Cybermed: Avian flu update
Our Cyberdoc Vadivale has an excellent update on H5N1 (Avian flu) in his
Cybermed Update for August 2004Timely reading considering the
first fatal human-human transmission of Avian flu has occured in Thailand.
Neighbouring Thailand, the only other country with human fatalities, has reported 10 deaths and announced yesterday the possibility that human-to-human transmission occurred in its latest case.
The case involved 26-year-old Pranee Sodchuen, who died on September 20 after contracting bird flu. Her 11-year-old daughter Sakuntala, who didn’t live with her, died on September 12. The child is believed to have died of bird flu she caught from chickens in her house in the northern province of Kamphaengphet. |
I ran a poll back in August and if you haven't yet cast your vote, please be my guest.
Lack of response?
The Star reported that the health Minister was disappointed by a "
lack of response" by private practitioners to an offer by the MOH to work part-time with the public service.
The report claims only 1 person has responded.
But the question should be - how hard has the MOH disseminated this information to the private practitioners? I personally never got any letter or circular from the MOH to that effect. In fact I suspect if you try to find out more from the MOH, you'll be like the Doctor
who loses patience trying to offer services to governmentGeneral practitioner Dr K. Balachandran wanted to register to work part-time in government hospitals and clinics, so he got on the phone to find out how to go about it.
Instead of getting the help he needed, he spent a frustrating morning yesterday making over 10 calls and being given the runaround by various departments under the Health Ministry.
“By the end, I was really fed up with the whole thing. Here I am responding to the Health Minister’s call to serve but my intention is hampered by lack of information on the ground,” he said. |
So who is to blame?
The
MOH website has a new link which says "Buku panduan penggunaan perkhidmatan swasta" which is a 4+ MB file in PDF format but they could have condensed this and made the information easier to digest Instead this "Buku panduan" looks like a bureaucratic nightmare to me.
If you are a Malaysian Medical Practitioner, do take a survey in
Dobbs to find out how well the information has been disseminated by the MOH and also your views on this matter.
Feedback: Saw Palmetto
W writes:
The article "Herbal slimming pills and sudden death" on your web-site sets me thinking about the safety of saw palmetto which I have been taking for BPH for the past few months.
According to some web-sites, this herb is widely used, especially in Europe and is supposed to be very save with little serious side-effects. I also have the go-ahead from my urologist to do so.
However, I noticed that I'm having serious weight loss since taking it (it dropped from 135 to 108 lbs). I'm not sure sure whether this could be coincidental. I hope that someone can enlighten me. |
Thanks for the feedback W.
Saw palmetto is also popular in Malaysia, being used as a herbal medication for relief of symptoms of Benign Prostatic Hyperplasia, a common disorder in older men.
There are some clinical studies which show benefit though from my observations, Saw Palmetto is less effective than modern medication for BPH.
Adverse effects (source: Lexicomp Natural Product database) of Saw Palmetto include mild gastrointestinal complaints such as diarrhea, vomiting, nausea and constipation. Headache, mild sexual dysfunction and pruritus have also been reported.
Based on its pharmacological activity, it should be used with caution in individuals receiving treatment for BPH (alpha adrenergic blocking agents, finasteride)
Individuals should have a prostatic exam and other investigations as necessary to rule out prostatic cancer and other conditions prior to use for symptoms of BPH.
There are likely to be other side effects not documented in the literature. I have personally seen a patient who was undergoing treatment for hypertension. He developed blue (cyanosed) toes and fingers of recent onset. A drug history revealed he was taking Saw Palmetto just prior to the onset of the symptoms. After stopping Saw Palmetto, the symptoms disappeared. I suspect it is some drug interaction with his anti-hypertensive agents.
Weight loss of 30 lbs is a serious symptom. One needs to consider underlying undiagnosed malignancy (cancer), diabetes mellitus, thyrotoxicosis amongst other diseases. You need to see your doctor to determine the cause.
Herbal slimming pills and sudden death
The Star reports
Sudden death shocks ministry staff
Staff at the Health Ministry headquarters here are still reeling in disbelief over the sudden death of their colleague, Rosni Mat, believed to have been caused by herbal-based slimming pills.
Instead of heading home to join their families when work ended at 1pm yesterday, a few of her colleagues huddled together on the second floor of their Jalan Cenderasari office, recalling Rosni’s last few days.
At first, they were hesitant to share their thoughts with The Star but they opened up when convinced that her fate could be an eye-opener for others.
They said the 24-year-old Universiti Malaya graduate – who joined the ministry as part-time research officer on May 24 and whom they described as bubbly, friendly and hardworking – had never taken a day of sick leave.
