Read this news for the context of the following passage.

Recently there was a Malaysian doctor accompanying a patient in an ambulance from Seremban Hospital to Selayang Hospital. On the journey, the tyre burst and an accident happened. The doctor suffered a terrible injury and eventually died.

Following that there were criticisms that Malaysian government doctors are not covered by insurance when carrying out their duty of escorting patients in ambulance. The government later denied that.

Now who’s right and who’s wrong I do not know. You just can’t rely on what you read in the news. But what amazed me with the Star’s news is that:

The family of young Dr Norbaizura Yahaya, who died two weeks after being involved in an ambulance accident, is not eligible for compensation because she was not confirmed in her post.

MMA president Datuk Dr Teoh Siang Chin said her death raised the issue of young doctors being exposed to occupational risks but not eligible for compensation until they are confirmed in their job. “Confirmation can take up to two years after reporting for duty and during this period the doctor has to carry out all normal duties in hospital as well as accompany patients on emergency transfer….”

Again, I do not know how accurate is this but still what was said is amazing.

First of all, what is this ’confirmation’? Perhaps some government doctors can enlighten outsiders like me. It is amazing to me that a doctor can be employed, made to carry out duties, paid salary like an employee but when accident happens, a different set of rule applies as if that doctor was never an employee.

Secondly an employee status should be confirmed and contract (with all the employee’s entitlements printed on it) signed before the job begins. Do Malaysian government doctors actually sign a contract like that before they start their jobs? If what MMA president said is true that the gov takes up to 2 years to ‘confirm’ and without the ‘confirmation’ doctors are not eligible for compensation, then one has to ask if the MOH is oblivious of the Occupational Health welfare of it’s junior employees. This makes a real mockery to the government’s recent preaching about Occupational Health issues and how employers should uphold this interest.

Drooling is defined as mismanagement of salivary control.

A dog may drool because it has been conditioned.

A man may be conditioned to drool too….

……if the association is strong and the supra-tentorial suppression is weak.

People drool for all sort of reasons.

Read the rest of this entry »

The Malaysian Indian women are 7-8 times more likely to get oral cancer than their Malay or Chinese counterparts, according to the recent report by NST. This is mainly because of the cultural habit of betel nut chewing. The second risk factor blamed was alcohol. I was really concerned that cigarette smoking was not mentioned at all in the report as a risk factor.

While population based screening (secondary prevention) seems to be gaining popularity, both US National Cancer Institute and Cancer Research UK agree that there is insufficient evidence that such practice reduces mortality.

Targetted screening by means of cancer awareness programme (pps format) was launched in West of Scotland. TV advertisement about oral cancer led to increased referral to Oral Medicine departments of mostly benign or normal oral findings, with no improvement of earlier stage of cancer presentation. Indeed, quietly there was concern that such cancer awareness programme may flood the Oral departments with the worried well while the at risk population continue to be ignorant of any health campaign, blissfully enjoying their intoxicated state.

But the ‘betel nut population’ should be sober enough to listen to any health message. Indeed educating young Indian girls to stay away from betel nut chewing maybe most cost effective (Stjernsward, J., Cost-benefit in Sri Lanka). Has the Malaysian TV ever encouraged its relevant audience to say “Tak Nak” to betel nut? Have the school teachers been instructed to educate their students from Indian ethnicity?

Btw, I said I was concerned that smoking was not mentioned as a risk factor for oral cancer. This is because there is solid evidence that avoidance of smoking reduces the risk of oral cancer. Smoking cessation is associated with a rapid reduction in the risk of oral cancers, with a 50% reduction in risk within 3 to 5 years. Ten years after smoking cessation, the risk for ex-smokers approaches that for life-long non-smokers.

Talking about education, here are a few pictures of oral cancer. I know I cannot educate the drunkards, but to the Chinese readers, pleaselah, these oral lesions are not caused by ‘heat’:

Picture 1 (tongue), 2 (tongue), 3 (floor of mouth, picture upside down)

Written by UK Doc while bored of watching ice-hockey in Edmonton.

Naturally we would think that advancement of technology will help us to detect cancer early, reduce mortality and improve quality of life. Unfortunately over zealous mass screening does not necessarily reduce mortality. More of concerned is that it can potentially disrupt the good quality of life which will otherwise not be affected by the disease if it were not picked up by screening.

