tag:blogger.com,1999:blog-61588090759429936362024-03-14T13:56:28.749+08:00MyHealthMattersHealth and Medical Professional Issues in MalaysiaDr D Quekhttp://www.blogger.com/profile/02878815376401309022noreply@blogger.comBlogger502125tag:blogger.com,1999:blog-6158809075942993636.post-88063754759739307502014-12-19T17:36:00.004+08:002014-12-19T17:36:51.685+08:00The Star: Confusion over GST and healthcare ..... by Dr Milton Lum<h2>
Confusion over GST and healthcare</h2>
by <a href="http://www.thestar.com.my/Authors?q=Dr+Milton+Lum">dr milton lum</a><br />
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The Doctor Says<input class="tagimaGuid" id="content_1_tagimaGuid" name="content_1$tagimaGuid" type="hidden" value="{BC8E169A-85EA-4431-8A09-7FDDF2FBF167}" /> <br />
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The Star: Sunday December 7, 2014 MYT 12:00:00 AM </div>
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<strong>Our columnist wades into the murky waters of what is exempted from GST and what is not in the private healthcare sector.</strong><br />
<strong></strong><br />
THE private healthcare sector is amorphous with various modes of organisation, ownership and payment by patients. Most interactions between the public and this sector are with clinics and/or hospitals, which is what this article is about. <br />
<br />
Some clinics are stand-alone , while clinics in hospitals may or may not be physically and/or administratively linked to the hospitals themselves. <br />
<br />
Meanwhile, hospitals can be single entities or part of a group, and are owned by limited or public companies.<br />
<br />
Healthcare services are provided in clinics and hospitals, while some general practitioners provide such services at the premises of large organisations.<br />
<br />
Clinics are operated by solo doctors who are general practitioners or specialists, or groups of doctors. <br />
There are also groups of clinics, the owners of which are solo doctors, partners, limited or public companies.<br />
<br />
Specialists practising in hospitals may be self-employed or employed by the hospital. They may be full-time or part-time, i.e. visiting during certain hours to provide services in accordance with a contract.<br />
<br />
Payments made by patients comprise consultation fees; procedure fees, if any; investigations e.g. laboratory and radiology; medicines; and hospital accommodation and services. <br />
<br />
Many general practitioners charge a composite fee for the services provided. <br />
<br />
Specialists, general practitioners and hospitals have separate charges for the various services provided.<br />
<br />
Doctors’ professional fees in clinics and hospitals are regulated by the Private Health Care Facilities and Services Regulations, but private hospitals’ charges are not regulated at all. <br />
<br />
Prime Minister Datuk Seri Najib Tun Razak, in his 2014 Budget speech on Oct 25, 2013, stated that education and health services were to be exempted from the GST (goods and services tax).<br />
<br />
In his budget speech on Oct 10 this year, he stated that: “Transportation services, such as bus, train, LRT, taxi, ferry, boat, highway toll, as well as education and health services are exempted from GST.”<br />
<br />
The Customs department has taken steps to implement the GST. During the past few months, its Guide on Healthcare Services (<em><a href="http://gst.customs.gov.my/en/rg/Pages/rg_ig.aspx">gst.customs.gov.my/en/rg/Pages/rg_ig.aspx</a></em>) has been issued (and reissued) on Oct 29 and Nov 16 and 19.<br />
<br />
The proposed implementation of the policy has been somewhat different from that announced by the <br />
Prime Minister though.<br />
<strong></strong><br />
<strong>Essential medicines</strong><br />
The Health Ministry (MOH) has an essential medicine list, NEML (<em><a href="http://www.pharmacy.gov.my/v2/en/documents/national-essential-medicine-list-neml.html">www.pharmacy.gov.my/v2/en/documents/national-essential-medicine-list-neml.html</a></em>), which is based on the essential medicine lists for adults and children from the World Health Organisation (WHO). <br />
<br />
The WHO’s combined list, after allowing for replications, contains 359 medicines by generic names.<br />
<br />
All medicines registered by the Drug Control Authority are currently exempted from sales tax. <br />
<br />
However, GST will have to be paid for medicines that are not on the Customs essential medicine list when it is implemented on April 1, 2015.<br />
<br />
The Customs department’s gazetted list (<em><a href="http://gst.customs.gov.my/en/rg/Pages/re_odr.aspx">gst.customs.gov.my/en/rg/Pages/re_odr.aspx</a></em>) contains about 2,900 items with 208 medicines. <br />
<br />
This came about because the same medicine is listed under its various doses and manufacturers. For example, paracetamol, a common pain killer, is listed 107 times in the Customs’ list, compared with three times in the MOH’s NEML. <br />
<br />
Other commonly used medicines like metformin, for diabetes; atenolol, for high blood pressure; and doxycycline, an antibiotic, are listed once in the MOH’s NEML, but 22, 19 and 19 times respectively in the Customs’ list.<br />
<br />
This means that the Customs gazette list is markedly shorter compared to the MOH and WHO essential medicine lists.<br />
<br />
Patients will be additionally burdened as they have to pay more for many essential medicines for common conditions like infections, high blood pressure, diabetes and pain. <br />
<br />
The extra price will be due to the GST itself, as well as the cost of administering the GST.<br />
<br />
This will lead to dissatisfied patients; decreased productivity; increased morbidity and mortality arising from the use of, and change to, different medicines, or patients foregoing some medicines due to increased prices; and increased workload at public clinics and hospitals.<br />
<strong></strong><br />
<strong>Hospital services</strong><br />
The Customs guideline states that GST is exempted only for services provided by doctors employed by private hospitals. <br />
<br />
It also states that the professional fees, clinic rentals, etc, of part-time specialists in private hospitals are subject to GST. <br />
<br />
The vast majority of doctors in hospitals, especially the specialists, are not employed by the hospitals and provide healthcare on contract. Therefore, their consultation and procedural – including surgical – fees would be subject to GST. <br />
<br />
The Customs guideline states that the following are also subject to GST:<br />
<ul>
<li>Rental of operation theatre and medical equipment</li>
<li>Sale of medical aids like crutches, wheelchairs, artificial limbs, hearing aids, etc</li>
<li>Consumable medical products </li>
<li>Ambulance services</li>
<li>Management services</li>
<li>Medical opinions sought from foreign specialists </li>
<li>Traditional and complementary medicine services</li>
</ul>
<br />
“Acquisition of goods by private healthcare facility in terms of machinery, equipment and medicines (which are not zero-rated) will be subject to GST” with exceptions for certain medical equipment approved by the Customs director-general. The Customs guideline does not state the process.<br />
<br />
Hospital bills are paid either out-of-pocket or by employers or third parties, i.e. insurance and managed care companies. <br />
<br />
Payments by third parties involve deductions for processing and management fees, before payment is made to the hospital, and subsequently, the doctors. The processing and management fees could be subject to GST. <br />
<br />
Add the various exempt, zero-rated or standard GST rates to the amorphous private healthcare sector, and the inevitable result will be various permutations of complex scenarios. <br />
<br />
The view that those who access private healthcare can afford it, and hence, should pay GST is at best, an inaccurate perception.<br />
<br />
Many seek private healthcare because the public sector is unable to cope with the demand, and this is reflected in its long queues and waiting lists for procedures, as well as short consultation times. <br />
<br />
Delays in treatment and non-treatment of illness results in, among other consequences, decreased productivity.<br />
<br />
In its present form, GST will impose additional financial and administrative burdens on healthcare providers, patients and payers. <br />
<br />
The above complex scenarios can only lead to multiplier effects with patients having to pay more for the same service when GST is implemented. <br />
<br />
Health, like education, is a public good. No one chooses to be sick. <br />
<br />
This alone makes a strong case for all healthcare goods and services to be GST-exempted or zero-rated.<br />
<br />
<br />
■ <em>Dr Milton Lum is a board member of Medical Defence Malaysia. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organization the writer is associated with.</em></div>
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Dr D Quekhttp://www.blogger.com/profile/02878815376401309022noreply@blogger.com0tag:blogger.com,1999:blog-6158809075942993636.post-86434317602425648522014-10-16T06:55:00.002+08:002014-10-16T06:55:59.921+08:00MedPage: Ebola and Hospitals: How Great Is the Threat?<header><hgroup><h1>
Ebola and Hospitals: How Great Is the Threat?</h1>
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<span style="color: #666666;">Published: Oct 15, 2014</span></div>
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By MedPage Today Staff </div>
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</aside>News
that a second Texas Health Presbyterian Hospital nurse has Ebola --
and that she was already slightly febrile when she boarded a flight
Monday from Cleveland to Dallas -- has heightened anxiety about the
true risk of Ebola in the U.S.<br />
<br />
As events unfold, many healthcare
workers, especially nurses, have expressed concern about their safety
when treating Ebola patients.<br />
<br />
Participants in a webcast sponsored
by National Nurses United vented about their frustrations, concerns, and
fears involving inadequacy of hospitals' response to the Ebola
situation. Nurses from throughout the U.S. told consistent stories of
their hospitals' lack of planning, training/education, and protective
clothing for nurses and other healthcare workers.<br />
<br />
A nurse from
Florida claimed that she was suspended from her job after officials at
her hospital learned she had contacted the CDC to request information
about preparations and precautions for Ebola.<br />
<br />
<strong>The Nurses' Story</strong><br />
Typical of that concern is this statement from Patricia Mungovan, an RN and regular <em>MedPage Today </em>reader who works in Chicago.<br />
<br />
"Today
yet another healthcare worker has been diagnosed. Dr. Tom Frieden has
lost the confidence of the healthcare workers in the country with his
blame the victim statements," Mungovan told <em>MedPage Today. </em><br />
<br />
She
noted that the CDC has now initiated more detailed protocols but
worried that action is coming too late. "But look at all the harm and
ill will his self-serving statements produced. We deserve better in this
country."<br />
<br />
Vernon Dutton, RN, who has 35 years' experience as an
acute care specialty nurse, said issues surrounding Ebola isolation are
symptomatic of a much larger problem that has "been a long time coming."<br />
<br />
The key, according to Dutton, who divides his time between two New Orleans hospitals, is symptomatic of system-wide failure.<br />
<br />
"The
nurses were pressed into taking that patient before they were ready,"
Dutton said. "No hospital is ready for Ebola. There's no continuity of
care.<br />
<br />
"The problem in Texas would have happened anywhere in the
country. Isolation isn't the problem in and of itself. It's the
hospital. [And] there's no standardization in isolation protocol,"
Dutton added.<br />
<br />
In an interview with Brian Short, RN, president and founder of <a href="http://allnurses.com/" target="_blank">allnurses.com,</a>
he said his organization surveyed 3,000 members and 74% said they
didn't feel safe or prepared to deal with a potential Ebola outbreak or
patient, and 73% said their hospital hadn't provided them with training
to handle a patient infected with Ebola.<br />
<br />
Short, who had an allnurses.com public relations person present during his interview with <em>MedPage Today</em>, said the organization conducted the survey before it was known that the first infected healthcare worker was a nurse.<br />
<br />
"I'm
sure that's going to raise the anxiety of the healthcare workers now.
All this level of awareness of the nurses not feeling safe and
prepared," Short said.<br />
<br />
Short said allnurses.com plans a follow-up survey for next week. "It's a great way to get a pulse on what nurses are feeling."<br />
<br />
"The
main thing that we can take away: nurses understand the risks that come
with their job. They're willing to do their job, but they need the
proper equipment and proper training to do the job effectively and
safely," Short added.<br />
<br />
Indeed, the ability to care for an Ebola
patient is far from simple, according to nurses from Emory Hospital,
which was the first U.S. hospital to treat Ebola patients.<br />
<br />
In an article in <a href="http://news.nurse.com/apps/pbcs.dll/article?AID=2014141013015#.VD6xat5yQ05" target="_blank"><em>NURSE.com</em></a>,
Carolyn Hill, MSN, RN-BC, nursing director of the serious communicable
disease unit at Emory, detailed the experience she and 20 of her nurses
shared while treating two U.S. aid workers who were flown to Emory from
Sierra Leone.<br />
<br />
This excerpt from that article stands in stark
contrast to the simple personal protective equipment (PPE) and private
room advice that the CDC has been offering:<br />
<br />
"While treating the
first two patients simultaneously, there were three nurses on duty at
all times wearing PPE -- one in each room with a patient, and one in
the adjoining anteroom. Instead of 12-hour nursing shifts, the team
switched to 8-hour shifts with one break, Hill says. After 4 hours in
one of the three rooms, nurses would doff their PPE, take a shower, and
then break for 30 to 45 minutes while physicians relieved them, Hill
said. Then the nurses returned for the 18-step process of donning the
Tyvek suit -- a 25-minute task that included putting on eye
protection, two pairs of gloves, a plastic apron and protective booties.
Another critical step included checking the gauge for the powered air
purifying respirator, which cleans air before it is inhaled."<br />
<br />
<strong>In the ED</strong><br />
Seth
Trueger, MD, MPH, an emergency medicine physician at the University of
Chicago, put it this way, "Everyone has made the assumption that there
was a protocol violation that comes with the assumption that if you
self-contaminate, you did something wrong. But no matter how good you
are, there's an inherent failure rate."<br />
<br />
Corey Slovis, MD, chairman
of emergency medicine, Vanderbilt Emergency Medicine, voiced what many
have been saying in comments sent to <em>MedPage Today: </em>"I'm
disappointed that the CDC did not get to Dallas quickly, and
disappointed that they are not clear enough on what and how is best to
prevent disease -- including why we are not going to disinfect our
hands like Doctors Without Borders."<br />
<br />
But, Eric J. Adkins, MD, MSc,
medical director of emergency services, Wexner Medical Center at The
Ohio State University, had high praise for the CDC. "In my opinion, the
CDC has been very out in front on this initiative. It appears that they
are doing everything possible to respond appropriately to the Ebola
outbreak," he said.<br />
<br />
Adkins said that, at his hospital, they have
had "dedicated sessions to practice use of PPE. We have worked to secure
adequate supplies of the appropriate equipment and are ensuring it is
readily available in our emergency department. We have recently
performed simulated 'mock' patients with Ebola viral disease to test our
response and have had much success with identifying how we can improve
the readiness of our staff."<br />
<br />
Ednan Bajwa, MD, director of the
infection control unit at Massachusetts General Hospital, noted that
information now being shared by Emory has been very helpful but more
information from Texas Health Presbyterian would be "most informative.
They had the sickest patient. They have not shared their experience."<br />
<br />
Bajwa
speculated that concerns about possible lack of protocols at the Texas
hospital has been a barrier to that information sharing.<br />
From his
perspective he said the concept of early treatment, like what was done
in Nebraska and Emory, was most interesting."They showed that early
treatment was critical. Every patient treated early has done well. If
you pay attention to early aspects of Ebola this is not a lethal
illness. It is clear Dallas made mistakes ... Emory and Nebraska had
protocols in place," Bajwa said.<br />
<strong>In Canada</strong><br />
North of our borders, Canadians are running their own preparedness drills.<br />
Niranjan
Kissoon, MB, vice president for medical affairs at BC Children's
Hospital and Sunny Hill Health Centre for Children in Vancouver, B.C.,
told <em>MedPage Today, </em>"Key departments have been advised to
purchase a minimum of 24 hours of Hemorrhagic Fever PPE (different than
the Decontamination PPE) and have been provided the list of equipment
necessary."<br />
The British Columbia health service "has been working
with us to ensure that the warehouse will be consistently stocking of
all of these items and after-hour contacts with HSSBC are in place for
departments to rush order."<br />
Moreover, Kissoon said, "Infection
Control has been working diligently to ensure training is available to
all staff on proper PPE donning and doffing procedures. They have
recently finished a training video they are making available as well."<br />
<strong>The Eyes of Texas</strong><br />
Meanwhile, across Texas major cities are responding with their own Ebola plans.<br />
<a href="http://www.chron.com/news/houston-texas/houston/article/Houston-officials-tout-preparedness-but-urge-5824300.php?cmpid=bna" target="_blank"><em>The Houston Chronicle </em></a>reported
that during a City Council meeting "health and first responders have
taken inventory of what equipment they would need in the case Ebola came
to Houston and have a plan in place. The key, Persse said, is to assume
the city will see an Ebola case and prepare accordingly."<br />
Similar scenes have played out in media reports from <a href="http://www.statesman.com/s/news/world/ebola/" target="_blank">Austin </a>and
San Antonio, which, along with Dallas and Houston, make up the four
largest cities in the state. All four are within 250 miles of one
another, and the state's fifth largest city, Fort Worth, is just 30
miles west of Dallas.<br />
Telephones have been busier than usual at the <a href="http://www.expressnews.com/business/health-care/article/S-A-facility-at-forefront-of-Ebola-fight-5822973.php#/0" target="_blank">Texas Biomedical Research Institute</a>
(TBRI) in San Antonio, which has conducted Ebola vaccine studies for
the past 10 years. According to the San Antonio Express-News, TBRI
officials have fielded calls from health officials and media
representatives throughout the world.<br />
At the <a href="http://www.utmb.edu/president/communications/messages/" target="_blank">University of Texas Medical Branch (UTMB) at Galveston</a>,
a statewide referral center, President David Callender, MD, said in a
statement that UTMB does not anticipate receiving any Ebola patients but
nonetheless has a contingency plan.<br />
UTMB houses one of the two <a href="http://www.niaid.nih.gov/labsandresources/resources/dmid/nbl_rbl/Pages/site.aspx" target="_blank">National Biocontainment Laboratories</a>
in the nation (the other being at Boston University Medical Center),
charged with conducting high-level studies of infectious organisms and
diseases. Work at the two national centers is supplemented and
complemented by a dozen regional biocontainment laboratories, all under
the auspices of the National Institute of Allergy and Infectious
Diseases.<br />
And, <a href="http://governor.state.tx.us/news/press-release/20220/" target="_blank"> Gov. Rick Perry established a statewide infectious disease task force</a>
charged with developing recommendations and a strategic plan for
responding to infectious disease threats, such as Ebola. The task force
has scheduled its initial meeting Oct. 23 in Austin.Dr D Quekhttp://www.blogger.com/profile/02878815376401309022noreply@blogger.com0tag:blogger.com,1999:blog-6158809075942993636.post-11363958789009157832014-09-03T23:00:00.001+08:002014-09-03T23:00:23.856+08:00Bad News, Ebola Outbreak likely to get worse... says CDC director<span class="entry-title"></span> <br />
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Frieden on Ebola outbreak: ‘Everything I’ve seen suggests over the next few weeks it’s likely to get worse’</h2>
<span class="by">Posted by <a href="http://outbreaknewstoday.com/author/robert/" rel="author" title="Posts by Robert Herriman">Robert Herriman</a> on September 3, 2014</span></div>
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<span class="by"> </span>
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<span class="IL_AD" id="IL_AD8">Centers for Disease Control and Prevention</span> (CDC) director, Dr. Tom Frieden just returned from West Africa to <span class="IL_AD" id="IL_AD9">get a</span>
bird’s eye view of the West Africa Ebola Virus Disease (EVD) outbreak,
the largest since the virus caused the first outbreaks in 1976.<br />
<br />
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<a href="http://outbreaknewstoday.com/wp-content/uploads/2014/06/705px-Map_of_West_AFrica.gif"><img alt="Public domain image/Mondo Magic" class="size-medium wp-image-625" height="255" src="http://outbreaknewstoday.com/wp-content/uploads/2014/06/705px-Map_of_West_AFrica-300x255.gif" width="300" /></a><div class="wp-caption-text">
Public <span class="IL_AD" id="IL_AD5">domain</span> image/Mondo Magic</div>
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In a press conference yesterday (<a href="http://www.cdc.gov/media/releases/2014/t0902-ebola-outbreak.mp3">LISTEN here</a>),
Dr, Frieden offered his thoughts and observations on the outbreak that
has infected more than 3,000 and killed more than half.<br />
<br />
<span style="color: black;">“The <span class="IL_AD" id="IL_AD10">bottom line</span>
is that despite tremendous efforts from the U.S. Government, from CDC,
from within countries, the number of cases continues to increase and is
now increasing rapidly. I’m afraid over the next few weeks; those numbers are likely to increase further and significantly. </span><br />
<br />
<span style="color: black;">“There is a window of opportunity to
tamp this down, but that window is closing. We need action now to scale
up the response. We know how to stop Ebola. The challenge is to scale it
up to the massive levels needed to stop this outbreak.”</span><br />
<br />
Frieden went on the call the Ebola situation in West Africa an “epidemic”. “<span style="color: black;">This
is really the first epidemic of Ebola the world has ever known. By
epidemic what we mean is it’s spreading widely through society but not
spreading through <span class="IL_AD" id="IL_AD3">new ways</span> <span class="IL_AD" id="IL_AD1">according</span> to everything we know.</span><br />
<br />
“<span style="color: black;"> It’s spreading from just two roots – people caring for other people in hospitals or homes. And unsafe <span class="IL_AD" id="IL_AD4">burial</span> practices where people may come in contact with <span class="IL_AD" id="IL_AD6">body fluids</span> of someone who has died from Ebola.”</span><br />
<br />
“<span style="color: black;">That is really the achilles heel of
this virus. We know how it spreads. We know how to stop it from
spreading. The challenge is to do that everywhere that’s needed. In
order to do that effectively, speed is key. The number of cases is
increasing so quickly that for every day’s delay, it becomes that much
harder to stop it”, Frieden notes.</span><br />
<br />
The director went on to describe the 3 things required to get this under control–<span style="color: black;"> “The first is more resources. This is going to take a lot to confront. The second are technical experts in <span class="IL_AD" id="IL_AD2">health care</span> and management to help in country. And the third is a global coordinated unified <span class="IL_AD" id="IL_AD12">approach</span>
because this is not just a program for – this is not just a problem for
West Africa, it’s not just a problem for Africa, it’s a problem for the
world and the world needs to respond.”</span><br />
<br />
Frieden’s visit to the three West African countries led to some dire statements. “<span style="color: black;">Everything I’ve seen suggests over the next few weeks it’s likely to get worse. We’re likely to see significant increases <span class="IL_AD" id="IL_AD11">in cases</span>.”</span></div>
Dr D Quekhttp://www.blogger.com/profile/02878815376401309022noreply@blogger.com0tag:blogger.com,1999:blog-6158809075942993636.post-74340029304305434332014-09-03T14:27:00.003+08:002014-09-03T19:06:16.213+08:00 Medical negligence — a doctor’s insight.... by DATUK DR N.K.S. THARMASEELAN, <h2 class="headline">
Medical negligence — a doctor’s insight </h2>
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<span style="font-weight: normal;"><span style="font-size: small;"><span style="font-weight: normal;">by DATUK DR N.K.S. THARMASEELAN, The Star, 03 September 2014</span></span></span></h2>
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<span style="font-size: small;"><span style="font-weight: normal;"><b> </b>http://www.thestar.com.my/Opinion/Letters/2014/09/03/Medical-negligence-a-doctors-insight/ </span></span></h2>
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<br />
<br />
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<br />
THE public has long held doctors
in high esteem. True to the Hippocratic Oath, doctors always did what
was thought to be in the best interest of their patients. <br />
<br />
A generation back, lawyers were unwilling to assist in suing members of a fellow profession. <br />
<br />
Even when sued, the judiciary was often benevolent towards doctors.