And yet she was found foaming at the mouth and gasping for breath early Friday morning by her housemates at their rented house in Taman Bukit Angkasa, Pantai Dalam here, and taken to the nearby University Malaya Medical Centre.
“She was already dead when the ambulance arrived at the hospital,” said a colleague.
Rosni, from Tanah Merah, Kelantan, left behind some clues in the last 48 hours of her life that might help shed some light on the tragedy.
“She bought a bottle of slimming pills on Tuesday evening and kept going to the toilet on Thursday,” recalled a colleague. |
Another tragic loss of a young life.
Without a post-mortem report, one can only speculate what the actual cause of death is.
But are herbal slimming pills safe? A lot of herbal drug pushers claim their products are "natural" and therefore safe. This couldn't be further from the truth. There are herbs which are known to be dangerous and can kill if taken for the wrong indications or if there are serious side effects (yes, herbs can have side effects too) or drug interactions.
A commonly found compound in "herbal slimming pills" is the substance Ephedra or in Chinese "Ma Huang". The active ingredient is
Ephedrine which has what in pharmacology is known as "sympathomimetic effects". The latter effects include stimulation of the heart and central nervous system. Potential toxic effects of ephedrine include delirium, stroke (intracerebral hemorrhage), palpitations and even heart attacks.
The FDA has been collecting
data on adverse events due to Ephedra and the shocking data shows:
- since 1994, the FDA has collected reports of over 100 deaths among ephedra users
- ephedra alkaloid dietary supplements have been associated with more deaths, myocardial infarctions, cardiac arrhythmias, hypertension, stroke, and seizure events than all other dietary supplements combined |
What irony that Rosni worked with the Ministry of Health. The previous Health Minister kept harping over the need to emphasise the use of herbal medicine but what we need is more caution and regulation on substances like these which are sold over the counter (or bought via the Internet) to unsuspecting consumers. They are consuming substances with potential adverse effects without doctors or pharmacists to properly advise them.
Bottom line: Herbs are drugs. Herbs are not free of side effects. Where is the regulation MOH?
World Heart Day
September 26 is the 5th annual World Heart Day.
The theme is "Children, Adolescents and Heart"
If you look around, you got to admit, many of our kids are simply unfit and too fat. The days of playing "rounders" on the field have been replaced by playing with their PlayStation IIs! Encourage a healthy lifestyle and make sure your kid eats a proper balanced diet and gets enough physical activity.
Smoking amongst teens and youngsters is another very bad habit which should be nipped in the bud. Legislation is useless unless you enforce it. Campaigns (remember the "Tak Nak" one) are soon forgotten. I think parents are ultimately responsible.
So, please take care of your heart. And start young.
World Heart Day
Kidney failure
The
NST reports that kidney failure in Malaysia is on the rise.
Some highlights from the article:
- there are about 100 new end-stage renal cases per million population every year. This however is believed to be an conservative under-estimate though and the actual incidence could be much higher.
- In Malaysia, the most common cause of kidney disease is diabetes mellitus. About one-third of patients suffering from diabetes mellitus will go on to develop kidney failure.
- Other causes of kidney failures are high blood pressure, stones in the kidney, abuse of painkillers, infections and reflux diseases in children
It's a sad state of affairs when the leading causes of kidney failure in the country include diabetes mellitus and hypertension. If properly managed, kidney failure can be prevented in these medical conditions. Unfortunately it's not uncommon for the Malaysian patient to attend to his or her health only until symptoms and complications develop. For instance, contrary to popular belief, hypertension is largely asymptomatic and there are no symptoms that one can rely on to tell if you have high blood pressure. Many hypertensive patients will happily get on with their lives and even default on medication thinking they are well if they are free of "giddiness" or "headaches".
Links:
National Kidney Foundation
e-Govt: MOH & MO application
As Malaysia has plummeted from 8th to 83rd in the global e-government rankings (
The Star), I decided to check out some of the Government medical websites again.
The main one of course is the
Ministry of Health website.
The reason why Malaysia's rankings dropped so much was that ther "websites do not state any privacy or security policy, nor do they provide disability access according to web content accessibility guidelines developed by the non-profit World Wide Web Consortium". Well I think the MOH website falls into this category. Personally I find the website very cluttered and poorly designed. There's too much glitzy details and it's hard to navigate or even to pick put any important messages the MOH is trying to deliver (or are they?). On the bright side, the MOH website seems to be updated form time to time and I spotted that they have included
Application forms for Medical Officers. Now you know a Specialist in the MOH gets a basic salary of about RM3800-5100 per month with allowances totalling RM4200. Medical Officers get a basic salary of abour RM2000-4000 per month with allowances totalling RM800 a month.
How competitive is this? I can tell you nurses in the Middle East will earn more than our local Specialists!
