Wednesday, June 26, 2013

Letter to Dr Steven Chow

Letter to Dr Steven Chow
Dear Fellow Doctors,

Re: Current Practice Issues

I have been reading the track of discussion regarding the above and my comments are as follows:
1: PHFSA & Regulations 
The Federation has been in the forefront objecting to and forewarning of the adverse implications the PHFSA and Regulations. When it was enforced on 24.4.2006 the justification by the Minister was that this law was meant to ”protect patients and the public” and “ensure that the medical care of patients should rest solely in the hands of registered medical practitioners”.

The law was meant to regulate the “business of medicine” and “empower the MOH to take action on unqualified healthcare practitioners like quacks etc etc”. It is indeed quite sad to note that in practice, the law has fallen short in these important objectives. I was shocked to hear this publicly admitted by the MOH recently .I am of the opinion that the Minister was wrongly advised.
Quacks, charlatans and their like continue to rampage through the nation. Patients are ripped off or just sent to RIP. Businessmen and big businesses now call the shots in almost all aspects of healthcare including dictating what doctors can and cannot do for their patients i.e: the business of medicine continues as usual. The law and its regulations continue to be seen to unnecessarily micromanage the operations of private clinics as if bona fide doctors are a whole bunch of unscrupulous businessmen/women.
Over the past 6 years, the Federation, MMA and other bodies have sat down in countless meetings with the MOH to draft and finalize amendments to the Regulations so as to amend the many “criminalizing” provisions. Up to the last meeting in 2011, we were told that these amendments would be forwarded to the AG Chambers before sending to the Cabinet for approval. We have worked on this past the term of office of two previous Ministers and two previous DGs of Health . We are still awaiting final news.
At the Dialogue with the new Minister of Health 3 weeks ago, the Federation has submitted a 15-point Memorandum which among other things included the status of amendments to PHFSA Regulations. Copies of the Memorandum were made available to the MPCN who were invited by the Federation to be part of our team. It would be good to share this among your members so as to keep them fully inform of the development.
Thus it is quite redundant for MPCN to re-invent the wheel on this matter. The Federation has in hand all the relevant documents and minutes of all the said meetings. The Federation will definitely invite your key office bearers to be part of our team when we next meet the Minister on this issue.
2: GP XR – Radiographer Issue
The Federation has already submitted an appeal to the MOH on this and has met the MOH recently to request for this requirement to be waived. At the same meeting we also requested that the date of implementation be postponed till the issue is resolved. If improving standards was an issue, we also offered to run certifiable CME/CPD radiography courses together with MOG for our doctors and their staff as well. All our requests were denied. It is clear that the decision was already cast in stone. We were informed that there are now 2000 unemployed radiographers in the country. This a strong lobbying force indeed. Beware, next you will get locally trained nurses and pharmacists etc doing likewise.
The Federation’s stand is clear. If radiographers are required by regulation then the MOH should immediately approve the higher fees for GP XRs accordingly. In the event that this is not forthcoming, then it is economically not viable for the private clinics to provide this service. That way the GPs need not carry the economic loss and the unemployed radiographers can seek employment elsewhere. Well trained and properly qualified radiographers will have no problem finding jobs. The private sector should not be forced to employ over-produced, poorly trained allied healthcare personnel.
3: Clinic Signboard
To my knowledge, I do not think this particular incident was instigated by any particular “skin doctor” or dermatologist. I do know that more than 20 years ago, the PDM had insisted that only duly registered dermatologists be allowed to advertise in their signboards stating “Pakar Kulit” or “Skin Clinics/Klinik Kulit”. As for creams, their only issue was pharmacists dispensing potent Class A&B topical steroid without prescription. There was no lobby to limit any doctor, GP or otherwise, prescribing and dispensing any cream.
I do know that the MMC had in the past, rather simple guidelines regarding signboards and advertisements of clinics. Bahagian Amalan, MOH themselves may have their own new operational guidelines empowered by the PHFSA & Regulations. I believe that the proposed regulations for the new Medical Act 2012 (presently still under OSA) will also have clear-cut provisions for the National Specialist Register. The specific paragraph in the MOH letter to the doctor forewarns me that there exists already another new set of rules to be followed. I personally am unaware what exactly they are. Sadly this is not the end but just the beginning.
If you look carefully in the PHFSA, the Minister has the power to virtually prescribe anything and everything on how our clinics can and should be run (i.e. micro-managed).They even tell you where you should place the toilet paper!!!! Such is the pathetic state of affairs for all private practice both old and new. Sadly at that time, we were the ONLY dissenting voice. On that fateful morning of 24.4.2006 many praised and blessed the PHFSA and its Regulations. It is now all ‘fiat acompli’. Doctors will now have to find ways to navigate around the many landmines and trap doors imposed by this Act.
Now you can appreciate why the Federation spoke so strongly against the PHFSA when it was launched. Our panel of lawyers reviewed the Act and its Regulations and found that individual private medical practice will be untenable if you are confronted with a “Little Napoleon” who insists that each and every letter of the law is complied with. There is a paper in hand that clearly states that the PHFSA shall be implemented to the letter when the need arises for the future healthcare landscape.
In practice, this usually starts with a complaint made to the MOH. It can be from a patient, a business rival (not necessarily a “skin doctor”) or just anyone wanting to make life difficult for the doctor. The nightmare then begins and will not end until the doctor complies. Our lawyer tells us that it will be just impossible to challenge the administration of this law in court. The entire law and its regulations have only prescriptive and punitive provisions. There is NO compassionate provision for the doctor. Sad, sad…we were taught and still think of medicine as a noble profession.

We has asked for and it was agreed that there will be a “Good Samaritan” clause for those providing basic emergency medical care that was required in the law .Even this is still pending.
Best wishes and may God Bless all the good doctors.
Steven Chow
President, FPMPAM

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