It’s not a business, says DG in New Sunday Times... By Annie Freeda Cruez

It’s not a business

New Sunday Times, 2010/12/05
By Annie Freeda Cruez
anniefc@nst.com.my

 

KUALA LUMPUR: Healthcare should not be equated with a business, director-general of Health Tan SriDrMohd Ismail Merican told private hospitals and doctors yesterday.

“Looking at profits solely, theway other businesses do,may not be ethically or morally justifiable. Profitsmademust be reasonable, and not excessive.”

Private hospitals and doctors, he said,must be responsible when charging patients for services rendered.

Dr Ismail made the call following public complaints over unreasonable charges by private hospitals, as highlighted in the media recently.

He said charges by hospitals must be acceptable without compromising the
patients’ safety and quality of care.

“Most of the complaints centre on the lack of information provided to patients
by the hospital authorities or healthcare providers at the outset of the treatment. Communication is crucial to keep patients informed of the
estimated and unanticipated charges, prior to the initiation of care or treatment.”

Patients, he added, had the right to be informed as this might help in averting
future misunderstandings and misconceptions.

Prime Minister Datuk Seri Najib Razak had said recently that patients had the option of seeking treatment from government hospitals and clinics or private ones, but they must be fully aware of the cost implications should they decide to go to private healthcare facilities.

Dr Ismail said healthcare providers, especially doctors, should abide by the
code of professional conduct and impose reasonable charges, providing a full explanation to patients should the charges be considered high.

He also called on all private healthcare providers to put in place grievance mechanisms to address all complaints by patients, including those related to unreasonable charges.

All managed care organisations (MCOs), meanwhile, were reminded to register with the Health Ministry and play their part in monitoring the reimbursement
process without interfering with the clinical decisions of doctors.

Dr Ismail said the ministry would hold a follow-up meeting with MCOs to get a better understanding of the charges imposed on patients and the unhappiness expressed by doctors over what they perceive as interference in their practice.

“We would like all private healthcare providers to comply with the Fee Schedule and all requirements stipulated under the Private Healthcare Facilities and Services Act 1998 (Act 586) and its regulations. The doctors’ professional fees are being reviewed and the new rates are expected to be further deliberated by the middle of next year.”

He warned that action would be taken against those violating the laws.

Following the public complaints on unreasonable charges by private hospitals,
a meeting was held on Nov 29 between the ministry, the Association of Private Hospitals, Malaysia and the National Heart Institute.

Issues deliberated included charges by private hospitals and doctors, ethics,
patient safety and quality of healthcare.

Dr Ismail, who chaired the meeting, said it was agreed that charges by private
hospitals were higher compared with that in government hospitals, and this was understandable given the government subsidy and hidden costs.

“It was also felt that healthcare costs in Malaysia are relatively lower and of
acceptable quality compared with neighbouring countries.”

Representatives from private hospitals said they had to operate as a business
entity because they were responsible for all expenses, including those related to the land, building, utilities and facilities for patients, and also answerable to the shareholders who have
invested substantially.


Read more: It’s not a business http://www.nst.com.my/nst/articles/It__8217_snotabusiness/Article/#ixzz17D32Z6v8

Nutgraph: Private healthcare: Too expensive? by Ding Jo-Ann

Private healthcare: Too expensive?

The Nutgraph, By Ding Jo-Ann | 06 July 2010

(Pic by Jyn Meyer / sxc.hu)

IN 2008, Malaysia spent about RM35 billion on healthcare, more than half of it in the private sector. Malaysian Medical Association (MMA) president Dr David Quek says RM18.8 billion was spent in the private sector that year. Of that amount, Malaysians forked out RM10.8 billion from their own pockets for private healthcare. They can expect to fork out more in the years to come.

This may account for health director-general Tan Sri Dr Mohd Ismail Merican’s comments, in early June 2010, about private hospitals’ “exorbitant fees”. Merican said price revisions were necessary, and he would meet the MMA to develop a comprehensive and acceptable fee schedule.

But why is the government attempting to curb private healthcare costs when there is supposed to be a readily available and more affordable public healthcare system? Shouldn’t the government focus on improving the public healthcare system, making it an automatic price check on private healthcare?
After all, why would someone pay RM30,000 for a heart bypass if they could get quality care for minimal cost at a public hospital?