PSA: No longer useful?
Highlighted in Medscape
End of an Era for PSA Screening: A Newsmaker Interview With Thomas Stamey, MD
Laurie Barclay, MD
Sept. 17, 2004 — Editor's Note: The era of using prostate-specific antigen (PSA) levels as a screening test for prostate cancer is over, according to the results of a study published in the October issue of the Journal of Urology.
Using data from more than 1,300 prostate tissue samples collected at Stanford University during the last 20 years, divided into four 5-year periods between 1983 and 2004, the investigators compared the volume and the grade of cancer with clinical findings, including rectal examination and blood PSA levels. Over time, the correlation between PSA levels and the amount of prostate cancer weakened dramatically, from 43% predictive ability in the first five-year group to 2% in the past five years. However, PSA levels continued to be accurate as a direct measure of benign prostatic hyperplasia |
Prostate specific antigen (PSA)is a common component in many routine blood investigations today. It is regarded as a screening tool specifically for prostatic cancer. It used to be said that the level of PSA in your blood correlates with the size of of a prostate cancer. The above article proves that we have been mistaken. PSA levels it appears may not be a foolproof test to detect prostate cancer with a predictive ability of only 2%. The best way is still a digital rectal examination where a nodule when felt by a doctors finger is highly suggestive of prostate cancer.
Similarly, many patients now flock to laboratories to have many blood tests taken in particular tumour markers. Tumour markers have long been known to be totally unreliable in diagnosing cancer. A normal level does not disprove cancer and vice versa. Nevertheless, many laboratories continue to advertise irresponsibly by claiming the wonders of tumour marker tests.
There is in the end no substitute for a proper history and physical examination in addition to
appropriate laboratory and investigative tests. Many patients continue to self diagnose and self medicate. This only increases the anxiety level that may be totally unnecessary.
The price of a hologram
In a move to try to combat fake drugs the MOH will implement a hologram system. This will be compulsory and "all OTC (over-the-counter) products, controlled items containing poison, traditional medicine and health supplements must bear the hologram by Jan 1, while products that need to be used in the form of injection must have the hologram by next July" so reports
The StarIt looks like the contract for the hologram system will go to a single company, Mediharta Sdn Bhd, in conjunction with a French hologram manufacturer.
Obvious questions are:
1) How effective will this hologram system be in curbing fake drugs? The same newstory has a "leading pharmaceutical company" quoted as commenting "the use of hologram was proven to be ineffective as they had tried using it before"
2) Packages have to be redesigned to accomodate the hologram, cost of production will go up and how much will the cost of drugs go up by? Consumers will stand to lose as the cost will be passed on to them.
3) If a single company monopolises the process, I think the public would be interested to know if there are any political links or parties involved in the said company.
I am surprised the Consumer Associations have not said anything yet.
Meliodosis on the rise
BBC News reports
Authorities in Singapore have expressed concern about the rising death toll from the tropical disease melioidosis.
Twenty-three of the 57 people diagnosed with the soil-born disease from January to July died, health officials said.
This pointed to a mortality rate of 47% - three times as much as with the deadly respiratory infection Sars. |
Meliodosis is endemic in Malaysia. We do see sporadic cases - presenting usually as fever, abscesses but occasionally with fulminant septicaemia and penumonia. Diabetic patients are somewhat more susceptible. It is a bacterial infection caused by the organism Pseudomonas pseudomallei which is found in the soil and it enters the body through cuts and abrasions in the skin.
I don't know if the trend our Singapore counterparts are experiencing is the same here in Malaysia but it would be good to take the simple precaution of not running around bare footed and protect your feet with a good pair of boots if you have to work in the field.
Links:
Meliodosis info from the CDC
Thinking of a Sound System? Think again!
IN the BMJ,
Rock and heavy metal music can damage your lungs
Researchers in Brussels report three young men who experienced sudden chest pain and dyspnoea while attending rock concerts or standing near an amplifier in a dance hall. All had developed pneumothorax. A fourth patient sustained the condition while listening to a 1000 watt base box situated in his car boot. Two had had a pneumothorax previously. The authors speculate that repetitive pressure changes in the high energy, low frequency sound range may tear alveoli or subpleural blebs, analagous to what happens in blast injury. They recommend asking specifically about exposure to loud music when treating patients with pneumothorax. |
This should be food for thought for all those who crave high decibel sounds. The next time you are thinking about upgrading your car stereo system or perhaps your home theatre entertainment with sounds that makes your heart thump, think again. Your lungs are at risk!
Is it Bull...?
Spotted this interesting article in
MedicalNewsTodayEnergy drinks have become increasingly popular in recent years - Many young people combine energy drinks with alcohol when 'clubbing' in a belief that the combination will improve their stamina.
