This was pointed out in the MMR Forums (Doctors section):
Does MSQH, or even MoH for that matter, realise that the use of the term or name “Clinic” when it is NOT manned by a Registered Medical Practitioner, is in violation of the law, specifically Medical Act 1971

Act 50 - Medical Act 1971 LAWS OF MALAYSIA Act 50 MEDICAL ACT 1971*
PART V GENERAL

33. (1) Any person not registered or exempted from registration under this Act who
(…)
(e) practises medicine or surgery; or
(f) uses the term clinic or dispensary or hospital or the equivalent or any of there terms in any other language in the signboard over his place of practice in purported practice of medicine or surgery as a
person registered under this Act; or
(g) uses a symbol designed by the Council for the use of registered medical practitioners only;
shall be guilty of an offence against this Act.

(2) For the purposes of subsection (1)
(a) the taking or using by any person of the term doctor or clinic or dispensary or hospital or the equivalent of any of there terms in any other language in relation to the practice of medicine or surgery shall be deemed to be the taking or using of a name, title, addition or description calculated to induce any person to believe that he is qualified to practise medicine or surgery according to modern scientific methods; and
(b) subject to regulations made under the provisions of paragraph (p) of subsection (2) of section 36, the using by any person in the practice of medicine or surgery of a sphygmomanometer, stethoscope,
hypodermic syringe or other instrument used exclusively by persons qualified to practice medicine or surgery according to modern scientific methods, shall be deemed to be the using of instruments
calculated to induce a person to believe that he is qualified to practise medicine or surgery according to modern scientific methods.

Perhaps as the MSQH suggests, the 1Malaysia “clinics” should be called “Triage Centres” instead. Or perhaps 1Malaysia Paramedical Services.
The MSQH themselves define Clinics as:

MSQH Medical Clinics Accreditation Standards (New)
“The term Medical Clinics for the purpose of these standards refer to all free standing outpatient clinic services managed by medical practitioner and cover both private and public sector clinics including specialist clinics. The term services include consultations, investigations and treatments.”

Thanks to dranony of the MMR Forums for the info.
- there’s the suggestion that it should be renamed to “1Malaysia Pondok Kesihatan”. I kinda like that.

This one should be easy:
20 year old with h/o abdominal and joint pains
platelet count 279 x 10^9/l, PT and PTT normal

Attention couch potatoes. A recent Aussie study suggests you should get off your butt, watch less TV and exercise more. Common sense right? But the chilling statistics might be just the thing to spur you to do the right thing. MedPageToday reports

Too much television watching could be shortening lifespans, a study of Australian adults showed.
Aussies who reported watching four or more hours of TV a day were 46% more likely to die during a 6.6-year period than those who watched less than two hours a day, according to David Dunstan, PhD, of Monash University in Melbourne, and colleagues.
The risk of dying from cardiovascular disease during follow-up was 80% greater in the excessive viewers, although statistically, the result attained only borderline significance (P=0.05), the researchers reported online in Circulation: Journal of the American Heart Association.
The associations were independent of leisure-time exercise and traditional risk factors such as smoking, poor diet, high blood pressure, and abdominal obesity.
“Sedentary living provokes coronary artery disease,” commented Gerald Fletcher, MD, a cardiologist at the Mayo Clinic in Jacksonville, Fla., and spokesman for the American Heart Association who was not involved in the study.
“Even if you exercise, if you have a lot of sedentary living with the things that go along with it — the bad diet and everything else — you still have a net degree of physical inactivity, which is a coronary artery disease risk factor,” Fletcher told MedPage Today.

OK now I have to juggle between Fringe, LOS, Bing Bang Theory to keep it down to under 2 hours a day

The recent introduction of the 1Malaysia clinics has more political connotations than a genuine attempt at providing quality healthcare to the poor. Clinics run by medical assistants with the minimal of equipment is to me a waste of public funds. As a person who has worked for many years with medical assistants, I can attest to the fact that the government is toying with the health of the public in order to earn some political points.