What? Screening can pick up cancer that will not affect people’s life??
Read the rest of this entry »

UK Doc is Guest Blogger for today and this is his article he submitted which summarises the position of overseas doctors in UK:

Further to Lord Warner’s announcement on 7 March 2006 about the new Work Permit requirement for IMGs intending to work in UK, I thought I should summarize what the new rule means to Malaysian doctors & medical students in UK.

1. All doctors wishing to work in the UK from outside the European Union (EU) will be required to have a work permit from April 2006. The move means that any NHS trust wishing to employ a doctor from outside the EU will have to prove that a ‘home-grown’ doctor cannot fill the vacant post, ending the current permit free training arrangement for international doctors. If there is one British or EU applicant for a certain training post, Malaysian doctors who have no Permanent Resident (PR) status in UK will not be eligible to apply. Practically, Malaysian doctors in UK without PR status can forget about post-graduate training in UK except:

2. Non-EU doctors who studied in UK universities are allowed permit free training to complete their TWO years Foundation Programme which is equivalent to the previous Pre-registration House Officer (PRHO) & first year Senior House Officer (SHO) level of training. This is to enable them to register with the General Medical Council (GMC). Thereafter, they too will be subjected to Work Permit requirement practically excluding them from further post-graduate training in UK.

3. Malaysian doctors who are currently working in UK will be allowed to complete their remaining contracts. After then they will not be eligible for further application or extension of post-graduate unless the Work Permit condition can be fulfilled (which is practically impossible). Those whose permit free visas are expiring but whose employment contracts remain valid will be allowed to extend their visa in the form of Work Permit to complete the remaining terms of their employment. There after they too will only be eligible to apply for posts that cannot be filled by EU or UK doctors. Effectively, if you are in the Type I Specialist Registrars’ post, you are safe. As for the rest, you have missed the boat.

4. Malaysian doctors who are in the process of applying for jobs will find their CVs literally thrown into the bins.

5. Those short-listed will be barred to proceed in their job application.

6. This is a tragedy to many Malaysian doctors affected by the new ruling. It means they will have to uproot their families, sell their houses and cars etc, come home and start from the bottom again, unless the Malaysian government is prepared to do something to bridge and complete their post-graduate training. The announcement came with virtually no warning and no grace period for people to adjust or make necessary arrangement.

7. Those who intend to sit the PLAB exam please stop doing it. PLAB has practically lost its reason to exist.

8. Malaysian prospective students and parents SHOULD NOT send their children to UK unless they are certain that they only want to come to UK for undergraduate training only. JPA on the other hand no longer has to worry about the issue of non-returning scholars.
9. There is protest going on. BMA and the Royal Colleges are speaking on IMGs behalf. The rule is unlikely to change in the near future but they are trying to help those IMGs who are already working in UK who have been most unfairly treated.

References:

1. Extra Investment and Increase In Home-Grown Medical Recruits Eases UK Reliance On Overseas Doctors
2. Overseas Doctors : Change to the Immigration Rules for Postgraduate Doctors and Dentists
Further reading:

3. The ‘Work Permit’ saga continues…(Greener Pastures Blog Post)

Related MMR Post:
Troubled times for International Medical Graduates in UK

Guest blogger, UK Doc writes:

Down syndrome is a chromosomal disorder characterised by mental retardation and Mongoloid facial features. People with Down syndrome have a high prevalence of many associated diseases including congenital heart problems, thyroid disorder, eye, ear, nose and throat (ENT) problems etc.

People with Down syndrome are often disadvantaged for many reasons. One of the biggest reasons is our society’s low expectation of how well they should perform. Often when speaking to parents of Down children, I get replies like: “He/she is not too great but what do you expect, the kid has Down.” So, even parents (and sadly sometimes health professionals) have the idea that they ought not to do too well. With such low expectation, many reversible/treatable conditions are overlooked and negligently put down to Down.

Using ENT as an example, Down children have every right to enjoy the best of their hearing. They invariably have glue ears which are treatable, and they are likely to develop progressive sensorineural hearing loss which is aidable. Their learning difficulty can only be worsened by their hearing problems and society will further disregard them as mentally retarded “because they have Down”. Likewise they have a higher prevalence of obstructive sleep apnoea (30-100%, depends on how hard you look for it), and the nocturnal hypoxia and unrefreshed sleep can only worsen their behavioural problems (and cardiac problem/pulmonary hypertension etc), straining their relationship with their carers, hence further disadvantage this group of very lovely children.

