Malaysian Medical Resources

Site may be down for a while as we plan to do an automatic WordPress update.

Who ever vetted this ad didn’t scrutinize the picture as carefully as Jimbo did. I agree, it’s Uninspiring

Do you know what the common allergens are in Malaysia? This is a often encountered scenario in the clinic yet there are so few clinical immunologists in Malaysia. The Malaysian Society of Allergy and Immunology has useful information in their website. Too often we only think about food allergens (not surprising given our food orientated culture. We musn’t forget about other home allergens which include not only house dust mites but cockroaches and animal dander.
Here’s a useful infographic about bed bugs and house dust mites:

Via: Allergy Asthma Technology

from TakNak1Care in Facebook

Our sister site, the MMR Forums has been up and about for more than 6 years now, with a total of 3497 registered members. A sizeable proportion are medical doctors who are given special access to a private area of the forum (called Dobbs or Doctors Only Bulletin Board System). Over the years, I have noticed a steady decline in usage of the non-Dobbs section of the MMR Forums. I suppose this is in part because of the popularity of social networking sites like Facebook which have contributed to a reduction in usage of Blogs and traditional Forums.
Another recent factor is that the engine powering the MMR Forums (Snitz Forums 2000) is getting rather cranky with age and server errors are cropping up ever too often.
As a result, in the coming weeks, the following changes will be implemented:

1) The MMR Forums will no longer be open to public users
2) Only the Dobbs forum will be maintained but this will run in a new system (currently under Beta testing)
3) Registered Dobbs users who are active will be automatically migrated over to the new system after the Beta test period is over. Inactive Dobbers will have to re-register.

The new MMR Dobbs Forums in the early stages is already looking good. It will be more than a Forum but serve as a private community and social network for Malaysian Doctors. Stay tuned for updates!

The Tak Nak 1Care awareness campaign seems to be taking off now in blogs and the social media.
Eyes Wide Open has written a nice blog post which lists all the salient points which trouble the proponents of Tak Nak 1 Care

Healthcare “reforms” called 1Care for 1Malaysia are upon us and it’s a truly frightening prospect.
The BN government has been selling 1Care in the MSM throughout 2011, describing it it glowing terms without giving away any details at all. A concerned citizens group called #taknak1care managed to get hold of some insider information and started a Tak Nak 1Care facebook campaign that’s picking up steam.
The revelations on their Tak Nak 1Care Facebook page worried the authorities enough that the Deputy Director General of the Ministry of Health, Datuk Dr Hisham Abdullah joined in the discussions on the page to try and do some damage control. However, he has so far been unable to answer or categorically refute any of the information revealed on the page and has been reduced to repeating the mantra of “nothing has been decided yet, but whatever it is will benefit the rakyat”.
But interestingly, the Dep DG has acknowledged is that Malaysia is currently about halfway through the 1Care implementation process. This blogger wonders how you can be halfway implementing something that doesn’t exist yet?!
As I understand it, 2012 is when the implementation is supposed to be stepped up. Already we see various articles in the mainstream media about the drawbacks of our current healthcare system. This is done so that the rakyat will be conditioned to accept the need for healthcare reform. The laws authorising the 1Care reforms may even be passed this year. So we don’t have much time to stop this train wreck from happening.

Read more at Eyes Wide Open

In the meantime, I’d like to remind everyone of the up coming public forum on 1Care which will be held on February 12 in PJ. Details here.

The Star had recently reported that housemen will no longer have to work 16 hours straight. It is perplexing that so much focus is given to housemen when it is critical at this juncture to train them to work under stress. Creating a bubble of comfort is hardly the way to go and makes future physicians lame and unable to take the actual burden of medical work in their future careers.

There are several faults in the system which has led to this misdirected attempt at rectifying the situation.

1. Housemen actually should not be the sole decision makers when they manage cases. All cases clerked must be under the supervision of a more senior staff. Hence, most of the work and responsibilities fall on the shoulders of the medical officers and more senior staff within the team. Afterall, a housemen is still under probation and only possesses a temporary registration from the Malaysian Medical Council.

