The Malaysian Medical Association will only have itself to blame if it is deregistered for failing to hold fresh elections.
Registrar of Societies Datuk Abdul Rahman Othman said the body had been given ample time to conduct fresh elections after it had violated several procedures during the last election in May.
“We cannot be issuing reminders to the MMA. We deferred their deregistration by six months and they should have rectified all wrongdoings committed during the last election,” he told The Star.
MMA president Dr Mary Cardosa had said the association was only told to abide by provisions in the Societies Act as well as its own laws in future to prevent the body from being struck off. She claimed that although the MMA had made some technical errors, this did not mean it had to declare the last election null and void.
It is understood that an MMA delegation led by Dr Cardosa met Deputy Home Minister Datuk Lee Chee Leong to discuss the issue last week.
The ROS deregistered the MMA on Nov 16 after it failed to give a proper explanation to several charges of irregularities during the May election.
The deregistration was deferred by six months after the MMA appealed.
Abdul Rahman said it was to be “understood” that the MMA must go back to its members for a fresh election for contravening election rules.

I am not sure why this appears in the press when if you go to the MMA website, you’ll see an announcment:

The MMA is happy to announce that we have received written clarification (attached here) from the Registrar of Societies regarding the interpretation of the decision of the Minister of Home Affairs in response to MMA’s appeal against the cancellation of MMA’s registration on 15th November 2011.
The ROS has confirmed that the current Council and Executive Committee will continue to function until the Annual General Meeting, scheduled to be held in May 2012, when another election will be carried out, in full compliance with the provisions under the MMA constitution and the Societies Act 1966.
Dr Mary Suma Cardosa
President MMA
21st December 2011

So all is well, or is it otherwise? If you read the letter from the ROS it does say the ROS requires the MMA to hold fresh elections within 6 months but I am not clear if it is 6 months from the date of the ROS letter (19 December 2011) or some earlier unspecified date (perhaps the appeal from the original threat of deregistration? If the latter is the case, then mid-May 2012 is cutting it very close to 6 months from mid-November 2011)
For the MMA’s sake I hope the scheduled May 2012 AGM and fresh elections are within the specified “6 month reprieve”.

from the Malaysian Medical Resources

MMA courting deregistration

from the Malaysian Medical Resources

How crowd sourcing can help save lives

from the Malaysian Medical Resources

Site optimisation and tips

1 Care for 1 Malaysia sounds like a very good slogan but behind this impressive slogan and all the controversies, rhetoric, claims and counter claims lies a very big and fundamental question of where is the funding of such a massive overhaul of our healthcare system going to come from?

We know that the basic principle of part-government and part-public funding underlies this concept and the reason behind this shift of funding policy is the ever-escalating health costs which the government cannot continue to provide funding for indefinitely.

Let me quote two very important facts.

1) According to the 2012 Budget that was announced by our prime minister, the allocation for health totals RM1.8 billion, which is equivalent to 3.7 per cent of the total budget. There were other ministries that have higher budget, notable ones being the Ministry of Defence.

The World Health Organisation recommends that at least five to six per cent of a total budget be allocated to health. Many other countries allocate up to seven to eight per cent. Malaysia is way below that mark.

2) A recent quote by the Minister in the Prime Minister’s Department, Datuk Seri Idris Jala, as published in The Star on February 19 is as follows “I am of the view that we must introduce the GST. We have 28 million people but only one million are paying tax.”

My questions to the ruling government are as follows.

1) Since Malaysia’s health allocation is still way below the WHO recommendations and that many other countries have much higher contributions, is it justifiable at this point to claim that we cannot continue to fund our healthcare system when many other countries are funding theirs at a much higher rate?

2) Even if this inability to fund the healthcare system is inevitable, wouldn’t it be prudent to cut costs first by running the system more efficiently, multitasking staff rather than having one staff for each and every task, preventing leakages and unnecessary wastage of medicine, resources etc and only finally if all this is done, then sources of other funding such as from the public are considered as any basic financial course will have taught us.

3) If only one million Malaysians are paying tax, how is it mathematically possible for the one million to support the healthcare bill of 28 million? How can the other 27 million contribute to the fund, when they are not even eligible to pay tax? Even if they are supposed to contribute to the fund, how much as total percentage will come from the 27 million? Inevitably, the government’s bill will still be substantially higher than what it is today considering that a big portion of this general fund will obviously go to the third party who will be tasked with running this massive system.