The quality of medical assistants is suspect, from the selection of candidates to their training methods. Many of these medical assistants lack basic aptitude to practice medicine. Some are even poorly qualified. Training of medical assistants are different and hardly involves the rigours of medical schools. Their diagnostic ability is questionable. Their role in the rural community is understandable but to allow this responsibility of managing clinics in the urban areas where doctors suffice, is tantamount to dereliction of duty by the policy makers.

Would any of our VIPs visit a medical assistant for even a simple ailment? Many would flock to ’specialists’ for the best available care. Why then are we toying with the health of the general public?

The reason of providing accessible healthcare to the urban poor is a misdirection. There are many clinics in the urban area, way too many actually. It might have been more prudent to implement schemes for the poor where their visits to the general practitioner is subsidised. There are actually existing programmes in place via the Welfare Department to cater to these group of individuals where their healthcare is fully borne by the government. So what is the role of 1Malaysia clinics?

The name speaks for itself. Promoting a political agenda using tax payers money with total neglect of their wellbeing.

Recommended read

Africanisation of Malaysian healthcare- Malaysiakini

I guess the title got your attention as it certainly did get mine from my usual trawling of Reddit! Physiologically speaking, conception is impossible from the act of fellatio (now that would be the boring medical equivalent of saying it’s not possible getting pregnant from a blowjob) but it seems there was actually a Case Report published in the British Journal of Obstet and Gynaecol. In case you are cynical, the girl had an aplastic distal vagina so conception via coitus was indeed not the case. Here are the details via Open Knowledge:

Read the rest of this entry »

HbA1c May Be Useful for Diabetes Screening, Diagnosis in Routine Clinical Practice

January 22, 2010 — Hemoglobin A1c (HbA1c) may be useful for diabetes screening and diagnosis in routine clinical practice, according to the results of a study reported online in the January 12 issue of Diabetes Care.

Read more

The use of HbA1c for diagnosis was once deemed wrong. However, it is now suggested that HbA1c is gaining credence as a diagnostic and screening tool, apart from its usual purpose of monitoring control of diabetes.

If widely accepted, it is set to replace the cumbersome oral glucose tolerance test which is certainly more labour intensive and uncomfortable for the patient. Will the OGTT test remain relevant in the years to come? Perhaps its relevance will remain in patients with gestational diabetes where the OGTT is logically more sensitive than the HbA1c which will take time to rise.

As mentioned, the pitfalls of HbA1c are in those patients with hemoglobinopaties and anaemia, where HbA1C will be inaccurate, in addition to the higher cost of this test.

The jury is out there.

Hydroxychloroquine (Plaquenil) has been used in SLE and RA for quite sometime and given particularly for patients with troubling skin and joint symptom flares. New research suggests that it perhaps should be given for all patients with SLE. Medscape Reports

Use of antimalarial agents can improve survival with systemic lupus erythematosus and should be given to all patients with the disease, according to a report in the January 7th issue of Arthritis & Rheumatism.
During a median follow-up period of 55 months, the mortality rate for non-users of antimalarial drugs was 11.5%, while that of users was just 4.4% (p < 0.001). Further analysis showed that patients who used the drugs for more than 2 years had the lowest mortality per 1000 person-years of follow-up — 0.54 deaths, compared to 3.07 in non-users.
Prior research has suggested that antimalarial therapy can help prevent flare-ups of lupus and reduce overall damage from the disease, Dr. Bernardo A. Pons-Estel, from Hospital Provincial de Rosario, Argentina and co-researchers note.

