapore and Malaysia benefits a lot as the major contributor of medical tourism in Malaysia are Indonesians. I do see quite a number of them and they practically DO NOT trust their doctors! I don’t blame them as when I see the medications and the diagnosis made, it is worst than whatever I had seen over here. However, some of their top universities are better than ours. Nowadays I see more Indonesian academics presenting papers in international conferences than Malaysians, despite their poorer command of English. One day, they might overtake us, who knows?

IN the UK, the Prime Minister is drafting a law to send doctors/healthcare staffs who neglect patients, to prison! It’s interesting when a politician talks about neglecting people!!  The NHS itself need a lot of rectifications before you implement such a law. The GMC in UK is already an independent strict body in monitoring the practice of doctors.  In March 2012, I wrote THIS where the GMC had warned that doctors will face stern action for ignoring poor care. It basically says that if you are a doctor who notice a poor care is being provided to a patient by another doctor, it is your duty to report it. If not, you will also be penalised!

So, what’s happening in our Bolehland? The quality of products are deteriorating day by day as we speak. We are still fighting over entry requirement when it should have been decided long time ago. The education system has gone down the drain with countless number of people scoring straight As. The deteriorating quality of junior doctors are very obvious as I had mentioned and shown evidences many times before. Will the same situation and laws be implemented in Malaysia in the future? I was saying that Indonesians are coming to Malaysia as they do not trust their doctors. Will the same scenario happen to Malaysians very soon? I can already see it happening when many patients who came to see me, openly said that they do not trust the junior doctors in KKs and government hospitals (not to say that the private doctors can be trusted either!). And, these were patients who have been going to government clinics/hospitals for a long time. Thus, they can see the difference.

There was also an interesting news in Malaysia when MOH withdrew the admitting/inpatient license of a private hospital in Seremban. This is one of the oldest private hospital in Seremban which started as a maternity centre. Unfortunately, over the last few years, I heard that many of the resident consultants left due to internal problems. They were surviving on visiting consultants. Hope the MOH and MMC will take similar stern actions on under-performing, unethical, doctors and hospitals.

OB/GYN Strike Reaches Jakarta as Doctors Threaten National Walk Out

Indonesia’s gynecologists continued to rally on Tuesday behind a pair of doctors jailed over the death of a patient, calling for a nationwide shutdown and protests in the capital over the alleged “criminalization” of medical professionals.

“It’s not a strike. It’s a solidarity action that we will take to stop the criminalization of doctors,” Nurdadi Saleh, the chairman of Indonesia Obstetrics and Gynecology Association (POGI), said on Tuesday. ”We are not fighting for doctors to be immune from the law, but the cause of the death was not negligence. It was due to a gas embolism.”

The Supreme Court agrees, in part, with Nurdadi’s statement. The mother, Julia Fransiska Makatey, did die of heart complications resulting from a gas embolism, but the panel of judges placed the blame in the hands of Dewa Ayu Sasiary Prawani and her peers. Three OB/GYNs, Ayu, Hendy Siagian and Hendry Simanjuntak, were found guilty of negligence over Julia’s death at Rumah Sakit Umum Pusat Prof. Dr. R.D Kandou by the Supreme Court on Sept. 18, 2012.

The three doctors failed to receive the consent of Julia or her family before beginning a Cesarean section. Before the procedure, the doctors did not check the patient’s vital signs with an electrocardiogram (EKG), the court ruled. Julia died a short time later as a substantial amount of gas trapped in her vascular system reached her heart.

While it is normal for air to enter the circulatory system during surgery, it takes a sizable amount of gas — in excess of 100 ml — to stop the heart. Gas embolisms are a common risk for surgeries like Cesarean sections, but deaths resulting from embolisms following C-sections are rare in countries like Singapore where proper preventative measures have greatly reduced the risk.

Indonesia has made strides in recent years to reduce maternal mortality rates, but the nation still has one of the highest rates of death for pregnant mothers in Southeast Asia. According to data compiled by the World Bank, 220 mothers die for every 100,000 live births. Vietnam, the Philippines, Malaysia, Singapore and Myanmar all reported lower death rates.