Political, economic ramifications
Universiti Malaya political economist Associate Professor Dr Terence Gomez says declining standards in government sectors have led the middle class to look for ways to bypass the public system.

“The promotion of medical insurance has led to private healthcare being more affordable for the middle class,” he tells The Nut Graph in a phone interview. Rising private healthcare costs, however, have led to higher insurance premiums, coupled with lower coverage.

Gomez says escalating private healthcare costs is therefore a political issue as well as an economic one.
“The government faces a potential backlash from the middle class who don’t want to pay huge insurance premiums and yet are not willing to return to the public health system,” he says.

“This is an issue of concern for the [Barisan Nasional] government, which is already facing declining middle-class support.”

Controlling businesses
But is capping private healthcare fees a sustainable way to ensure affordable and quality healthcare for all Malaysians?

Sunway Medical Centre chief executive officer Dr Chong Su Lin says running a hospital business is not as lucrative as imagined. “Our nett profit margins are only about 5%,” she tells The Nut Graph in an interview. “That is, if we do make any profit in any given year.”

Merican confirms this. Quoting Association of Private Hospitals Malaysia data, he says private hospitals’ profit margins are about 6%.

Dr Chong says forcing private hospitals to cap their charges could be a disincentive for businesses to remain in the medical market. She disagrees that hospital fees are “exorbitant”. “I’ve offered for the government to go through our accounts and examine the cost of every single item and tell us how we can price things differently,” she says.

The Nut Graph asked Merican how the government would balance the competing interests of ensuring affordable private healthcare and the private sector’s profitability. In an e-mail response, he merely said:
“Private hospitals sustain their profitability by offering efficient and quality healthcare services and compete to attract patients by adding comfort and luxury. Smaller private hospitals may be at an advantage by having lower maintenance and overhead costs and can compete in terms of pricing. Practitioners can also help make services more affordable by reducing their professional fees.”

Merican adds that health tourism will also help private hospitals sustain profitability while generating foreign revenue for Malaysia. Neither response shed light on the question at hand.

Engine of growth?

Dr Quek argues that it’s in the government’s interest to ensure the private sector’s survivability because it shoulders a significant burden of maintaining public health.

“[Private] general practitioners see 62% of first-time ill patients, while private hospitals admit about 25% to 30% of hospital patients,” he tells The Nut Graph by e-mail. Despite this, he says, the private sector does not receive any allocation of the national healthcare budget, which is utilised exclusively in the public sector.

Dr Chong says the private sector fuels a whole sector of growth. “We do this by growing the labour force; we up-skill our staff and purchase a whole range of supplies and services – supplies, ambulances, equipment, drugs … it’s a whole ecosystem.”

Yet, she says, the government has sent the private sector extremely mixed messages. “On one hand, we’re one of the engines of growth; [but on the other hand], we’re the bad [person] because our prices are too high.”

Dr Chong says the government needs to decide if it wants to be more socialist and provide everything, or more capitalist and allow market forces to dictate prices. “Until that is decided, we can’t plan strategy.”

To complicate matters further, Dr Quek says the government, in fact, owns some of the large corporations that have entered the private healthcare business. “Khazanah Nasional owns 60% of the Pantai-Gleneagles group, while KPJ is wholly owned by the Johor state government. Since they’ve entered the market, they’ve been aggressively pushing profit margins higher and higher,” he says.

Merican acknowledges the private healthcare sector’s role as an engine of growth and says that steps will be taken to boost the health tourism industry. However, he did not expressly respond to The Nut Graph’s question on whether the government was sending mixed signals by talking about scaling back hospital fees, which may threaten their profitability.

Public sector, again
Gomez says the ultimate solution to ensuring universal quality and affordable healthcare is to get the public healthcare system back on track. There will be no quick fix, however, and a complete reassessment and revamp will take years to implement.

“There is a growing concern of the quality of healthcare, especially for the poor. There needs to be a significant amount of reinvestment in the public health sector. Training and incentives for [public sector] doctors also need to be looked at,” says Gomez.

Whether or not a government already in deficit will be able to afford the revamp is another question.
Merican says the public sector is heavily government-subsidised, and the increasing cost of healthcare will make these services difficult to sustain in the long term.

Dr Quek agrees that heavily subsidised services are not sustainable in the long run. “Currently, the public only co-pay 2% of the actual public healthcare costs,” he says. He adds that the financing of national healthcare will need to be reviewed and revamped to ensure affordable, quality healthcare for all, including end-of-life care.