There was much reluctance to find doctors guilty of negligence.<br />
<br />
Over the past few decades, the high pedestal on which doctors stood,
has slowly been eroding. As patients’ rights movements gained momentum,
the dust and clouds created have made the “halo” around the doctors
less visible. They have realised that doctors are mere mortals too and
reverence to them was misplaced, as was done by their earlier
generation.<br />
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More patients are questioning their doctors and are prepared to sue
their regular family doctor of many years. The doctor-patient bond has
now been replaced by an unemotional, commercial business-like link.<br />
<br />
There is no dearth of lawyers who are more than willing to act on
behalf of a patient even on frivolous grounds. We cannot fault them as
they are just doing their job. The judiciary too, has become less
benevolent and has increasingly taken serious views of the cases before
them. The awards are unbelievable and have been sky-rocketing over the
years. <br />
<br />
They now follow the standard of care, as reflected in Rogers vs
Whitaker where the courts ultimately decide on the issues at hand,
rather than following the principles in Bolam where the profession were
left to decide whether a fellow professional had breached the standard
of care for advice. <br />
<br />
The Whitaker decision is now followed in Malaysia as pronounced in
the Federal Court in Foo Fio Na. With the judiciary becoming more
assertive and proactive, the awards are expected to multiply. <br />
With the increasing settlements and awards handed out by the courts,
litigation costs and premiums for indemnity coverage and insurance have
risen exponentially. <br />
<br />
Can we blame anybody for this scenario which has caused turbulence and turmoil within the medical fraternity? <br />
<br />
Doctors are now less inclined to specialise in certain areas due to
exorbitant indemnity premiums. We may not have doctors becoming
obstetricians or spinal surgeons soon. Ultimately it affects patient
care.<br />
<br />
As the standard of living rises, expectations rise in tandem. The
Internet revolution has delivered medical information to the doorstep of
every home. This information comes from various sources, some of
doubtful origin. <br />
<br />
This has led to unrealistic expectations by patients. Patients
expect perfect results when they seek treatment and are less likely to
accept side effects and complications even if adequately informed before
commencement of treatment. <br />
<br />
Not only are expectations influenced by dubious Web-based
information but also by “well-read” relatives and friends. Sometimes an
“unintended” incendiary remark by a colleague causes unwarranted
confusion to an already agitated patient.<br />
<br />
Doctors sometimes justify errors with statistics which is of
irrelevance to the patient. A 1:100,000 mortality or morbidity which
appears insignificant to the doctor is usually a 1:1 for the patient and
relatives. <br />
<br />
Routine procedures are not viewed in the same manner. A simple
lumbar puncture is viewed and construed as major surgery by some
patients. The patients’ views and understanding of a medical problem are
different from those held by doctors. <br />
<br />
The doctor is often tried by the media and this inflicts a lifelong
deep abrasion on the doctor’s reputation. Knowing the impact of negative
publicity, patients and even lawyers make inappropriate demands on
doctors. <br />
<br />
The media attention towards medical errors has encouraged the layman
to proceed with litigation as he knows that he will be able to “avenge”
a wrong done to him or his relative.<br />
<br />
It is not only the patient who suffers, the doctor too is subjected
to tremendous mental stress and agony. Some senior doctors have given up
the practice of medicine on account of a single misadventure. A
litigation exercise has devastating effects on his career and personal
life. Even if they win the battle in court, they are bruised during the
proceedings and remained scarred for life.<br />
<br />
Doctors suffer and as a result the patient too suffers in the long
run. The strong bond is broken. Doctors begin practising defensive
medicine and the patients will have to ultimately bear the cost. <br />
<br />
A strong family-like bond is turned into a business-like
proposition. The patient is no more a patient, he becomes a customer
just as in any business transaction.<br />
<br />
Medical paternalism has given way to patient autonomy. The patient
is the focus of treatment without whom the doctor has no role to enact.<br />
<br />
Doctors and patients need to work as partners in order to restore the trust and confidence of yesteryears.<br />
<br />
Effective communication is essential and a vital tool in providing
high quality care for patients. Doctors must spend more time
communicating with their patients to create a more congenial atmosphere
in the medical arena. <br />
<br />
Patients should understand that doctors are not God and to err is
human. This understanding will probably earn more respect, create a
stronger bond and hopefully reduce litigation.<br />
<br />
<b><br /></b>Dr D Quekhttp://www.blogger.com/profile/02878815376401309022noreply@blogger.com0tag:blogger.com,1999:blog-6158809075942993636.post-16910175434585420152014-09-02T15:13:00.000+08:002014-09-02T15:13:37.540+08:00Doctors Beware, Caveat Venditor: Doctor Jailed for medical manslaughter<div class="_5pbx userContent" data-ft="{"tn":"K"}" id="js_664">
There
has been a trend to charge doctors for medical manslaughter... Caveat
Venditor, supplier beware, patients expect not just adequate care but
also expect that the goods be delivered without the worst outcomes no
matter how unrelated, or risks explained...<br />
<br />
Patient safety and
outcome now form the new norms of expectations... physician inattention
and neglect, and failure to take appropriate and quick life-saving
measures may be deemed manslaughter if patients die or suffer egregious
consequences in an unexpected way!<br />
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<h2>
<span style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: large;"><b>David Sellu trial: Jail for doctor in manslaughter case</b></span></span> </h2>
http://www.bbc.com/news/uk-england-london-24825665<br /><br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiyZ9eX9kxXlSsknkcE_gJEwMHsy-gtjoWf7Egde88zaNP5BNjpBOPf6J1bH5AnPz9oIIb2OyN06CJwUMQldWla6I1I23n_u-W6jfxl6eZba0gdWfc8ay8GlSoHWd96gRRqMkEFQIe61xU/s1600/Screen+Shot+2014-09-02+at+2.52.45+PM.png" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiyZ9eX9kxXlSsknkcE_gJEwMHsy-gtjoWf7Egde88zaNP5BNjpBOPf6J1bH5AnPz9oIIb2OyN06CJwUMQldWla6I1I23n_u-W6jfxl6eZba0gdWfc8ay8GlSoHWd96gRRqMkEFQIe61xU/s1600/Screen+Shot+2014-09-02+at+2.52.45+PM.png" height="400" width="392" /></a><br />
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David Sellu's care was 'far below the expected standard', said prosecutors<br />A senior doctor at a private hospital in north-west London has been jailed for two-and-a-half-years for killing a patient.<br /><br />
Surgeon David Sellu was found guilty at the Old Bailey of manslaughter by gross negligence of a patient.<br /><br />
James Hughes, 66, died in 2010 at the Clementine Churchill Hospital in Harrow, having suffered a<br />perforated bowel after a routine knee replacement.<br /><br />
Sellu ignored his condition and carried on with his clinic, the court heard.<br /><br />
After Mr Hughes's knee operation on 5 February 2010, the retired builder from County Armagh, Northern Ireland, developed abdominal pain and was transferred to the care of Sellu.<br /><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><b>'Terrible consequences'</b></span><br />The Old Bailey heard he "simply ignored" the urgency of the potentially life-threatening condition and instead of operating on Mr Hughes carried on with his scheduled appointments.<br /><br />
Mr Hughes died on 14 February.<br /><br />
Elizabeth Joslin of the Crown Prosecution Service said Sellu's care "fell far below the expected standard, with terrible consequences".<br />
<br />"This doctor's actions were not mistakes or errors of judgement but negligence so serious that he has now been convicted of a criminal offence," she said.<br /><br />
Mr Hughes's widow Ann Hughes said the family had been subjected to a "tortuous purgatory" only brought to an end by "truth and justice".<br /><br />
She said: "Our trust in normal processes, authorities and structures of society was shattered by the<br />inexplicable, callous and deceitful actions of the medical profession entrusted with the most basic<br />responsibility to protect human life."<br /><br />
Sellu, 66, had denied gross negligence manslaughter.<br /><br />
He was was found not guilty of perjury after he was accused of lying to the victim's inquest under oath. </div>
Dr D Quekhttp://www.blogger.com/profile/02878815376401309022noreply@blogger.com0tag:blogger.com,1999:blog-6158809075942993636.post-53842929682988247632014-08-18T20:43:00.000+08:002014-08-18T20:43:05.473+08:00Advice From a 101 Old Doctor! by Dr Shigeaki Hinohara<span style="color: #f84c18; font-size: 27pt;"><b>Advice From a 101 Old Doctor!</b></span><br />
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<span style="font-size: small;"><b><span style="color: firebrick;">Dr. Shigeaki Hinohara</span></b><span>, Japan, turned 101 on 4th October 2012</span></span></div>
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<span style="font-size: small;"><b><span style="color: red;">As a 101 year old Doctor, he was interviewed, and gave his advice for a long and healthy life.</span></b></span></div>
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<span style="font-size: small;"><span>Shigeaki Hinohara is one of the
world's longest-serving physicians and educators. Hinohara's magic touch
is legendary: Since 1941 he has been healing patients at St. Luke's
International Hospital in Tokyo and teaching at
St. Luke's College of Nursing.</span></span></div>
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<span style="font-size: small;"><span>He has published around 15 books
since his 75th birthday, including one "Living Long, Living Good" that
has sold more than 1.2 million copies. As the founder of the New Elderly
Movement, Hinohara encourages others to live
a long and happy life, a quest in which no role model is better than
the doctor himself.</span></span></div>
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<span style="font-size: small;"><b><span style="color: green;">Doctor Shigeaki Hinohara's main points for a long and happy life:
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<span style="font-size: small;"><span style="background-color: #ffff99;"><span>*</span><span> <b>Energy comes from feeling good, not from eating well or sleeping a lot.
</b>We all remember how as children, when we were having fun, we often
forgot to eat or sleep. I believe that we can keep that attitude as
adults, too. It's best not to tire the body with too many rules such as
lunchtime and bedtime.</span></span></span></div>
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<span style="font-size: small;"><span style="color: green;">* </span><b><span>All people who live long regardless of nationality, race or gender share one thing in common:</span></b><span> <b><span style="color: red;">None
are <i>overweight</i></span><i>. </i></b>For breakfast I drink coffee, a
glass of milk and some orange juice with a tablespoon of olive oil in
it. Olive oil is great for the arteries and keeps my skin healthy. Lunch
is milk and a few cookies, or nothing when
I am too busy to eat. I never get hungry because I focus on my work.
Dinner is veggies, a bit of fish and rice, and, twice a week, 100 grams
of lean meat.</span></span></div>
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<span style="font-size: small;"><span></span> </span></div>
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<span style="font-size: small;"><span style="color: green;">* </span><b><span>Always plan ahead.
</span></b><span>My schedule book is already
full until 2014, with lectures and my usual hospital work. In 2016 I'll
have some fun, though: I plan to attend the Tokyo Olympics!</span></span></div>
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<span style="font-size: small;"><span style="color: green;">* </span><b><span>There is no need to ever retire, but if one must, it should be a lot later than 65.</span></b><span>
The current retirement age was set
at 65 half a century ago, when the average life-expectancy in Japan was
68 years and only 125 Japanese were over 100 years old. Today, Japanese
women live to be around 86 and men 80, and we have 36,000 centenarians
in our country. In 20 years we will have
about 50,000 people over the age of 100...</span></span></div>
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<span style="font-size: small;"><span style="color: green;">* </span><b><span>Share what you know.</span></b><span> I give 150 lectures a year, some for 100 elementary-school children, others for 4,500 business people.
I usually speak for 60 to 90 minutes, standing, to stay strong.</span></span></div>
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<span style="font-size: small;"><span style="color: green;">* </span><b><span>When
a doctor recommends you take a test or have some surgery, ask whether
the doctor would suggest that his or her spouse or children go through
such a procedure.</span></b><span>
Contrary to popular belief, doctors can't cure everyone. So why cause
unnecessary pain with surgery I think music and animal therapy can help
more than most doctors imagine.</span></span></div>
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<span style="font-size: small;"><span></span> </span></div>
</div>
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<span style="font-size: small;"><span style="color: green;">* </span><b><span style="color: red;">To stay healthy, always take the stairs and carry your own stuff</span></b><b><span>.</span></b><span>
I take two stairs at a time, to get my muscles moving.</span></span></div>
</div>
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</div>
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<span style="font-size: small;"><span style="color: green;">* </span><b><span>My
<span style="color: red;">inspiration</span></span></b><span style="color: red;"> </span><span>is
Robert Browning's poem "Abt Vogler." My father used to read it to me.
It encourages us to make big art, not small scribbles.
It says to try to draw a circle so huge that there is no way we can
finish it while we are alive. All we see is an arch; the rest is beyond
our vision but it is there in the distance.</span></span></div>
</div>
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<span style="font-size: small;"><span style="color: green;">* </span><b><span>Pain is mysterious, and having fun is the best way to forget it.</span></b><span>
If a child has a toothache, and you start playing a game
together, he or she immediately forgets the pain. Hospitals must cater
to the basic need of patients: We all want to have fun. At St. Luke's we
have music and animal therapies, and art classes.</span></span></div>
</div>
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<span style="font-size: small;"><span></span> </span></div>
</div>
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<span style="font-size: small;"><span style="color: green;">* </span><b><span>Don't be crazy about amassing material things.</span></b><span> Remember: You don't know when your number is up, and you can't take it with
you to the next place.</span></span></div>
</div>
</div>
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<span style="font-size: small;"><span></span> </span></div>
</div>
</div>
<span style="font-size: small;"><span style="color: green;">* </span><b><span>Hospitals must be designed and prepared for major disasters</span></b><span>,
and they must accept every patient who appears at their doors.
We designed St. Luke's so we can operate anywhere: in the basement, in
the corridors, in the chapel. Most people thought I was crazy to prepare
for a catastrophe, but on March 20, 1995, I was unfortunately proven
right when members of the Aum Shinrikyu religious
cult launched a terrorist attack in the Tokyo subway. We accepted 740
victims and in two hours figured out that it was sarin gas that had hit
them. Sadly we lost one person, but we saved 739
</span><span>lives.</span></span>
<div>
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<span style="font-size: small;"><span></span> </span></div>
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<span style="font-size: small;"><span style="color: green;">* </span><b><span>Science alone can't cure or help people.</span></b><span>
Science lumps us all together, but illness is individual. Each person
is unique,
and diseases are connected to their hearts. To know the illness and
help people, we need liberal and visual arts, not just medical ones.</span></span></div>
</div>
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<span style="font-size: small;"><span></span> </span></div>
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<span style="font-size: small;"><span style="color: green;">* </span><b><span>Life is filled with incidents</span></b><span>.
On March 31, 1970, when I was 59 years old, I boarded the Yodogo, a
flight from Tokyo to
Fukuoka. It was a beautiful sunny morning, and as Mount Fuji came into
sight, the plane was hijacked by the Japanese Communist League-Red Army
Faction. I spent the next four days handcuffed to my seat in 40-degree
heat. As a doctor, I looked at it all as an
experiment and was amazed at how the body slowed down in a crisis.</span></span></div>
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<span style="font-size: small;"><span style="color: green;">* </span><b><span style="color: red;">Find a role model and aim to achieve even more than they could ever do.</span></b><span style="color: red;"> </span><span>My
father went to the United States in 1900 to study at Duke University in
North Carolina. He was a pioneer and one of my heroes. Later I found a
few more life guides, and when I am stuck, I ask myself how they would
deal with the problem.</span></span></div>
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<span style="font-size: small;"><span style="color: green;">* </span><b><span style="color: red;">It's wonderful to live
</span></b><b><span>long.</span></b><span>
</span><span>Until one is 60 years old, it is
easy to work for one's family and to achieve one's goals. But in our
later years, we should strive to contribute to society. Since the age of
65, I have worked as a volunteer. I still put
in 18 hours seven days a week and love every minute of it.</span></span></div>
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</blockquote>
<br />
Sources:<br />
http://ajw.asahi.com/article/behind_news/people/AJ201308080086 </div>
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Dr D Quekhttp://www.blogger.com/profile/02878815376401309022noreply@blogger.com2tag:blogger.com,1999:blog-6158809075942993636.post-11064520901261578262014-08-13T13:59:00.000+08:002014-08-13T13:59:00.623+08:00Best Doctors? Indeed How should one measure up?<div dir="ltr" style="background-color: white; color: #222222; font-family: arial, sans-serif;">
<b><span style="font-size: large;">Top Doctors? Indeed How should anyone measure up?</span></b></div>
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A recent post in the NY Times posit this very relevant id puzzling question. </div>
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Indeed, how often is it that we've been asked to refer to the best doctor in this or that discipline? Just this morning, one of my long-time patients called and asked if I could refer her to the best orthopedic doctor in a nearby hospital nearer her home. I was instantly flabbergasted, as I've just read the post attached below, last evening... </div>
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Indeed, for that matter, how should I or we as physicians, know? Would our so-called professors in the academic centres, our past mentors and teachers know any better? Does this mean that the more academically inclined or brilliant or up-to-date physician would be the better doctor for any discipline or surgery or special care? </div>
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Perhaps, I would guess we do so based on or by virtue of our own biases, depending on our usual coterie of friends or kindred-spirited colleagues whom we've shared or co-referred patients. Otherwise, we might become aware through some sort of 'connection' via academic or shared interests groups... Or even because of quid pro quo... because that colleague has treated you or another member of your family, and therefore, we are obliged to cross-refer back as a sort of a goodwill gesture, a thank you... </div>
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But of course in our own little niche of practice and circumstance, we've become accustomed or knowledgeable about this or that doctor whom we think has been good, excellent or technically brilliant or kind, or whichever traits or skills that might fire up our more intimate or inner connection. </div>
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But really I would think that this is indeed very arbitrary... is the physician with the most citations in research be a top doctor in his or her field? Is that media-savvy doctor being the most recognisable be the best? Is someone who's heading a medial society or discipline the best or top doc? Or is another fully dedicated physician totally immersed in teaching in academia the best?</div>
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Finally how do we personally measure up in the esteem and eyes of our colleagues, our peers, our patients?</div>
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Food for thought indeed. </div>
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<b>Top Doctors, Dead or Alive</b><br /><span style="font-size: 12.727272033691406px;">By ABIGAIL ZUGER, M.D.</span><br /><span style="font-size: 12.727272033691406px;">NYTS AUGUST 11, 2014</span></div>
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The official letter is sitting on my desk, announcing that a relative of mine has just been named one of the world’s top physicians in his area of expertise. Once he confirms his biographical details, he is guaranteed inclusion in online and print directories of similarly honored peers (“not only a tribute to your success, but also a valuable resource for potential patients”).</div>
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I can clearly imagine his reaction had he opened the letter himself: a combination of amusement, dismay and just a small hint of pleasure. However, since he has been dead for 16 years, his widow passed the envelope over to me, and I got to experience all those emotions myself.</div>
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The amusement and dismay speak for themselves. The pleasure lay in this really superb demonstration that skepticism should attend all interactions with services promising to lead you through the thickets of subpar and merely average doctors directly to best of breed.</div>
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The methodology of these enterprises varies. Some, evidently, cull names and addresses from obsolete phone directories. Some poll doctors themselves for the biggest luminaries of their acquaintance. Some rely on patients’ reviews, operating under the premise that a doctor who delivers a five-star health experience for one will do so for all.</div>
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It is easy to dismiss them all as just so much advertisement and avarice, contributing yet more buzzy white noise to the already crazy-making din of health care. But a more nuanced and charitable view is also possible. These services may simply be trying, valiantly if clumsily, to remedy the single biggest mystery in all of health care: that we do not have a clue what makes a top doctor, let alone how to find one.</div>
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Is it nature (unusual intelligence, compassion, common sense)? Nurture (diplomas from prestigious and pricey institutions)? Self-sufficiency? (Patients say proudly, “My doctor never has to send me anywhere.”) A central location in a medical network? (“My doctor refers me to all the top people.”) Is it speed or deliberation, ability to follow rules or ability to break them? Exuberant personal charisma or a peaceful office that runs like a Swiss watch?</div>
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No one has the slightest idea. Even the terms of the question are undefined. Is a top doctor one who keeps you in top shape, hauling you up when you plunge down? Or is it one who encourages you to remain in whatever shape feels right to you, even if some of your habits might give pause to less enlightened observers?</div>
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A sedentary, seriously overweight patient I know cannot walk a block. She adores the doctor who cheerfully tells her: “Who needs to walk? You should ride!” To her, he is unquestionably a top doctor. To the rest of her family, not so much.</div>
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I contemplate various listings of top doctors, recognizing the occasional name or face, often residents I knew long ago. Many of them, I think, are probably quite good. But why should I think that? Do I really know what goes on when they are closeted with a patient who drives them nuts, or when they are running late and have theater tickets, or when they completely miss the diagnostic boat and land on an atoll somewhere in the sea of wrong assumptions, many leagues from where they should be? Do they acquit themselves in top-doctor style then?</div>
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In fact, nobody knows who the top doctors are, not even the top doctors themselves. It is safe to say that the very topmost doctors, confusingly, are probably not top doctors: They have become news media stars and household names through efforts that presumably leave them little time to hone those top-doctor skills. But otherwise, all is smoke and mirrors.</div>
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Can the average consumer glean any information at all from the top doc lists? Here is one tip: Pay attention to the source of the information. Traits that doctors prize in their colleagues may be different from the ones patients rank high. Consultants who will see any patient at the drop of a hat — referring doctors love that — may have jam-packed waiting rooms and move with the speed of greased pigs. The rock stars of modern medicine, experts who publish widely and lecture all over the globe, may spend most of their workweeks in flight, inaccessible for humbler purposes.</div>