New findings indicate that Red Bull®, when consumed jointly with alcohol, does not improve a person's physical performance.
Energy drinks – usually a mixture of caffeine, taurine, carbohydrates, B-complex vitamins and gluconolactone – have become very popular in recent years. Although several studies support the widespread belief that energy drinks may enhance mood and/or improve cognitive and physical performance, very little research has investigated their purported ability to delay the depressant effects of alcohol on the central nervous system, thereby prolonging its excitatory effects. A study in the September issue of Alcoholism: Clinical & Experimental Research has found that an energy drink called Red Bull®, when consumed jointly with alcohol, does not improve a person’s physical performance. |
So it seems that combining this drink with alcohol does not have any beneficial effect with regard to physical performance or counteracting alcohol's depressant effects. What about the effectiveness of these energy drinks when consumed by themselves? Is it hype and a lot of bull....? A PubMed search does show some studies which demonstrate some
effect on mood and human performanceThe effects of red bull energy drink on human performance and mood.
Alford C, Cox H, Wescott R.
Psychology Department, University of the West of England, Bristol, United Kingdom.
The effects of Red Bull Energy Drink, which includes taurine, glucuronolactone, and caffeine amongst the ingredients, were examined over 3 studies in a total of 36 volunteers. Assessments included psychomotor performance (reaction time, concentration, memory), subjective alertness and physical endurance. When compared with control drinks, Red Bull Energy Drink significantly (P < 0.05) improved aerobic endurance (maintaining 65-75% max. heart rate) and anaerobic performance (maintaining max. speed) on cycle ergometers. Significant improvements in mental performance included choice reaction time, concentration (number cancellation) and memory (immediate recall), which reflected increased subjective alertness. These consistent and wide ranging improvements in performance are interpreted as reflecting the effects of the combination of ingredients |
On the other hand, there have been reported toxic interactions with other drugs as well as a Pubmed search reveals this report on
Acute psychosis due to the interaction of legal compounds--ephedra alkaloids in 'vigueur fit' tablets, caffeine in 'red bull' and alcohol.What do I drink? Well for my daily caffeine fix I prefer to stick to my coffee thank you.
Lymphoma Awareness
Today, September 15th is the inaugural World Lymphoma Awareness day.
Lymphoma is a cancer of the lymph glands and lymphatic tissue. It is one of the cancers which is increasing in incidence globally including in Malaysia where it is one of the top 10 cancers.
Early diagnosis and appropriate treatment may cure lymphoma. Some of them like stage I Hodgkin's disease have an over 90% cure rate with modern treatment. One of the grouses I have with Malaysian Insurance companies is that for Cancer insurance some of them put Hodgkin's Stage I as an
exclusion clause. I can't understand why they do this other than the fact to me it is an unscrupulous act trying to fleece the consumer. Why penalise the consumer just because he has a curable cancer? Simple answer is that they are trying to protect their bottom-line and if they can help it, I suspect there will be more addtions as the list of curable cancers grow!
Modern treatment facilities for lymphoma incorporate not only chemotherapy, radiotherapy but also stem cell transplantation and "targeted therapy" with new drugs like monoclonal antibodies, radioimmunotherapy and other new exciting developments.
Links:
Lymphoma Research FoundationLymphoma CoalitionLymphoma Support
Herbal Medicine and Hepatitis B
Highlighted in The NST,
Herbal hope for hepatitis carriers
Annie Freeda Cruez
KUALA LUMPUR, Sept 11:
Clinical trials to be done by Selayang Hospital on a herb has raised the hopes of some 1.5 million Malaysians who are carriers of hepatitis B.
The herbal product, soon to be tested on 20 patients, will help those afflicted with the silent killer. Without treatment, some of these patients will eventually develop liver cancer.
The clinical trials will be conducted on those whose liver enzymes are minimally raised, which is what happens when the virus attacks the organ. This leads to inflammation and chronic infection. |
Complementary medicine is gaining increasing prominence in modern medicine. No doubt even if every Western trained physician remain sceptical as to its role in treatment of diseases, it cannot be ignored further. This is because a substantial proportion of patients do visit alternative healers for their medicines. However, it is important to maintain a strict code of ethics and conduct for these alternative practitioners. Even their medicines should go through the necessary stringent trials to prove its worth. Anecdotal reports of successes should no longer be accepted as an evidence of success. This is to avoid the emergence of bogus practitioners whose only hopes are to exploit the vulnerabilities of those stricken with chronic diseases.
Herbal medicines have been researched extensively in China with regards to treatment of Hepatitis B. As published in the American Journal of Public Health, a more concrete research needs to be done due to the poor quality of existing research especially from China.