These are fundamental questions that need to be answered before such a scheme can even be considered in finer detail.

Very good questions indeed. The Health Minister and indeed the Public keep going on about the quantum of healthcare tax but it’s not the main issue. The issues are:
- the stagnant Government spending in the public healthcare sector (by %GDP) since 2004
- the underspending by the Government on public healthcare by WHO recommendations, the healthcare budget being miniscule compared to others like the PM’s Department
- the financial leakages and wastage in Government spending including the financial mismanagement seen in public healthcare expenditure (just refer to the Auditor-General’s report)
- the huge number of working citizens who are not paying taxes – truly not qualified or tax evaders?

Fix these first and there may not be a need to radically change the current healthcare system.

from the Malaysian Medical Resources

Dear Health Minister and the MOH: Show us the math

Looks like the last one, which was based on a report in the Star back in December 2010, is nothing but a lie.
Now I’ve just heard from a fellow Dobber in the Doctor’s only forum Dobbs:

Another new medical school has been approved – University College Shahputra (UCSA) in Kuantan, Pahang

The UCSA website lists the Faculty of Medicine as “coming soon” – how soon one can only guess.
Malaysia will soon be known for it’s medical degree mills. What of the quality of doctors these mills churn out? The so-called moratorium was only lip-service. The only positive side to the huge number of medical graduates is that the end result will be HOs (and eventually MOs) being offered only contracts instead of permanent jobs when they start off. This is the easier way to weed out the bad ones since it’s pretty hard to sack them from service once they are “in the system”.
Too bad even though their were numerous warnings about the Unhealthy growth of medical schools, the powers-that-be were not listening.

from the Malaysian Medical Resources

Yet another medical school approved!

PETALING JAYA: Former premier, Dr Mahathir Mohamad’s, defence of the proposed 1Care healthcare system as a means to counter the rising cost of healthcare has come as no surprise to the Citizens Healthcare Coalition (CHC).
Mahathir had said that the government could no longer support the country’s current healthcare costs alone and that the need for contribution towards healthcare could be valid.
But CHC representative, Dr T Jayabalan, said that Mahathir’s comments were to be expected as he was the “architect of healthcare reforms” in 1983.
“By 1994 the pharmaceutical services were privatised, but with the government being a stakeholder,” he said in a statement.
“With the privatisation came a 15-year monopoly for pharmaceutical supplies to the government health facilities by Pharmaniaga. It was a closed tender and this disallowed competition.”
An online news report had earlier noted that “1Care aims to place private medicine under government control, a step further than Dr Mahathir Mohamad’s sweeping health privatisation upheavals in the 1980s that delivered a hefty windfall to Umno’s partners, including Dr Mahathir’s son Mokhzani.”
Jayabalan stated that privatisation had caused the prices of generics to sky-rocket, subsequently denying the underprivileged and the less fortunate access to medicines.
He added that the privatisation process had also involved co-payment by the patient wherein the patient had to purchase essential drugs and devices that were expensive and not in the inventory.
“A study by researchers from Universiti Sains Malaysia (USM) in 2008 on pre and post privatisation prices of drugs showed a price increase of 10.42% from 1995-1996 compared to the pre-privatisation price,” Jayabalan quoted.
“There was also a massive price increase of 64.04% in the prices of drugs from 2001-2003. The study also indicated that drug prices don’t match the inflation rate or the Consumer Price Index (CPI).”

Poor can’t afford IJN
Jayabalan used the National Heart Institute (IJN) as an example, saying that its corporatisation made it the costliest specialists centres in the country where the poor wait for about two years for treatment while the rich are allowed to schedule overnight surgeries.
“This is what privatisation does and we can credit Mahathir for this dismal state of affairs,” he said.
“It is a warped argument to suggest that rising costs of pharmaceuticals has made healthcare unsustainable since the government only spent 2% of its annual gross domestic product (GDP) on healthcare over the last 13 years.”
Jayabalan called the privatisation of healthcare a “great disservice to the people” as up to 70% of Malaysians are dependent on public facilities.
“Healthcare is a public good and should not be made to fit into a market system,” he asserted.
1Care has sparked outrage from industry practitioners and consumer associations who claim that wage-earners would be forced to contribute 10% of their income to a government-run insurance scheme.
The new scheme however is said to provide limited benefits and force the public to fork out more money for basic healthcare.