If this revamp doesn’t take place, and public hospitals do not improve across the board, Malaysians will find it increasingly hard to afford quality healthcare when they need it the most.

The Star: DGH Ismail Merican: Ensuring access to healthcare

Ensuring access to healthcare
At Your Service by TAN SRI DR ISMAIL MERICAN
The Star, Saturday March 20, 2010

In responding to ‘Serving 1Malaysia’, especially towards ensuring equitable healthcare, the ministry has boldly moved towards initiating a major reform of the delivery of healthcare

The saying “health is wealth” holds true in every sense. Indeed, being the director-general of health, it is my responsibility to set the direction and course for the entire health system.

Having been both a healthcare professional and administrator, it has always been my priority to ensure equity (in health) by eliminating disparities in its provision. Our goal is for every individual to get the highest quality of care possible. Prudent investments in health are vital for national growth, human development and poverty reduction. The importance of a healthy population cannot be more strongly emphasised. It will improve the quality of life and increase productivity.

Equity in health implies that everyone should have a fair opportunity to attain his or her full health potential and that no one should be deprived of care when it is needed. In 2007, the London School of Economics reported that Malaysia’s public health sector has been relatively successful in providing equitable healthcare. To a large extent, access to healthcare is dependent on how healthcare is organised.

Historically, after Malaysia gained independence in 1957, the system was largely funded by the government. Patients only had to pay a nominal sum for access to outpatient and hospital admissions. In the 1980s, the service transformed from a system that depended heavily on the government to a dichotomous parallel system – the other player being the sizable and thriving private sector, for whom the Government has given strong encouragement for growth.

The private sector is, in fact, playing an ever-increasing role in the provision of healthcare for the country. However, as in most countries, the private sector, responding to market forces, has been concentrating its facilities in the more economically-developed regions. This contributes little to equity and social justice as such services mainly cater for patients who are able to afford them.

Nevertheless, the country’s health system has continued to perform relatively well over the years, despite the expanding dichotomy. The World Bank World Development Report published in 1993 stated that Malaysia was one of the countries where public health spending was biased towards the poor.

Truly, the government health services have benefited all. There is a strong consensus that subsidised public healthcare, if it continues to be properly tailored and targeted, can further the goal of promoting equity. Nevertheless, inequalities exist for many reasons such as distance, socio-demography, cost and transport problems. Therein lies the future challenges for our health system.

Based on current economic circumstances, the government is concerned about its ability to continue sustaining such levels of expenditure towards ensuring fairness in financing and the continued protection of the general population, and more so, the disadvantaged and vulnerable groups.

Demographic and epidemiological changes continue to alter demand for new healthcare services, whilst increasing affluence heightens expectations for care of even better quality. It is the primary objective of the government to have an efficient system that maximises well-being at the lowest cost to society.

The Health Ministry is in the process of examining reform options to ensure healthcare remains accessible, affordable and relevant. The role of the ministry must shift towards a stronger stewardship function – focusing on policy-making and enforcing regulations across both the public and private health sectors to ensure continued targets of equity, affordability and appropriateness of care are met.

In addition, the ministry will continue to set and monitor standards to ensure suitable quality of care. The fundamental step towards achieving better equity will be to strive for maintaining and enhancing universal access to healthcare. Although the concept of universal access has been well entrenched over the years, more needs to be done. This can be pursued by introducing a more structured and integrated health system, with greater participation of the private sector, underpinned by a comprehensive governance framework.

The plan for a big and bold transformation of the healthcare sector seeks to integrate both the public and private sectors, initially, in the provision of primary healthcare (PHC) services. This is a logical step since the majority of patient contacts occur at this level. If we are serious in our philosophy to provide healthcare based on the principles of needs, solidarity and equity, and in a cost-effective manner, it is prudent to pool resources. This is very much in line with the call of the Prime Minister towards serving 1Malaysia aspiration.

Focusing on PHC has received very strong support from the World Health Organisation. The latter calls for all member states to strengthen this strategy, as PHC can provide a stronger sense of direction and unity in the current context of fragmented health systems.

Specifically for Malaysia, strengthening the capacity and capability of the primary care physician and the multi-disciplinary team of allied health personnel will go a long way towards undertaking a “gatekeeper’s role”.