Chinese herbal medicine and interferon in the treatment of chronic hepatitis B: a meta-analysis of randomized, controlled trials.
Am J Public Health 2002 Oct;92(10):1619-28(ISSN: 0090-0036)
McCulloch M; Broffman M; Gao J; Colford JM
Pine Street Clinic, San Anselmo, CA, USA.
OBJECTIVES: This meta-analysis was conducted to examine the effectiveness of Chinese herbal medicine (either alone or with interferon alfa) in treating chronic hepatitis B.
METHODS: We searched the TCMLARS, AMED, CISCOM, EMBASE, MEDLINE, and Cochrane Collaboration databases and then hand-searched the articles' bibliographies.
RESULTS: Chinese herbal medicine significantly increased seroreversion of HBsAg and was equivalent to interferon alfa in seroreversion of HBeAg and hepatitis B virus (HBV) DNA; Chinese herbal medicine combined with interferon alfa significantly increased seroreversion of HBsAg, HBeAg, and HBV DNA. The Chinese herbal medicine active component bufotoxin combined with interferon alfa significantly increased HBeAg and HBV DNA seroreversion. The Chinese herbal medicine active component kurorinone was equivalent to interferon alfa in seroreversion of HBeAg and HBV DNA.
CONCLUSIONS: Although the quality of existing studies was poor, these data suggest that further trials of Chinese Herbal Medicine and interferon in chronic hepatitis B infection are justified.
Chinese medicinal herbs for chronic hepatitis B: a systematic review.
Liver 2001 Aug;21(4):280-6 (ISSN: 0106-9543)
Liu J; McIntosh H; Lin H
The Cochrane Hepato-Biliary Group, The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, H:S Rigshospitalet, Copenhagen, Denmark. JianpingLiu@ctu.rh.dk.
AIMS/BACKGROUND: Chronic hepatitis B is a serious health problem worldwide. Chinese medicinal herbs are widely used for treatment of chronic hepatitis B in China and many clinical trials have been conducted. This systematic review is to assess the efficacy and safety of Chinese medicinal herbs for chronic hepatitis B.
METHODS: Randomised clinical trials comparing Chinese medicinal herbs versus placebo, no intervention, nonspecific treatment, or interferon treatment for chronic hepatitis B with > or = 3 months follow-up were included. No language and blinding limitations were applied. The electronic databases were searched, combined with handsearches on Chinese literature. Data were extracted independently by two reviewers. The methodological quality of trials was assessed by the Jadad-scale plus allocation concealment.
RESULTS: Nine randomised trials (n=936) were included, with only one being of high quality. There was a funnel plot asymmetry (intercept 3.37, p=0.047). Compared to nonspecific treatment or placebo, the herbal compound Fuzheng Jiedu Tang showed an effect on clearance of serum HBsAg (relative risk 5.19, 95% CI 1.24-21.79), HBeAg (10.85, 3.56-33.06), and HBV DNA (8.50, 1.23-58.85). Polyporus umbellatus polysaccharide showed an effect on serum HBeAg (3.06, 1.13-8.29) and HBV DNA (4.14, 1.0-17.19); Phyllanthus amarus showed an effect on serum HBeAg (3.35, 1.49-7.56). Phyllanthus compound and kurorinone showed no significant difference on clearance of serum HBeAg and HBV DNA and on alanine aminotransferase normalisation compared to interferon. No serious adverse event was observed.
CONCLUSIONS: Chinese medicinal herbs are not recommended for chronic hepatitis B because of the publication bias and low quality of the trials. Rigorously designed, randomised, double-blind, placebo-controlled trials are needed. |
So the effectivenesss of this herbal medicine can only be effectively proven by a good clinical trial, ideally a large double blind controlled trials. The reported trial in Selayang Hospital involves 20 patients. I am only sceptical about the power of this study with such a small study population. From the sounds of it, it is hardly going to be a controlled trial eg herbal vs conventional treatment or herbal vs placebo treatment. I seriously doubt that the ability of the study in Selayang to shed further light on this issue. A more careful read of its methodology would enlighten us all. But before that, I would caution the media on glorifying herbal medicine prematurely.
Feedback: Caveat emptor
W sends in this experience:
A few years ago, I had a swelling on my sole, just below the big toe. I went to see a GP, a well qualified one at that. He took a look at the spot and said that I had an
accumulation of fat which can be removed by him at his clinic.