Gas embolisms caused only 2 percent of those deaths region-wide, according to World Health Organization data tracking maternal deaths from 1997 to 2007. Hemorrhaging, or blood loss, resulted in 32 percent of maternal deaths in Southeast Asia during the same period.

Allegations of malpractice are common in Indonesia, but doctors’ so-called “conspiracy of silence,” has hindered efforts to prosecute negligent health care professionals. When Ayu, Hendry and Hendy were first brought up on malpractice charges, the three were declared innocent by a local court. The verdict was later overturned by the Supreme Court but by that point the doctors were already missing.

All were sentenced to 10 months in prison and were ordered to report to the jail to begin their sentences in early Nov. The Attorney General’s Office declared the doctors fugitives from justice after none of them reported to prison. Ayu was found working in Balikpapan on Nov 8 and detained. Her former colleague Hendry was detained a short time later.

Hendy is still at large.

The arrests sent shockwaves through the nation’s OB/GYN community. Gynecologists in North Sulawesi and Gorontalo walked out on a three-day strike last week over allegations of a witch hunt. The anger has now spread to the capital, where some 600 doctors plan to march on the Supreme Court on Wednesday. Gynecologists will wear a black armband and pins in solidarity with the three OB/GYNs, Nurdadi said.

“We have all been working nicely, but if we are still being stepped on how can we not shout with a protest,” he said.

The association is calling for the Supreme Court to revoke its decision and allow the doctors to walk free. The Indonesian Doctors Association (IDI) and POGI North Sulawesi have already filed for a judicial review. The case sets a dangerous precedent in Indonesia, IDI chairman Zaenal Abidin said.

“It could be bad jurisprudence as the doctors could be charged if the patients died or did not recover from illnesses,” Zaenal said. ”We will prove that the Supreme Court is wrong in implementing the law.”

The IDI itself admits that a gas embolism was found in Julia’s autopsy. But the POGI alleged that complications like gas embolisms are unpredictable and unpreventable. The patient was admitted to the emergency room and was only 26 years old, too young to necessitate a EKG reading before her surgery, Nurdadi said. She needed fast treatment to save the life of her child, which the OB/GYN staff successfully did, he said.

The doctors cannot be held liable for deaths that are out of their hands, Nurdadi said.

“How could something outside doctors’ capabilities be caused by negligence?,” he said.

The case received the backing of Indonesian Health Minister Nafsiah Mboi on Tuesday who said she supported the protest. The Ministry of Health will assemble a team to investigate the death, she said.

“The media and public must understand [the doctors’] feelings,” Nafsiah said. ”[What] if friends of yours were treated unfairly like this? Ayu was trying to help a pregnant woman and her unborn baby. She was in critical condition.

“The baby survived but the mother did not.”

Prime Minister David Cameron is promising tough action [REUTERS]

David Cameron said NHS workers who mistreated and abused patients would face “the full force of the law”, under the creation of the new criminal offence.The Prime Minister revealed one of the recommendations from a review of patient safety, set up following the Mid Staffs scandal.

Earlier this year, a public inquiry found poor care may have led to hundreds of needless patient deaths at Stafford Hospital.

A package of measures will be unveiled by Health Secretary Jeremy Hunt in Parliament on Tuesday.

Staff who mistreat and abuse patients will face punishment modelled on laws against the wilful neglect of adults under the Mental Capacity Act.

These include fines and prison sentences of up to five years.Mr Cameron said: “The NHS is full of brilliant doctors, nurses and other health workers who dedicate their lives to caring for our loved ones.

“But Mid-Staffordshire hospital showed that sometimes the standard of care is not good enough.

“That is why we have taken a number of different steps that will improve patient care and improve how we spot bad practice.

“Never again will we allow substandard care, cruelty or neglect to go unnoticed and unpunished.”

He added: “This is not about a hospital worker who makes a mistake, but specific cases where a patient has been neglected or ill-treated.