The reality is that this is not happening and housemen are left pretty much on their own. This is due to a warped mentality of more senior staff, who appear to be deluded that a housemen is competent in all aspects of patient care. Or the more likely scenario is that many senior staff are lazy and view teaching housemen as an absolute waste of their time. Unfortunately, when mistakes occur, they blame the housemen, who would decry this accusation, instead blaming the long working hours which have drained them.

2. Even senior doctors make poor ward managers. From over investigation to a disorganised plan, leads often times to duplication of work. Doctor A comes to do ward rounds and orders a slew of tests at 8 am. Senior doctor B then comes along at 9am and disagrees with the plan and opts for another set of further testing. Consultant C then decides to walk in at 11am and changes the plan again. Housemen are then kept busy poking and repoking patients, on top of having to organise radiological procedures. There is just no organisation at times in the wards.

3. Many hospital systems are inefficient. The failure to adopt technology to advance and simplify workflows has resulted in housemen having to fill up forms after forms. In addition, they have to run to the radiologist to ask for an investigation that could have been ordered remotely or via the telephone. The mess of the radiology departments can make the trip there as arduous as it can be, often sapping precious time.

4. As the meaning of housemen itself is self explanatory, unfortunately, many housemen are actually no longer “in house”. Most housemen were previously actually required to stay within the quarters of the hospital. This is to enable an easy commute and facilitate more rest times by negating the need to travel. Housemanship is a period of intense work and learning which is meant to introduce young doctors to the rigours of medicine, reminding them that it is hard work that gets you to the top. Moreover, more time spent on the wards means better learning experiences, not more classroom type CMEs!

Therefore, housemen can rest quickly when they are off duty or could take a few winks during breaks. Even if they are on call, they could technically go back to their quarters for a quick shower while a colleague holds the fort. This teaches camaraderie amongst housemen, a quality that is glaringly absent in the current shift system.

Unfortunately, many housemen now stay away from hospitals for varying reasons. Perhaps this trend should be checked.

It is not just the housemen that are subjected to long working hours. So what are we going to do the help the medical officers, who are equally burdened with work?? Why are we fixated on only the housemen?

Although it is important to improve on the previous systems, it is feared that the policy makers are barking up the wrong tree and make weaklings out of future doctors. It is the system that needs rectification, otherwise we will just be shifting the problem from one corner to the next.

Similar like piloting, housemen need those hours which can potentially be the difference between life and death in future management of patients. Otherwise, future medical officers will turn up incompetent and unable to cope with the stresses of medical life, which by the way entails long hours uncurtailed by the 16 hour mark!!

A lengthy discourse in Science-Based Medicine which concludes:

TCM is a pre-scientific superstitious view of biology and illness, similar to the humoral theory of Galen, or the notions of any pre-scientific culture. It is strange and unscientific to treat TCM as anything else. Any individual diagnostic or treatment method within TCM should be evaluated according to standard principles of science and science-based medicine, and not given special treatment.

I’m sure this article will ruffle some feathers amongst TCM proponents including the MOH

The Star has a story on some insurance companies Making it hard for claimants and Hundreds of true-life trials of the insured
Some of it is as a result of the insured not reading or understanding the fine print (who does anyway?) and sometimes it’s because of non-disclosure of pre-existing illnesses (perhaps the fault of the agent who may dismiss it as not necessary).
Sometimes, it’s just that some insurance companies are being purposely difficult (deny first, make it difficult to claim strategy) such as in our post Dealing with difficult insurance companies
Sometimes, it’s just poorly trained or idiotic claims personnel, like the real story of the claim for critical illness which was rejected because the doctor used the term “carcinoma” instead of “cancer”.
Recently I encountered a claimant who was scheduled for a follow-up PET scan after cancer therapy and she was told “if the scan is negative you cannot claim” – absurdity!

It’s time the authorities take a hard look at the shenanigans in the private health insurance arena and come down hard on the bad boys.

We have covered the dangers of texting while driving but how many of you text while you walk? Here’s a cool video which shows you the hazards of texting while you walk and the proper way to do so

via GAS

Seriously. The Ministry of Health, Malaysia’s health portal, MyHealth has recently launched some browser based games with health themes. You can check out Health Games for yourself.