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Otherwise, I suspect we are left with only a single unarguable definition of a top doctor: one who is not on the bottom. Top doctors are, for instance, not in jail. They have valid licenses. They are presumably enthusiastic about taking new patients (although you can never be sure how enthusiastic they’ll be about their insurance). I used to think that at least they were all living and breathing, but now I guess you can’t be sure of that, either.</div>
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Dr D Quekhttp://www.blogger.com/profile/02878815376401309022noreply@blogger.com0tag:blogger.com,1999:blog-6158809075942993636.post-7218882639911455582014-08-09T22:31:00.000+08:002014-08-09T22:31:01.637+08:00Americans think that most physicians have it made. They’re wrong. by John La Puma MD<span style="line-height: normal;">Americans think that most physicians have it made. They’re wrong.</span><br />
<span style="line-height: normal;">JOHN LA PUMA, MD | </span><br />
KevinMD<span style="line-height: normal;"> | AUGUST 6, 2014</span><br />
<br />
<span style="line-height: normal;"><br /></span>
<span style="line-height: normal;">There’s at least one hidden reason the health care system is failing people who just want some face time with a doctor: too many dedicated physicians are not just overwhelmed but burned out.</span><br />
<span style="line-height: normal;"><br /></span>
<span style="line-height: normal;">According to a 2012 JAMA Internal Medicine Mayo Clinic study, 46% of all U.S. physicians are emotionally exhausted, feel cynical about work or have lost their sense of personal accomplishment … or all three.</span><br />
<span style="line-height: normal;"><br /></span>
<span style="line-height: normal;">Americans think that most physicians have it made. But the reality is very different.</span><br />
<br />
<span style="line-height: normal;">Many physicians have little control of their work. They feel emotionally detached from patients and like cogs in a medical industrial machine. Slotted into 10 or 15 minute appointments, often double booked or more, without leeway to offer more time without penalty, physicians careen from one place to the next, like pinballs. Endless new forms and electronic screens, a chaotic work pace, substantial debt, uncertain reimbursement and a perpetual concern about lawsuits are to blame.</span><br />
<span style="line-height: normal;"><br /></span>
<span style="line-height: normal;">Burnout also sickens physicians, who commit suicide more often, have more trouble with addictive drugs and alcohol, and divorce more frequently than other professionals. Some retire early or leave medicine entirely. A 2012 study of 5000 physicians showed that 89% of practicing physicians would not recommend medicine as a profession to their children or other family members.</span><br />
<span style="line-height: normal;"><br /></span>
<span style="line-height: normal;">When physicians are unwell, patient care suffers. Referral rates for diagnostic tests and specialists rise, increasing risks for unnecessary and redundant tests and conflicting advice. Physicians interact with a computer screen instead of the patient. They take short cuts, follow procedures less, and can make serious mistakes.</span><br />
<span style="line-height: normal;"><br /></span>
<span style="line-height: normal;">Physician burnout may be one reason that the VA appointment waiting lists are so long: The newly approved VA bill provides for hiring more physicians, but in the current system, they too will be simply chewed up.</span><br />
<span style="line-height: normal;"><br /></span>
<span style="line-height: normal;">Primary care physicians have it worst. There is a predicted deficiency of 45,000 primary care docs (and 46,000 specialists) by 2020. But the reason primary care is on the ropes is not because of too limited primary care residency training positions, as is currently thought in Congress. It’s because doctors are leaving medicine: A 2012 Urban Institute study of primary physicians found that 52% of those over 50 planned to leave practice within five years.</span><br />
<span style="line-height: normal;"><br /></span>
<span style="line-height: normal;">For new physicians, it is no better. They owe a median of $170,000 upon medical school graduation, according to the AMA. Their residency training is not supposed to exceed 80 hours per week (in practice it is up to 50% more). Their salary mean is about $51,000 a year, for three years. They see attending physicians having to fight with insurers for care that patients need. They spend, on average, but eight minutes with each patient. They see medicine as a job to be negotiated, not a calling to serve.</span><br />
<span style="line-height: normal;"><br /></span>
<span style="line-height: normal;">What can we do about physician burnout? Its causes are systemic, not individual. Yet most interventions are individual: meditation, stress reduction, self-awareness and reflection. These interventions require more time, almost always unpaid, from the physician, already at wit’s end.</span><br />
<span style="line-height: normal;"><br /></span>
<span style="line-height: normal;">One solution is organizational change within health care systems. Organizations should allow physicians to structure more of their own work flow. They should teach and pay for time and training to avoid, prevent, recognize and improve burnout, and allow physicians to rediscover resilience and fulfillment.</span><br />
<span style="line-height: normal;"><br /></span>
<span style="line-height: normal;">Primary care especially requires innovation. Pharmacists and nurse practitioners could do routine primary care like checkups, screenings and explaining medication. Primary care physicians could be better utilized for coordinating care, evaluating more serious conditions and helping patients make complex, personal medical decisions.</span><br />
<span style="line-height: normal;"><br /></span>
<span style="line-height: normal;">Practicing better lifestyle habits helps both physicians and patients: those physicians who exercise regularly recommend it more to their patients than those who don’t. Ditto for those who eat healthfully.</span><br />
<span style="line-height: normal;"><br /></span>
<span style="line-height: normal;">What would happen if physicians could practice more of what we preach about fitness and food, and physician’ employers helped them do it? Would patients’ blood pressures and cholesterol numbers improve?</span><br />
<span style="line-height: normal;"><br /></span>
<span style="line-height: normal;">Being a physician is a privilege and an honor. But even the best physician can burn out. It’s time physicians and health care systems shared the responsibility to lessen the depersonalization and exhaustion so many physicians feel.</span><br />
<span style="line-height: normal;"><br /></span>
<span style="line-height: normal;">To fix the primary care delivery problem, we must fix burnout, and heal physicians.</span><br />
<span style="line-height: normal;"><br /></span>
<span style="line-height: normal;"><br /></span>
<span style="line-height: normal;">John La Puma hosts PBS’ ChefMD Shortsand blogs at Paging Dr. La Puma. </span>Dr D Quekhttp://www.blogger.com/profile/02878815376401309022noreply@blogger.com0tag:blogger.com,1999:blog-6158809075942993636.post-13698023483125504762014-08-02T11:41:00.002+08:002014-08-02T11:41:24.176+08:00BBC via WHO: Ebola crisis: Virus spreading too fast!<span class="story-date" style="background-color: white; color: #505050; display: block; float: left; font-family: Arial, Helmet, Freesans, sans-serif; font-size: 13px; line-height: 16px; padding: 13px 0px 8px; width: 290px;"><span class="date" style="font-weight: bold;">1 August 2014</span> <span class="time-text" style="color: #666666;">Last updated at </span><span class="time">22:03</span></span><br />
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Ebola crisis: Virus spreading too fast, says WHO</h1>
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<img alt="Medical workers speak to families about how they can best protect themselves from the Ebola virus disease in Conakry, March 31" height="351" src="http://news.bbcimg.co.uk/media/images/76687000/jpg/_76687010_3d5d14d7-32ea-4c26-97e3-e1af4b3ebe8f.jpg" style="-webkit-user-select: none; border: 0px; font-style: italic; letter-spacing: 0px; position: relative;" width="624" /><span style="display: block; width: 624px;">Medical workers have been deployed to explain to residents how to protect themselves</span></div>
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Ebola crisis</h2>
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The Ebola outbreak in West Africa is spreading faster than efforts to control it, World Health Organization (WHO) head Margaret Chan has said.</div>
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She told a summit of regional leaders that failure to contain Ebola could be "catastrophic" in terms of lives lost.</div>
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But she said the virus, which has claimed 728 lives in Guinea, Liberia and Sierra Leone since February, could be stopped if well managed.</div>
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Ebola kills up to 90% of those infected.</div>
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Ebola explained in 60 seconds</div>
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It spreads by contact with infected blood, bodily fluids, organs - or contaminated environments. Patients have a better chance of survival if they receive early treatment.</div>
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Initial flu-like symptoms can lead to external haemorrhaging from the eyes and gums, and internal bleeding that can lead to organ failure.</div>
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A US relief agency says <a href="http://www.bbc.co.uk/news/world-us-canada-28596416" style="color: #4a7194; font-weight: bold; line-height: 16px; text-decoration: none;">will repatriate</a> two of its American staff who have contracted the virus in Liberia.</div>
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They are believed to be the first Ebola patients ever to be treated in the US.</div>
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Hundreds of US Peace Corps volunteers have already been evacuated from the West African countries.</div>
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Separately, US President Barack Obama announced that delegates from affected countries attending a US-Africa conference in Washington next week would be screened.</div>
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"Folks who are coming from these countries that have even a marginal risk, or an infinitesimal risk of having been exposed in some fashion, we're making sure we're doing screening," he said.</div>
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<img alt="An employee of the Monrovia City Corporation sprays disinfectant inside a government building in a bid to prevent the spread of the deadly Ebola virus (1 August 2014)" height="351" src="http://news.bbcimg.co.uk/media/images/76683000/jpg/_76683761_023370193-1.jpg" style="-webkit-user-select: none; border: 0px; font-style: italic; letter-spacing: 0px; position: relative;" width="624" /><span style="display: block; width: 624px;">Offices are being sprayed with disinfectant in the Liberian capital Monrovia to prevent the spread of the Ebola virus</span></div>
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<strong style="line-height: 16px;">Analysis: David Shukman, BBC science editor</strong></div>
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Friday's summit should provide the kind of international co-operation needed to fight Ebola but the battle against the virus will be won or lost at the local level. An over-attentive family member, a careless moment while burying a victim, a slip-up by medical staff coping with stress and heat - a single small mistake in basic hygiene can allow the virus to slip from one human host to another.</div>
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The basic techniques for stopping Ebola are well known. The problem is applying them. Since the virus was first identified in 1976, there have been dozens of outbreaks and all of them have been contained. Experts point to these successes as evidence that this latest threat can be overcome too.</div>
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But working against them are suspicions among local people and the unavoidable fact that this is an extremely poor part of the world, much of it still reeling from conflict. Deploying the right equipment in properly trained hands is always going to be a struggle, one that is now extremely urgent.</div>
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<img alt="line" height="2" src="http://news.bbcimg.co.uk/media/images/74982000/jpg/_74982323_line976.jpg" style="-webkit-user-select: none; border: 0px; font-style: italic; letter-spacing: 0px; position: relative;" width="624" /></div>
<span class="cross-head" style="background-color: white; color: #505050; display: block; font-family: Arial, Helmet, Freesans, sans-serif; font-size: 1.231em; font-weight: bold; line-height: 16px; margin: 0px 0px 16px; text-rendering: optimizelegibility;">Ebola since 1976</span><br />
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<img alt="Graphic showing Ebola virus outbreaks since 1976" height="382" src="http://news.bbcimg.co.uk/media/images/76659000/gif/_76659369_ebola_deaths_624_latest.gif" style="-webkit-user-select: none; border: 0px; font-style: italic; letter-spacing: 0px; position: relative;" width="624" /></div>
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<img alt="A map showing Ebola outbreaks since 1976" height="483" src="http://news.bbcimg.co.uk/media/images/76659000/gif/_76659370_ebola_deaths_624_latest.gif" style="-webkit-user-select: none; border: 0px; font-style: italic; letter-spacing: 0px; position: relative;" width="624" /></div>
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Dr Chan met the leaders of Guinea, Liberia and Sierra Leone to launch a new $100m (£59m) Ebola response plan.</div>
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The plan includes funding the deployment of hundreds more health care workers to affected countries.</div>
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"This meeting must mark a turning point in the outbreak response," Dr Chan <a href="http://who.int/dg/speeches/2014/ebola/en/" style="color: #4a7194; font-weight: bold; line-height: 16px; text-decoration: none;">said at the summit</a> in Guinea's capital, Conakry.</div>
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"Cases are occurring in rural areas which are difficult to access, but also in densely populated capital cities."</div>
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She said the outbreak was the deadliest and most widely spread, and had also demonstrated an ability to spread through air travel, unlike past outbreaks.</div>
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<img alt="A news chalk board in the centre of the Liberian capital, Monrovia is called The Daily Talk and is run by Alfred Sirleaf who puts up different headlines each day for discussion (Photograph: Jonathan Paye-Layleh, BBC) " height="351" src="http://news.bbcimg.co.uk/media/images/76683000/jpg/_76683765_img_0206.jpg" style="-webkit-user-select: none; border: 0px; font-style: italic; letter-spacing: 0px; position: relative;" width="624" /><span style="display: block; width: 624px;">The spread of the virus is dominating the headlines in Liberia</span></div>
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<img alt="A Liberian military police truck with warnings on its side door, one reading "Tell Everyone You Meet About Ebola" patrol through the streets to prevent panic over the Ebola virus in the city of Monrovia, Liberia (1 August 2014)" height="351" src="http://news.bbcimg.co.uk/media/images/76683000/jpg/_76683763_023370593-1.jpg" style="-webkit-user-select: none; border: 0px; font-style: italic; letter-spacing: 0px; position: relative;" width="624" /><span style="display: block; width: 624px;">Military vehicles in Liberia are displaying warnings and advice about Ebola to prevent panic over the spread of the virus</span></div>
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Separately, the Liberian government declared Friday a holiday to allow a huge sanitisation and chlorination exercise in government ministries and places of public gathering.</div>
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Information Minister Lewis Brown said "the intent is to let us come to the realisation that something is wrong and what is wrong is serious".</div>
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Up to 30 Commonwealth Games athletes from Sierra Leone, meanwhile,<a href="http://www.bbc.co.uk/news/uk-scotland-28609896" style="color: #4a7194; font-weight: bold; line-height: 16px; text-decoration: none;" title="BBC Sport story">are considering extending their stay in Glasgow</a> amid fears over the Ebola virus.</div>
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<img alt="line" height="2" src="http://news.bbcimg.co.uk/media/images/74982000/jpg/_74982323_line976.jpg" style="-webkit-user-select: none; border: 0px; font-style: italic; letter-spacing: 0px; position: relative;" width="624" /></div>
<span class="cross-head" style="background-color: white; color: #505050; display: block; font-family: Arial, Helmet, Freesans, sans-serif; font-size: 1.231em; font-weight: bold; line-height: 16px; margin: 0px 0px 16px; text-rendering: optimizelegibility;">Ebola virus disease (EVD)</span><br />
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<img alt="Coloured transmission electron micro graph of a single Ebola virus, the cause of Ebola fever" height="351" src="http://news.bbcimg.co.uk/media/images/76476000/jpg/_76476153_76475767.jpg" style="-webkit-user-select: none; border: 0px; font-style: italic; letter-spacing: 0px; position: relative;" width="624" /></div>
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<li style="background-image: url(http://news.bbcimg.co.uk/view/3_0_20/cream/hi/shared/img/story_sprite.gif); background-position: -1200px 5px; background-repeat: no-repeat; font-size: 1.077em; line-height: 18px; margin: 0px 0px 8px; padding: 0px 0px 0px 16px; text-rendering: auto;">Symptoms include high fever, bleeding and central nervous system damage</li>
<li style="background-image: url(http://news.bbcimg.co.uk/view/3_0_20/cream/hi/shared/img/story_sprite.gif); background-position: -1200px 5px; background-repeat: no-repeat; font-size: 1.077em; line-height: 18px; margin: 0px 0px 8px; padding: 0px 0px 0px 16px; text-rendering: auto;">Fatality rate can reach 90%</li>
<li style="background-image: url(http://news.bbcimg.co.uk/view/3_0_20/cream/hi/shared/img/story_sprite.gif); background-position: -1200px 5px; background-repeat: no-repeat; font-size: 1.077em; line-height: 18px; margin: 0px 0px 8px; padding: 0px 0px 0px 16px; text-rendering: auto;">Incubation period is two to 21 days</li>
<li style="background-image: url(http://news.bbcimg.co.uk/view/3_0_20/cream/hi/shared/img/story_sprite.gif); background-position: -1200px 5px; background-repeat: no-repeat; font-size: 1.077em; line-height: 18px; margin: 0px 0px 8px; padding: 0px 0px 0px 16px; text-rendering: auto;">There is no vaccine or cure</li>
<li style="background-image: url(http://news.bbcimg.co.uk/view/3_0_20/cream/hi/shared/img/story_sprite.gif); background-position: -1200px 5px; background-repeat: no-repeat; font-size: 1.077em; line-height: 18px; margin: 0px 0px 8px; padding: 0px 0px 0px 16px; text-rendering: auto;">Supportive care such as rehydrating patients who have diarrhoea and vomiting can help recovery</li>
<li style="background-image: url(http://news.bbcimg.co.uk/view/3_0_20/cream/hi/shared/img/story_sprite.gif); background-position: -1200px 5px; background-repeat: no-repeat; font-size: 1.077em; line-height: 18px; margin: 0px 0px 8px; padding: 0px 0px 0px 16px; text-rendering: auto;">Fruit bats are considered to be virus' natural host</li>
</ul>
Dr D Quekhttp://www.blogger.com/profile/02878815376401309022noreply@blogger.com0tag:blogger.com,1999:blog-6158809075942993636.post-14069181733729005222014-07-31T22:57:00.001+08:002014-07-31T22:57:48.289+08:00Ebola: Sierra Leone declares ‘State of Public Emergency’<br />
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<a href="http://outbreaknewstoday.com/category/africa/" style="color: #222222; text-decoration: none;">Africa</a> » <span class="entry-title">Ebola: Sierra Leone declares ‘State of Public Emergency’</span></div>
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Ebola: Sierra Leone declares ‘State of Public Emergency’</h2>
<span class="by">Posted by <a href="http://outbreaknewstoday.com/author/robert/" rel="author" style="color: #222222; text-decoration: none;" title="Posts by Robert Herriman">Robert Herriman</a> on July 31, 2014 // <a class="comments-link" href="http://outbreaknewstoday.com/ebola-sierra-leone-declares-state-of-public-emergency-57619/#respond" style="color: #222222; text-decoration: none;" title="Comment on Ebola: Sierra Leone declares ‘State of Public Emergency’">Leave Your Comment</a></span></div>
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As of July 27, the West African nation of Sierra Leone has recorded 533 <span class="IL_AD" id="IL_AD2" style="background-attachment: scroll !important; background-clip: initial !important; background-color: transparent !important; background-image: none !important; background-origin: initial !important; background-position: 0% 50%; background-repeat: repeat !important; background-size: initial !important; border-bottom-color: rgb(0, 153, 0) !important; border-bottom-style: solid !important; border-bottom-width: 1px !important; color: rgb(0, 153, 0) !important; cursor: pointer !important; display: inline !important; float: none !important; padding: 0px 0px 1px !important; position: static; text-decoration: underline !important;">Ebola Virus Disease</span> cases (473 confirmed, 38 probable, and 22 suspected) including 233 deaths. To put that in perspective, prior to the current West Africa EVD outbreak, the most cases reported in any Ebola outbreak was 425 (Uganda 2000-2001).</div>
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<a href="http://outbreaknewstoday.com/wp-content/uploads/2014/05/Sierra_Leone-CIA_WFB_Map.png" style="color: #16387c; text-decoration: none;"><img alt="Image/CIA" class="size-medium wp-image-541" height="300" src="http://outbreaknewstoday.com/wp-content/uploads/2014/05/Sierra_Leone-CIA_WFB_Map-278x300.png" style="border: none; margin: 0px 0px 5px; padding: 0px;" width="278" /></a><div class="wp-caption-text" style="font-size: 11px; line-height: 12px; padding: 0px;">
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On Wednesday, Sierra Leone President, Dr. Ernest Bai Koroma addressed the nation concerning the Ebola situation, which included a few words about the passing and loss of Dr Shek Umar Khan and the announcement of a declaration of a State of Public Emergency.</div>
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<a href="http://www.statehouse.gov.sl/index.php/component/content/article/925-address-to-the-nation-on-the-ebola-outbreak-by-his-excellency-the-president-dr-ernest-bai-koroma-july-30-2014" style="color: #16387c; text-decoration: none;">Here is a transcript of the President’s address</a>:</div>
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Today, I ask the entire nation to mourn with the families of our <span class="IL_AD" id="IL_AD11" style="background-attachment: scroll !important; background-clip: initial !important; background-color: transparent !important; background-image: none !important; background-origin: initial !important; background-position: 0% 50%; background-repeat: repeat !important; background-size: initial !important; border-bottom-color: rgb(0, 153, 0) !important; border-bottom-style: solid !important; border-bottom-width: 1px !important; color: rgb(0, 153, 0) !important; cursor: pointer !important; display: inline !important; float: none !important; padding: 0px 0px 1px !important; position: static; text-decoration: underline !important;">national</span> heroes including<a href="http://outbreaknewstoday.com/sierra-leones-ebola-doctor-shek-umar-khan-dies-from-ebola-66516/" style="color: #16387c; text-decoration: none;">Dr. Shek Humarru Khan</a> who lost their lives battling the Ebola outbreak in our country.</div>
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They were true patriots, paragons of service. We must win this fight in honor of their memory, and with prayers in our hearts, for all our compatriots who are victims of this<span class="IL_AD" id="IL_AD12" style="background-attachment: scroll !important; background-clip: initial !important; background-color: transparent !important; background-image: none !important; background-origin: initial !important; background-position: 0% 50%; background-repeat: repeat !important; background-size: initial !important; border-bottom-color: rgb(0, 153, 0) !important; border-bottom-style: solid !important; border-bottom-width: 1px !important; color: rgb(0, 153, 0) !important; cursor: pointer !important; display: inline !important; float: none !important; padding: 0px 0px 1px !important; position: static; text-decoration: underline !important;">deadly disease</span>.</div>
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Since the outbreak, my government, in collaboration with development partners has continued to mobilize and deploy resources and expertise nationally and internationally to fight the disease.</div>
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I have been in contact with world leaders and global partners to meet the challenges; we have set up coordinating <span class="IL_AD" id="IL_AD9" style="background-attachment: scroll !important; background-clip: initial !important; background-color: transparent !important; background-image: none !important; background-origin: initial !important; background-position: 0% 50%; background-repeat: repeat !important; background-size: initial !important; border-bottom-color: rgb(0, 153, 0) !important; border-bottom-style: solid !important; border-bottom-width: 1px !important; color: rgb(0, 153, 0) !important; cursor: pointer !important; display: inline !important; float: none !important; padding: 0px 0px 1px !important; position: static; text-decoration: underline !important;">mechanisms</span> with the World Health Organization and other international bodies; we set up an inter-ministerial committee to mobilize MDA support activities; trained and deployed hundreds of health workers, contact tracers and burial teams; and facilitated awareness raising on the disease by paramount chiefs, religious leaders, non-governmental organizations, civil society organizations, musicians, okada riders, market women, the media and ordinary citizens.</div>