It was very fortunate that I refused to have it done. The swelling subsequently subsided by itself without any intervention. Another instance was the time I went
to see an ENT specialist who had a string of medical qualifications from the U.K. about my chronic rhinitis. I was given a CT scan and also adviced to have my septum realigned. However, I did not go through with it. At that time I was taking a medication for BPH and it was much later that I found out that one of the side effects of the medicine is rhinitis, besides syncope and a cough, both of which I
also experienced. After stopping this medication, I was not bothered by these problems. Although I have informed the specialist of the medicines that I was
taking, no suspicion was aroused. I think the side effects of medication taken by the patients should be the first to come to mind before treating a patient. I have so far been very fortunate but as patients we should also practise the principle of caveat emptor! |
Thanks for sharing your experiences W. Doctors are indeed fallible and the art of making a diagnosis remains an art - it is not 100%. I am of the opinion that a well informed and articulate patient goes a long way towards helping establish the diagnosis. I do hope to see more patients who wish to understand the nature of the underlying problem first instead of asking for medicine, injections or quick fixes.
Nusing standards deteriorating
Highlighted in The Star
High failure rate of trainee nurses rings alarm bells
HALF of the trainees in government nursing schools failed to make the grade in their final examinations, reported China Press.
The daily quoted Health Minister Datuk Dr Chua Soi Lek as saying that the number of such trainees had reached a worrying rate.
He said the ministry would investigate the reasons for such a situation through a committee led by the ministry’s parliamentary secretary, Lee Kah Choon.
He said trainees in private nursing schools, who also went through the same training programme, had achieved a 100% passes in their examinations.
It was speculated that the unsatisfying entry qualification of nurses in government schools was the main reason these nurses did not do well. |
Not a surprising report at all. The quality of nurses of today leaves much to be desired. Our Health Minister certainly hit the nail on the head when he commented about the unsatisfactory entry qualifications as the reason for such a poor performance of nursing students.
To improve the quality of nursing care, first and foremost, there needs to be a change in mindset. The role of nurses should be expanding to encompass more responsibilities as time and technology progresses. They should not limit themselves to the basic chores of patient management. They need to acquire more skills, skills that were previously confined to doctors. There should also be an endless commitment to continuing education and be more involved in research. All of this, in my opinion, begins in nursing schools.
There should be no compromise in entry qualifications of nursing schools. The quality of future nurses depends on it. English language courses should be a compulsory addition to the nursing curriculum especially in government run institutions. Nurses of today are so poorly versed in English that basic orders by doctors are sometimes not understood. This is because many courses are still run in Bahasa Malaysia. Lectures and notes are given in Bahasa. This limits our nurses in terms of medical literature that they can assess and understand.
Medical knowledge of our nurses today needs improvement. Aside from specially trained nurses in ICUs and CCUs, the nurses elsewhere display a poor knowledge of basic anatomy, physiology and pathology. There needs to be more emphasis in acquiring knowledge in this regard.
Nurses of today are more concerned about managerial nitty gritties; despite being important, should remain on the sidelines of patient management, especially for students and new nursing graduates.
So long as favoritism and protectionist policies exist that stiffles healthy competition, the situation will hardly improve. Despite more favourable statistics and demographics in the job arena, it remains to be seen if it will indeed hold up in the true face of globalisation where competition is stiff. I remain adamant that certain areas should not be subjected to a lower standard as this just enables more imcompetent personnel to penetrate a service that relies on a good and hardworking workforce.
When is it time to stop?
From
The StarTan Sri Dr M. Mahadevan, the country’s foremost psychiatrist, is turning 75 today but has promised to keep on going until he “can no longer move.”
Although retired from government service since 1984, the bachelor has yet to retire from his profession.
Dr Mahadevan runs a clinic at his home in Ukay Heights, Kuala Lumpur, for a small number of patients, whom he continues to treat by appointment. |
No disrespect meant to Dr. Mahadevan who is an eminent psychiatrist but this story prompted me to think about retirement guidelines for doctors in this country - there doesn't seem to be a mandatory retirement age. If we were to put the onus on deciding when to stop on individual doctors, then it would entirely depend on the individual doctor's insight which may not be very objective.
I personally think there should be a compulsory retirement age and for the good of the profession there should be compulsory re-accreditation on fitness to practice.
Overworked and Underpaid Doctors
The topic of overworked doctors have been debated for decades. However, unlike in European countries, very little has changed in Malaysia? Doctors, especially the junior ones, remain overworked. Even if we decide to selectively forget about the doctors' social and physical well being, would the health of the patients that they care for be compromised by a tired mind? Perhaps this article published on BBC News on 2 February 2001 could enlighten us all.
Friday, 2 February, 2001, 13:58 GMT
Overworked doctors 'like drunks'
Overworked junior doctors in Australia are so tired that they have symptoms similar to drunkeness, the Australian Medical Association (AMA) has said. The AMA said a survey had found more than 80% of the country's junior doctors - who often work 18-hour shifts - were working an unsafe number of hours every week.
