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For Future Doctors: Malaysian Healthcare System for the Dummies Part 2

Time flies! I didn’t realise that it has been 2 months since I wrote the first part of this topic on 28/02/2011. Well, I think I had given enough info regarding the public primary healthcare system and it is time to know more about the hospital based public health care system.

I will divide this topic into 2 parts which consist of district and general hospitals.

Public Hospitals

1) District Hospitals

Almost every district has a government hospital. Each of this hospital is equipped with 2-7 medical officers, some even as low as 2-3 medical officers, especially in rural areas of Sabah and Sarawak. There are 2 types of district hospitals: with and without specialists.

In some bigger districts like Segamat and Kluang in Johor or Kuala Pilah in Negeri Sembilan, there will be at least 1 specialist in each basic discipline. These hospitals are also equipped with Operating Theatres to perform minor surgeries. There are also some district hospitals which may function as a general hospital such as Muar/Batu Pahat/Seberang Jaya/Teluk Intan et etc.

However, most of the smaller District Hospitals are manned by Medical Officers, mostly who had just completed their housemanship. Almost all of these hospitals do have basic diagnostic capabilities such as routine blood investigations, basic X-ray imaging except Ultrasound and facilities to do Forcep and Vacuum delivery. As such, it is presumed that any MO who is posted to these district hospitals should have the competency to diagnose and treat common medical conditions. This is where some major issues arise. There are practically no senior doctors to supervise you or to teach you any procedures, except an MO who is probably at the most 3-4 years senior to you. You may have Visiting Consultants from the nearest general hospital on a monthly basis to run a clinic and to see some non-urgent referrals. Any case that the MO feels cannot be managed in these hospitals, need to be transferred/referred to the nearest general hospital. However, you need to realise that whatever necessary procedures or treatment that need to be done has to be done immediately before transferring the patient as the journey may easily take 1-2 hours in an ambulance!

There are also certain limitations for doctors who are working in a non-specialist based district hospitals. This is mainly concerning the drugs that a MO can prescribe as I had mentioned in my Part 1 of this topic. Only drugs that are listed as List B and C can be prescribed by an MO. No list A drugs can be prescribed which includes many antibiotics and antihypertensive drugs.

In smaller district hospitals, only 1 MO is “on-call” each day and during this “call” you need to cover the whole hospital, including the emergency department, wards and labour room. Usually, the medical assistants and nurses will do most of the necessary early management before calling you. In a busy district hospital, it can really be very stressful. Imagine, while you are attending a case in emergency department, the labour room calls you to do a vacuum/forcep delivery? It is basically a one man show during the night and you need to put whatever you had learned as a HO to good use. This is the reason why housemanship is such an important posting in Malaysia as immediately after that you can be thrown to a district hospital to run the show. Remember, you are dealing with lives and can’t afford to make mistakes!

Some district hospital, especially those in Sabah and Sarawak are situated quite deep into the interior that you need to do certain surgeries including Caesarean sections, acute abdomen surgeries etc. Usually the anaesthesia is given by Medical Assistants’ trained in giving anaesthesia. Thus, it is important for doctors who are going to be posted here to know how to do certain surgeries.

2) General Hospitals

Every state has a general hospital. It used to be known as Hospital Besar but over the last 10-15 years, the names were gradually changed reflecting the state’s monarch. Each of this hospital is usually well equipped with all basic specialities. Some of the hospitals also have subspecialties including cardiology, neurosurgery, gastroenterology etc. They are also well equipped with diagnostic laboratories and imaging such as CT scan and even MRI.

Most of this hospital are overcrowded and congested with patients. Each ward can have between 40-60 patients at any one time. These are also the hospitals that are used to train housemen and postgraduate students. The workload is extremely high and stressfull due to patient load and lack of specialists. The standard of care is definitely not up to any international standards but can’t blame the doctors. Imagine receiving 30-50 new admissions in just 8 hours when you had not even finished the day’s ward round. Of course, this is in reference to general medical wards but the situation may be better in smaller disciplines. The clinics in these hospitals are also another “mad house” or shall I say “fish market”.

You may find some General hospitals being more relaxing than the other. This depends on the state and the number of big hospitals that are available. For example, in Perak, you have 3 big hospitals with specialist service namely Taiping, Ipoh and Teluk Intan which dilutes the number of patients. However, when I say more relaxing, don’t assume that you can shake legs and relax! Most of the time, the patient load is almost the same in most general hospitals but the doctor load varies. Some popular hospital may have better number of doctors compared to others. For example, most hospitals in Klang Valley have adequate number of doctors but same can’t be said about Johor Bahru or Sabah. The maldistribution of doctors is a major problem in Ministry of Health where cables and strings are used by certain people to prevent themselves from being transferred out. Thus, you will find many hospitals in Klang Valley being well equipped with doctors so much so, some of them can even go missing in the afternoons. I will discuss more about this in my last part.

Next………………….. Private health care system