We extend our condolences to the families of the three young doctors from QE Hospital Sabah who were killed in a car-bus accident.
The circumstances of this accident are not clear but we do implore young doctors to be extra careful if you are planning car trips after an exhausting call as we have heard of fatal accidents involving such tired doctors. Consider getting someone else to do the driving.

Fellow Malaysians, you can do your bit to help the unfortunate Haitians who have been struck by a devastating earthquake.
Donations can be made to:
Unicef Malaysia Haiti Appeal
and the
Malaysian Red Crescent

Even if the aftershocks have stopped, for the doctors in Haiti, the Worst is Yet to Come

Happy New Year to all! What will 2010 hold for us? As for the medical profession, I note that it starts with a bang with the MMA President making a New Year 2010 Call to Action. The reason for this is the controversial 1Malaysia Clinic plan the Government wants to implement. While the public may think this is a good idea David had already written that we should rethink this as the so-called 1Malaysia Clinics will be run by medical assistants and nurses rather than doctors.
It is ironically double standards being practised as clinics under the Private Healthcare Facilities and Services Act cannot by law hire Medical assistants. It seems to me, at least in this circumstance, 1Malaysia means 1 rule for the Government and another 1 rule for the private sector.
Please also read David’s post on MMA’s Grave Concern about 1Malaysia Clinics being manned by Medical Assistants/Nurses

Why is the MMA so concerned about clinics being manned by medical assistants or other unregistered medical practitioner? Because under the Medical Act, this is illegal.
Because as of now and in the past, doctors who employ such unregistered persons have been charged and penalized for unprofessional conduct, with some severely sanctioned, even suspended or de-registered!
Because medical assistants cannot prescribe any more than some very simple medicines, cannot sign any medical leave chits or write any report, and would become subject to medico-legal challenges, with no precedents.
Because we are concerned that ‘bogus doctors’ should not be allowed to harm our rakyat! In the past there have been some bogus personnel who have continued to defraud many patients because many of them do not know the limits of their level of competence and training—who feel that they are not bound by any laws.
There should not be one law for some and another for others, even if approved by the government or the MOH.

We have our respects for our paramedical colleagues - the MAs and the nurses - who play a vital role in delivering healthcare in the nation. The concern here is that their role will be altered to one of a medical doctor in the primary care setting. For instance, will the MA or nurse be able to more reliably than a trained doctor determine if the so-called “minor illness” like “fever and cough” be an Upper respiratory tract infection or actually be a more serious pneumonia? This will put the MAs and nurses in a spot as they should realise that their roles and responsibilities in the 1Malaysia Clinics now take on an elevated position, one which they and the Government will ultimately be responsible for should there be mishaps and misdiagnoses in this setting.
The non-medically trained politicians must realise that patients when they seek care at clinics do so with problems and not with the diagnosis on the platter. It may be chest pain or a fever. It may be back ache, fatigue or weight loss. So you tell me if the MA or nurse is the one to distinguish IHD from anxiety neurosis? URTI from H1N1? Depression from Cancer? Dear Health Minister, calling it a “minor illness” is not as easy as you think.

Once again, read Dr. Quek’s Call To Action. David says the 1Malaysia Clinic plan will effectively “place our standards on the level of countries that have a scarcity of fully-registered physicians”. We already have a plethora of medical schools, with another one being planned in Perak and it seems that quality is not as important as quantity with the mushrooming of medical schools in this country.
Malaysia is NOT short of doctors. What is happening is that there is a mal-distribution of doctors, there being a rural-urban disparity. It only requires a better plan to get more doctors in the rural and under-served areas and that may be achieved to some extent with better private-public sector cooperation.

Teoh Beng Hock’s inquest will resume this month. A second post-mortem was conducted and one wonders the sparks which might fly if there is any truth to the allegation that TBH was murdered rather than it being “suicide”. There might be an interesting exchange between the reknown Thai pathologist Dr. Pornthip and the UK pathologist hired by the MACC if both are called to testify.
Already the Kugan case has cast a “black eye” on the medical profession, the pathologists in particular, since there are at very least implications on the impartiality of doctors if not the competence issue. As doctors, we have to assess and present the evidence as they stand. We cannot and should not provide evidence which only our political masters want us to produce. Doing so not only is a major failing to ourselves but a major failing on the trust patients and the public put on us.

I predict that in 2010 we shall see more instances of fake doctors and quack surgeries. We already highlighted this Miracle Surgery Scam to the MMA and the authorities (the MOH) but there has not been any feedback nor any apparent action taken. This disappoints us greatly. The original intent of the PHFSA was to safeguard the public against quacks and fraudulent medical practice. It is sad to see “doctors” like these practising with impunity, whereas genuine doctors are harassed by little Napoleons who are seemingly more concerned about clinic dimensions.
Please go after doctors promoting things like that Bleeding scam and fraudulent Ozone therapy. Surely that’s more important than a clinic’s ceiling height?