Personally, I find the “games” rather lame and don’t see the purpose behind them. A truly interactive game which teaches the user in a subliminal fashion as he or she plays it might be more useful rather than inane “arcade type” games with some health theme which serves little purpose other than fill the time of those who are utterly bored.

The MyHealth portal is one of several Health Portal links in the MMR.

The big news yesterday, which came somewhat as a surprise, it that the Malaysian Medical Council, the governing body which maintains the medical register and also is responsible for overseeing medical standards and ethics, is to be corporatised according to the report in the Sun Daily

Health Deputy Director General (Medical) Datuk Dr Noor Hisham Abdullah told theSun recently that once the amendment is passed, the MMC will be a professional body responsible for maintaining medical standards in the country, and more significantly, for performance monitoring of doctors.
The amendment is expected to be tabled when the Dewan Rakyat reconvenes in March.
“The corporatisation of MMC is to emulate the General Medical Council (GMC) in the United Kingdom, where it functions not only to set and monitor standards of the medical profession, but also the competency of doctors registered with it,” said Noor Hisham.
GMC is a fee-based registered charity which maintains a register of its medical practitioners, and functions to protect public interests by ensuring compliance to medical standards.
Noor Hisham said the monitoring of doctor’s performance is the way forward for quality healthcare.
Health Minister Datuk Seri Liow Tiong Lai told theSun that the move is to make the council more efficient in its daily administrative work, as well as free it from government bureaucracy.
“MMC is growing by leaps and bounds, it has registered around 35,000 doctors now, so we have to look into making MMC more efficient and not tie it down with government bureaucracy or circular,” said Liow.
He added that corporatising the council will ensure that it operates as a stand-alone, independent professional body, akin to the Malaysian Institute of Accountants, the Bar Council and the Institute of Engineers Malaysia.
Under the purview of the Health Ministry, the MMC currently functions under the same principles as the GMC, and also acts as a disciplinary body for the medical profession.
A long serving member of the council, who is also a senior doctor in a public hospital, told theSun the move will resolve the occasional conflict between the functions of the council as the ‘whip’ of the medical profession, and its role as advisors to the Health Ministry.
“The very fact that the council is funded and run by the ministry, there will be some conflict of interest between the two,” the doctor, who declined to be named, said.
He said there were also occasionally some difficulties for the MMC to exercise its disciplinary roles, especially when involving ministry-employed doctors, though he did not give specific examples.
“The move has of course been welcomed by the MMC, and hopefully with its corporatisation it will receive more funding, be more efficient, and able to function independently and with professionalism,” he said.
Meanwhile, the Malaysian Medical Association also welcomed the move, although it admits that it was not consulted on the matter.
“However, the move is a good as it will make the MMC an independent body and there will be no potential conflict of interest, since currently the Health Ministry director general is also the chairman of the MMC,” said MMA president Dr Mary Cardosa.
She added that in the interest of good governance, the MMC must have representatives from all stakeholders who will be responsible for the registration of doctors and maintenance of standards of practice and ethics among doctors.
However, Cardosa disagreed that there may be an increase in fees paid for annual practising certificates (APC) with the corporatisation, and that it may be passed down to patients. Doctors in private practice currently pay RM50 per annum.
“Currently government doctors have their APC fees waived, but even if the APC fees are increased, it will not burden the patients as the fees are not high, and doctors’ fees are closely regulated by the law,” she said.

I am not really sure how corporatisation was entirely necessary in the first place if the MMC were to achieve the goals of registration of of doctors and also continuous monitoring of doctors’ performance. I guess the powers-that-be acknowledged that Government bureaucracy would be too much an obstacle for the MMC to progress in this direction. The article did not state where the funding of the corporatised MMC would come from but my guess is from it’s monitoring activities. I foresee that there will be:
- compulsory CME
- compulsory specialty registration
- compulsory re-accreditation
and all these exercises will require “fees” which will generate income for the MMC. I am not as confident as Dr. Cardosa on the APC fees – I suspect that there will be a substantial increase in this as well.
Together with the hefty subscription rates that Malaysian doctors already pay for medical malpractice protection (O&G doctors for instance have to fork out RM57,000 per year which is not even tax-deductible), practicing as a doctor in Malaysia will become increasingly expensive for sure.