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The disease is beyond the scope of any one country, or <span class="IL_AD" id="IL_AD8" style="background-attachment: scroll !important; background-clip: initial !important; background-color: transparent !important; background-image: none !important; background-origin: initial !important; background-position: 0% 50%; background-repeat: repeat !important; background-size: initial !important; border-bottom-color: rgb(0, 153, 0) !important; border-bottom-style: solid !important; border-bottom-width: 1px !important; color: rgb(0, 153, 0) !important; cursor: pointer !important; display: inline !important; float: none !important; padding: 0px 0px 1px !important; position: static; text-decoration: underline !important;">community</span> to defeat. Its social, economic, psychological and security implications require scaling up measures at international, national, inter-agency andcommunity levels.</div>
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Extra-ordinary challenges require extra-ordinary measures. The Ebola Virus Disease (EVD) poses an extra-ordinary challenge to our nation. Consequently, and in line with the Constitution of Sierra Leone Act Number 6 of 1991, I hereby proclaim a State of Public Emergency to enable us take a more robust approach to deal with the Ebola outbreak.</div>
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In order to continue to take direct control of the situation, I have cancelled my trip to the US-Africa Summit in the United States of America. On Friday, I will be travelling to Conakry, Guinea to meet with my colleague Heads of State of the Mano River Union to discuss our sub-regional strategies to defeat the disease.</div>
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We are launching a National Response Plan to inaugurate Phase Two of our fight against the disease. I also hereby establish a Presidential Task Force on Ebola which I will chair to champion the implementation of the following:</div>
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All epicenters of the disease will be quarantined;</div>
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The police and the military will give support to health officers and NGOs to do <span class="IL_AD" id="IL_AD5" style="background-attachment: scroll !important; background-clip: initial !important; background-color: transparent !important; background-image: none !important; background-origin: initial !important; background-position: 0% 50%; background-repeat: repeat !important; background-size: initial !important; border-bottom-color: rgb(0, 153, 0) !important; border-bottom-style: solid !important; border-bottom-width: 1px !important; color: rgb(0, 153, 0) !important; cursor: pointer !important; display: inline !important; float: none !important; padding: 0px 0px 1px !important; position: static; text-decoration: underline !important;">their work</span>unhindered and restrict movements to and from epicenters;</div>
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Localities and homes where the disease is identified will be quarantined until cleared by medical teams;</div>
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Public meetings and gatherings will be restricted with the exception of essential meetings related to Ebola sensitization and education;</div>
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Active surveillance and house-to-house searches shall be conducted to trace and quarantine Ebola victims and suspects;</div>
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Parliament is recalled to promote MPs leadership at constituency levels;</div>
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Paramount chiefs are required to establish bye-laws that would complement other efforts to deal with the Ebola outbreak;</div>
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Mayors, chairmen of councils and councilors are hereby required to support Ebola control measures in their local government areas;</div>
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All deaths must be reported authorities before burial;</div>
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New protocols for arriving and departing passengers have been instituted at the Lungi International Airport;</div>
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Cancellation of all foreign trips by ministers and other government officials except absolutely essential engagements.</div>
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These measures will initially be implemented for a period of 60 to 90 days, and subsequent measures will be announced as and when necessary.</div>
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In addition, Government is establishing a special account for donations from corporate interests, organizations, the <span class="IL_AD" id="IL_AD7" style="background-attachment: scroll !important; background-clip: initial !important; background-color: transparent !important; background-image: none !important; background-origin: initial !important; background-position: 0% 50%; background-repeat: repeat !important; background-size: initial !important; border-bottom-color: rgb(0, 153, 0) !important; border-bottom-style: solid !important; border-bottom-width: 1px !important; color: rgb(0, 153, 0) !important; cursor: pointer !important; display: inline !important; float: none !important; padding: 0px 0px 1px !important; position: static; text-decoration: underline !important;">Diaspora</span> and the general public to support the fight against Ebola.</div>
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I also hereby declare Monday August 4, 2014 aNational Stay at Home Day <span class="IL_AD" id="IL_AD4" style="background-attachment: scroll !important; background-clip: initial !important; background-color: transparent !important; background-image: none !important; background-origin: initial !important; background-position: 0% 50%; background-repeat: repeat !important; background-size: initial !important; border-bottom-color: rgb(0, 153, 0) !important; border-bottom-style: solid !important; border-bottom-width: 1px !important; color: rgb(0, 153, 0) !important; cursor: pointer !important; display: inline !important; float: none !important; padding: 0px 0px 1px !important; position: static; text-decoration: underline !important;">for Family</span>Reflection, Education and Prayers on the Ebola outbreak.</div>
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Fellow citizens, this is a national fight, and it behoves all of us to stand together to promote the truth about this deadly disease. Ebola is real, and we must stop its transmission. There have been over 130 survivors of the disease. There is hope that early detection of the virus in persons can boost their chances of survival. This is why it is very necessary to get those with the virus to treatment centers not only to prevent others from contracting the virus, but also increasing their own chances of survival.</div>
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Fellow citizens, Sierra Leone is in a great fight. We are a resilient people. And we must not fail. The sustainability of our actions for prosperity depends on winning this fight. Failure is not an option. We all need to come together to win this battle.</div>
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<span class="IL_AD" id="IL_AD1" style="background-attachment: scroll !important; background-clip: initial !important; background-color: transparent !important; background-image: none !important; background-origin: initial !important; background-position: 0% 50%; background-repeat: repeat !important; background-size: initial !important; border-bottom-color: rgb(0, 153, 0) !important; border-bottom-style: solid !important; border-bottom-width: 1px !important; color: rgb(0, 153, 0) !important; cursor: pointer !important; display: inline !important; float: none !important; padding: 0px 0px 1px !important; position: static; text-decoration: underline !important;">Thank you</span> for <span class="IL_AD" id="IL_AD3" style="background-attachment: scroll !important; background-clip: initial !important; background-color: transparent !important; background-image: none !important; background-origin: initial !important; background-position: 0% 50%; background-repeat: repeat !important; background-size: initial !important; border-bottom-color: rgb(0, 153, 0) !important; border-bottom-style: solid !important; border-bottom-width: 1px !important; color: rgb(0, 153, 0) !important; cursor: pointer !important; display: inline !important; float: none !important; padding: 0px 0px 1px !important; position: static; text-decoration: underline !important;">listening</span> and God Bless Sierra Leone. For more infectious disease news and information,<a href="https://www.facebook.com/infectiousdiseasenews" style="color: #16387c; text-decoration: none;"><strong> visit and “like” the Infectious Disease News Facebook page</strong></a></div>
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Just a little more about the passing of Dr. Khan,<a href="http://politicosl.com/2014/07/editorial-rest-in-heaven-dr-khan/" style="color: #16387c; text-decoration: none;">in an editorial in the Sierra Leone news source, Politico</a>, the author had some great words to say about Dr. Khan that I wanted to share.</div>
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At 39 years, and the country’s only specialist in viral haemorrhagic fevers, Dr Shek Umar Khan could have landed a hugely lucrative job anywhere <span class="IL_AD" id="IL_AD10" style="background-attachment: scroll !important; background-clip: initial !important; background-color: transparent !important; background-image: none !important; background-origin: initial !important; background-position: 0% 50%; background-repeat: repeat !important; background-size: initial !important; border-bottom-color: rgb(0, 153, 0) !important; border-bottom-style: solid !important; border-bottom-width: 1px !important; color: rgb(0, 153, 0) !important; cursor: pointer !important; display: inline !important; float: none !important; font-size: 28px !important; padding: 0px 0px 1px !important; position: static; text-decoration: underline !important;">in the world</span>. But he chose to return home to fight a medical war against<span class="IL_AD" id="IL_AD6" style="background-attachment: scroll !important; background-clip: initial !important; background-color: transparent !important; background-image: none !important; background-origin: initial !important; background-position: 0% 50%; background-repeat: repeat !important; background-size: initial !important; border-bottom-color: rgb(0, 153, 0) !important; border-bottom-style: solid !important; border-bottom-width: 1px !important; color: rgb(0, 153, 0) !important; cursor: pointer !important; display: inline !important; float: none !important; font-size: 28px !important; padding: 0px 0px 1px !important; position: static; text-decoration: underline !important;">viral diseases</span>.</div>
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A man from Port Loko district in the north, he put himself forward to go to the east to fight, initially, Lassa Fever knowing very well that his predecessor Dr Aniru Conteh had died of the Lassa Fever he had been saving others from. Dr Khan braved it. And when Ebola emerged, he was a General who commanded his troops from the frontline and not from the cosiness of his office.</div>
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Dr D Quekhttp://www.blogger.com/profile/02878815376401309022noreply@blogger.com0tag:blogger.com,1999:blog-6158809075942993636.post-27998555814336135092014-07-31T18:07:00.003+08:002014-07-31T18:07:51.094+08:00For recidivist alcoholics, these booze bracelets might be the only way to track and deter their addiction!<div style="background-color: white; color: #282828; font-family: georgia, 'times new roman', times, serif; font-size: 10px; margin: 0px; padding: 0px;">
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For recidivist alcoholics, these booze bracelets might be the only way to track and deter their addiction!</h1>
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<a href="http://www.telegraph.co.uk/news/uknews/crime/11002125/US-style-booze-bracelets-to-be-fitted-to-offenders-which-measure-alcohol-in-sweat.html">US-style 'booze bracelets' to be fitted to offenders which measure alcohol in sweat</a></h1>
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Boris Johnson launches new powers for courts to crack down on Britain's 'booze culture'</h2>
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<span style="color: #404040; font-size: 1.1em; line-height: 1.38em; margin: 0px 5px 0px 0px;">Lindsay Lohan wearing her alcohol monitoring bracelet on her ankle in 2007</span> <span style="color: #999999; font-size: 1em; line-height: 1.38em;">Photo: Rex</span></div>
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By <a href="http://www.telegraph.co.uk/journalists/Georgia-Graham/" rel="author" style="color: #234b7b; outline: 0px; padding: 0px; text-decoration: none;" target="_blank" title="Georgia Graham">Georgia Graham</a>, Political Correspondent</div>
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The Telegraph,</h2>
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8:05AM BST 31 Jul 2014</div>
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Binge drinkers across the UK could be fitted with US-style electronic tags that constantly monitor their alcohol intake in a new scheme to crack down on Britain’s “booze culture”, the Justice Secretary has said.</div>
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From today “Booze bracelets” are to be fitted to persistent offenders who are banned by the courts from drinking after they are charged for alcohol fuelled crimes such as drink driving across South London.</div>
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In a trial launched by Boris Johnson, the Mayor of London, courts in Britain will have the power to issue the electronic tag, which records the wearer’s alcohol intake by measuring air and perspiration emissions from the skin every 30 minutes.</div>
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At least once every 24 hours, the bracelet is connected to the internet to send alcohol levels to the probation officer.</div>
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If the blood or sweat has an alcohol level of more than 0.02 then it will be followed up by a visit by the police or probation officer.</div>
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<img height="287" name="1478bd9d9ecfda52_booze-bracelet" src="https://blogger.googleusercontent.com/img/proxy/AVvXsEibF_5_TsBWsKmd_XvEg2L6TxPkAnmq2ac2s-JQbjDTiAzgp7Yj7pYDXHpLXQS9u7wRoYMs8gcKTX6G-zK-EfsjxCyhPCCjoxj1XUcyqcAPnECE78Ape1ZxxNJ1in9qHQYThoIVxVdtiJD8O99job3dNA1JHEGjEnjpqA6Apx0iwjPEtcYBwY1Qrlxyyrg=s0-d-e1-ft" style="border: 0px; display: inline; overflow: hidden;" version="c" width="460" /></div>
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The scheme has been backed by Chris Grayling, the Justice Secretary the “intriguing project” that would tackle the “root cause” of alcohol related crime. If successful it could be rolled out across the UK.</div>
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The tag rose to fame after Hollywood star Lindsay Lohan was forced to wear the bracelet – which tends to be attached to the ankle – after failing to turn up to a probation hearing relating to a drink-driving case.</div>
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The tags can be issued in the boroughs of Croydon, Lambeth, Southwark and Sutton alongside community or suspended sentences, and can be offenders can be compelled to wear them for up to four months.</div>
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Offenders will either be given a limit that they are allowed to drink, or banned from consuming alcohol together.</div>
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Boris Johnson, the Mayor of London who will launch the scheme at Croydon Magistrates’ Court, said: “Alcohol-fuelled criminal behaviour is a real scourge on our high streets, deterring law-abiding citizens from enjoying our great city especially at night, placing massive strain on frontline services, whilst costing businesses and the taxpayer billions of pounds.</div>
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“I pledged to tackle this booze culture by making the case to Government for new powers to allow mandatory alcohol testing as an additional enforcement option for the courts.</div>
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“This is an approach that has seen impressive results in the US, steering binge drinkers away from repeated criminal behaviour and I am pleased we can now launch a pilot scheme in London.’</div>
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Alcohol related crime is estimated to cost the UK between £8bn and £13bn every year and places a heavy burden on public services - 40 per cent of all A&E attendances are related to alcohol misuse.</div>
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Professor Keith Humphreys, former White House Drugs Advisor, who has advised on the project said: “24/7 sobriety schemes have had a transformative effect on alcohol-fuelled crime in the US and I am delighted that it is now being piloted in the UK, where it is clearly much needed.”</div>
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Dr D Quekhttp://www.blogger.com/profile/02878815376401309022noreply@blogger.com0tag:blogger.com,1999:blog-6158809075942993636.post-86493948952002033832014-07-31T10:50:00.000+08:002014-07-31T13:15:19.097+08:00Your missed heart beat may not be so benign....<b><span style="font-size: large;">Your missed heart beat may not be so benign....</span></b><br />
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Prognostic Significance of Premature Ectopic Beats<br />
Joel M. Gore, MD Reviewing Qureshi W et al., Am J Cardiol 2014 Jul 1; 114:59<br />
July 25, 2014<br />
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An incidental finding on a screening electrocardiogram might be worth taking seriously.<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOS3DLTcPzAudPP2t3aW4qAo5Sq0Nwf6cnHztZ1-eoVRJ0YRhoqa_gZL6zNYknSUCyKjAta5NCYw6cBHhP_WPgQKOylJnaEOgb38BEMUiEUlo3o2Z8TzXoqxmjiie_4u3DmadsiL7cVaM/s1600/ecg-PSVCs1.png" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOS3DLTcPzAudPP2t3aW4qAo5Sq0Nwf6cnHztZ1-eoVRJ0YRhoqa_gZL6zNYknSUCyKjAta5NCYw6cBHhP_WPgQKOylJnaEOgb38BEMUiEUlo3o2Z8TzXoqxmjiie_4u3DmadsiL7cVaM/s1600/ecg-PSVCs1.png" height="312" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Frequent PSVCs (or APCs)</td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAAuvrgwtOusYF7bokIXomm3TSLhM4uLde3hL85nqmBQ6sTYthisaGMK3PsFBUpogEPuM3Ml77XEsn3aelensKXliR88xYjPldML0xrl4-n2_3e0qoaZMgePimG64W63ITPWM3wxwfo00/s1600/ecg-frequent+VPCs3.png" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAAuvrgwtOusYF7bokIXomm3TSLhM4uLde3hL85nqmBQ6sTYthisaGMK3PsFBUpogEPuM3Ml77XEsn3aelensKXliR88xYjPldML0xrl4-n2_3e0qoaZMgePimG64W63ITPWM3wxwfo00/s1600/ecg-frequent+VPCs3.png" height="356" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Frequent PVCs</td></tr>
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<br />
To evaluate the prognostic implications of atrial premature complexes (APCs) and ventricular premature complexes (VPCs) detected on a single 12-lead electrocardiogram (ECG) in healthy individuals, investigators analyzed NHANES III data for 7504 adults (mean age, 60; 47% women; 49% white) without cardiovascular disease who had good-quality ECGs showing sinus rhythm without conduction abnormalities.<br />
<br />
At baseline, 89 participants (1.2%) had APCs and 110 (1.5%) had VPCs. Compared with participants without premature ectopic beats, those with premature complexes were more likely to be older, male, and white and to have higher systolic blood pressure and greater prevalence of pulmonary disease and left ventricular hypertrophy; participants with APCs were more likely to have cancer.<br />
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During a mean follow-up of 13 years, 2386 participants died. All-cause mortality, cardiovascular mortality, and ischemic heart disease (IHD) mortality were all higher in both the APC and VPC groups than in the group without premature complexes.<br />
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In analysis adjusted for demographics, comorbid conditions, and ECG indexes, APCs were associated with significant increases in risk of 41% for all-cause mortality, 64% for cardiovascular mortality, and 106% for IHD mortality. VPCs were not an independent risk factor for any type of mortality after adjustment.<br />
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Comment<br />
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Electrocardiograms are frequently obtained for screening purposes in the general population. Though rarely present, premature ectopic beats may have prognostic significance, according to this study. Clinicians may be prudent to step up vigilance in caring for patients who have premature ectopic beats on routine ECGs.<br />
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Citation(s):<br />
<br />
Qureshi W et al. Long-term mortality risk in individuals with atrial or ventricular premature complexes (results from the Third National Health and Nutrition Examination Survey). Am J Cardiol 2014 Jul 1; 114:59. (http://dx.doi.org/10.1016/j.amjcard.2014.04.005)<br />
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NEJM Journal Watch • 860 Winter Street • Waltham, MA 02451 • USA<br />
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Copyright 2014. Massachusetts Medical Society. All rights reserved.<br />
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<br />Dr D Quekhttp://www.blogger.com/profile/02878815376401309022noreply@blogger.com0tag:blogger.com,1999:blog-6158809075942993636.post-32770198360451091342014-07-31T01:05:00.003+08:002014-08-01T09:14:54.475+08:00Ebola outbreak spreads in west Africa: country by country data<br />
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Ebola outbreak spreads in west Africa: country by country data</h1>
<div class="stand-first-alone" data-component="Article:standfirst_cta" id="stand-first" itemprop="description">
The
outbreak of the deadly Ebola virus currently sweeping through parts of
west Africa has so far killed an estimated 673 people. As of 23 July
there had been a total of 1,202 confirmed, probable or suspected
infections</div>
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</div>
<ul class="article-attributes trackable-component b4" data-component="Article:byline">
<li class="byline">
<div class="contributor-full">
<span itemprop="author" itemscope="" itemtype="http://schema.org/Person"><span itemprop="name"><a class="contributor" href="http://www.theguardian.com/profile/frances-perraudin" itemprop="url" rel="author">Frances Perraudin</a></span></span> </div>
</li>
<li class="publication">
<a href="http://www.theguardian.com/" itemprop="publisher">theguardian.com</a>,
<time datetime="2014-07-30T15:27BST" itemprop="datePublished" pubdate="">Wednesday 30 July 2014 15.27 BST </time></li>
<li class="publication"><time datetime="2014-07-30T15:27BST" itemprop="datePublished" pubdate=""> </time></li>
<li class="publication"><time datetime="2014-07-30T15:27BST" itemprop="datePublished" pubdate=""><a href="http://www.mirror.co.uk/news/world-news/ebola-virus-symptoms-start-sore-3933920#.U9jWf4sWMoY.facebook">Mirror-ebola-virus-symptoms & graphics</a></time>
</li>
</ul>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWG8VVeRimesE5JiZlH6yvNwxWIraWhJi2tHz0UllnalbO2ZNdQvmmH8VbV1TnR9qcy2ITZiATqj26Ec5y7oGuJPD-y8oOLirVOg9unN0QGKmJn_YrPGZ_TtbTF9T6KNvT1SKyDixeqUE/s1600/MAIN-Ebola-virus.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWG8VVeRimesE5JiZlH6yvNwxWIraWhJi2tHz0UllnalbO2ZNdQvmmH8VbV1TnR9qcy2ITZiATqj26Ec5y7oGuJPD-y8oOLirVOg9unN0QGKmJn_YrPGZ_TtbTF9T6KNvT1SKyDixeqUE/s1600/MAIN-Ebola-virus.jpg" /></a><br />
<br />
<h2>
Guinea: 427 cases, 319 deaths</h2>
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<h1 style="background-color: #f9f9f9; color: #111111; font-family: ProximaNova, Arial, Helvetica, sans-serif; font-weight: normal; letter-spacing: -1px; line-height: 1; margin: 0.25em 0px; padding: 0px; text-rendering: optimizelegibility; word-wrap: break-word;">
<span style="font-size: large;">Ebola: what is it and how does it spread? <span style="color: #999999; font-family: Arial, Helvetica, sans-serif;">By</span><span style="color: #999999; font-family: Arial, Helvetica, sans-serif;"> </span><a href="http://www.abc.net.au/news/tim-leslie/167086" style="color: #310099; font-family: Arial, Helvetica, sans-serif; margin: 0px; padding: 0px; text-decoration: none; word-wrap: break-word;" target="_self" title="">Tim Leslie</a><span style="color: #999999; font-family: Arial, Helvetica, sans-serif;">, illustrations by Lucy Fahey</span></span></h1>
</div>
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<br /></div>
<div>
The first recorded case in
the current outbreak of the Ebola virus was in February this year in
Guinea. On 25 March, the Ministry of Health of Guinea reported that
southeastern districts were affected with an outbreak of “Ebola
hemorrhagic fever”. In late May the disease had spread to Guinea’s
capital Conakry, a city with around two million inhabitants. The lack of
water and sanitation in the city made it very hard to contain the
spread of the disease. The latest <a href="http://www.who.int/csr/don/2014_07_27_ebola/en/">World Health Organisation update</a>
confirmed 311 cases with 208 dead in the country. There are another 99
probably cases that all resulted in death and 17 more suspected cases,
12 of them deaths.</div>
<br />
<img src="http://static.guim.co.uk/ni/1406712842351/Ebola_outbreak_map_WEB.svg" style="width: 100%;" /><br />
<br />
<br />
<h2>
Liberia: 249 cases, 129 deaths</h2>
Ebola
was reported in the Lofa and Nimba counties of Liberia in late March
and by mid-April possible cases had been recorded in Margibi and
Montserrado County. In the latest <a href="http://www.who.int/csr/don/2014_07_27_ebola/en/">WHO update</a>,
84 were confirmed infected and of those 60 had died. A further 165
probable or suspected cases were reported with 69 of those deaths.