The overall effects of such a move on health are positive. Over-reliance on specialists and hospitalisation can be reduced by filtering out unnecessary uptake. As a result, the costs of hospital care can be reduced, the duration of hospitalisation shortened and the quality of post-hospitalisation follow-up improved.

The issue of equity is challenging but not insurmountable. Pressures are building for health reforms but these need to be managed in line with the development of a comprehensive strategy, tailor-made for the country.

In responding to “Serving 1Malaysia”, especially towards ensuring equitable healthcare, the ministry has boldly moved towards initiating a major reform of the delivery of healthcare. In this transformation, the ministry will develop and foster a system which is wide-ranging, in terms of scope and delivery, yet equitable, affordable, effective and efficient.

By laying a stronger foundation, involving greater collaboration with the private sector, the ministry will be able to pool scarce skilled resources and share high-tech equipment towards ensuring greater fairness in patient services. Given the right environment and political support, adhering to the principles of solidarity and social responsibility, and embracing the ethos “Rakyat didahulukan, Pencapaian diutamakan” will enable Malaysia to provide equitable and quality health services for all.

Tan Sri Dr Ismail Merican is the Health Director-General

Malaysiakini: Houseman's work hours, a US perspective

Houseman's work hours, a US perspective

Leong Chuo Ren
Jan 27, 10
5:40pm

I refer to the Malaysiakini report Housemen not over-worked in hospitals'.

I am currently completing my surgical residency in the US. Being a Malaysian citizen and having friends who have remained in Malaysia to complete their housemanship training, I have the opportunity to compare the work environment, training atmosphere as well as the issue of work hours in both places.

Health Director-General Dr Ismail Merican is either completely oblivious to the fact that – yes, housemen in Malaysia are grossly overworked and underpaid or he is ignoring the obvious.

He needs to get his feet down to reality and start taking the physical, mental and social health of housemen seriously. After all, ultimately, all these affect patient care and as the health DG, he has an obligation to make sure it is taken care of.

In the US, there exists strict 80 hours per week work rules. It is also illegal to have residents work more than 24 hours without at least a 12-hour break before the next shift. These are strictly regulated by the Accreditation Council for Graduate Medical Education (ACGME) and was implemented in 2003.

The ACGME regularly conducts spot checks on residency programmes to review resident work hours. Any programme which violates these rules are subjected to hefty penalties, including firing of programme directors or having the entire residency programme placed on probation.

In Malaysia, such regulatory bodies do not exist and there is no council that overlooks the welfare, training and education of housemen.

There is research from Europe and the US on nonstandard work hours and sleep deprivation and they found that late-hour workers are subject to higher risks of gastrointestinal disorders, cardiovascular disease, breast cancer, miscarriage, pre-term births, and low birth weight of their newborns.

Chronic sleep deprivation and the resulting fatigue and stress can affect job productivity and the incidence of workplace accidents.There are also social effects such as a significantly higher rate of marital difficulties and divorce among physicians who work long hours.

Almost every single friend of mine who did their housemanship in Malaysia tell me about their 100+ hours work week, poor pay, 36-hour straight on-call, the resulting fatigue, weight loss, social problems, health and safety issues (including a few near post-36 hour on-call car accidents). They aren't the only ones affected - their patients suffer as well as their care is affected by physician fatigue.

Senior physician bullying is also a common problem in Malaysian hospitals and I feel for the housemen because they do not seem to have anyone to turn to for help. In the US, any act of bullying, coercion or harassment is reportable to the ACGME and appropriate investigative and disciplinary actions are undertaken with severe consequences.

I think there needs to be a regulatory body formed for the Malaysian healthcare system which specifically functions to regulate and monitor housemen/medical officers/registrars work hours and well-being as well as provide specific patient-oriented core competencies like the ones endorsed by the American ACGME.

This includes Patient Care, Medical Knowledge, Practice- based Learning and Improvement, Interpersonal and Communication Skills, Professionalism and Systems-based Practice I do not know if the Malaysian Medical Association has provisions for this.

Then again, given the attitude and track record of our politicians and the higher-ups in the health ministry, I doubt this will ever materialise in the near future. However, I do encourage more housemen to continue voicing out their discontent and to fight not only for their right to provide the best healthcare, but to be adequately compensated and their own physical, financial and mental well-being taken care off.