The survey found that 29% of junior doctors worked up to 106 hours a week, rated as a "high risk" for impaired performance from fatigue, while 53% worked up to 86 hours a week.
The association's training representative, Dr Sarah Whitelaw, said clinical studies showed performance levels after 18 hours without sleep were the same as having a blood alcohol level greater than 0.05%.
Safeguards
"If junior doctors were considered drunk on the job, hospitals would stop the doctors working. There must be safeguards put in place to eliminate workplace fatigue through excessive hours," Dr Whitelaw said.
She added that doctors were "resuscitating, treating and operating" in this condition.
The AMA said one doctor reported working 63 hours non-stop on hospital duty, while another said he worked more than 200 hours over two weeks.
Another doctor in Sydney worked 120 hours one week - with three night shifts - and 99 hours the next week, including 38 on his feet in one stretch.
"This is not acceptable for doctors - or patients," said the association's national president Dr Kerryn Phelps.
Junior doctors also endure long hours in other countries, including Britain.
A European Union directive, which must shortly be implemented, stipulates that by 2004, junior doctors must conform to the maximum working week of 48 hours, which covers working practices in most other employment fields under EU law. |
No wonder some doctors get cranky! Would you like to be treated by a "drunk" doctor? In Malaysia, there is no cap on the maximum number of hours he/she could work. One can be on call for the night and end up with a busy schedule the following day. In a week, a junior doctor can be on call for up to 3 nights. The situation may be far more acute in smaller district hospitals. Perhaps the article below can be more convincing.
Resident Doctors Overworked.
Newsletter-People's Medical Society; 6/1/2000
For years, it was a given that residents--new doctors in training for a medical specialty--would be overworked. It was regarded as a right of passage. After all, the specialists overseeing their training had lived through ridiculous schedules in which they were on call for up to 36 hours and survived. It was simply expected. As time went on, however, research revealed that the sleep deprivation, fatigue and stress experienced by residents affected not only their own health but also that of their patients. As a result, New York state passed a regulation limiting the number of hours a resident can work, and residency programs adopted rules of their own. Years later, the research about sleep deprivation, fatigue and stress is even stronger. Medical errors are in the public spotlight. But the work-hour rules are being ignored. ...... |
As expectations of doctors by the public rise, little is done to improve the working conditions of doctors in Malaysia, especially those in the public service. More rules and protocols are implemented by the day and statements by senior doctors about surviving their previous ordeals, no longer holds ground in the current era. It should not be the way doctors are trained. Such "baptism of fire" , in my opinion, is obsolete and is a totally inefficient way of learning. It could also endanger the lives of unfortunate patients.
In the British Medical Association website,
Key hospital doctors overworked and demoralised, BMA survey shows issued by - BMA London Office - Thursday 05 Aug 2004
A key group of hospital doctors is working far above European limits on hours, a survey by the BMA shows today (Thursday 5 August).
There are around 12,500 staff and associate specialist (SAS) doctors in the NHS in the UK. They are distinct from junior doctors and consultants.* The BMA survey of over 2500 SAS doctors reveals that those on full-time contracts work on average 73 hours a week, far in excess of the European Working Time Directive limit of 48 hours.
Half the doctors surveyed are suffering from low morale and most feel it has declined in the last five years. Around one in five is considering retirement in the next five years. If this trend is applied nationally, it represents a loss of 2,500 doctors to the NHS..... |
With such inhumane working conditions, it is not a mystery why some doctors decide not to remain in public service. Even if you put up with all the hard work, your reward at the end of the day is paltry. It reflects the lack of communicative and human resource management skills of our top administrators. Unfortunately, most of our grieviances have fallen on deaf ears.
KIdney Failure
In the Star,
Kidney failure alarming
NIBONG TEBAL: Ten thousand Malaysians are expected to suffer from kidney failure in the next five years due to lack of exercise and poor eating habits, said Health Minister Datuk Dr Chua Soi Lek.
He said RM30mil had been allocated to equip every district hospital with a minimum of four haemodialysis machines each by the end of this year.
“But these machines will never be enough to cater to the alarming increase in the number of kidney failure patients,” he told reporters after launching the Sungai Bakap Hospital’s haemodialysis unit yesterday.
He said there were now about 9,000 patients in the country seeking haemodialysis treatment, with an average 2,500 new cases reported annually. |
One of the main causes of kidney failure is diabetes. The rising trend of diabetes has resulted in a similar rise of kidney failure patients in Malaysia. One of the greatest dilemmas in the treatment of kidney failure is the availability of hemodialysis machines. Despite the best efforts of the Government to provide dialysis machines to every hospital, the shortage has become increasingly acute. The role of non-governmental organisations has thus become valuable in efforts to provide hemodialysis for those patients in need.