Liberian doctor, Samuel Brisbane, who had been treating people with the
disease, <a href="http://www.theguardian.com/world/2014/jul/27/liberia-ebola-first-doctor-dies-brisbane-virus-outbreak">was confirmed to have died from ebola</a> on 27 July. Two <a href="http://www.theguardian.com/science/2014/jul/27/us-doctor-liberia-tests-positive-ebola">US aid workers</a> for the christian humanitarian aid group Samaritan’s Purse were also reported to be infected.<br />
<h2>
Sierra Leone: 525 cases, 224 deaths</h2>
<br />
<br />
<br />
<br />
<br />
<figure class="element element-image" data-media-id="gu-fc-44dea5b5-e62a-44f1-a893-1345e5c330d2">
<img alt="Sheik Umar Khan" class="gu-image" src="http://static.guim.co.uk/sys-images/Guardian/Pix/pictures/2014/7/30/1406728405114/46236d80-8312-477e-bf6f-87bdba647f0c-460x276.jpeg" height="276" width="460" />
<figcaption>Sheik Umar Khan. Photograph: Reuters</figcaption>
</figure>
The first cases in Sierra Leone were reported on 25 May in Kailahun District. The outbreak spread rapidly and <a href="http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news/4225-ebola-virus-disease-west-africa-18-july-2014.html">by 17 July</a>
the number of suspected cases reached 442, overtaking the number in
Guinea and Liberia. The first case in Sierra Leone’s capital Freetown
was recorded in late July and the current <a href="http://www.who.int/csr/don/2014_07_27_ebola/en/">WHO estimates</a>
are that of 525 confirmed, probable or suspected cases, 224 people have
died. On 29 July the leading Ebola doctor Sheik Umar Khan also died of
the disease.<br />
<h2>
Nigeria: one case, one death</h2>
On 20 July, Liberian civil servant <a href="http://www.theguardian.com/world/2014/jul/25/first-case-ebola-lagos-nigeria">Patrick Sawyer</a>
arrived in Lagos, Nigeria’s largest city, by air and was hospitalised
before dying of Ebola. There are fears that the disease might have
spread to Togo, where his flight stopped over. </div>
</div>
Dr D Quekhttp://www.blogger.com/profile/02878815376401309022noreply@blogger.com0tag:blogger.com,1999:blog-6158809075942993636.post-84694789255232927492014-07-30T23:31:00.001+08:002014-07-30T23:31:21.107+08:00How to succeed against malpractice suits, judge's tips<div dir="ltr">
<span style="font-size: large;"><b>Judges reveal secrets to successful malpractice trials</b></span></div>
<div dir="ltr">
PRACTICE ECONOMICS - MALPRACTICE</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOdqJYBqiBNysJ3mwvGkSFFje3P-PWxHIrTwyc12YlcH1IvLQOrdPmmdX4DPhbT284yxMTi4LZf7ZiGgPoGKP9_8kCM9pOLWRzx5uUMX7t9V-WRxZGn9tPEd0p6C1uRGcDp-wEYJYJO4M/s1600/justice+hammer1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOdqJYBqiBNysJ3mwvGkSFFje3P-PWxHIrTwyc12YlcH1IvLQOrdPmmdX4DPhbT284yxMTi4LZf7ZiGgPoGKP9_8kCM9pOLWRzx5uUMX7t9V-WRxZGn9tPEd0p6C1uRGcDp-wEYJYJO4M/s1600/justice+hammer1.jpg" height="187" width="320" /></a></div>
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<br /></div>
<div dir="ltr">
<a href="http://www.clinicalpsychiatrynews.com/practice-economics/single-view/judges-reveal-secrets-to-successful-malpractice-trials/807957d2eed41e5f7d4c194b89c67ed4.html?email=ivan-oransky@erols.com&ocid=3425077&utm_source=MagnetMail&utm_medium=email&utm_term=ivan-oransky@erols.com&utm_content=cog140730_final&utm_campaign=Judges%20reveal%20secrets%20to%20winning%20malpractice%20cases">Clinical Psychiatry News-malpractice tips</a></div>
<div dir="ltr">
<br /></div>
<div dir="ltr">
When it comes to the outcome of a medical malpractice jury
trial, a physician’s attitude, demeanor, and presentation make all the
difference, say judges who’ve presided over many such cases.</div>
<div dir="ltr">
<br /></div>
<div dir="ltr">
"The fact finder has to look at them and find them credible
and sincere when they’re hearing their story," said Lorenzo F. Garcia,
chief magistrate judge emeritus for the U.S. District Court for the
District of New Mexico.</div>
<div dir="ltr">
<br /></div>
<div dir="ltr">
"There’s truth and there’s perception, and perception can
trump the truth. In litigation, being right isn’t always good enough.
You can be right in a claim or right in a defense and still lose if the
fact finder doesn’t believe the testimony or dislikes a person, witness,
or an attorney."</div>
<div dir="ltr">
<br /></div>
<div dir="ltr">
Exhibiting arrogance or defensiveness when testifying can
quickly sway a jury against a defendant doctor, adds Judge Garcia, who
provided trial insight with several other judges at the American
Conference Institute’s obstetric malpractice claims forum.</div>
<div dir="ltr">
<br /></div>
<div dir="ltr">
When taking the stand, it helps to remain respectful at all
times, refrain from acting combative, and demonstrate concern when
discussing patients who were injured, he said.</div>
<div dir="ltr">
<br /></div>
<div dir="ltr">
Physicians should also be aware of how their attorneys are
presenting themselves and interacting with legal parties. Being rude to
judges, litigants, or attorneys can have a negative impact on jurors’
view of that particular side, said Sandra Mazer Moss, a retired
Philadelphia Court of Common Pleas judge.</div>
<div dir="ltr">
<br /></div>
<div dir="ltr">
Doctors have a critical role in helping court participants
understand the medicine surrounding a case, notes Judge Mazer Moss, who
also spoke at the ACI conference. This includes properly preparing
attorneys to speak about medical events and ensuring jurors clearly
understand medical facts.</div>
<div dir="ltr">
<br /></div>
<div dir="ltr">
Health providers "can help explain procedures so that
attorneys can understand and relay the information," she noted. "When
you put a witness on the stand, they have to [clearly] explain how the
procedure was done. It would help if the doctor had physical aids,
PowerPoint [slides], or models."</div>
<div dir="ltr">
<br /></div>
<div dir="ltr">
However, Judge Garcia stresses that physicians and their
attorneys shouldn’t overly rely on technology during a trial. He has
presided over medical malpractice cases in which electronic equipment
failed and caused long delays, he said.</div>
<div dir="ltr">
<br /></div>
<div dir="ltr">
In some cases, the technology problems prevented plaintiffs or defendants from effectively presenting their arguments.</div>
<div dir="ltr">
<br /></div>
<div dir="ltr">
"To start a trial in such a fashion and see that jurors are
not happy and that time is going by; there’s a valuable lesson" there,
he said. "Make sure you practice and try the technology ahead of time. [Technology] can be exceedingly effective, or it can be a disaster if it
doesn’t work well."</div>
<div dir="ltr">
<br /></div>
<div dir="ltr">
Another contributor to a successful malpractice case is the
ability to tell a powerful story, Judge Garcia said. In his experience,
litigants who choose a central theme and weave that idea throughout the
trial are most effective.</div>
<div dir="ltr">
<br /></div>
<div dir="ltr">
For example, the defense may open the trial by emphasizing
that the case is about a patient’s bad luck, not bad medicine, and
coming back to that point throughout the proceedings.</div>
<div dir="ltr">
<br /></div>
<div dir="ltr">
"Quite frankly, that’s what jurors like to hear," he said.
"They want to hear a story, so part of the preparation is trying to find
the most important [piece] of the litigation and developing a story
that can be a recurring theme.</div>
<div dir="ltr">
<br /></div>
<div dir="ltr">
The development of a theme is one of the most significant
tasks parties can engage in, and it assists in the presentation of the
claim or the defense."</div>
Dr D Quekhttp://www.blogger.com/profile/02878815376401309022noreply@blogger.com0tag:blogger.com,1999:blog-6158809075942993636.post-75761342022342087112014-07-28T12:00:00.003+08:002014-07-28T14:08:03.417+08:00Professional Fees: Can Doctors Police themselves?<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgd78Kx2g9HIbKJYWprQ85vEoxHKmvBqU7NZrOic551l0mpWdDrHkfjOr3aWX_L4ENEEyVb3Jmh-gtblKEyvj42Z2HAbN7432v8gdnM6DKWAZs4YZGdoduh2pUKvXC0b8PcOecvJp8EC8g/s1600/health+care+costs+dollar+signs.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgd78Kx2g9HIbKJYWprQ85vEoxHKmvBqU7NZrOic551l0mpWdDrHkfjOr3aWX_L4ENEEyVb3Jmh-gtblKEyvj42Z2HAbN7432v8gdnM6DKWAZs4YZGdoduh2pUKvXC0b8PcOecvJp8EC8g/s1600/health+care+costs+dollar+signs.png" height="207" width="320" /></a></div>
Can doctors police themselves? Well more often than not, the 'human'
aspect of self-interest tempts and in some cases, overwhelms good sense and conscience--the
classical if inescapable 'moral hazard' and conflict of interests.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiL3eHELnRRppBTjOmZqhJzdf13zG0oacNy75nEd60OmEcPNA6q1rvVB9rFN_BiWYbA4yW57XITitA15nJFXjxM7QmVYsE_VxEzrCx5vMFalVIL020taHvIV5B5rwDx4e5_6iIHqk9pq2g/s1600/who's+the+doctor+here.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiL3eHELnRRppBTjOmZqhJzdf13zG0oacNy75nEd60OmEcPNA6q1rvVB9rFN_BiWYbA4yW57XITitA15nJFXjxM7QmVYsE_VxEzrCx5vMFalVIL020taHvIV5B5rwDx4e5_6iIHqk9pq2g/s1600/who's+the+doctor+here.png" height="220" width="320" /></a></div>
<br />
<br />
<a href="http://www.todayonline.com/singapore/guidelines-doctors-fees-could-be-reinstated">http://www.todayonline.com/singapore/guidelines-doctors-fees-could-be-reinstated</a><br />
<br />
As doctors, we have a duty and responsibility to determine this fine
line, to ensure that our patients' interests are our first and foremost
concern. We have to remind ourselves of our medical professionalism and
the Tavistock principles that most of our peers from time immemo<span class="text_exposed_show">rial have vouched to preserve--patients' rights, well-being, safety and altruism being the major pillars of our professional remit...</span><br />
<br />
<blockquote class="tr_bq">
<span style="color: #990000;"><span class="text_exposed_show"><a href="http://search.tb.ask.com/search/redirect.jhtml?action=pick&ct=GD&qs=&searchfor=tavistock+principles&cb=ZR&pg=GGmain&p2=%5EZR%5Efox999%5ES09184%5Emy&qid=617b92b792fa48afb38e3eaac08c0878&n=780bd98c&ss=sub&pn=1&st=tab&ptb=DC3413DF-7AC9-43DA-9A0A-8729B93E20AF&tpr=hpsb&redirect=mPWsrdz9heamc8iHEhldEfE%2BsEUe0ck3Ob1HQy2UG2LlrAovC7UdV5cpgy9SdyPf8e4clWJjL4abIobYv49ZFg%3D%3D&ord=0&"><b>Tavistock Principles </b></a></span></span><br />
<ol>
<li><span style="color: #990000;"><span style="font-size: small;"><b>R<span style="font-family: "Times New Roman";">ights</span></b></span></span></li>
<ul>
<li><span style="color: #990000;"><span style="font-size: small;"><span style="font-family: "Times New Roman";">People have a right to health and
health care.</span></span></span></li>
</ul>
<li><span style="color: #990000;"><span style="font-size: small;"><span style="font-family: "Times New Roman"; font-weight: bold;">Balance</span></span></span></li>
<ul>
<li><span style="color: #990000;"><span style="font-size: small;"><span style="font-family: "Times New Roman";">Care of individual patients is
central, but the health of populations is also our concern.</span></span></span></li>
</ul>
<li><span style="color: #990000;"><span style="font-size: small;"><span style="font-family: "Times New Roman"; font-weight: bold;">Comprehensiveness</span></span></span></li>
<ul>
<li><span style="color: #990000;"><span style="font-size: small;"><span style="font-family: "Times New Roman";">In addition to treating illness,
we have an obligation to ease suffering, minimise disability, prevent disease,
and promote health.</span></span></span></li>
</ul>
<li><span style="color: #990000;"><span style="font-size: small;"><span style="font-family: "Times New Roman"; font-weight: bold;">Cooperation</span></span></span></li>
<ul>
<li><span style="color: #990000;"><span style="font-size: small;"><span style="font-family: "Times New Roman";">Healthcare succeeds only if we
cooperate with those we serve, each other, and those in other sectors.</span></span></span></li>
</ul>
<li><span style="color: #990000;"><span style="font-size: small;"><span style="font-family: "Times New Roman"; font-weight: bold;">Improvement</span></span></span></li>
<ul>
<li><span style="color: #990000;"><span style="font-size: small;"><span style="font-family: "Times New Roman";">Improving healthcare is a serious
and continuing responsibility.</span></span></span></li>
</ul>
<li><span style="color: #990000;"><span style="font-size: small;"><span style="font-family: "Times New Roman"; font-weight: bold;">Safety</span></span></span></li>
<ul>
<li><span style="color: #990000;"><span style="font-size: small;"><span style="font-family: "Times New Roman";">Do no harm.</span></span></span></li>
</ul>
<li><span style="color: #990000;"><span style="font-size: small;"><span style="font-family: "Times New Roman"; font-weight: bold;">Openness</span></span></span></li>
<ul>
<li><span style="font-size: small;"><span style="color: #990000;"><span style="font-family: "Times New Roman";">Being open, honest, and
trustworthy is vital in healthcare.</span></span></span><span style="color: white; font-family: "Times New Roman"; font-size: 24.0pt; language: en-GB; mso-ascii-font-family: "Times New Roman"; mso-bidi-font-family: +mn-cs; mso-color-index: 1; mso-fareast-font-family: +mn-ea;">
</span></li>
</ul>
</ol>
</blockquote>
<br />
<div class="text_exposed_show">
From my social and personal perspective, ethical fee guidelines do need
to be there; boundaries need to be drawn and established by peers or
society.<br />
<br />
If one chooses to charge professional fees far
exceeding prescribed norms, then clearly venal interests have trumped
common sense and practice... One veers perilously close to offering
boutique-type medical services--not necessarily bad or wrong, but one
that's similar to desirable luxury goods and services! But here's where
most if not all patients or consumers of healthcare must have, a prior
informed choice or alternative to decide...<br />
<br />
Ultimately in most
health services around the world, excessive fees and costs have been the
bane against the concept of universal access to health for all. Point
of care fees are known to deter and derail population health access for
the worse.<br />
<br />
Even when there are third party payers and insurance,
there are limits as to how much these payers have the finite capacity or
the willingness to reimburse. But society by virtue of its invisible
hand of the free market can lend guidance or advice as to which or what
health care services or fees would be considered excessive... However,
more often than not, this top-down type of fluctuating market forces
might be too slow and sporadic to influence common or safe practices...<br />
<br />
As such, something as profound and indispensable as health cannot be
let to its own devices to find its level of fair pricing... Professional
fee's and overall health care costs should be dictated to some extent
by market forces and then some, by overarching health authorities and
policy makers, providing the necessary but difficult balance of controls
and limits, as well as the bottom line social safety nets, when all else
fails for those hapless patients who simply can't afford to pay.<br />
<br />
Health for populations must be considered a social good that cannot
simply be left to free market forces and so-called free competition! For
most if not all, health must increasingly be considered a basic human
right, and not just a market-driven aspiration or dream!</div>
Dr D Quekhttp://www.blogger.com/profile/02878815376401309022noreply@blogger.com3tag:blogger.com,1999:blog-6158809075942993636.post-80846922078068820882013-12-13T13:03:00.002+08:002013-12-13T13:03:48.613+08:00MRC: Stem Cell therapy-Myths and Facts.... by Dr Ng Soo Chin<h2 class="art-PostHeaderIcon-wrapper" style="background-color: #f8f7fc; font-family: Arial, Helvetica, sans-serif; font-size: 24px; font-weight: normal; letter-spacing: -1px; margin: 0.2em 0px; padding: 0px;">
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November 5th, 2007 | Author: <a href="http://medicine.com.my/wp/2007/11/stem-cell-therapy-myths-and-facts/#" style="color: #474a6b; margin: 0px;" title="Author">palmdoc</a></div>
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Dr Ng Soo Chin<br />Consultant Haematologist<br />
<br />(This article appeared in the Star November 4, 2007 and is also reproduced here with the permission of the author)<br />
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<strong>Preamble:</strong><br />There is something about Stem cell therapy (SCT)- a google search on the subject yielded 3.35 million hits! It is of interest to a diverse groups of people including doctors (haematologists, cardiologists, neurologists, paediatricans, geriatricians endocrinologists ….), basic research scientists, politicians, religious leaders, businessman in pharmaceutical industry, and last but not least the lay public including patients. Recently our honorable Health Minister rightly pointed out that they are many claims of stem cell therapy that are misleading and advised patients to exercise caution to avoid being taken for a ride. There are some ‘stem cell therapists’ touting promising treatment results in Malaysia and worldwide. This is an immediate and present danger to our innocent patients (refer to ATC saga).<br />
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<strong>1) What are stem cells?</strong><br />Stem cells are fascinating. They are undifferentiated, master cells capable of self renewal (immortal!) and have the ability to differentiate into various specialized tissues. It is important to distinguish the type of stem cells we are talking about-the embryonic stem cells (ESC) present in the inner cell mass of pre-implanted embryo or the ‘adult’ stem cells (ASC) present in umbilical cord blood, amniotic fluid or in blood/marrow. There are significant differences between ESC and ASC. ESC is pluripotent i.e. capable of developing into any of the cell types found in the human body. ASC are able to make a few cell types and are considered as multipotent. To date no formal trials using ESC have been conducted because of safety issue related to uncontrolled growth which results in tumor formation which has been seen in laboratory animals. ASC are attractive as research tools and for treating disease as they do not involve the destruction of embryos. They are also attractive as it may be possible to use a patient’s own stem cells to generate tissue for transplant, thus avoiding problems with immune rejection common to other types of transplantation. However the limited ability to form other tissues may limit its application. Though the phenomenon of plasticity has been described in ASC i.e. Ability of ASC to form cells of different lineage under suitable environment but scientists are not sure how this can be exploited adequately in clinical settings.<br />
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<strong>2) What are the potential uses of stem cells?</strong><br />Stem cells have potential uses in many different areas of research and medicine. It has the potential to revolutionize our approach to study of human biology and treatment of diseases. Some of the important potential applications are as below:<br /><br />
a) In regenerative Medicine:<br />Due to their ability to replace damaged cells in the body, stem cells could be used to treat a range of conditions including heart failure, spinal injuries, diabetes and Parkinson disease. It is hoped that transplantation and growth of appropriate stem cells in damaged tissue will regenerate the various cell types of that tissue. For example, <a href="http://www.biotechnologyonline.gov.au/topitems/glossary.cfm#haematopoieticstemcells" style="color: #2d2f43;" target="_blank">haematopoietic stem cells</a> (stem cells found in bone marrow) could be transplanted into leukaemia patients to generate new blood cells, or neural stem cells may be able to regenerate nerve tissue damaged by spinal injury.<br /><br />
b) For human developmental studies which will shed light on why some cells become cancerous and how some genetic diseases develop, which may lead to clues as to how they may be prevented.<br /><br />
c) New drug testing and screening of toxins. These can be done on stem cells grown in the laboratory which would provide a better testing model than current animal model.<br />
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<strong>3) Is stem cell therapy an established form of therapy?</strong><br />Depending what type of stem cell therapy we are talking about. Haematopoietic stem cell transplant (HSCT) or better known as bone marrow transplant is an established and curative form of treatment for blood cancers such as leukemia ,lymphoma, myeloma , bone marrow failure syndromes such as aplastic anemia and certain genetic diseases such as thalassemia or severe combined immunodeficiency state. It has taken haematologists (experimental and clinical) a good 35 years to reach the current state of practice whereby annually up to 40000 or more HSCT are done yearly. In Malaysia more than a thousand patients had HSCT and around 70% of these patients are long term survivals. Transplant medicine is now rather refined with various form of HSCT being performed ranging form autologous transplant (stem cells from patient) to allogeneic transplant (stem cells from donors). Innovative changes to the conditioning regimen enable older patients to undergo HSCT in reduced intensity HSCT. Stem cell therapy other than HSCT remain experimental treatment and should only conducted in the setting of clinical trials under close supervision and also need clearance from appropriate ethic committee.<br />
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<strong>4) What are clinical trials all about? Should not we just trust the opinions of our ‘prominent doctors’?</strong><br />We are now living in an era whereby the practice of medicine should be evidence –based. Clinical trials are essential to generate unbiased data based on careful studies on variables that we are interested in. For instance if we are interested to find out if treatment A is useful for a particular disease, the answer will be forth-coming after 3 phases of study. In phase1 study we have to ascertain whether treatment A is safe to give to humans follow by phase 2 study which would examine whether treatment A is effective or not. The acid test is in phase 3 trial when treatment A is compared to an established treatment and hopefully it is able to demonstrate superior results with acceptable side effects then treatment A is destined for pay-back time. In the case of a new drug, FDA or EU registration will be sought before marketing is allowed. Before clinical trials are approved, the protocols are subjected to scrutiny by an independent ethical committee comprising of doctors, and at least a lawyer and a lay person. Generally the data after studies are published in established medical journals and also presented in important clinical meetings so that the knowledge gained from study is assessable to every interested party. One would expect the same results be duplicated if similar studies are performed else where.<br />
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<strong>5) What are the pre requisites for successful stem cell therapy?</strong><br />For stem cell therapy to work, the prerequisites would include understanding/defining the clinical problem, knowing the right type of cells to give and in adequate number, overcoming the immunological barrier if allogeneic or stem cells from outside source is used, putting the stem cells in the right place and finally getting the transplanted stem cells to work. Referring to <a href="http://medicine.com.my/wp/2007/11/stem-cell-therapy-myths-and-facts/#table" style="color: #2d2f43;">table 1</a>, one would appreciate why HSCT is an established science while in the setting of stem cell therapy with aim to replace damaged myocardium after acute myocardial infarction (AMI), there are many unresolved issues. Bortin reported the first 203 cases of BMT done in the 70’s ed only 5 of them survived. The current HSCT results are much better (Transplant related mortality is <5% for autologous HSCT and <15% for allogeneic HSCT respectively). The marked improvement in treatment results is the fruit of intense basic research and clinical work which result in the understanding of HLA system in selecting the right donor and also ability to provide supportive care in terms of blood products, anti-infectives as well as immunosuppressive therapy in appropriate circumstances. Obviously much fine tuning is needed before SCT become a viable treatment in AMI setting.<br />
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<strong>6) What are the raging ethical debates on stem cell therapy that even President Bush is caught up with?</strong><br />The ethical issue only arises in ESC as use of ESC results in the destruction or death of the embryo. This is a passionate issue that resulted in strict government regulation in some countries forbidding creation of embryo for research purposes. There are also legitimate fears that some rogue scientists will attempt human cloning which is banned in all countries. ESC when transplanted into experimental animals generally continue to multiply in an untamed fashion, with a tendency to form tumors or various unwanted tissues. It would be difficult to justify use of ESC in human therapy unless the problem of potential tumor formation is fixed.<br />There are no ethical issues with the use of adult stem cells but one of the potential hurdles for the use of adult stem cells is their limited ability to generate different cell types.<br />
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<strong>7) There are claims that stem cell therapy could cure diabetes mellitus, spinal injury, and Parkinson's diseases...and the list goes on and how credible are these claims? Apparently such services are available in Malaysia!</strong><br />These are claims and they will remain as claims unless and until they are backed up by good sciences and data one should view them critically and not let our senses take leave. It is worthwhile checking out some of these claims at good website such as <a href="http://www.quackwatch.org/" style="color: #2d2f43;" target="_blank">Quackwatch</a>. Quackwatch Inc. is an American non-profit organization that aims to “combat health-related frauds, myths, fads, fallacies, and misconduct” with a primary focus on providing “quackery-related information that is difficult or impossible to get elsewhere.” On the claims by the stem cell companies the Quackwatch comments were: their theories and methods are simplistic; their treatments may have adverse effects; they offer no credible outcome data; and their promises go far beyond what is now possible. No reason to believe that they are providing a legitimate service. As the good old saying goes-when something is too good to be true, it usually is.<br />
<span id="more-2769"></span><br /><strong>8 ) What is the chance of Malaysia becoming the hub of stem cell therapy?</strong><br />While I do not underestimate the ‘Malaysia boleh’ entrepreneurship, to grow a 250 million RM business from a not tested technology is stretching it too far! It is more than irrational exuberance to believe that this will happen. We should keep our feet on the ground and participate in some good basic research. The local UKM research laboratory headed by Prof SK Cheong performed some interesting studies on the role of mesenchymal cells as cancer delivery agent and continual research in the same direction will enable us to tap on advances that can be translated from laboratory to bedside in time to come.<br />
