Health Care in Malaysia: A New Era - A New Phase

Today, 18th May 2008, marks my foray into the world wide web as a blogger.

I had been fighting shy of the irresistible pull of weblogging, ever since I first was enthralled with the uncertain promises of the information interconnectivity in 1996. I had misgivings as to the alternative audience, the readers and yes, even the enthusiasms of the cyber communities and 'nerdy' neophytes.

Then, we were all patiently content with the snail's pace of web page connectivity and downloads, but we could link up with like-minded friends as never before, at the touch of the mouse. Some enthusiasts have gone on to personalise their own webpages; alas, most of these have now demised from neglect, falling attention and disuse, or simply from growing up and out... like a fading romance...

Although I was then as of now, always been interested in writing and reading, I was still enamoured with and tethered to 'hard copies' and the 'older' medium of the printed word. That was a long decade of techno-revolution ago.

Since then however, we have been hapless witnesses scurrying to keep pace with the exponential torrent of changes that had swept the entire world. The terabytes of information and trillions of web-pages and importantly the rise of targetted sociocultural and political blogging testify to the unprecedented ubiquity of the information largesse and freedom, which has and continue to penetrate even the most hermetically-sealed and totalitarian dictatorships of nations and the most closeted or parochial of minds.

Ordinary folks and masses are now reachable and have access to hitherto unknown or forbidden information and knowledge so denied from yesteryears of inequitable access, censorship and stultifying propaganda.

The unfettered ingenuity of the internet users has been blamed for excesses and exposes which had been credited to have toppled governments, political aspirants and the like.

Our own unexpected "political tsunami" at the just concluded Malaysian elections 2008 in March, appears to have bolstered the legitimacy and the shocking power of the undercurrents of opinions, bred from these unlocked and unleashed freedom to think and to share.

While many of us welcome this change and paradigm-shifting era, there are others who have reasons to fear these unrecognisable sociocultural and political landscapes.

Like it or not, these are here to stay and perhaps even to expand and further encapsulate our lives, where discourses (whether fact, rumour or fiction) thrives with the anarchic legitimacy of selective "truths" and possess the unquenchable potency of influence unless quickly countered with irrefutable proofs or reasoning to the contrary.

This is the new era of openness, freedom of expression, and quick and ready opinions--one where we have to engage positively if we are to have any modicum of legitimacy or representative authority--and engage we must, lest we wish to fall further into irrelevance and become marginal players.

It is in this context that I feel the medical profession must address this era, this new phase of engagement with our like-minded friends, fellow professionals, and especially so with the public--our patients.

Health and medical related issues are very immediate and often life-changing concerns for many of us, and as doctors in this information age, we must be ready to meet and influence the challenges which surely will surface, as these impinge upon our ambit and terrain.

Our health authorities are also caught in this changing web of uncommon challenges, and although entire rafts of regulations (The Private Health Care Facilities and Services Regulations, PHFSR 2006) have now been introduced, their enactments have sorely tested the resolve of many doctors caught in the crossfire of untested waters and increasingly tightening restrictions.

Many doctors are furious and blame their professional bodies (especially the Malaysian Medical Association, MMA) for neglect and inaction and for being too pusillanimous when dealing with these issues as dictated by the authorities. They complain that these new regulations have emasculated their rights unfairly.

However, many physicians as usual, choose to remain armchair critics, angry and angst-driven, but often languishing in self-destruct mode of impotency. Silent majorities of doctors must rise up to the challenge, and make their concerns better known and recognised--they must learn to speak up, and the e-medium is one possible forum to engage with. I encourage all to try this, so that we can together make more responsible noises and take more responsive steps.

But for now, doctors must brace for more to come. The as-yet unannounced and secretive National Health Financing Act has been tossed about for several years now, with the initial plan to offer a wholly-restructured single-payer health care system. We understand that quite lot of water has flowed under the bridge and that many modifications have been proposed which would make this schema difficult to fathom, much less to recognise.

Whatever the final form that this takes, I believe doctors and the public must be fully informed, and everyone with a legitimate interest must be given their full say and hearing. This would surely be an earthshaking and momentous event, likely to be at par with the 1948 Bevan report and founding of the British NHS (National Health Service), and we should not be left in the dark.

Lately too, to make matters worse, third party payers such as managed care organisations (MCOs) are increasingly challenging the patient-doctor relationship by interjecting a middleman 'gatekeeper' mechanism. Doctors now find themselves being questioned as to which tests or therapies they can or cannot do, their authority eroding through threats of no-reimbursement--this stems from the delay-or-deny mechanisms inherent among profit-oriented insurance companies.

As yet unregulated, many MCOs are relentlessly working at squeezing volume discounts from most private hospitals, and are lobbying to further lower physician fees (notwithstanding that the PHFSR 2006 has already capped the physician fees!), much to the chagrin of the beleaguered doctors.

Community pharmacists too have been pushing at separating prescribing from dispensing practices of medical doctors--while at the same time paying lip service to doctor concerns that ethical dispensing means better and more prudent professional pharmaceutical responsibilities.

Doctors rightfully demand that pharmacists should be better regulated from stepping beyond their bounds and expertise. Doctors insist that pharmacists exercise their duties with careful and ethical non-encroachment into the legitimate diagnostic or therapeutic rights of fully-trained medical doctors. Doctors insist that prescriptions should be honoured and that pharmacists refrain from illegal prescribing of drugs for which they have no right to do so.

The Malaysian Pharmaceutical Society must exert its full authority to rein in their errant members, and only then can we debate the separation of the doctors duties vis-a-vis dispensing or not. We urge the Ministry of Health enforcement officers to rigorously ensure and prosecute illegal dispensing as demanded of the Medical Act. This debate promises to escalate in the coming months and years...

Continuing professional development (CPD) and their role in the service promotion of the public-sector physicians, and especially CPD with the coming revalidation exercises associated with the mandatory renewal of practicing licenses, are other areas which may need comment, periodically.

The new Medical Act is also expected to be finalised by end of 2008, and its final form remains within the purview of the de facto Law Ministry (PUU). Other unresolved professional issues such as medical examinations for heavy vehicle or public-transport drivers; training and possible licensure of allied health workers, nursing aides, medical technologists remain on the drawing board; and emergency medical care arrangements-minimal standards as well as good Samaritan laws have yet to be enacted; etc.

So, there is really a whole lot of issues to consider from time to time. And perhaps this blog would be the most appropriate medium of engagement that can help reach the medical profession with greater ease and timeliness. I will also use this blog to help members of the medical profession and the interested public to comment and bring up concerns and issues related to health care and medical practice.

Together I believe this can be the way forward towards a more responsible, more enlightened and more accessible health service for Malaysians, one that is patient-centred and doctor-engaged, and approached with the greatest of transparency and good governance.

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