For those already stricken with end stage kidney failure, hemodialysis is inevitable. Next would be to find a center with an available vacancy to enable frequently needed dialysis. Secondly would be to find the necessary funds to maintain the habit of hemodialysis. My search of the internet has resulted in one outstanding site ,
Global Dialysis. This site has a list of dialysis centers in 115 countries. It has a list of 190 dialysis centers in Malaysia, complete with their contact information.
National Kidney Foundation of MalaysiaMalaysian Society of Nephrology
Palliative care
Dr. SS writes:
Wonder if you can give me some advice regarding paliative care in Malaysia? I am finding it difficult when the child is dying in Intensive Care Unit, and the medical team is asking the parents to sign DAMA. In fact, I find it is not against my medical advice for those
terminally ill patients to go home and died peacefully. But I was told this is how Malaysian doctors do it?? (to protect ourselves from being sued in the future?!) |
Thanks for your comments SS. I presume DAMA = Discharge Against Medical Advice. I don't believe this practice is uniformly prevalent throughout Malaysian hospitals. I certainly don't request my patients to sign such a form. What is important is that the family members have been adequately counselled and everyone understands the situation (what annoys me are the Johnny-come-lately "relatives" who suddenly appear at the last minute demanding explanations when throughout the patient's illness they were never to be seen). I also feel it is important that when the terminally ill patient goes home, he/she continues to receive adequate palliative care.
Links
Hospis Malaysia
Patient safety
It's good to read of the establishment of a
Patient Safety Council.
Long in coming but nevertheless welcomed, the council will collect data on medical errors and negligence; investigate the root causes of such cases and recommend strategies for the safety of patients.
Above all, the council, to begin operations soon, will publish regular reports to keep the public informed of such matters — an indication of how critical patient safety has become in the overall agenda of the Health Ministry.
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I think the scope of the council should encompass the Public as well as the Private sector. It should go beyond Allopathic medicine and also encompass mishaps which arise with Alternative medicine. The "adverse reactions, wrong procedures, wrong diagnoses, delayed and inappropriate treatment" could well apply to Alternative medical practitioners as well.....
Free Pedometer!
Well, only if you are amongst the first 10,000 people to arrive at the Natonal Stadium in Bukit Jalil on 12 September which marks the launch of the National Fitness Council.
From
The Star “We hope those given the pedometers will use them and record at least 1,000 steps daily,” said Youth and Sports Minister Datuk Azalina Othman Said.
Prime Minister Datuk Seri Abdullah Ahmad Badawi would launch the council on Sept 12 before more than 30,000 people at the stadium in Bukit Jalil.
Azalina said Malaysia’s health aspect was becoming a problem.
“We need to exercise to stay active, healthy and united.
“But it would be pointless to exercise then eat nasi lemak and drink teh tarik after that,” she told a press conference at the stadium yesterday. |
Excellent advice. I know of people who faithfully go for their morning walks and spoil it all by ending up with that Bah Kut Teh for breakfast!
CT scan : A Cancer Threat?
Our threshold for radiological investigations is rapidly decreasing. It has become a standard for many to have some sort of radiological examination, even in their annual routine medical checkups. New technologies have surfaced in radiology that provides a physician with more and better choices. Even some patients would demand for certain radiological assessments despite being told of its redundancy. We seem to have forgotten that most radiological assessments involve radiation, thus its name.
Recently in Medscape,
Full-Body Computed Tomographic Scanning May Significantly Increase Cancer Risk
News Author: Laurie Barclay, MD
Aug. 31, 2004 — Full-body computed tomographic (CT) scanning may significantly increase the risk of cancer, according to the results of an analysis published in the September issue of Radiology.
"Our research provides definitive evidence that radiation risk is associated with full-body CT scans," lead author David J. Brenner, PhD, DSc, from Columbia University in New York, says in a news release. "The radiation dose from a full-body CT scan is comparable to the doses received by some of the atomic-bomb survivors from Hiroshima and Nagasaki, where there is clear evidence of increased cancer risk."
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As mentioned in the article, despite controversy regarding the effectiveness of full body CT and the lack of data supporting a life prolonging benefit, many still request that a CT scan be done on an elective basis. Some centers have even promoted the CT scan as a tool for detecting coronary heart disease and cancers, thus are offering it in packages during one's routine medical checkup.
HealthWorld Asia
Cyril writes in to inform us that HealthWorld Asia will commence tomorrow:
| It opens on the 2 September through to the 5 at the PWTC. RM 150 for any one day for local residents and US150 for overseas delegates. NGOs can send three health workers for free.20 free seats for every University to send their final year medical and dental students, any additional student RM 50.Call early to reserve place.Limited places. www.healthworldsasia.com |