To my mind, just the administrative costs of 1Care alone (projected to be perhaps as much as 20% of the estimated 40 billion ringgit healthcare fund) will inflate healthcare expenditure. One wonders what the CEO salary of the administrative body will be! If you have separation of dispensing and consultation, the cost of GP visits will go up. If you mandate the use of specific software and hardware for use by 1Care practitioners, then the additional expenditure (plus perhaps any compulsory CME, certification etc.) will be passed on to the tax and SHI paying consumer.
So will 1Care curb healthcare expenses? I sincerely doubt it. Like any other “privatisation” exercise in the healthcare sector implemented by the current administration so far, e.g. Fomema and Pharmaniaga, we have only seen increased costs, not cost saving.

from the Malaysian Medical Resources

Will 1Care increase healthcare expenditure rather than curb it?

The quick action and exemplary dedication of the doctors from Gleneagles Hospital Jalan Ampang, led to the severed hand being reattached to its owner within 10 hours of the violent crime which occurred outside a restaurant in Jalan Ampang about 9pm of Feb 3.
The victim, who wished to be identified only as Poon, 47, had been attacked by three robbers including a woman, who chopped off his left hand before relieving him of his handphone and money he had withdrawn from an ATM shortly before driving to meet friends at the restaurant.
A shocked Poon, on realising his hand had been severed, drove himself to seek treatment at the Gleneagles Hospital, less than 2km away.
Doctors said when Poon reached the emergency department at around 9.30pm, he was about to collapse due to loss of blood.
“His car was smeared with blood. His blood pressure was dropping and the emergency doctor was quick to calm him down and treat him,” Gleneagles Hospital consultant trauma and hand microsurgeon Dr Palani Ramasamy told theSun.
Palani said the hospital immediately reported the incident to the police and sought their help to locate the severed hand for reattachment.
“When we did not hear from the police even 30 minutes after seeking their help, our medical team decided that we should go and look for the hand ourselves as the crime scene was not far from the hospital,” he said.
“We were racing against the clock, because the faster you reattach it, the better it would be. There is a chance for limbs to be successfully reattached within six hours to 12 hours of being severed, depending on whether or not it is kept in ice,” he said.
“We knew we could save his hand if we could find it in time,” he said, adding that the team found the severed member about 100m away from the place Poon was attacked, after searching the area around the restaurant for about a half hour.
Then came eight hours of surgery by Palani and his team through the night, beginning from 11.30pm to 7.30am the next day.
“We had to shorten the bone a little and stitch three major nerves, three major arteries, three veins, and about 30 muscles and tendons,” said Palani, adding that Poon was lucky that everything worked out well.
He said after the surgery, Poon was beginning to be able to move his hand and feel some sensation.

Kudos to the Gleneagles team for going that extra mile to look for the severed limb. How many other hospitals (private and public) would have done the same? The sad thing too is to read of the allegedly slow response by the Police and that violent crime is still prevalent in the streets of Kuala Lumpur.

from the Malaysian Medical Resources

Going that extra mile

A whois search shows that the administrative contact for medicalert.com.my is:

Well-Oil sdn bhd
No 5 Jalan Laksamana 12/1
Seksyen 12
40100 Shah Alam
Selangor
Malaysia
khairianuar@gmail.com
(Tel) 012-9262711

Pretty strange administrative contact for MedicAlert Foundation Malaysia – is this an oil related company? I suspect the domain name may not have been renewed or there is some other account issue with the hosting Mesra.net. MedicAlert is a pretty important service for as an International organisation, it is supposed to provide “dependable emergency medical information and identification service” in the form of live 24/7 emergency support to healthcare services in the event of well, emergencies. The website being down is probably not reflective of the service downtime which emergency healthcare staff access by a phone call to the MedicAlert hotline, right? So what is the hotline number then if we can’t locate it on the web?
The only other record of Yayasan MedicAlert is the old application form still hosted online in UMMC (PDF) and the 24 hour hotline number there is 603-79575111. A call there this morning reached a nurse who said that the number was no longer in use. She then directed me to the UMMC main operator who gave me another number which is 603-77820515. At 6:25 am February 17, 2012, there was no answer when I tried calling this line, so either this is not the correct 24/7 Hotline number or the Yayasan MedicAlert Foundation does not have a 24/7 Hotline number service which is quite pointless.

