Minister's Dialogue with Private Medical Doctors help clear the air...

Thursday's meeting (28 August 2009) with the Minister of Health, Dato' Sri Liow Tiong Lai and the Director General of Health Tan Sri Mohd Ismail Merican, was certainly a high point in timely dialogue between two seemingly disparate and separate sectors of the health service for Malaysia, particularly in the context of the current outbreak of the A(H1N1) influenza.

Among the many doctors (>60) who attended were several enthusiastic representatives from the MMA, PPSMMA, FPMPAM, PCDOM, APHM, AFPM, as well as several other interested medical practitioners from the Klang Valley, and even as far away as from Penang. It underscores the importance of such a meeting to help demystify the approach to the swine flu which has taken Malaysia by storm.

More importantly, the meeting was rather civil and accommodating with both sides cautiously trying to understand some of the undercurrents of unease which has permeated the relationship, especially whenever some untoward event related to the H1N1 occurs. The most recent recriminations took place when a woman teacher died after some supposedly possible delay in her treatment, when she had come down with the flu.

The difficulty in obtaining the antiviral drug (oseltamivir) was once again highlighted, and the restrictions in its use, were exposed, although in theory, the algorithm for managing the flu patient had been disseminated. Clinical judgement regarding moderate or severe symptoms and signs are not as clearcut as many would like to have believed.

The epidemiology of the Flu thus far was given by Dato' Dr Abdul Hassan, Director of Communicable Diseases, MOH. Dr Chris Lee gave a quick but comprehensive summary of the management guidelines as agreed to by the MOH and its task force and experts.

Clarifications were sought, with the plea by most private medical practitioners to further simplify the management of referring patients with suspected more serious complications to hospital sooner. Examples of patients being given the round around when referred for further action at various hospitals were given, which demonstrated that on the ground, practical issues still dominate the actual situation about whether the individual patient gets the treatment without too much delay. Some bureaucratic hiccups still take place, which may make the patient and doctor experiences very frustrating.

There was a further plea by the FPMPAM president, that there should not be too much finger-pointing at the private sector doctors, every time something bad or untoward occurs, because this is felt to undermine the credibility and morale of private doctors, who very often are not really to blame, and where circumstances and actual issues are the bugbears which create an environment of miscommunication and confusion.

However, in the light of the wide community spread of this H1N1 flu, there was a pledge on both sides to work harder to address these problematic areas, and ensure smoother and perhaps more constructive management of very ill patients.

Because, the MOH did not have a system in place to monitor or survey the usual flu like illness, in the country, it was felt that this makes it very hard to know if this current flu outbreak was really out of the ordinary, or perhaps just a little more virulent for some. Thus, it was agreed that GPs will assist the MOH by completing daily update notifications of all ILI, to help us maintain a closer surveillance and scrutiny of the situation on the ground.

Closer collaboration with the district MOH offices was also urged, with the plea for the MOH to circulate to all neighboring doctors any current or changed protocols so that GPs can be alerted to these more timely and accurately--the district MOH offices were felt to be the best community area to disseminate these updates.

Current changes will be notified at the MOH special H1N1 wbsite, and all doctors are urged to keep themselves apprised of changes or modifications regularly.

It was further announced that a National A(H1N1) Pandemic Influenza Conference 2009 would be organised very soon on 12 September 2009 at the Renaissance Hotel KL. This will be jointly organised by the MMA, the MOH and FPMPAM.