If things continue the way they are, many doctors are going to continue opting out of public service or seek greener pastures overseas. The public health system will continue to suffer a 'brain drain' and we will continue to hire poorly-trained foreign medical graduates.

Taxpayers money will not translate into improvements in health care but on the contrary into worse treatment by tired, disgruntled, poorly trained and underpaid physicians.

-------------ooooo00000ooooo----------------

He was so tired, houseman slept off at traffic lights

Anne Matthews
Jan 27, 10
5:36pm

 

I refer to the Malaysiakini report 'Housemen not over-worked in hospitals'.

I have worked in hospitals and these are the comments that I would give concerning housemen in hospitals.

Do not compare housemen of times past who worked without any complaints (a comparison usually made by our so called health directors and our dear health director-general).

Please be aware that we are in the 21st century and not in primitive ages. First and foremost, the health director-general should go down to the ground and meet the housemen personally.

Talk and find out the truth about their complaints Do not just take the words of those you delegate the job to. Each and everyone would like to 'cover' for themselves by being a goody tow-shoes in your record book.

The housemen will not complain for they will be blacklisted by their so called Medical Officers and specialists. This reminds me of one houseman who slept off at a traffic light because of overworking and was exhausted from lack of sleep having worked from 6.30am till 6pm the day after.

Is this what the DG wants? You are answerable and responsible for this problem. You are a DG for the health ministry and not a politician. Go down and see for yourself the conditions and the working hours. All hospitals should be uniformed of the same.

 

-------------ooooo00000ooooo-----------------

42 hours straight: 'We have to beg our patients to urinate'

Housemen
Jan 27, 10
5:42pm

 

I refer to the Malaysiakini report 'Housemen not over-worked in hospitals'.

I am a house officer working at a state general hospital. I thank your readers for all the responses and comments. We really feel appreciated. Many, or shall I say, all the responses were against our health director-general.

I would like to emphasise here that this is not a housemen vs DG issue. It's about understanding a houseman's life. Our DG gave his view based on the feedback he gets. And I believe it;s true that until now he has yet to receive any formal complaint from a houseman or even an ex-houseman who is still in government service.

Why? One obvious reason, it is the PTK . Our yearly 'penilaian tahap kecekapan' is signed by our head of department, verified by the hospital's director Pengarah and evaluated by the ministry. So I don't think any government service doctors who are in their right mind will ever lodge a formal complaint.

I do appreciate my DG's call to us , saying that we can always come to him on any problem. But Tan Sri, I daresay you will never will hear anything from us. That's the reason I am writing this letter anonymously to Malaysiakini.com.

Now let's have a look at the issue. Are housemen overworked? I will pen down my view as a house officer, and let you judge. As a houseman, we start our day at work at 6.30 or 7am. And we thereafter have no breakfast or lunch break. At some hospitals, housemen shouldn't be seen at the hospital canteens.

As a health service provider, Malaysian government hospitals give top class service. We will see our patients three times a day via our official 'rounds'. Meaning we will be following and presenting our patients to our bosses three times a day. First at 8am, then 3pm and 8pm.

And its our responsibility to know our patients well prior to the official rounds and to get all the necessary 'jobs' done after the official rounds and be prepared with everything for the next round. We even need to beg our patients to pass urine, bottle it, run to the lab and get the results printed. Don't be shocked, but this is what we are doing and are expected to do.

So we will be done with our work earliest by 6pm in some of the departments. But there are some departments which still demand us to work till 12 midnight. Personally, I don't complain about this because I and many others take this as an opportunity given to us to learn.

But trust me - not many can bear this pressure and they break down. And many fail to give their optimal service to their patient due to exhaustion.

As for the on call scenario, life starts as usual at 6.30am and we will perform our routine responsibilities in addition to fulfilling our on-call duties. This goes on until 7am the next day. And after that, we have to carry on with our normal routines that most of the time extend even until 11 or 12 pm. That is more then 40 hours.

Of course, we get ourselves cleaned, fed and maybe shut our eyes for an hour or so with the mercy of our fellow housemen. But this is 'off the record' and if we ever get caught, we can be considered as 'ponteng' and can be disciplined for that. At least a warning letter or a public humiliation by our bosses.

And for all this, what do we get in return?

• Much lesser pay compared to our counterparts in other countries.

• No weekends off.