I predict too that in 2010, sales in supplements, herbs and traditional medicines will continue to skyrocket despite a lack of evidence any of these work. There will continue to be fraudulent practice where so called “natural” and “herbal” products are actually laced with poisons or potent substances notoriously in “Slimming products” and “aphrodisiacs”.
Never mind for instance if the evidence shows that Gingko is useless if you take it for the prevention of dementia or Alzheimer’s disease. People will continue to buy it and consume it, as they are influenced by unregulated commercials and mass marketing of these products which make unfounded claims on efficacy. I hold the powers-that-be in part to blame for their promotion of TCM in public hospitals despite such a paucity of evidence base in TCM practice.
We should not be proud of an “alternative medicine and supplements” industry which generates billions of ringgit, but should be ashamed that we can be proud of an industry which relies on gullible people being duped into parting with billions of ringgit for largely useless products.
The MMR will continue to keep track of news in our CAM Watch and Fraud Watch categories.

Have a good year!

The MMR would like to wish all our blog readers a Healthy and Happy New Year 2010!

Interesting video sent in by my sister which shows brain surgery being conducted on a patient who is awake - necessary if one wants to preserve certain functions e.g. speech.

FYI, this type of surgery is available in Malaysia as well.

The MMR would like to wish all Christian readers a Joyous Christmas and a Blessed New Year!

It’s not like they don’t have a contact number or email - they do located somewhere in the rather busy MOH Webpage
The problem is when you call the MOH, you will likely get an operator and then get passed around from Department to Department until you reach the right place only to find out the officer in charge is away at a meeting! Call again Sir? Sure, only an hour later to play the musical department game again.
As for email, you’ll be lucky to get any reply.
Such is the sad state of affairs that a comment in my Facebook wall got my attention. Is the MOH contemplating having a call centre?
If the MOH indeed had a call centre, what would features would you like this call centre to incorporate?

Indeed some information could be automated like status of transfers, promotions, applications etc. provided the backend office is properly integrated.
I think there should be three sections in the call centre:
1) For MOH employees
2) For Private medical sector
3) For the Public
to address the myriad of possible questions
Common ones include:
for MOH - transfers, courses, promotions
for Private doctors - PHFSA related
Public - complaints, complaints, complaints

Should the MOH have a Call Centre?
If they do, what suggestions do you have?

The MMR wishes all Hindu readers a Happy Deepavali!

The MMR wishes all Muslim readers Selamat Hari Raya Aidilfitri.

This video brings up an interesting point (via Digg)

A British GP has recently been reported to have died after catching H1N1

Dr Michael Day, from Bedfordshire, north of London, died on Saturday at Luton and Dunstable Hospital, local NHS officials said.
Tests showed he had tested positive for the H1N1 virus, known as swine flu, although the exact cause of death was still unknown.

While details are sketchy at this point in time, it is a warning to healthcare workers that they must be vigilant and continue to take protective measures. In the US, at least 81 healthcare workers have contracted H1N1 according to the CDC, about half most likely in a healthcare setting. In the MMWR reminds healthcare workers the importance to adhering to infection control guidelines:

Routine infection-control recommendations to decrease the risk for transmission of seasonal influenza to HCP include vaccination, isolation of infected patients in single rooms, and use of standard precautions and droplet precautions. For infections with the novel influenza A (H1N1) virus, because of the lack of a vaccine and little initial information regarding the severity and transmissibility of the virus, CDC’s interim infection-control recommendations for the care of patients with such infections have included the use of fit-tested N95 respirators, eye protection, and contact precautions in addition to routine infection-control practices applied to seasonal influenza. In addition, CDC has recommended that aerosol-generating procedures (e.g., bronchoscopy) should be performed in an airborne infection–isolation room with negative pressure air handling. In this analysis, among the 11 HCP infected because of probable or possible patient to HCP transmission for whom information was available, none adhered to these recommended practices completely.

The Malaysian public should appreciate our healthcare system where the dedicated under-appreciated workforce of nurses, MAs, doctors etc. face healh hazards daily in the course of their work. I don’t think we are going to see a situation like in Argentina where there are reports of some hospitals where 40% of workers did not show up for work.
The WHO has sounded the clarion call for a vaccine. This is needed urgently and the priority should go to healthcare workers who are in the front-line. The Health Minister has made a similar pronouncement. Development and supply of the vaccine is still months away so the only thing we can do is be vigilant and take infection control precautions.

Over the years, the role of subspecialties in internal medicine has expanded. Many procedures, which were previously under the purview of other specialties, have since been mandatory skills to be obtained during subspecialty training. In rheumatology, ultrasound is gaining acceptance as a vital tool in aiding diagnosis and monitoring of therapeutic responses to assisting invasive procedures, for example, intraarticular joint injections.

Ultrasound is an imaging modality that is very operator dependant. The skill of the ultrasonographer can determine the quality of images obtained as well as the interpretation of those grainy images. Even existing grading systems are subjective and reproducibility is suspect. Time constraints during patient consultations can also be a deterrent for busy rheumatologists in performing ultrasounds in clinics.

However, if performed well, it could be a potentially important diagnostic tool. In rheumatoid arthritis for example, early damages to the cartilage can be detected even before any changes in Xrays is evident. Even the microarchitecture of tendons and its surrounding structures can be scrutinised for damages.

Ultrasounds can also be used to aid invasive procedures like intraarticular joint injections. Even a fluid collection of 1mm2 can be aspirated under ultrasound guidance. It can also aid in more accurate delivery of drugs to intended targets, like steroid injections which were previously done blindly.

Would musculoskeletal radiologist be pleased? I think that it will be an opportunity for a greater collaboration between specialties.

Guidelines for musculoskeletal ultrasound in rheumatology

MSK ultrasound in rheumatology