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<strong>9) Do we need to have some regulations to safeguard the general well being of our patients?</strong><br />The answer is a resounding yes. Any form of stem cell therapy advertisement should be vetted by the Ministry of Health and stem cell therapy other than HSCT should only be conducted in the setting of a clinical trial so that the practice/ results can be monitored. The chance of a rogue doctors creating havoc with uncontrolled SCT is much higher than a rogue scientist running foul of law. We are duty bound to ‘protect’ our patients.<br />
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<strong>10) Do I think stem cell therapy will fulfill its great promises and transform the practice of medicine?</strong><br />It is not a question whether it will happen but rather when this will happen .While haemopoietic stem cell therapy/transplant is an established modality of treatment, other form of stem cell therapy is still at very early stage of development. Prof Peter Braude, a leading stem cell researcher felt that stem cell therapy needs to be nurtured safely and methodically to provide real benefits to patients in the future. Much more basic research work needs to be done. In a positional statement, the International Society for stem cell research proclaimed that no reputable scientists think stem cell therapy (other than haemopietic stem cell therapy) is ready for prime-time yet. The people who are providing such therapies are mavericks!<br />
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<strong>The saga of ATC</strong><br />In May 1996 a group of doctors involved in cancer care (including the author) wrote in a letter to Star Editor highlighting the exploits of a Singapore doctor (his clinic was called clinic Sinai!) treating Malaysian patients with advanced cancer using ATC (autologous target cytokines). There were no absolutely firm scientific data on the ATC treatment. The patients were promised fantastic results and charged exorbitant fees. We voiced our distress that patients were misled and wonder whether our health authority can stem such unhealthy practices. There was some interesting follow up development-the Malaysian authority could not take any action against the Singapore doctor since he is not registered here while the Singapore counterpart cannot take action against him because he was not treating patients in Singapore! He was ultimately nabbed by the Singapore authority for internet advertising and deregistered accordingly.<br />
The author is the current President of <a href="http://haematology.org.my/" style="color: #2d2f43;" target="_blank">Malaysian Society of Haematology</a>. Some contents of the article are taken from a lecture entitled ‘Stem Cell therapy-do we know where we are going to? ‘ delivered by the author in the symposium organized by Malaysian Academy of Sciences in July 2007.<br />
<a href="" name="table" style="color: #5340a0; text-decoration: underline;">Table 1</a><br />
<a href="http://www.flickr.com/photos/44432840@N00/1854225213/" style="color: #2d2f43;" title="Photo Sharing"><img alt="image002" height="360" src="http://farm3.static.flickr.com/2192/1854225213_2f2117dc6a_o.gif" style="border: 1px solid rgb(133, 116, 200); margin: 1em;" width="480" /></a></div>
Dr D Quekhttp://www.blogger.com/profile/02878815376401309022noreply@blogger.com0tag:blogger.com,1999:blog-6158809075942993636.post-55845146995041206952013-12-02T13:24:00.003+08:002013-12-02T13:24:44.297+08:00India Medical Times: Doctors are victims of costly training and poor healthcare policies.... by Dr Kunal Sarkar <div class="MsoNormal" style="margin-bottom: 0.0001pt; vertical-align: baseline;">
<b><span style="color: #ea1622; font-family: 'Trebuchet MS', sans-serif; font-size: 16pt;">Doctors are victims of costly training and poor healthcare policies</span></b><b><span style="color: #ea1622; font-family: 'Trebuchet MS', sans-serif; font-size: 12pt;"><o:p></o:p></span></b></div>
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<span style="border: 1pt none windowtext; font-family: Arial, sans-serif; font-size: 9pt; padding: 0cm;">by </span><a href="mailto:kunal.cardiac@gmail.com" target="_blank"><b><span style="border: 1pt none windowtext; color: windowtext; font-family: Arial, sans-serif; font-size: 9pt; padding: 0cm; text-decoration: none;">Dr Kunal Sarkar</span></b></a><span style="border: 1pt none windowtext; font-family: Arial, sans-serif; font-size: 9pt; padding: 0cm;"> </span></div>
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<span style="border: 1pt none windowtext; font-family: Arial, sans-serif; font-size: 9pt; padding: 0cm;">I</span><span style="color: #666666; font-family: Arial, sans-serif; font-size: 9pt; line-height: 12pt;">ndia Medical Times, Sunday, September 1, 2013 </span></div>
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<span style="font-family: Arial, sans-serif; font-size: 10pt;">The guardians of the nation’s health find themselves in a state of desperate sickness. The diagnosis has long been known and shared in privacy; not often have we mustered the guts to express the cardinal manifestations of the disease.</span></div>
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<span style="font-family: Arial, sans-serif; font-size: 10pt;">The process of the making of a doctor — is it fair and rational? Both the ethics and method need scrutiny. Based on fallacious reports in the 1980s, governments stymied the expansion of state medical colleges. The opportunity to set up medical colleges was thrown open to the private sector. So we had stiff competition for the seats in government institutions and the private seats were acquired by auction, under the covert legitimization of capitation fees. Private enterprise should have supported the medical colleges with the income from the hospitals. Instead, both the hospitals and the colleges were being supported by the oppressive capitation fee system. Mediocre medical colleges were serviced by substandard hospitals, almost without exception. The attention was not on providing quality education and service but on a hurried capitalization of the prohibitive fee structure.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 10pt;">After initial protests the cowboy educators were joined by the high priests of equitable healthcare, which meant a submission to systematic plunder. Multiple escape routes and exceptions to the merit lists were devised. This ushered in an era of unashamed cash and carry education in a society that was aspiring to be fair and inclusive. The cash and carry segment had engulfed more than 60 per cent of the undergraduate and 40 per cent of the postgraduate seats. The proverbial politician can never be far away from the scent of money — no wonder that this sector is firmly in the clutches of political power brokers.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 10pt;">With the price tags of Rs 50 lakh </span><span style="background-color: white; font-family: Arial, sans-serif; font-size: 10pt;">(1 lakh = 100,000)</span><a href="file:///C:/Users/Dr%20D%20Quek/Desktop/Doctors%20are%20victims%20of%20costly%20training%20and%20poor%20healthcare%20policies.docx#_ftn1" name="_ftnref1" title=""><span class="MsoFootnoteReference"><span class="MsoFootnoteReference"><span style="background-color: white; background-position: initial initial; background-repeat: initial initial; color: black; font-family: Arial, sans-serif; font-size: 10pt; line-height: 14px;">[1]</span></span></span></a><span style="font-family: Arial, sans-serif; font-size: 10pt;"> for an undergraduate seat and Rs 1-4 crore </span><span style="background-color: white; font-family: Arial, sans-serif; font-size: 10pt;">(1 crore = 10,000,000)</span> <span style="font-family: Arial, sans-serif; font-size: 10pt;">for a postgraduate seat, are we not kidding ourselves with great expectations of ethical uprightness? The pressures to recover the mortgage are enormous. A naïve society will continue to express surprise that a doctor is a commercial creature. Does he have a choice?<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 10pt;">The quality of education is yet another matter. Regardless of how many stages of filtration we set up, money will rule. The chances of a college letting a Rs 3 crore<a href="file:///C:/Users/Dr%20D%20Quek/Desktop/Doctors%20are%20victims%20of%20costly%20training%20and%20poor%20healthcare%20policies.docx#_ftn2" name="_ftnref2" title=""><span class="MsoFootnoteReference"><span class="MsoFootnoteReference"><span style="font-size: 10pt; line-height: 14px;">[2]</span></span></span></a> seat go vacant for a term are small. There is still no national standard monitoring agency. The state subject of health remains feudal and fragmented. The Medical Council of India’s process of recognition and renewal has been a ‘you scratch my back, I scratch yours’ type of transaction. The standardization of education and amenities remains a distant dream. The focus of medical education has been the number and cost of seats. Quality has not figured in the agenda — not at all.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 10pt;">The recent judgment that annulled common entrance tests probably had its points of legal validity, but it was a severe setback for the cause of standardization and quality enhancement. It is a pity that successive regimes in the ministry and the MCI have had neither the clarity of purpose nor the legal expertise to push it through.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 10pt;">In recent times, there has been a campaign to exponentially increase the number of postgraduate seats. It is emotive to equate the number of specialists to population statistics. Pragmatism demands that some cognizance is taken of the stagnation in the infrastructure and in absorption opportunities. An increase of specialists with a stagnant national bed count makes little sense. It will produce a gross excess of manpower, thereby producing a cattle market of low-paid professionals. The average pay for a newly qualified postgraduate doctor is already quite modest compared to peer group professionals.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 10pt;">It is all too easy to fan the fire through social media at the expense of the prevailing reality. In the last few years, postgraduate seats have already been increased, but as the healthcare infrastructure has remained virtually stagnant, there is more than a hint of oversupply. Over a good part of the last decade, the national bed census has been static at 10 per 10,000 population, vis-à-vis a projected capacity of twice as much. With all the insight and inspiration, this figure refuses to budge for years on end. What are qualified doctors, who have paid an arm and a leg for their education, supposed to do? Serve in rural outbacks without a modicum of civic infrastructure and livelihood? Their life was supposed to be a profession, not an act of penance. And less than 30 per cent of all doctors are in organized employment. Do we dare to add to this clutter of stagnant mediocrity?<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 10pt;">Mindless populism has struck the healthcare industry’s viability another deadly blow. The revenue potential of the industry has been seriously capped with the regulation of charges via population insurance and government reimbursement schemes. These meagre tariffs very often render basic procedures unsustainable for hospitals. For the sake of maintaining numbers, some hospitals patronize these schemes at the cost of viability and quality.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 10pt;">Reduced charges for the financially hard-pressed is not a matter of contention. But if these are applied to all and sundry, the result is catastrophic. Private equity is justified in expecting some return for investment. Is it conceivable that the retail or information technology sector will have their earnings truncated? How do we cost-cap a system, 80 per cent of which is based on private equity? This paradox is further aggravated by the pretences to low-cost care. Low-cost care in mass scale has and will remain a pipe dream. Eighty per cent of the business for such providers is based on market prices with less than a fifth having some form of concession. The slogan is appealing but the economics does not add up. It helps create an image but not a sustainable system. Making unsubstantiated claims without an audit or a national database on procedures and outcome has become a pastime.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 10pt;">Until we resort to a nationalized healthcare system, with both the delivery and professional reimbursement being standardized on a national scale, populism at the expense of economic viability is inevitable, and a dangerous path to tread.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 10pt;">With severe pressure on revenues and margins, the first impact is on the hapless doctors. They are made to toil for a pittance. Barring successful private practitioners, they can bid goodbye to any substantial raise in earnings. The pressure on margins is passed on the doctors. This remains the only professional segment that is being attacked by pseudo-socialization and extreme political populism. It is not surprising that the interest of investors has been slow and unsure.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 10pt;">It is a supreme paradox that after spending crores to buy a mediocre medical education, the young professional is likely to be trapped in a stagnant industry of low growth and lower earnings. How does the young doctor then justify the expensive gestation? Cutting corners of practice and presumed ethics will be enforced as an instinct for survival. The tragedy of being trapped between myopic policy-makers, educational entrepreneurs (out there to make a fast buck) and the false prophets of populism is being enacted in all its frenzy. That the bubble will burst is not in question — it is a matter of time.<o:p></o:p></span></div>
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<span style="font-family: Arial, sans-serif; font-size: 10pt;">In a country where an economist prime minister has ushered in an era of stagnation it is not surprising that medical messiahs have added to the problem and not to the solution. Caught in the crossfire of pseudo-socialization and crude commercialization will the doctor become a truly endangered species?<o:p></o:p></span></div>
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<i><span style="border: 1pt none windowtext; font-family: Arial, sans-serif; font-size: 10pt; padding: 0cm;">Dr Kunal Sarkar</span></i><span style="font-family: Arial, sans-serif; font-size: 10pt;"><br />Senior Vice Chairman<br /><i><span style="border: 1pt none windowtext; padding: 0cm;">Medica Superspecialty Hospitals, Kolkata<o:p></o:p></span></i></span></div>
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<i><span style="border: 1pt none windowtext; font-family: Arial, sans-serif; font-size: 10pt; padding: 0cm;">Note: This article first appeared in </span></i><a href="http://www.telegraphindia.com/1130831/jsp/opinion/story_17286794.jsp#.UiMqZ2S4qAO" target="_blank"><i><span style="border: 1pt none windowtext; color: windowtext; font-family: Arial, sans-serif; font-size: 10pt; padding: 0cm; text-decoration: none;">The Telegraph</span></i></a><i><span style="border: 1pt none windowtext; font-family: Arial, sans-serif; font-size: 10pt; padding: 0cm;"> on August 31, 2013 (with permission).</span></i><span style="font-family: Arial, sans-serif; font-size: 10pt;"><o:p></o:p></span></div>
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<span style="font-family: Times, Times New Roman, serif; font-size: x-small;"><a href="file:///C:/Users/Dr%20D%20Quek/Desktop/Doctors%20are%20victims%20of%20costly%20training%20and%20poor%20healthcare%20policies.docx#_ftnref1" name="_ftn1" title=""><span class="MsoFootnoteReference"><span class="MsoFootnoteReference"><span style="line-height: 14px;">[1]</span></span></span></a> <span lang="EN-US">100 Rupees (Rs) = MYR 5.17; thus Rs 50 lakh = MYR 260,000<o:p></o:p></span></span></div>
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<span style="font-family: Times, Times New Roman, serif; font-size: x-small;"><a href="file:///C:/Users/Dr%20D%20Quek/Desktop/Doctors%20are%20victims%20of%20costly%20training%20and%20poor%20healthcare%20policies.docx#_ftnref2" name="_ftn2" title=""><span class="MsoFootnoteReference"><span class="MsoFootnoteReference"><span style="line-height: 14px;">[2]</span></span></span></a> </span><span lang="EN-US"><span style="font-family: Times, Times New Roman, serif; font-size: x-small;">Rs 3 crore = MYR 1.55 million</span></span></div>
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Dr D Quekhttp://www.blogger.com/profile/02878815376401309022noreply@blogger.com0tag:blogger.com,1999:blog-6158809075942993636.post-90224851958458119382013-11-30T13:31:00.002+08:002013-11-30T13:31:11.460+08:00MCs by 1Malaysia clinics – illegal?.......... By Dr Anony<h2 class="title" style="background-color: white; font-family: 'EB Garamond', Georgia, Tahoma, 'Century Schoolbook L', Arial, Helvetica; font-size: 27.200000762939453px; letter-spacing: -0.04em; margin: 0px; padding: 0px;">
MCs by 1Malaysia clinics – illegal?</h2>
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I refer to the reply given by Dr Nooraini Baba (NST, March 30th, 2010) in which she claimed that Assistant Medical Officers (AMO) can issue Medical Certificates.</div>
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She had then explained that the MCs issued by AMOs are not illegal, but just that they are invalid for the purpose of workers absenting themselves from work without pay under Section 60F of the Employment Act. In her reply, Dr Nooraini had quoted from the MEDICAL ACT 1971 (Act 50).</div>
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I would like to point out that there is NO provision under any Act of Parliament for the Medical Assistants who man the 1Malaysia clinics, to be referred to as “Assistant Medical Officers.” Instead, the<br style="margin: 0px; padding: 0px;" />Medical Assistants are governed under the MEDICAL ASSISTANTS (REGISTRATION) ACT 1977 (Act 180), and they are thus properly referred to as Medical Assistants, and NOT as “Assistant Medical Officers.”</div>
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I would like to ask Dr Nooraini, whether the fact that 1Malaysia clinics are manned by Medical Assistants, is in violation of MEDICAL ACT 1971, specifically Section 33. (1) (f), which reads:<br style="margin: 0px; padding: 0px;" /> ’33(1) Any person not registered or exempted from registration under this Act who –<br style="margin: 0px; padding: 0px;" /> (f) uses the term “clinic” or “dispensary” or “hospital” or the equivalent or any of there terms in any other language in the signboard over his place of practice in purported practice of medicine or surgery as a person registered under this Act; shall be guilty of an offence against this Act.’</div>
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Also, the fact that these Medical Assistants are running the “1Malaysia clinics” without supervision of Fully Registered Medical Practitioners, would mean that they are also in violation of the MEDICAL (INSTRUMENTS) (EXEMPTION) REGULATIONS 1986, specifically Section 4(1) which reads:<br style="margin: 0px; padding: 0px;" /> ’4. Condition of exemptions.<br style="margin: 0px; padding: 0px;" /> (1) In the case of a registered medical assistant who is employed in a Government hospital, Government health centre or other Government institution for the care, treatment or rehabilitation of patients the exemption shall only apply if he is using any of the instruments specified in the Schedule in the course of<br style="margin: 0px; padding: 0px;" />carrying out his duties in the Government hospital, Government health centre or other Government institution for the care, treatment or rehabilitation of patients under the supervision of the officer.’<br style="margin: 0px; padding: 0px;" />For those who are uninitiated, the MEDICAL ACT 1971 prohibits Non-registered Medical Practitioners from using certain medical instruments, which are normally used in the practice of medicine and surgery. The MEDICAL (INSTRUMENTS) (EXEMPTION) REGULATIONS 1986 was enacted specifically to exempt Medical Assistants from the prohibition under MEDICAL ACT 1971 of using those medical instruments.</div>
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However, it is clear that MEDICAL (INSTRUMENTS) (EXEMPTION REGULATIONS 1986, Section 4(1) allows their exemption ONLY when these Medical Assistants are practicing under the supervision of doctors.</div>
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Of course, one may then dispute the interpretation of the words “under supervision of.” This then leads us to the Poisons Act 1952 (Act 366), in which the prescription and supply of Poisons are strictly governed (many medications dispensed at clinics are scheduled poisons and require the words “Ubat Terkawal” to be imprinted on the packaging.) Section 19 of Poisons Act 1952 (Act 366) reads thus:<br style="margin: 0px; padding: 0px;" /> ’19. (1) Any poison other than a Group A Poison may be sold, supplied or administered by the following persons for the following purposes –<br style="margin: 0px; padding: 0px;" /> (a) a registered medical practitioner may sell, supply or administer such poison to his patient for the purposes of the medical treatment of such patient only;<br style="margin: 0px; padding: 0px;" /> (4) Any medical practitioner, dentist or veterinary officer who sells or supplies any poison or medicine containing a poison not prepared by him or under his immediate personal supervision shall be guilty of an offence against this Act.’ It is also in the very same Poisons Act 1952 (Act 366), that the interpretation of “immediate personal supervision” is clearly defined, in Section 2(2):<br style="margin: 0px; padding: 0px;" /> ‘ (2) In this Act where anything is required to be done under the immediate personal supervision of any person it shall be deemed to have been so done if such person was at the time it was done upon the premises where it was done and available for immediate consultation by the person doing such thing’</div>
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As far as had been publicized in the media, these “1Malaysia clinics” are manned only by Medical Assistants, who therefore are NOT practicing under the “supervision” of any fully registered medical practitioner, as defined by law. Thus, I can only conclude that these Medical Assistants are practicing in violation of several laws.</div>
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Now, if these Medical Assistants are functioning in a capacity which is illegal, aren’t the certificates, including the Medical Certificates, which they issue, also illegal?</div>
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Furthermore, by allowing these Medical Assistants to practice illegally, aren’t their superiors in the Ministry of Health, also guilty of abetment, as defined under the PENAL CODE (Act 574), specifically Sections 107, which reads:<br style="margin: 0px; padding: 0px;" /> ’107. A person abets the doing of a thing who—<br style="margin: 0px; padding: 0px;" /> (a) instigates any person to do that thing;<br style="margin: 0px; padding: 0px;" /> (b) engages with one or more other person or persons in any conspiracy for the doing of that thing, if an act or illegal omission takes place in pursuance of that conspiracy, and in order to the doing of that thing; or<br style="margin: 0px; padding: 0px;" /> (c) intentionally aids, by any act or illegal omission, the doing of that thing.’</div>
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It would thus seem to me that the entire concept and practice of “1Malaysia clinics” are illegal, and in violation of more than one law, and therefore in the absence of any repeal or amendment to the violated laws, all Medical Certificates issued by the Medical Assistants manning the clinics are therefore also illegal.</div>
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Dr D Quekhttp://www.blogger.com/profile/02878815376401309022noreply@blogger.com0tag:blogger.com,1999:blog-6158809075942993636.post-24284037433503840662013-10-08T13:01:00.002+08:002013-10-08T13:01:24.683+08:00UNITY: Our Medical Fraternity must learn to work together<span style="font-family: Trebuchet MS, sans-serif; font-size: large;">UNITY: Our Medical Fraternity must learn to work together</span><div>
<span style="font-family: Trebuchet MS, sans-serif;">by Dr David KL Quek<br /><br />Dear medical colleagues and enthusiastic friends on the ethereal waves of cyberspace,</span><div>