SLE is common in Malaysia and patients and advocates should consider joining the Persatuan Lupus Malaysia. Plaquenil is a drug to be taken only under medical supervision and the most serious potential adverse effect is retinopathy and hence the need for regular monitoring by an ophthalmologist

For those who are interested (medical students or house officers), you can download the pdf file here: Management of Type 2 DM

Thurs, 210110 @ 0700

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

If you think 20+ medical schools are not enough for Malaysia, UTAR will be starting theirs, and the intake is in May 2010. The Star reports

Universiti Tunku Abdul Rahman’s (Utar) new Faculty of Medicine and Health Sciences will hold its first intake in May, at a cost of about RM50,000 a year, a fraction of what parents would have to pay for medical courses in other local private universities.The Higher Education Ministry has just approved the faculty’s Bachelor of Medicine and Bachelor of Surgery (MBBS) programme and the faculty will accept an initial 50 students this year.
Housed at the varsity’s Sg Long campus in Selangor, the MBBS programme will cost RM50,000 per annum and around RM250,000 for the entire five-year course.
A memorandum of agreement was also signed with the Health Ministry Friday, formalising the placement of Utar medical and health sciences students at government hospitals.
With the MoA, Utar students will undergo their practicum, industrial training or clinical studies at the Kuala Lumpur Hospital, Ampang Hospital, Sultan Ismail Hospital in Johor Baru and Raja Permaisuri Bainun Hospital in Ipoh.

I said it before and I’ll say it again. There is no acute shortage of doctors in this country. There is however a mal-distribution: rural-urban, public sector-private sector.
Addressing these imbalances and the root causes for the internal and external “brain drain” is a better long term solution than simply churning out more medical graduates.
The leak will continue…

Related MMR posts:
Yet another medical school to be built in Perak
Mushrooming medical schools pose concern

WEEKEND SEMINAR IN CARDIOLOGY FOR PRIMARY CARE
27th-28th March 2010
Sime Darby Convention Center

Contact : Mr Gary Yap HP 6017-9858310
Servier Malaysia

K writes in:

Hi MMR, I’m a doctor recently graduated from an unscheduled university from Ukraine. I’m fully aware of the consequences of graduating from an unrec uni and I’m NOT against the need to sit for MQE as i believe that a good doctor should be able to pass the exam.
Hereby, i would like to express my sincere comments for the sake of Malaysian patients. From my own experience, i would like to share certain things. As i mentioned above, i studied in unscheduled uni in Ukraine. During my 3rd year, Malaysian Government offered “credit transfer” for unrec students. I wanted to take that opportunity to change to Crimea State Medical University. I had completed all my docs and decided to go to CSMU and stay there for a week before i submit my papers. It was a week which deeply disheartened me. I’ll make it short here… students smoking weeds.
Alcohols are like mineral waters for some. Some girls, well i don’t want to mention it. Education process more like pay money, u get your marks..
Its not all but quite a lot of them like that… And the best thing is that they are already in Malaysia working as HOs.. Seeing this, i returned back to my uni. I didnt mind losing USD 1000 which it cost me to pay for the transferring process and an agent fee. My uni is not Harvard or John Hopkins or UM, but i believe it gave me adequate knowledge to be a doctor.
Now, i don’t know if i will pass the exam or not, but i know i made a right decision for myself… But higher officials, are they willing to put the political issues aside and think for the sake of people???!!
IF I pass USMLE STEP 2CS which I’ll be taking in May, i could start my internship in US. But my dreams is always to work in Malaysia so that i can always be near my family , but now it seems a bit difficult as its already January and still no news regarding the MQE. MMC themselves not sure
when will the exam be conducted and interestingly, they are saying it might be canceled.. I don’t know how far its true, but I’ve already waited for 7 months and its really bothering me as the last time i saw a patient was in June 2009!!! Medical knowledge without practice, doesn’t mean
anything…
I love Malaysia, but i have to leave….

Hi K.
Thanks for sending in your thoughts. First of all we would like to wish you all the best for the USMLE and the MQE. Your attitude that a “good doctor should be able to pass the exam” is commendable.
Your week’s experience whilst in CSMU is troubling and hopefully certainly not reflective of what goes on there the year round.
I would think that it is the exception rather than the norm but it is still troubling nonetheless and it brings us back to our previous posts on Concern over Russian and Ukraine Med Schools
Strive to always better yourself and at the end of the day, you can at least hold your head high knowing yours is not a Vodka Medical Degree