“This offence will make clear that neglect is unacceptable and those who do so will feel the full force of the law.”

Health chiefs urged the Government to make sure the new offence is accompanied by legally enforceable staffing levels on hospital wards, especially in the case of elderly care.

Dr Peter Carter, chief executive of the Royal College of Nursing, told BBC Radio 4’s Today programme: “This on its own will not be a remedy, it will not be a panacea to cure the perceived ills of the NHS.

“What you need to do is to ensure that you have legally enforceable staffing levels so that you don’t end up with the situation that we are finding increasingly with the care of the older people.”

The Government is acting on the recommendations of a report into the Mid Staffs scandal [EPA]

“Never again will we allow substandard care, cruelty or neglect to go unnoticed and unpunished”

David Cameron

NHS campaigners also want the new charges to include hospital managers who suppress or ignore whistleblowers.”This alone will not avoid another Mid Staffs,” said Julie Bailey, who set up the Cure the NHS group which campaigned for a public inquiry into Mid Staffs.

“When staff try and reach out and inform managers there is a problem on those wards, staff need to be listened to.

“And if they are not listened to by the managers, that’s when we need that criminal offence.

“It may be extreme, but it will save lives.”

But, the chair of the Royal College of GPs, Dr Maureen Baker, said proper, effective systems were more important than the introduction of new criminal charges.

“Doctors, nurses – we are human, human beings make mistakes. You can’t change the human condition, but you can help support the humans in having systems around them that help keep them safe, caring and compassionate,” she said.

“You can’t rely on the law to properly regulate how people do their jobs. We need to rely on the professionalism of doctors, nurses, managers.

“What we need to do is let the professionalism take more centrality so that people can flag up the way they need to work in a safe system to care for patients properly.”

Health Ministry shuts down Chinese Maternity Hospital

NOVEMBER 22, 2013

KUALA LUMPUR, Nov 22 — The Health Ministry has issued an order to the N.S. Chinese Maternity Hospital and Medical Centre (NSCMH) to suspend its in-patient services with immediate effect.

Health director-general Datuk Dr Noor Hisham Abdullah said this was because the hospital was found to have committed 10 violations of the Private Healthcare Facilities and Services Act 1998.

“These violations encompass matters involving both in-patient and out-patient services. One such example is that NSCMH lacks full-time resident doctors in certain core disciplines, thus raising concerns about patient safety,” he said in a statement, here.

The statement dated yesterday was faxed to Bernama, here, today.

Dr Noor Hisham said the hospital was now not allowed to admit new patients and the existing in-patients were to be transferred to other hospitals as patient safety and quality of healthcare were of paramount importance to the ministry.

He said the suspension order followed a thorough investigation into a complaint received by the ministry in August and was substantiated by findings obtained during a verification visit to the hospital on Sept 4.

“The ministry had twice issued show-cause letters on Sept 18 and Oct 21 respectively, asking for the hospital to provide detailed response regarding the remedial actions that had been taken and those that were being planned in order to overcome these 10 violations.”

He said a special meeting was convened on Oct 17 with the hospital’s representatives and NSCMH life members, seeking detailed explanation for the 10 violations noted during the verification visit and also to discuss possible solutions to the problems faced by the hospital.

“The hospital’s management was given 14 working days to respond to the second show-cause letter dated Oct 21 and that period lapsed on Nov 8.

“Hence, due to the failure of the hospital’s management to adequately address and overcome these 10 violations, the ministry was left with no other option but to issue a notice of immediate suspension of in-patient services at the hospital in order to ensure safe medical practices and to protect the interest of the patients,” he said. — Bernama

– See more at: http://www.themalaymailonline.com/malaysia/article/health-ministry-shuts-down-chinese-maternity-hospital#sthash.sjdkWGbM.dpuf

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Over the last few months, the mainstream newspaper has been writing regarding the increase in doctors fee over and over again with multiple letters to the editor. The government has “sort of” approved a 14% hike in fees which is yet to be made official but the newspapers are running articles after articles as though the world is coming to an end. I had written about the issue over here and here. Today, the Star had yet again ran an article ( here and here) regarding this issue, comparing with the proposed fee increase by MMA.