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<span style="font-family: Trebuchet MS, sans-serif;">I've been active in medical societies and associations for close to 30 years, and I hope you will at least bear with me when I caution against internet members being too overzealous in casting aspersions against older institutions, societies, etc.<br /><br />With due respect, I think we mustn't get carried away with our own importance and imagine that what we wish for and articulate loudly in this internet forum, we will get! <br /><br />Different societies and associations have their own rules and regulations and constitutions and are not bound by the MMC or whichever authority except as determined by the ROS. Come on, some of these societies have been there for decades and still survive because some things they do must still be effective. </span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">Most if not all of these have gone through numerous challenges as well and yes perhaps some of them appear tired and out of date, but nevertheless they have real physical members who pay annual dues, are life members, etc. The MMA for instance still has more than 8,000 paying members, and more than 2-3000 life members. They are real societies with tangible support and are therefore recognised by the health ministry and other government and regulatory authorities . <br /><br />I sincerely commend the MPCN and MPCAM for reigniting the private sector doctors and their interests across cyberspace, but please don't be under the impression that this is enough. Believe me, right now it is not. It is indeed a great platform to share information rapidly, and have quick responses from anyone without much need to edit or whatever.<br /><br />But it is certainly not sufficient to influence hard-nosed realities without proper methods of preparing for example working papers or major policy guidelines or even clear systematic arguments vis-a-vis e.g. some of the contentious regulations that the private sector has been saddled with, for the medical profession. <br /><br />Some of these much lamented problems, concepts and ideas are already there, but they need updating and refreshing and yes, renewing every now and again because circumstances change, political and regulatory positions change. But perhaps some of the processes and issues need more attention into formulating these into solid tangible plans of action. </span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">But many of these discourse don't need the tedious and unnecessary re-inventing of the wheel. Most would need re-tweaking and modifying, and made current and in sync with the times and with our current aspirations and wishes.<br /><br />Let's get enough interested people (medical doctors) to work in concrete terms and not just simply writing facebook commentaries. Whether we like it or not, most commentaries in facebook or twitter just fritter away into obsolescence and become forgotten bits and bytes of the ever enlarging humongous cyberspace.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">The reality for societies wishing to make any impact however, is that there is actually quite a lot of physical work that needs to be done--debates, discussions, planning, writing out proposals, getting majority of those around to agree or compromise, then getting these formulated ideas into working or policy summaries then papers, then presenting these to the authorities, then maybe some of these get translated into regulations or changes etc., if members wish to fully participate. <br /><br />But we must get into mainstream activities where some of your points of view will then hopefully, be incorporated and concretised into real change. Imagine if anyone and everyone is speaking, how much of these disparate 'noise' are in total agreement, or are being heard at all? </span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">Yes, currently we appear to be friendly and cautiously sensitive toward each other, but this can all easily change when even simple disagreements arise... there is language and statement consistencies that need at least most to agree upon, but these cannot happen with just individual postings all over the place. Is there anyone to collate or to summarise or to build up a systematic transmissible model of our thoughts. our ideas? I think not yet.<br /><br />But then again, we think some of the things we talk about are so important and unique, but most of these have been raised and discussed before by others, with most falling on deaf ears, even with the presentation of formal papers, dialogues, workshops, etc. We must learn to work together rather than to alienate other societies, which I'd tried to do but failed during my presidency of the MMA in 2009-2011, because too many of us work in silos and are unwilling to work together! <br /><br />When I recently tried to broker a bridge between MPCN with the current MMA leadership, there were strong objections from the MMA exco because many there felt that MPCN has been 'badmouthing' them without understanding the history, contributions and the traditions of MMA's struggles.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">Perhaps the 'old guards' are too sensitive, you might say... Grow up and take it on the chin, and get over it, you say... but that is the reality of life, we do get hurt and are displeased, angered even, when slighted or worse criticised! Sometimes unknowingly, we do condemn unfairly without knowing all the facts and the figures...<br /><br />Again, I say let's not get carried away with the fact that we in the MPCN/MPCAM are the only ones who know what has been happening in the medical profession and our practice. We're not, and even I am certainly not the know-all either... just someone who has been there and done that, in my limited capacity to try build more bridges and maybe influence in some small measures the Malaysian health scene, which is incredibly complex!<br /><br />It will not happen overnight and no amount of 'shouting' in the dark would make any major dent on the system that we are all trying to improve and make sense of... <br /><br />Sorry if I offend anyone! Just food for thought, which I feel is timely! Thanking those of you who are willing to listen and read this long plea!</span></div>
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Dr D Quekhttp://www.blogger.com/profile/02878815376401309022noreply@blogger.com0tag:blogger.com,1999:blog-6158809075942993636.post-4576643578888330962013-08-13T14:14:00.002+08:002013-08-16T19:17:10.539+08:00Orwellian Future for Medicine: Rationing health care vs. Screening or not at all.... by Dr David KL Quek<b><span style="font-family: Trebuchet MS, sans-serif; font-size: large;">Orwellian Future for Medicine: Rationing health care vs. Screening or not at all.... </span></b><br />
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<b><span style="font-family: Trebuchet MS, sans-serif;">by Dr David KL Quek</span></b><br />
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<span style="font-family: Trebuchet MS, sans-serif;">Increasingly we are bombarded by more and more stories about health care rationing and what is prudent or parsimonious healthcare practices. The latest salvo came in the wake of a post criticising former President GW Bush's angioplasty and stenting, as unnecessary <a href="http://www.washingtonpost.com/opinions/president-bushs-unnecessary-heart-surgery/2013/08/09/c91c439c-0041-11e3-9a3e-916de805f65d_story.html">http://www.washingtonpost.com/opinions/president-bushs-unnecessary-heart-surgery/2013/08/09/c91c439c-0041-11e3-9a3e-916de805f65d_story.html</a></span><br />
<span style="font-family: Trebuchet MS, sans-serif;">Another article continues the trend against so-called unnecessary screening tests for health (<a href="http://www.huffingtonpost.com/leana-wen-md/medical-tests_b_3735156.html">http://www.huffingtonpost.com/leana-wen-md/medical-tests_b_3735156.html</a></span><span style="font-family: 'Trebuchet MS', sans-serif;">).</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">How do we draw the line between being blissfully ignorant vs. being worried well and having health check-ups? </span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">Is our human body only to be treated like some automobile/motor car only when it runs into trouble or breaks down? Or shouldn't we carry out maintenance checks so that we can perform that much more efficiently and perhaps more safely, even enhance our chances of living better, with less hassles of disease/disability/incapacity, or living longer!?</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">I think society is increasingly straitjacketing itself into economic silos, where the individual's benefits or rights have increasingly been giving way to societal and community constraints, rights and well-being, primarily driven by escalating costs issues...</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">Because on a larger scale for the community such health 'screening' practices even out toward neutral or no benefit or that appears on cluster analysis to show no significant difference for the greatest majority of the people; or so our growing armies of health economists have deemed... So such practices need to tow the line, we need to be more prudent and therefore cut out all the fat, i.e. all that's unnecessary and wasteful!</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">Even if it means sacrificing some "inconvenience" such as perhaps suffering an arguably low risk of an unannounced heart attack or stroke, or a silent cancer, just because there have been no symptoms or signs... </span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">So it appears that we have been urged to be sensible and brave, to wait until complications or disability occur, or is it really? What about the famously silent hypertension, diabetes, the high blood cholesterol levels, and yes even the many lurking coronary narrowings and cancers? Do we do nothing until announced by an untoward event?</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">According to the US Preventive Task Force (driven in large part at trying to rein in healthcare costs, and dredging evidence-based cost-effectiveness research and data, much like UK's Cochrane Institute, NICE), more and more so-called health screenings are now rendered pointless and discouraged because these have not been shown to offer significant benefits on multivariate analysis and reviews. That many of these tests have resulted in further testing and sometimes even more complications from the more intrusive and invasive diagnostics or even therapies... means that these are not to be preferred as health pathways... So what are we to do?</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">Of course, truth be told, a good history taking and simple comprehensive physical exam could obviate further testing in perhaps 80% of the time... The best diagnosticians among us doctors would of course be superb in picking up the near-miss diagnosis of any major potentially catastrophic illness! But can the majority of us, mere mortals, bread and mortar physicians, be as good or expert? Can we be certain we have not missed some or any silent illness or unheralded risk factors? Have every one of our patients been totally open with us the doctors, and have they disclosed all that matters, accurately? Can we as doctors be allowed to risk being fallible in our medical checks without some of these newer tests and technologies?</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">But we know intuitively and also practically that primary prevention measures and some screening can and does pick up hidden covert dangers (although we should never dare boast of our 100% certainty!). We are aware that some of these silent health hazards can endanger lives, risk complications and could possibly result in some health catastrophes and even death!</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">Otherwise why indeed do we still offer health check ups that appear to have stood the test of time and tradition? Of course these may not be very cost-effective, even 'expensive' on a larger scale; but barring that, no one can dispute that early detection might or could actually save some lives whose symptom-free disease would otherwise have been missed. </span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">Perhaps, President Bush should just go on and live a busy energetic life, oblivious of his narrowed heart artery... the heart is certainly 'usually' resilient, but it's also notorious with that minuscule chance of being twitchy and deadly, an off-chance risk really... ;)) Perhaps, he should just have allowed his acceptable chance of possibly dropping dead suddenly during his long-haul cycling exercises or running, then what? </span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">Perhaps, Steve Jobs shouldn't have had a scan to pick up his pancreatic cancer, perhaps his liver transplant was a dodgy wasteful therapeutic choice... then he could have passed on after just a few months (usual prognosis for most pancreatic cancer, <5-15% survival beyond 6 months) ... certainly much more cheaply, instead of that 2 - 3 years or so of extended meaningful life that he chose to have and could afford to have... </span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">Perhaps Angelina Jolie shouldn't have had her bilateral mastectomy and reconstruction, because the BRCA testing is still so expensive (USD4k) and this celebrity option might spark too many wannabee worried-well women from asking for such testing! Perhaps she should have just taken this lying down, like her now demised middle-aged mum and aunt...</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">Perhaps in cost-strapped health systems, we should allow a few people to die suddenly; suffer some heart attacks and increase more heart failures; have more advanced incurable cancers because these have only marginally improved with not very effective but terribly expensive 'therapies'! </span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">Perhaps, in the near future, society should dictate who should live and for how long, who should be treated and who not, and who should be allowed to die... an Orwellian "1984" beckons!</span>Dr D Quekhttp://www.blogger.com/profile/02878815376401309022noreply@blogger.com1tag:blogger.com,1999:blog-6158809075942993636.post-18814653278454230772013-06-26T13:54:00.002+08:002013-06-26T14:02:48.717+08:00Letter to MCPN....by Dr Steven Chow<span style="font-family: Trebuchet MS, sans-serif; font-size: x-large;"><b>Letter to MCPN....by Dr Steven Chow</b></span><br />
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Dear Fellow Doctors,<br />
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<b><span style="font-size: large;">Re: Current Practice Issues</span></b><br />
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I have been reading the track of discussion regarding the above and my comments are as follows:</div>
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<strong style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">1: PHFSA & Regulations </strong><br />
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”.<br />
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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.</div>
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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 <i>bona fide</i> doctors are a whole bunch of unscrupulous businessmen/women.</div>
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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.</div>
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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.</div>
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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.</div>
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<strong style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">2: GP XR – Radiographer Issue</strong></div>
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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.</div>
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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.</div>
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<strong style="background-color: transparent; border: 0px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">3: Clinic Signboard</strong></div>
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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.</div>
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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.</div>
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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.</div>
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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.</div>
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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.<br />
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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.<br />
Best wishes and may God Bless all the good doctors.</div>
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Steven Chow<br />
President, FPMPAM</div>
Dr D Quekhttp://www.blogger.com/profile/02878815376401309022noreply@blogger.com0tag:blogger.com,1999:blog-6158809075942993636.post-42396684558675615412013-06-26T12:59:00.003+08:002013-06-26T13:00:51.430+08:00How Doctors Die... by Dr Ken Murray<span style="font-family: Trebuchet MS, sans-serif; font-size: x-large;"><b>How Doctors Die</b></span><br />
<span style="font-family: Trebuchet MS, sans-serif; font-size: large;"><b>It’s Not Like the Rest of Us, But It Should Be</b></span><br />
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by Dr Ken Murray<br />
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<span style="font-family: Trebuchet MS, sans-serif;">Years ago, Charlie, a highly respected orthopaedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds—from 5 percent to 15 percent—albeit with a poor quality of life.</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They’ve talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen—that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">Almost all medical professionals have seen what we call “futile care” being performed on people. That’s when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this occurs in the Intensive Care Unit at a cost of tens of thousands of dollars a day. What it buys is misery we would not inflict on a terrorist. I cannot count the number of times fellow physicians have told me, in words that vary only slightly, “Promise me if you find me like this that you’ll kill me.” They mean it. Some medical personnel wear medallions stamped “NO CODE” to tell physicians not to perform CPR on them. I have even seen it as a tattoo.</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">To administer medical care that makes people suffer is anguishing. Physicians are trained to gather information without revealing any of their own feelings, but in private, among fellow doctors, they’ll vent. “How can anyone do that to their family members?” they’ll ask. I suspect it’s one reason physicians have </span><span style="font-family: 'Trebuchet MS', sans-serif;">higher rates of alcohol abuse and depression than professionals in most other fields. I know it’s one reason I stopped participating in hospital care for the last 10 years of my practice.</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">How has it come to this—that doctors administer so much care that they wouldn’t want for themselves? The simple, or not-so-simple, answer is this: patients, doctors, and the system.</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">To see how patients play a role, imagine a scenario in which someone has lost consciousness and been admitted to an emergency room. As is so often the case, no one has made a plan for this situation, and shocked and scared family members find themselves caught up in a maze of choices. They’re overwhelmed. When doctors ask if they want “everything” done, they answer yes. Then the nightmare begins. Sometimes, a family really means “do everything,” but often they just mean “do everything that’s reasonable.” The problem is that they may not know what’s reasonable, nor, in their confusion and sorrow, will they ask about it or hear what a physician may be telling them. For their part, doctors told to do “everything” will do it, whether it is reasonable or not.</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">The above scenario is a common one. Feeding into the problem are unrealistic expectations of what doctors can accomplish. Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor. I’ve had hundreds of people brought to me in the emergency room after getting CPR. Exactly one, a healthy man who’d had no heart troubles (for those who want specifics, he had a “tension pneumothorax”), walked out of the hospital. If a patient suffers from severe illness, old age, or a terminal disease, the odds of a good </span><span style="font-family: 'Trebuchet MS', sans-serif;">outcome from CPR are infinitesimal, while the odds of suffering are overwhelming. Poor knowledge and misguided expectations lead to a lot of bad decisions.</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">But of course it’s not just patients making these things happen. Doctors play an enabling role, too. The trouble is that even doctors who hate to administer futile care must find a way to address the wishes of patients and families. Imagine, once again, the emergency room with those grieving, possibly hysterical, family </span><span style="font-family: 'Trebuchet MS', sans-serif;">members. They do not know the doctor. Establishing trust and confidence under such circumstances is a very delicate thing. People are prepared to think the doctor is acting out of base motives, trying to save time, or money, or effort, especially if the doctor is advising against further treatment.</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">Some doctors are stronger communicators than others, and some doctors are more adamant, but the pressures they all face are similar. When I faced circumstances involving end-of-life choices, I adopted the approach of laying out only the options that I thought were reasonable (as I would in any situation) as early in the process as possible. When patients or families brought up unreasonable choices, I would discuss the issue in layman’s terms that portrayed the downsides clearly. If patients or families still insisted on treatments I considered pointless or harmful, I would offer to transfer their care to another doctor or hospital.</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">Should I have been more forceful at times? I know that some of those transfers still haunt me. One of the patients of whom I was most fond was an attorney from a famous political family. She had severe diabetes and terrible circulation, and, at one point, she developed a painful sore on her foot. Knowing the hazards of </span><span style="font-family: 'Trebuchet MS', sans-serif;">hospitals, I did everything I could to keep her from resorting to surgery. Still, she sought out outside experts with whom I had no relationship. Not knowing as much about her as I did, they decided to perform bypass surgery on her chronically clogged blood vessels in both legs. This didn’t restore her circulation, and the surgical wounds wouldn’t heal. Her feet became gangrenous, and she endured bilateral leg amputations. Two weeks later, in the famous medical center in which all this had occurred, she died.</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">It’s easy to find fault with both doctors and patients in such stories, but in many ways all the parties are simply victims of a larger system that encourages excessive treatment. In some unfortunate cases, doctors use the fee-for-service model to do everything they can, no matter how pointless, to make money. More commonly, though, doctors are fearful of litigation and do whatever they’re asked, with little feedback, to avoid getting in trouble.</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">Even when the right preparations have been made, the system can still swallow people up. One of my patients was a man named Jack, a 78-year-old who had been ill for years and undergone about 15 major </span><span style="font-family: 'Trebuchet MS', sans-serif;">surgical procedures. He explained to me that he never, under any circumstances, wanted to be placed on life support machines again. One Saturday, however, Jack suffered a massive stroke and got admitted to the emergency room unconscious, without his wife. Doctors did everything possible to resuscitate him and put him on life support in the ICU. This was Jack’s worst nightmare. When I arrived at the hospital and took over Jack’s care, I spoke to his wife and to hospital staff, bringing in my office notes with his care preferences. Then I turned off the life support machines and sat with him. He died two hours later.</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">Even with all his wishes documented, Jack hadn’t died as he’d hoped. The system had intervened. One of the nurses, I later found out, even reported my unplugging of Jack to the authorities as a possible homicide. Nothing came of it, of course; Jack’s wishes had been spelled out explicitly, and he’d left the paperwork to prove it. But the prospect of a police investigation is terrifying for any physician. I could far more easily have left Jack on life support against his stated wishes, prolonging his life, and his suffering, a few more weeks. I would even have made a little more money, and Medicare would have ended up with an additional $500,000 bill. It’s no wonder many doctors err on the side of overtreatment.</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">But doctors still don’t over-treat themselves. They see the consequences of this constantly. Almost anyone can find a way to die in peace at home, and pain can be managed better than ever. Hospice care, which focuses on providing terminally ill patients with comfort and dignity rather than on futile cures, provides most people with much better final days. Amazingly, studies have found that people placed in hospice care often live longer than people with the same disease who are seeking active cures. I was struck to hear on the </span><span style="font-family: 'Trebuchet MS', sans-serif;">radio recently that the famous reporter Tom Wicker had “died peacefully at home, surrounded by his family.” Such stories are, thankfully, increasingly common.</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">Several years ago, my older cousin Torch (born at home by the light of a flashlight—or torch) had a seizure that turned out to be the result of lung cancer that had gone to his brain. I arranged for him to see various specialists, and we learned that with aggressive treatment of his condition, including three to five hospital visits a week for chemotherapy, he would live perhaps four months. Ultimately, Torch decided against any treatment and simply took pills for brain swelling. He moved in with me.</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">We spent the next eight months doing a bunch of things that he enjoyed, having fun together like we hadn’t had in decades. We went to Disneyland, his first time. We’d hang out at home. Torch was a sports nut, and he was very happy to watch sports and eat my cooking. He even gained a bit of weight, eating his favorite foods rather than hospital foods. He had no serious pain, and he remained high-spirited. One day, he didn’t wake up. He spent the next three days in a coma-like sleep and then died. The cost of his medical care for those eight months, for the one drug he was taking, was about $20.</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">Torch was no doctor, but he knew he wanted a life of quality, not just quantity. Don’t most of us? If there is a state of the art of end-of-life care, it is this: death with dignity. As for me, my physician has my choices. They were easy to make, as they are for most physicians. There will be no heroics, and I will go gentle into that good night. Like my mentor Charlie. Like my cousin Torch. Like my fellow doctors.</span><br />
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Ken Murray, MD, is Clinical Assistant Professor of Family Medicine at USC.Dr D Quekhttp://www.blogger.com/profile/02878815376401309022noreply@blogger.com0tag:blogger.com,1999:blog-6158809075942993636.post-63436485522752263162013-06-26T12:41:00.000+08:002013-06-26T12:41:33.058+08:00Medical Defence Union: Doctors warned against sharing photos online<h1 class="header" style="background-color: #e8ebf0; color: #333333; font-family: arial, helvetica, sans-serif; font-size: 36px; font-weight: normal; margin-top: 0px; padding: 5px; zoom: 1;">
<span class="red" style="background-color: #e1161f; color: white;">Doctors warned against sharing photos online</span></h1>
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24 June 2013</div>