As the situation stands, a Healthcare provider in Malaysia cannot sensibly advise his or her patients with a serious medical condition or on important drugs like anticoagulants to register with Yayasan MedicAlert Malaysia if their website does not work and if their Hotline is not working. I am not impressed at all. Do contact us if their website finally comes online again (if at all)

from the Malaysian Medical Resources

Yayasan MedicAlert Malaysia – where are you?

from the Malaysian Medical Resources

Registration for comments

Another HO quits, and publicly blogs about it too. See:

A Letter to the DG where he lists his grouses, and
Life After Medicine where he discusses career options.

It’s always a pity when you see HOs quit at such an early stage of their career. Some of the reasons posted were symptomatic of someone not quite prepared to be a Scut Monkey (aka Gofer or Runner) which is part and parcel of Housemanship training. This ex-HO mentioned:

There is something that I’m rather confused. According to the job description of a houseman given by SPA, we are actually spending more time doing tasks which is out of the description. For example :
1. Sending and tracing blood investigation
2. Tracing files in the record department for the registrar’s CME case presentation
3. Professional telephone operator – informing patient regarding op date, cancelled op, rearrange appointment, etc
4. Data Collectors – doing all data collection, not knowing the end results, whilst the boss gets to present and publish

As a colleague of mine pointed out:

I think his comments about the extra clerical work is not fair. Tracing results, calling up patients are extremely important for patient care. These things, if delegated to someone else may not get the results. I trace results and call my patients regularly. tracing and recording data, when used for publication is acknowledged, sometimes as co authors. Before one does this, one discusses what “rewards” are in store. When you feel things are not fair, there must be an outlet to voice this. Housemanship is part of being a doctor. If all housemen feel it was bad, then change it when you become someone senior. If every one changes just ONE bad thing, things can only improve. Leaving the service does not change the system.

Even the act of running to Radiology to push for early appointments is not a menial task but it educates the Houseman on how to present cases, pick out the importance of doing that test and dealing with senior colleagues. Tracing results, recording data, filling forms etc. – hello Loner, we do this all the time and after nearly 30 years I am still doing it.
Call me harsh but I think some youngsters think the world owes them a living and that their jobs must be lined with soft cushions. If you fail to see why something benefits you it could well be you don’t have the insight but if you did not discuss or engage your seniors and just Quit your job then you will be forever be labelled a Quitter. If you blog about it openly, in my opinion that’s a pretty stupid thing to do so as well, as future employers will have insight into you and whining about why you Quit isn’t going to score you brownie points with any future employer.

Related posts:
Feedback: a HO wants to quit
Housemanship is good training

from the Malaysian Medical Resources

Another House Officer quits

The Citizens’ Healthcare Coalition (CHC) claimed that all current general practitioners would be screened via special authority called the National Health Financing Authority (NHFA), and that the new accreditation would have to go through the Malaysian Society for Quality Health (MSQH).
“GPs have to accredited to be become a gatekeeper. Anyone who wants to be in the primary healthcare system, the criteria is that they be accredited.
“It’s double licensing,” CHC spokesman Dr T. Jayabalan told reporters at the sidelines of a 1 Care forum today.
He also claimed that each general practitioner would have to come up with RM10,000 to pay for the certificate of accreditation.
Jayabalan was one of three speakers at forum on the proposed 1 Care organised by CHC. Also speaking were Dr Ng Swee Choon of the Federation of Private Medical Practitioners’ Association of Malaysia (FPMPAM) and Selangor executive councillor Dr Xavier Jeyakumar.

So life as a GP in the near future won’t be easy and patients may also be inconvenienced. There’s to be separation of dispensing – which means GPs cannot dispense medicines and patients will have to get from Pharmacies. Now there’s also talk of “accreditation as a 1Care doctor costing RM10,000 in fees”, compulsory CME etc. Some of this is good such as CME but the question remains who runs and finances it?
If there is restriction on computers, software and things to go with practicing, then it may be prone to abuse with contracts going to “favoured” companies related to the powers-that-be.
There needs to be greater transparency and constant engagement with all parties. Secrecy and defensive PR will only make the Rakyat more suspicious.

from the Malaysian Medical Resources

Group claims GPs will need ‘double-licensing’ under 1 Care

from the Malaysian Medical Resources

Updating theme