Obviously, our FOMCA representative and TPA VIce President do not know what they are talking about. The doctor’s fee has not increased since the last 15-20 years. A surgeon who has been in private practise for 20 years told me that his fee for doing an appendicectomy has not increased since he started his private practise! However, the total cost of an appendicectomy has increased from RM 2-3 000 when he first started, to about RM 7-8 000 currently! So, where are the extra charges coming from ? The answer is very simple, it is the hospital charges that has increased by leaps and bounds. But why over all these years, this so-called consumer association does not make any noise but when the doctors request for a 15-30% hike in their fee after 20 years, the whole world goes into chaos! The doctor’s fee are regulated by the government but not the hospital’s fee. If they are really sincere, they should go after the hospital’s fee which they would not, as almost all private hospitals are owned by GLC aka the government !

As what MMA President has said in the articles below, many doctors are struggling to meet the ends. The income of doctors are gradually declining as I had mentioned many times before but the cost of running a service has increased tremendously. The public feels that all doctors in private hospitals are employed by the hospital which is obviously not true. I had many of my patients who also thought the same until I told them the reality. We are just renting a room in the hospital to run our service. We have to pay a monthly rental and the hospital will also take 10-15% of our consultation fee as their administrative fee. Only the balance of our consultation and surgical fees are given to us. Then we have to pay for our indemnity insurance which is also increasing by about 8-10% annually. When there is any legal suit, the hospital will wash off their hands and you have to deal with it. The recent appeal court’s decision in awarding RM 3.5 million(not including interest) has set a new benchmark for further medico-legal suits in this country. That’s the reason MMI has increased their indemnity insurance for O&G by almost 100% this year.

As for the public, private healthcare is an option. No one is forcing you to go to a private hospital/clinic. The government hospitals and clinics are always available for you with a very minimal charge of RM 1-5. So, why complain. If you choose to go to a private hospital, then don’t make a fuss out of it. Most patient who attend private hospitals nowadays are insurance paid. Only about 10-20% of patients are self paying. This is the trend that we are seeing lately. Insurance companies on the other hand are finding it difficult to cope with the increase in private healthcare cost. They have started to question many of the decisions made by doctors in the management of the patients. They are even scrutinising each and every blood test and X-rays that are done. There will come a point where it will collapse. Any increase in premium is not sustainable and this will lead to their inability to pay the hospitals. The bigger private hospitals will then not be able to sustain the operational cost and will eventually collapse. That’s what happened in the US in 1990s and many big tertiary hospitals collapsed due to high overhead cost. They restructured their hospitals with small community based hospital and 1-2 big tertiary hospital in each district. The insurance companies now dictate everything, as I had written over here. Similar situation will happen over here eventually.

So, for those who do medicine thinking that they are going to make tonnes of money in the future by spending RM 500K for their “undergraduate” education ( which is of no value in the future without further postgraduate education) , please rethink your decision carefully. THink what you can do with that amount of money in so many other ways. Many out there think that medical postgraduate education is similar to undergraduate education. How ignorant our society has become. I had written about medical postgraduate education in this blog since I started blogging in 2010 but yet I get asked the same questions repeatedly. I can only say one thing: current generation do not read and want to be spoon-fed all the time. I don’t know how they are going to become a doctor where you need to read and search literature throughout your life………………..

Finally, I was happy to meet DR Jim Loi today in JB ( sitting beside in the photo below). He is the President of MPCAM and MPCN which is a coalition of doctors whose objective is  to create unity among doctors to stand as one voice. I wish him best of luck. I once wrote an article in MMA in 2006 ” Rebranding and Restructuring of MMA: An urgent need for a Revolution”. I hope MPCN can achieve what I had suggested then.

Good luck to you, Bro……………

PETALING JAYA: Patients will have to brace themselves for a “deeper cut” if a proposal to increase fees for specialist procedures is adopted by the government.