• No medical leave. In some departments we must go to work as usual even if we are sick and get ourselves examined by our bosses before getting permission for an MC. Not to mention the hours we have to wait for them.

• Being humiliated by our bosses in front of our patients.

• Getting our tenures extended for three months for minor misdeeds

• Running around doing 'other' people's work. Like those of the ward attendants, staff nurses etc. This because at end of the day, we will be blamed and only we will be blamed if things are not done.

I am writing this letter after 42 straight hours of work, without any sleep and only one meal.

malaysiakini-DG Health: 'Housemen not over-worked in hospitals'

'Housemen not over-worked in hospitals'

Aidila Razak & S Pathmawathym, malaysiakini, Jan 26, 10, 11:14am

The Health Ministry has not received formal complaints from any trainee doctor (housemen) about stressful work conditions in government hospitals, said director-general Dr Ismail Merican.

He countered that, to his knowledge, some hospital wards have too many trainees who end up being under-worked.

"I'm surprised (that there are complaints)... if you go to the surgical ward, there will be 20 housemen floating around, and they will be fighting to do an appendectomy," he said in an interview.

He was asked to comment on an issue frequently raised in the 'Letters' forum of newspapers. These have highlighted work shifts for up to 36 hours if the houseman is on call - and there have been claims that call-duty could go on for 15 days a month.

Ismail conceded, though, that he has received complaints

from parents of trainees, describing it as a "problem" that did not exist when he went through the system as a houseman.

"We worked much harder then and we didn't complain to (our) parents...I'm approachable, (the trainees) can e-mail or SMS me or drop by my office, but no one has complained other than the parents," he said.

In Europe, the practice of long shifts has been banned, with doctors allowed to only work a maximum of 12 hours without a break.

Housemen in Malaysia have further claimed that they are affected by bullying and the high-handedness of senior doctors, in a carry-over of treatment they themselves had suffered as trainees.

Interestingly in 2008, Ismail had revealed that many trainees cannot cope with housemanship, succumbing to neuroses (mental disorders) including anxiety, fear and anger, due to the competitive environment.

The long hours and emotional pressure are also a bone of contention, according to some trainees, because of the relatively low pay.

Their counterparts in Singapore earn S$40,000 (approximately RM86,000) a year after tax, which is almost five times more than the pay in Malaysia.

The relatively low pay has also been named as the reason for the number of doctors opting out of public service, a claim that Ismail refuted.

"A lot of government doctors and specialists are staying on because of faster promotions, better career development and perks with the civil service," he said.

In fact, he said, many private general physicians are "complaining" and "accusing (the government) of providing a better deal because (the government pays) RM80 for locum (work)", which can be undertaken in a doctor's free time.

'We won't have too many doctors'

While housemen complain that they are feeling the strain due to a shortage of doctors, Malaysian Medical Association education committee chairperson Dr N Athimulam said the country is headed for a day where doctors will need to "clamour for patients".

He said 1,200 doctors graduate from local institutions annually, with seven more private institutions to offer medical courses in the next few years.

Ismail disagreed to some extent, pointing out that the challenge is that there will not be enough doctors to serve areas in the interior of the country.

"We were thinking that perhaps by 2015 we may reach (a national doctor-patient) ratio of 1:600. But even then, I don't think it will solve the problem because there are states like Sabah, Sarawak and Pahang (which will still face a shortage)," he said.

"In Kuala Lumpur you can get a ratio of 1:300 or 1:400, better than in Britain. But if you go to Sabah, it's about 1:3,000 or 1:2,500. There's a disparity in the doctor-patient ratio," he added.

 ------------ooooooo000000ooooooo------------------

Fatigued housemen not a good thing for patients

Tan Loh; Jan 26, 10, 5:03pm

I refer to the Malaysiakini report 'Housemen not over-worked in hospitals'.

Based on what I read in my management class (hospitals are a favorite setting for my professor), the health director-general is defending his identity when he says:

'We worked much harder then and we didn't complain' - a classic reason hospital administrators in the USA 'back then' used while defending the long, long on-call hours.

Sleep deprivation is dangerous. Researchers have shown that being awake for 19 hours produces impairments that are comparable to having a blood alcohol concentration (BAC) of .05 percent.

Being awake for 24 hours is comparable to having a BAC of roughly .10 percent. This means that in just five hours — the difference between going without sleep for 19 hours versus 24 hours — the impact essentially doubles.

