Friday, November 27, 2009

1Malaysia Clinics and AFPM: Dato Dr DM Thuraiappah's Comments

Dato Dr DM Thuraiappah's Comments 27 Nov 2009

Dear Dr David Quek,

I have read with interest the many replies to Dr Xavier’s mail with interest. I feel there has been some misunderstanding of Dr Xavier’s letter.

Firstly the concept of ‘One Malaysia Clinics’ was the Prime Minister’s proposal that twenty odd clinics be opened to be manned by HA’s or equivalent to manage simple outpatient illnesses with standard prescriptions by a visiting medical officer and these clinics are to be located in heavily populated areas in Malaysia with budget of about RM200,000.00 and to be opened by January, 2010. This is indeed a tall order and whether this will be realised is questionable.  This idea is good for patients who currently use the public primary care system.    

Secondly, the proposal by the MOH to enable general practitioners to care for chronic diseases in order to reduce the workload of Kelinik Kesihhatan and public hospital outpatient departments was the point which Dr Xavier was making. For this to happen, to be fair to all concerned, although it will be good for the general practitioner there are several prerequisites to be in place. 

  1. There has to be a referral system in place from the general practitioner to the consultant and returned to the care of the general practitioner. In order for this process to happen, the consultant has to be confident that such care can be continued in the general practitioner set-up. Here, various definitions have to be clear and precise.
  2. That the patients will have to be able to receive the same investigations, procedures and prescriptions from the general practitioner as they receive from the public sector. How the mechanism for payment for such services rendered will take place will only take effect when the national health financing mechanism is in place or any other mode of payments is established.
  3. Currently there is concern whether the investigations, procedures or prescriptions can be uniform among all general practitioners. The concern has arisen that some clinics may lack some essential items to carry out acceptable methods of care.
  4. The nature of general practice is family care but some clinics may not have some essential equipment and do not practice a variety of services such as pre-employment medical examinations, wellness services, counselling services,  surgical or gynaecological care or procedures. The common chronic diseases which need to be looked at are hypertension, coronary artery disease, metabolic syndrome, screening for cervical cancer, asthma ad mental health.  
  5. It is therefore in our interest that these disparities must be discussed among ourselves and we must endeavour to provide the expectations of the public sector so that we can be united by auditing our selves by our own profession.
  6. CME may not be sufficient because of its opportunistic in nature. One must look at structured CPD be in place so that doctors can learn skills to equip them in accessible, continuous and comprehensive family oriented care.  
  7. The Director General of Health has repeatedly announced at various meetings that general practitioners should be trained to a level of primary care physician, and I think there is a message in his frequent announcements that it may be a requirement in the future.
I hope that Dr Xavier’s mail be taken in the spirit it was written.

Yours truly,

D. M. Thuraiappah, Council Chairman, AFPM        

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