Association of Third Party Medical Claims Administrators Malaysia (TPA) vice-president Paul Cheok said the Malaysian Medical Association (MMA), in asking for a 30% increase in consultation charges last month, had also proposed staggering increases in charges for specialist procedures.

TPA members, who form part of the country’s managed care organisations, provide administrative and medical claim processing services for insurance companies and more than 1,000 employers, mostly corporations.

“We are not against the approved 14.5% hike in consultation fees agreed on by the Health Ministry, but the MMA’s proposal for an increase in surgical procedures and anaesthetist fees must not be allowed. Patient volume has increased over the years, so based on the current rates, specialists are already fairly compensated,” he said.

“Specialists think private hospitals make a lot of money, but the reverse is true.”

TPA estimates that there are about 800 to 1,000 procedures listed in the 5th Edition of the MMA Fee Schedule.

Cheok said the MMA must also justify why certain procedures have been upgraded to a higher surgical fee category.

“Some procedures which were previously categorised as minor, have been pushed into the ‘major category’.

“Coupled with the new rates, this will lead to patients paying more than 200% of current charges.

“Patients should be more concerned over the proposed cost of surgical procedures instead of worrying about a rise in consultation fees,” he said, adding that often, one operation consists of multiple surgical procedures which could lead to multiple charges.

MMA president Datuk Dr NKS Tharmaseelan however said specialist procedure fees in Malaysia were still the lowest in the region.

He said doctors should not be blamed for high hospital bills as their fees only amounted to 20% of the bills.

“If hospital bills have risen, it is due to the hospitals charging higher fees for their services and other items,” he claimed.

“Many specialists in private practice can hardly make ends meet. And, they have to pay exorbitant indemnity insurance. For example, obstetricians and gynaecologist and plastic surgeons pay almost RM80,000 per annum in premiums.”

On TPA’s claim that MMA’s proposal to increase the fees for surgical procedures would lead to patients paying more than 200% than current charges, he said their calculations for the new fee rates for specialist procedures were “mere conjecture”.

“I don’t know where they are plucking the numbers from,” he said.

Medical Practitioners Coalition Association of Malaysia (MPCAM) and Malaysian Primary Care Network (MPCN) president Dr Jim Loi said the proposed rate for procedures are justified if “100% goes to the specialists”.

“The cost of items and materials have risen in tandem with the current economic state and the total cost of procedures. Specialists need to invest a lot of money,” he said.

Consumers unhappy with ‘secrecy’ over private healthcare charges

PETALING JAYA: Consumers are unhappy that private healthcare charges are still being shrouded in secrecy, said Federation of Malaysian Consu­mers Association (Fomca) secretary-general Datuk Paul Selvaraj.

“Will consumers only find out about the increase in specialist fees after they are slapped with a hefty bill?” he asked.

“The fees must be put on hospital websites so that consumers can compare healthcare charges. Now, consumers are paying ‘5-star rates’ without knowing what it’s for.”

Health director-general Datuk Dr Noor Hisham Abdullah said most of the professional fees submitted by the Malaysian Medical Association (MMA) in its latest proposal increased by 30% from the last one.

“However, all medical practitioners in private hospitals have always adhered to the 13th Schedule of the Private Healthcare Facilities and Services (Private Hospitals and Other Private Healthcare Facilities) Regulations 2006 for their professional fees,” he added.

He said the ministry would add new clauses to the regulations to reduce any attempt by medical practitioners to manipulate the cost of procedures.

MMA president Datuk N.K.S. Tharmaseelan explained that the association was preparing a new, comprehensive fee schedule which would cover new procedures, such as advanced robotic and computer-assisted navigational surgery.

Dr Tharmaseelan also dismissed a claim that specialists earn RM150,000 monthly, saying most specialists only earn an average of RM25,000 to RM30,000 per month.

On Aug 23, a reader from Kuala Lumpur claimed that a private specialist earns an average of RM150,000 per month and “have ways to fleece the patients”.

Citing an example, he said an ENT surgeon could do an operation and charge for four separate procedures.

 

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