Depriving housemen of enough rest is like asking a drunkard to take care of my medical needs. Obviously, it is better to break the 36-hour shifts into shifts of 8-12 hours each for the sake of lowering fatigue.

Perhaps its time to stop carrying out old practices because of prior experience 'back then'. After all, the medical profession is all about the patients' well-being and not 'defending the identity of old doctors.

Sorry, I'm not from the medical profession but as I have a sibling midway through his med- school, I hope to see him not killing or hurting patients due to fatigue imposed on him by the system.

 

-----------------ooooooo000000ooooooo------------------------

Housemen are suffering in hospitals

Concerned Parent, Jan 26, 10, 5:05pm

 

 

I refer to the Malaysiakini report 'Housemen not over-worked in hospitals'.

The director-general of health Dr Ismail Merican has denied that housemen serving government hospitals are not overworked and in says in some departments there are already too many housemen.

I know for a fact that at the Hospital Kuala Lumpur (HKL) the housemen are expected to work seven days per week comprising five days of 12-hour days and two days of a 36 hour continuous stretch all totalling about 110 hours per week.

The average working week for all Malaysians is 40 hours per week and the labour laws allow up to 48 hours per week. So a houseman works up to three times more than a normal Malaysian.

When a houseman is on call, he is paid RM100 for 24 hours of work (the other 12 hours is already paid as salary) which is just above RM4 per hour which is a pitiful amount to pay a professional who has to forgo his sleep, family and social life.

Which branch in government service be it nursing, the military, the police, PTD officers, etc have to work such long hours in such a demanding working environment? Housemen have to deal with many sick patients some of whom are alcoholics and drug addicts.

There are also emergencies and trauma patients, etc. No doubt this environment is to be expected in a hospital but coupled with the crazy hours, being always on their feet, the irregular meal times and the low income, I doubt many people will last long as housemen.

The housemanship for these young doctors is two years and during this period they are not allowed to take medical leave- if they fall sick, the leave taken will be deducted from their annual leave. Meanwhile, annual leave can be applied for but there is no assurance that it will be approved.

The DG has mentioned that no housemen has complained to him about being overworked and he also highlighted that during his service as a houseman, there were no complaints. I am appalled that the DG has feigned ignorance of the unacceptable working conditions of housemen in our government hospitals.

These housemen are the frontliners and without them many hospitals would not be able to function properly. Any parent with a son or daughter as a houseman can tell you the suffering that their child is going through.

In fact, during this two-year housemanship, their life is almost non-existent as all they want to do after work is to go to sleep. In fact, some of them have become withdrawn and suffer from depression and anxiety.

There must be a better way of duty roster-ing the housemen. For example, in Australia, housemen work about 40 hours per week and their duty roster comprises of permanent work shifts for each houseman.

I hope the health DG will quickly start finding solutions to this perennial problem instead of saying that there is no problem at all.

DG Health Ismail Merican: 1MALAYSIA CLINICS: Urban poor need shot in the arm

1MALAYSIA CLINICS: Urban poor need shot in the arm

NST: 2010/01/01

TAN SRI DR MOHD ISMAIL MERICAN, Director-general of Health

SEVERAL letters have been published expressing concerns over the establishment of 1Malaysia clinics by the government.


The Malaysian Medical Association president wrote that it was being done in haste without due thought to the role these clinics will play.

He and another writer, a fourth-year medical student, felt that the Health Ministry was taking a step backwards by having paramedics and staff nurses run these clinics.

It saddens me to read their exhortations, one a presumably experienced clinician in the private sector and the other a student who has yet to earn his stripes as a doctor. While both mean well, they should have given some thought to what they are writing.

Suggesting that the ministry had acted in haste and is being retrogressive in its approach clearly reflects their lack of understanding of the role of the 1Malaysia clinics.

I would like to shed some light on the 1Malaysia clinics so that Malaysians will be assured that by establishing these clinics in urban settings, we are helping to meet the urgent health needs of the rakyat.

Rural Malaysians receive better healthcare than their poorer urban counterparts.

Malaysia has a dichotomous healthcare system. People have the option of either going to government-run clinics and hospitals or the private sector. Many throng our health clinics and almost all have to wait long hours to get served, even for minor ailments or simple procedures.

The ministry extended the hours of outpatient services until 9.30pm at selected busy clinics. We have also opened our clinics during lunch hour for patients' convenience.