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<strong>The Medical Defence Union (MDU) is today reminding doctors of the risks of sharing photographs and other recordings of patients through photo sharing apps and websites, following recent news that one such app has been launched specifically aimed at doctors who wish to share clinical photos.</strong></div>
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The MDU, which is the UK's leading medical defence body, has revealed it has received over 100 calls in the last five years from members seeking advice about taking and sharing photographs, audio and video recordings of patients. In some cases the members have received complaints from patients as a result of taking photographs or recordings. The calls received included:</div>
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<li style="color: #333333; font-family: arial, helvetica, sans-serif;">Members who have taken photographs of rare or interesting conditions seeking advice on whether they could share them online for medical colleagues to see.</li>
<li><span style="color: #333333; font-family: arial, helvetica, sans-serif;">Specialists wanting to use clinical images for teaching purposes.</span></li>
<li><span style="color: #333333; font-family: arial, helvetica, sans-serif;">Doctors who have been asked to take part in television documentaries, concerned over protecting the confidentiality of patients.</span></li>
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Dr Mike Devlin, head of advisory services at the MDU says,</div>
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"There are many circumstances where doctors feel it may be beneficial to take a photograph of a patient’s clinical signs or record a consultation. However, it is important that they have the patient's informed consent before doing so and they must follow <a href="http://www.gmc-uk.org/guidance/ethical_guidance/making_audiovisual.asp" style="text-decoration: none;" target="_blank">GMC guidance on making and using visual and audio recordings</a> of patients.</div>
<div style="background-color: #e8ebf0; color: #333333; font-family: arial, helvetica, sans-serif; padding: 0px;">
<br /></div>
<div style="background-color: #e8ebf0; color: #333333; font-family: arial, helvetica, sans-serif; padding: 0px;">
"If photographs are taken of patients being treated in an NHS setting then it is essential that any applicable hospital trust policies and procedures are followed. This may mean that only clinical photographers are permitted to take photographs of patients. Similar procedures may apply in private hospitals and the onus is on the doctor to find out if there are any relevant policies."</div>
<div style="background-color: #e8ebf0; color: #333333; font-family: arial, helvetica, sans-serif; padding: 0px;">
<br /></div>
<div style="background-color: #e8ebf0; color: #333333; font-family: arial, helvetica, sans-serif; padding: 0px;">
"Where a photograph of a patient is taken and then stored on a smart phone, camera or other digital device it will need to be protected in the same way as would apply to other clinical records or recordings. We advise that such devices used for this purpose are encrypted and if they are not, that the images are immediately downloaded to a device that is and the original image permanently deleted.</div>
<div style="background-color: #e8ebf0; color: #333333; font-family: arial, helvetica, sans-serif; padding: 0px;">
<br /></div>
<div style="background-color: #e8ebf0; color: #333333; font-family: arial, helvetica, sans-serif; padding: 0px;">
"With many doctors now owning smart phones which have access to the internet, the temptation may be to make use of popular or more niche file sharing apps and websites, in order to share photographs with medical colleagues. Although sharing photos in this way may seem like a useful way to gain opinion or discuss medical conditions with like-minded medical professionals, it comes with many risks which are likely to outweigh the benefits. With this in mind, the MDU advises doctors that they should be very cautious about sharing photographs of patients online. If a doctor is considering doing so, they should contact their medical defence organisation for advice on specific cases."</div>
<div style="background-color: #e8ebf0; color: #333333; font-family: arial, helvetica, sans-serif; padding: 0px;">
<br /></div>
<div style="background-color: #e8ebf0; color: #333333; font-family: arial, helvetica, sans-serif; padding: 0px;">
The MDU has published the following advice to members who wish to take photographs or recordings of patients:</div>
<div style="background-color: #e8ebf0; color: #333333; font-family: arial, helvetica, sans-serif; padding: 0px;">
<br /></div>
<span style="background-color: #e8ebf0; color: #333333; font-family: arial, helvetica, sans-serif;"><ol>
<li>When seeking specific consent to record patients as part of their care, explain why it is needed, how it may be used and stored.</li>
<li>If you wish to use it for secondary purposes, such as in anonymised form for teaching, research or other healthcare purposes, this must be explained to patients and their specific consent obtained, making a note of the discussion in the patient’s records.</li>
<li>Specific consent is not necessary to record certain clinical images such as x-rays and images of pathology slides but doctors should explain to patients, where practical, what is involved when seeking consent for the examination, including that this recording may be used in anonymised form for other healthcare purposes such as teaching.</li>
<li>Think carefully before using a mobile phone or tablet computer to take and store clinical images. If the image should ever fall into the wrong hands it is unlikely that you will be able to argue that you had taken all reasonable steps to protect its security given it contains confidential patient information. Such devices should be protected with encryption software.</li>
<li>If you do decide to take a photograph or recording with a mobile phone or tablet computer, make sure your settings do not allow images to be uploaded to the internet automatically through photo sharing apps and websites.</li>
<li>Guard against improper disclosure of recordings made as part of patient care in the same way as you would medical records.</li>
<li>If patients lack capacity, you must obtain permission from someone with authority to act on their behalf for recordings which form part of clinical care. For other recordings, you and the person with proper authority should be satisfied the recording is necessary, in the patient's best interests and that the purpose cannot be achieved another way. There are some exceptions, such as for clinical research, and doctors should seek further advice in these circumstances.</li>
<li>Children with the necessary maturity and understanding can usually consent to recordings as part of their care or for secondary reasons but you should encourage them to involve their parents. Otherwise, you should obtain authority from the person with parental responsibility but you may need to check whether recordings can be used for secondary purposes as young patients mature and attain the capacity to consent themselves. Be prepared to stop recording if a child shows any signs of distress.</li>
<li>Specific consent is usually needed to disclose recordings in which the patient is identifiable, unless disclosure is required by law or can be justified in the public interest such as to prevent a serious crime.</li>
<li>Covert recording of patients is rarely justified and can only be considered with specific authorisation and in line with the law.</li>
<li>Where a patient has died, you should follow their known wishes about recordings made while they were alive although if the patient is identifiable in the recording, you may need to consider obtaining further authority from their executor or family before it appears in the public domain.</li>
<li>Be cautious about agreeing to take part in television or radio programmes involving patients, or to appear in print or on the internet. As well as satisfying yourself that the patients have given their consent, you should check they understand the implications and be prepared to raise concerns and even withdraw your cooperation if you believe the recording is unduly intrusive or damaging to them.</li>
</ol>
</span><ul style="background-color: #e8ebf0; color: #333333; font-family: arial, helvetica, sans-serif; list-style: none; margin: 0px; padding: 0px;">
<li><br /></li>
</ul>
<span style="background-color: #e8ebf0; color: #333333; font-family: arial, helvetica, sans-serif;">- See more at: http://www.themdu.com/press-centre/press-releases/doctors-warned-against-sharing-photos-online#sthash.R5AXj23Z.dpuf</span>Dr D Quekhttp://www.blogger.com/profile/02878815376401309022noreply@blogger.com1tag:blogger.com,1999:blog-6158809075942993636.post-88557824693550936212013-06-24T13:50:00.001+08:002013-06-24T13:50:15.779+08:00malaysiakini: Haze kills: Deaths rise as air pollution increases... by Prof. Chan Chee Khoon<div style="background-color: white; color: brown; font-family: Verdana; font-size: 18px; font-weight: bold; margin: 10px 0px;">
<span class="il" style="background-color: #ffffcc; background-position: initial initial; background-repeat: initial initial; color: #222222;">Haze</span> <span class="il" style="background-color: #ffffcc; background-position: initial initial; background-repeat: initial initial; color: #222222;">kills</span>: Deaths rise as air pollution increases</div>
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<tr><td align="left" style="margin: 0px; width: 70px;" valign="top"><img src="http://b.mkini.net/authors/Chan%20Chee%20Khoon.jpg" /></td><td align="left" style="margin: 0px; width: 260px;" valign="bottom"><span style="color: #888888; font-size: 11px; font-weight: bold;"><ul style="margin: 0px; padding: 0px;">
<li style="display: block; margin: 2px 0px; padding: 0px;"><a href="http://www.malaysiakini.com/browse/a/en/Chan%20Chee%20Khoon" style="color: #1155cc;" target="_blank">Chan Chee Khoon</a></li>
<li style="display: block; margin: 2px 0px; padding: 0px;">4:31PM Jun 23, 2013</li>
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<span style="font-size: medium;">In 2002, Narayan Sastry, currently a professor of demography at the University of Michigan, published a paper entitled ‘Forest Fires, Air Pollution, and mortality in SE Asia' in the February 2002 issue of the journal<strong><em> </em></strong><em>Demography.</em><br style="letter-spacing: 0px;" /><br style="letter-spacing: 0px;" />The smog of 1997 coincided with an <em>El </em><em>Niño </em>year which had intensified the seasonal mid-year drought.<br style="letter-spacing: 0px;" /><br style="letter-spacing: 0px;" />The land clearing and forest fires in that year burnt an estimated 2-3 percent of Indonesian land area, mostly in Sumatra and Kalimantan but also affecting sizeable tracts in Irian Jaya, Sulawesi, Java, Sumbawa, Komodo, Flores, Sumba, Timor, Wetar as well as areas in Sarawak and Brunei.<br style="letter-spacing: 0px;" /><br style="letter-spacing: 0px;" /><span style="background-color: yellow;">Sastry obtained daily mortality statistics from the Department of Statistics in Malaysia and correlated these with the daily Air Pollution Index (API) readings from the Malaysian Meteorological Department<strong><em>, </em></strong>in order to analyze the acute mortality in Kuching and Kuala Lumpur </span>following upon days of high air pollution (defined as days when PM<sub>10</sub> > 210 ug/m<sup>3. </sup>The Air Pollution Index is largely based on the amount of suspended particulates of size 10 microns and below, PM<sub>10</sub>).<br style="letter-spacing: 0px;" /><br style="letter-spacing: 0px;" />For a fifteen-day period in September 1997, the Air Pollution Index in Kuching reached or exceeded 850. (A reading of 0-50 indicates good quality air; anything exceeding 300 is considered hazardous).</span><br />
<span style="font-size: medium;">The highest API reading recorded was 930, and visibility was down to about 10 metres.<br style="letter-spacing: 0px;" /><br style="letter-spacing: 0px;" /><span style="background-color: yellow;">In Peninsular Malaysia, API readings hovered in the 200-300 range during the same period.</span> One shudders to imagine what the situation would have been like closer to the hot spots.<br style="letter-spacing: 0px;" /><br style="letter-spacing: 0px;" />His salient findings were reported thus in <em>Demography</em>:<br style="letter-spacing: 0px;" /><br style="letter-spacing: 0px;" /><em>"A high air pollution day associated with the smoke <span class="il" style="background-color: #ffffcc;">haze</span> increased the total all-cause mortality by roughly 20 percent. Higher mortality was apparent in two locations -Kuala Lumpur and Kuching (Sarawak) - and affected mostly the elderly. </em><br style="letter-spacing: 0px;" /><em></em><br style="letter-spacing: 0px;" /><em>I<span style="background-color: yellow;">n Kuala Lumpur, non-traumatic mortality among the population aged 65-74 increased about 70 percent following a day of high levels of air pollution. </span></em><span style="background-color: yellow;"><br style="letter-spacing: 0px;" /></span><em></em><br style="letter-spacing: 0px;" /><em>This effect was persistent; it was not simply a moving forward of deaths by a couple of days (a "harvesting" effect). </em><br style="letter-spacing: 0px;" /><em></em><br style="letter-spacing: 0px;" /><em>This finding suggests that there were real and serious health effects of the smoke <span class="il" style="background-color: #ffffcc;">haze</span>... one implication of these results on the short-term effects of the smoke <span class="il" style="background-color: #ffffcc;">haze</span> in Malaysia is that the effects in Indonesia itself are likely to have been tremendous. </em><br style="letter-spacing: 0px;" /><em></em><br style="letter-spacing: 0px;" /><em>The presence of significant mortality effects in Malaysian cities that are several hundred miles away from the main fires strongly supports this notion. </em><br style="letter-spacing: 0px;" /><em></em><br style="letter-spacing: 0px;" /><em>Unfortunately, there are no appropriate health or mortality data for Indonesia to study this issue directly."</em><br style="letter-spacing: 0px;" /><br style="letter-spacing: 0px;" /><span style="background-color: yellow;">In plain language, the acute (immediate) death rate among elderly people (excluding deaths due to accidents or violence) increased by 70 percent when API readings exceeded 210.</span><br style="letter-spacing: 0px;" />We are rightly concerned about the long-term health effects of recurrent exposure to seasonal smog.</span><br />
<span style="font-size: medium;">But we already have strongly suggestive evidence that smog such as we experience now have immediate effects beyond temporary discomfort - they can <span class="il" style="background-color: #ffffcc;">kill</span>.</span></div>
Dr D Quekhttp://www.blogger.com/profile/02878815376401309022noreply@blogger.com0tag:blogger.com,1999:blog-6158809075942993636.post-70080339270797470442013-05-01T13:49:00.000+08:002013-05-01T13:49:13.846+08:00GE13 : VOTE FOR DEMOCRATIC CHANGE... by Dr Ronald McCoy<br />
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<b style="mso-bidi-font-weight: normal;"><span style="font-size: 14.0pt; line-height: 150%;">GE13 : VOTE FOR DEMOCRATIC CHANGE<o:p></o:p></span></b></div>
<div align="center" class="MsoNormal" style="font-weight: bold; text-align: center;">
<b style="mso-bidi-font-weight: normal;"><span style="font-size: 14.0pt;">Dr Ronald McCoy<o:p></o:p></span></b></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-size: 14pt;">President, Malaysian Physicians for Social
Responsibility<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<span style="font-size: 14.0pt;">Past-President, International Physicians for the Prevention
of Nuclear War (IPPNW)<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 14.0pt;">Malaysia
is at a critical crossroads, after fifty-six years of independence. Its historical
struggle for freedom from British colonial rule has now morphed into a growing
struggle to be free of the Barisan Nasional government, a neocolonial-like
construct of racially structured political parties, cleverly dividing and
ruling a nation. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 14.0pt;">Reeking
with corruption, its abuse of power has gone on for too long. It has lost its
way in a political jungle of its own creation by incessantly amending the Constitution;
pushing through dubious laws to reinforce its power; crushing judicial
independence; permitting arbitrary arrest and detention without trial;
disregarding police brutality and custodial deaths; encouraging corrupt crony
capitalism; allowing the flight of illicit money; ignoring the serious economic
consequences of a ballooning national debt; and stifling dissent, freedom of
speech, peaceful assembly, and other fundamental human rights. Yes, the country
needs a change of government. It’s the only way to genuine reform, rule of law
and democratic governance. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 14.0pt;">It
was not always so in the first twelve years of independence, when the then
Alliance coalition government was made up of the “<i style="mso-bidi-font-style: normal;">Merdeka </i>generation” of <span style="mso-spacerun: yes;"> </span>leaders who had a broad, inclusive nation-state view and a
value system, so different from the current ethnocentric Barisan Nasional
regime. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 14.0pt;">Malaysia
is predominantly Malay, but it has one of the most diverse societies in the
world. This ethnic diversity has enriched its cultural and social fabric and
strengthened its economic footing. And yet, its very diversity has generated
serious ethnic tensions and divided the population, owing to unfair policies. The
Barisan Nasional (BN) government has increasingly infused ethnicity into
national politics, based on an elastic interpretation of the meaning and status
of the inter-ethnic “social contract” which emerged in 1957 when Malaysia
became independent.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 14.0pt;">Dominated
by the United Malay National Organisation (UMNO), the BN government continues
to shore up its support among the Malay majority by implementing affirmative
action for the Malays and insisting that the social contract and <i style="mso-bidi-font-style: normal;">Ketuanan Melayu </i>(Malay dominance) are
immutable and literally carved in stone. In practice, this has translated into
systemic corruption, nepotism and cronyism, which has enriched only the anointed
few in UMNO. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 14.0pt;">Such
ethnocentric politics has polarised a multicultural society and subverted
nation building. It has now reached a tipping point. The time has come to
dismantle racial politics by voting out Barisan Nasional at the ballot box and eliminating
outdated political pygmies, before the country is irreparably damaged
politically, economically and environmentally. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 14.0pt;">The
status quo must give way to twenty-first century political thinking and
nation-building that will embrace a Malaysian Malaysia, free of ethnic bias, religious
bigotry and impenetrable mindsets. Such an opportunity for nation-building will
present itself on 5<sup>th</sup> May 2013 when the nation holds its thirteenth
general elections, arguably the most anticipated and contentious elections
ever. <span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 14.0pt;">Nation-building
requires a strong constitutional foundation which will support the many pillars
of democracy: free and fair elections; judicial independence; the rule of just
law; separation of powers; commitment to human rights, equity and social
justice; honest, efficient, transparent and accountable governance; a free press;
an ecologically sustainable economy; universal, equitable, quality health care;
and a sound, progressive education system.<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 14.0pt;">Malaysia
is a federation of fourteen states, with a constitutional monarchy and a
parliamentary democracy. The Constitution was designed to embody the supreme
power of the land and provide for the rule of law and a judiciary, separate
from and independent of control by parliament and the executive. It aims to limit
arbitrary, excessive use of power by the temporary holders of political office
and wielders of power. But the BN government has for decades subverted the
Constitution by repeatedly amending it at will to serve its own political ends,
exploiting its two-thirds majority in parliament.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 14.0pt;">The
benefits of elections are not always assured. Elections can strengthen
democracy or undermine it. Credibility and legitimacy in elections will depend
on whether they are conducted in a clean and fair manner on a level playing
field. Opposition parties must be free to organise and campaign without fear. Politicians,
election officials, the bureaucracy and institutions must be held accountable
to the voting public. Voters must feel safe from intimidation and be confident
that the ballot is secret. Only then will they enjoy equal opportunity to
participate in and influence the democratic process. Only then will the result
of the elections be accepted without protest. But if protests are made, they
must be peaceful. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 14.0pt;">There
is no doubt that political donations, particularly from corporate entities,
will undermine and corrupt the electoral process. And yet in the period
building up to the elections, the BN government and the Prime Minister himself,
in desperation, have blatantly resorted to handouts to various groups, on the
incredibly flimsy excuse that this represents government aid for the poor and needy,
not bribery. Poverty and need have suddenly become more visible to the
government just before a general election! The prime ministerial bargain, “You
help me … I help you,” deserves a place in our history books!<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<i style="mso-bidi-font-style: normal;"><span style="font-size: 14.0pt;">Bersih, </span></i><span style="font-size: 14.0pt;">a coalition of concerned civil society groups, has
made legitimate demands of the Elections Commission to secure clean and fair
elections. The response has not been very encouraging, confirming the general
perception that the Commission is manipulative and pro-government. The national
mood before the impending general elections is understandably sombre and anxious,
reflecting fears and suspicions that the electoral process leading up to the
polls has not been <span style="mso-spacerun: yes;"> </span>clean or fair, following
reliable reports of irregularities, such as gerrymandering and the illegal
registration of unqualified voters, including foreign workers and other phantom
voters. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 14.0pt;">In
almost every country, people distrust their governments and are eager for
change. The 2012 Trust Barometer study by Edelman, one of the world’s largest
independent public relations companies, has pointed to a severe breakdown in
government trust globally. In Europe, less than 50% of citizens in Ireland,
Germany, the United Kingdom, Russia, Poland, Italy, France and Spain trust
their governments. Only 52% of Malaysians trust the Barisan Nasional
government.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 14.0pt;">The
study also shows that there is a growing public conviction worldwide that
elected representatives have grown too remote, too arrogant, too corrupt and
too closely associated with corporate interests to serve the common good. It confirms
that incestuous cronyism between government and private enterprise increasingly
raises suspicions of corruption. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 14.0pt;">People
in most countries are increasingly aware of corrupt practices involving private
enterprise and state bureaucracies. In its 2012 assessment of 176 countries,
based on a new upgraded methodology, where the new Corruption Perceptions Index
(CPI) scores range from 0 to 100 (0 being most corruption and 100 being
corruption-free), Transparency International<span style="mso-spacerun: yes;"> </span>indicated that Malaysia’s score was 49 with a country
ranking of 54, together with Czech Republic, Latvia and Turkey. One very
telling indicator of corruption was the result of a question asked of companies
in Malaysia: <i style="mso-bidi-font-style: normal;">“During the last 12 months,
do you think that your company has failed to win a contract or gain new
business because a competitor has paid a bribe?” </i>Fifty per cent answered <i style="mso-bidi-font-style: normal;">“Yes”, </i>the highest score among the 30
countries surveyed.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 14.0pt;">Transparency
International Malaysia expressed the view that a 50% response may indicate that
corruption in the public sector is systemic and in some areas
institutionalised. It also indicated the need to reform the political arena to
reduce monetisation of politics, strengthen law enforcement institutions,
uphold the rule of law, overhaul the Official Secrets Act, introduce a Freedom
of Information Act, enforce transparency and accountability in public
procurement, and improve whistleblower legislation. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 14.0pt;">The
BN government has politicised education and penalised and handicapped generations
of schoolchildren because of their poor grasp of the English language, now a
global language. Meritocracy has been abandoned and mediocrity or worse floods
the country. The ambitious and talented flee across the causeway and Singapore
thrives on our brain drain.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 14.0pt;">Medical
education has been hijacked by the Ministry of Higher Education and farmed out
to third rate medical schools in distant lands. Such medical graduates
frequently fail to qualify for professional registration, but will swell the
ranks of government medical services. The profession of medicine has been
betrayed by the government’s policy of privatising health care. Medicine is a
vocation. When government policy makes medicine a business, doctors will be
forced to become businessmen.<o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 14.0pt;">There
is widespread discontent across the country, deep concern for the future, and a
strong desire for change. The political bottom line is that the people of
Malaysia can no longer tolerate a government that first serves itself and its
cronies and is incapable of mustering the necessary political will to reform
itself. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-size: 14pt;">The
rakyat wants change. Business as usual and political accommodation are no
longer acceptable options. A fat, corrupt and arrogant Barisan Nasional government
is eminently replaceable. Let’s do it. <b><o:p></o:p></b></span></div>
<!--EndFragment--><br />
Dr D Quekhttp://www.blogger.com/profile/02878815376401309022noreply@blogger.com0