The UK Down’s Syndrome Medical Interest Group (DSMIG) compromises a network of doctors whose aim is to ensure equitable provision of medical care for all people with Down’s syndrome in the UK and Republic of Ireland. Nonetheless, I thought the information provided in their website may be relevant to Malaysian health care providers and public.

Among the information provided is a list of guidelines for basic medical surveillance. Because of the low expectation and high prevalence of certain disorders, we cannot rely solely upon parents or GPs to bring their children for tests when they suspect problems. A pro-active surveillance programme is therefore necessary because people with Down syndrome have every right as a human being to enjoy the best of their health and the best quality of lives.

Addendum
Malaysian links (from the MMR’s Support and Society links):
Kiwanis Down Syndrome Foundation
Malaysian Down Syndrome Society

Please welcome our new Guest Blogger, UK Doc, who has submitted this posting for the MMR. We welcome any contributions readers might have for posting on the MMR (subject to Editorial review of course) – just send use feedback

Universal Neonatal hearing screening –Why?
By UK Doc 29/10/2005

Dobbs posted a nice blog about the future of cochlear implant recently. This prompted me to post something about universal neonatal hearing screening. Greater Glasgow has recently implemented the universal neonatal hearing screening programme where all newborns are screened for hearing impairment prior to being discharged home.

Neonatal hearing screening has been practiced for many years now. It is estimated that 1 in 1000 newborns (the true figure is likely to be higher) suffers from congenital hearing loss. This makes it a much more prevalent problem than diseases such as hypothyroidism which have long been universally screened.

Premature babies, certain intrauterine infections, those born with certain recognisable genetic disorders (and etc, for full list see attached link below) are at risk and they were the first groups of neonates to get hearing screening. However it is estimated that only half of babies born with congenital hearing disorders are found in the high risk groups, hence the justification for universal screening of every new born baby.

Like every population screening practice, this is only justifiable if we have cheap/reasonably affordable, non-invasive and acceptable method of screening and if intervention is available to significantly change the outlook of the condition if the problem was identified early. And yes, for congenital hearing loss, all the criteria to justify universal screening are met.

For those babies who do not have hearing screening at birth, their hearing impairment will only be picked up by parental observation or health visitors’ hearing screening (in UK, this is usually done when babies are 7-8 months old, not sure about Malaysia).

The trouble with parental observation is that not all parents are watchful enough to be able to pick up hearing impairment. Failure to response to sound or delayed babbling or language development can be too subtle to the unsuspecting parents. The rising trend of both parents working, the increasing reliance on foreign maids to bring up children and perhaps most worryingly the practice of minority parents who leave their babies with ‘carers’ during the week and only have them back during the weekends can only reduce the odds of these parents detecting their children’s hearing impairment. It can be too late when the penny finally drops because of the phenomenon of ‘neural plasticity’. After the age of 5, the language centre in the deaf children’s brains will no longer be teachable (even after the age of 3, the potential for speech development will be significantly reduced).

There are problems with health visitors screening too. Distraction hearing test is a special skill that requires special training, and health visitors are not generally trained for that.

While it is easy for us to pity the blind, we often mistaken the deaf as being ‘thick’ or stupid. Mild to moderately deaf children can be mistaken as stubborn by their parents and slow learners by the unsuspecting teachers. Early recognition and provision of hearing aids will help them in their language development and many other aspects of their lives.

Our society is designed for those with spoken language. The future of profoundly deaf children with spoken language is undoubtedly much much better than those who communicate with sign language only. In term of education, employment or even socialising, there is no question which group will do better.

One condition that will evade neonatal hearing screening is the so called ‘progressive sensorineural hearing loss’. In this condition children are born with normal hearing but the hearing deteriorates with time. So, even if a baby has passed a hearing screening, there is no harm to subject him/her to a second hearing test if there is any suspicion of deafness at a later age.

Please see the ‘common misconceptions held by the public and the clinical facts’ in the following link:
http://www.emedicine.com/ent/topic576.htm

So, should Malaysian government make hearing screening universal to every new born?