One of the ministry's primary objectives is to ensure the delivery of equitable quality healthcare to the rakyat.

The establishment of the 1Malaysia clinics was certainly not done in haste. In nations throughout the world, there is a progressive migration from rural to urban areas. Malaysia is no exception. It is estimated that by 2015, more than 50 per cent of the population will be living in urban settings.

With the migration of people to urban areas, there is a growing concern for the plight and specific health needs of the urban poor. Many face various socio-economic problems, including access to quality healthcare.

Malaysia has often been cited by the World Health Organisation as having one of the best rural healthcare services, with strategically located rural clinics making quality healthcare accessible.

Many are managed by paramedics, that is, assistant medical officers (previously called medical assistants) and staff nurses, under the supervision of a doctor stationed at a larger nearby clinic. This doctor is responsible for ensuring that the care delivered by the paramedics is in accordance with good medical practice.

This system has stood the test of time and it was felt that a similar structure would now be appropriate to cater for the needs of the urban poor, many of whom do not have access to the services enjoyed by those in rural areas.

A task force comprising senior officers from the relevant divisions of the ministry, who are well versed in the current strengths and limitations of our existing healthcare delivery in urban areas, drew up comprehensive guidelines for the establishment and running of these clinics.

It was to address this need that the idea of 1Malaysia clinics was put forward. Such clinics will fulfil the government's social responsibility of delivering equitable healthcare to every Malaysian.

This proactive step to address the growing health needs of the urban poor will alleviate the suffering of those who require urgent attention for minor ailments.

The paramedics manning these clinics are experienced officers who know their limitations and are able to detect clinical conditions that would require urgent referral to doctors. We have enlisted a group of doctors, both in the public and private sectors, in the vicinity of these clinics, to see such patients where necessary.

In addition, a doctor will be held responsible for ensuring that the treatment provided by the paramedics is proper, in accordance with the established guidelines and procedures, and meets our standards.

To belittle the capability of the paramedics and staff nurses in handling minor illnesses is unfair and reflects ignorance of the role of these healthcare providers in our healthcare delivery system.

There are clear job descriptions for staff nurses and assistant medical officers. They are qualified to carry out minor surgical procedures and are allowed to use specific surgical instruments under the Medical Act 1971.

Their role in these clinics is within their current scope of work at hospitals and clinics. They will not be asked to take on more than they have been trained for and will adhere to the guidelines on the type of services that can be offered at all times.

With the setting up of these clinics, one need not take an elderly relative to a large clinic or hospital to change a bladder catheter or dress a minor injury sustained at home, school or at work.

A 1Malaysia clinic, which operates from 10am to 10pm daily, can get this done promptly without the hassle of looking for transport. These clinics will be situated in areas where there is a concentration of urban poor.

While some are questioning the use of paramedics, there is a growing trend in most developed countries such as Australia and the United Kingdom to delegate the routine follow- ups and monitoring of stable patients with chronic illness such as diabetes, asthma, hypertension and even stable heart failure to staff nurses.

Our 1Malaysia clinics will similarly be able to offer point-of-care tests to help monitor the status of patients with chronic illnesses and, when necessary, initiate a referral either to a family physician or to a hospital for definitive care. Of course, they have to be trained and supervised by a doctor in the course of their work.

Having staff nurses to help monitor these patients is not a move backwards, but a move forward in keeping with changing trends of medical care.

I would like to reassure the public and the medical fraternity that the ministry gave this a lot of thought.

It is not our intention to take the business of healthcare away from our primary care doctors. On the contrary, we have proposed that the government introduce an integrated primary healthcare system so the rakyat can seek treatment from doctors in both public and private sectors.

We hope to introduce the concept of a "family doctor" and have taken steps to encourage our primary care doctors to become effective "gatekeepers".

While waiting for that to materialise, we need to urgently address the health needs of the urban poor, and having the 1Malaysia clinics, just 50 of them throughout the country (three or four in each state) is not going to dent the purse of our doctors.

Let me reiterate that although we would like to provide convenience to the rakyat, we will not compromise on the standards of care.

Let us all give the 1Malaysia clinics a chance to prove their worth. Should there be any infringements of quality of care, we can always put in remedial measures. We are open to feedback from all.

Should any of you have good ideas on how we can provide better healthcare for you, please let us know. We are ready to serve you better.