malaysiakini-Susan Loone: Malpractices alleged at 1Malaysia clinics

Malpractices alleged at 1Malaysia clinics

Susan Loone
Mar 22, 10
2:43pm

 

A medical practitioner has criticised newly formed 1Malaysia clinics set up by the Ministry of Health for providing poor quality of medical services to patients, which include wrong prescription of medicines and wrong diagnoses.

Dr T Jayabalan, who represents workers and the Malaysian Trade Union Council, claimed that a recent study he conducted in Kampar, Perak revealed that medical assistants in government clinics have been issuing wrong prescriptions to patients.

He cautioned that the clinics, brainchild of Prime Minister Najib Abdul Razak (right) which aimed to provide access to healthcare for all Malaysians nationwide, may also be affected by these malpractices as all of them are manned by medical assistants and nurses.

"This seems to be common practice among medical assistants. They are giving out prescriptions for the wrong medicines, or prescribing medicines which they are not allowed to prescribe. They have also been found to have wrongfully diagnosed patients," said Jayabalan, who is also health adviser to the Consumers Association of Penang.

Though he called setting up the clinics "laudable", he said that the public now want quality instead of just 'good' access to healthcare.

Jayabalan made these claims at a talk titled 'What is wrong with our health care system?' on Saturday at the Caring Society Complex in Penang.

The event was organised by Sembang-Sembang Forum, a group of Penangites concerned with social and civil issues affecting their daily lives. Former Gerakan assemblyman for Machang Bubok Toh Kin Woon moderated the event.

Jayabalan also said he was appalled that the 44 clinics, launched in January, targeting the urban poor, and charging merely RM1 for its facilities, were not set up in a transparent manner as doctors were caught unawares by the project.

Currently, there are 10 1Malaysia clinics in the Klang Valley, five each in Penang and Johor, four each in Perak, Sabah and Sarawak, two in Kedah, one in Perlis and three each in the rest of the states.

Questionable staffing of clinics
His statement is supported by Malaysian Medical Association president (2009-2011) Dr David KL Quek in January who said that "while the MMA supports better, affordable and more accessible healthcare facilities to the public, the manner in which this has been announced, where they are to be sited, as well as the fact that these clinics were to be manned by medical assistants and nurses, took many doctors by surprise".

Meanwhile, Dr Jeyakumar Devaraj (right), Parti Sosialis Malaysia Sungai Siput parliamentarian, lamented the acute shortage of medical staff, especially specialists, to attend to the needs of rising number of patients.

He said that in April last year, the Ministry of Health has approved licenses to establish 45 new private hospitals in the country.

Health Minister Liow Tiong Lai has disclosed that since the implementation of the Private Healthcare Facilities and Services Act 1998 and its regulations in 2006, the ministry has received 55 applications for the establishment of new private hospitals, of which 45 have been approved.

Jeyakumar brought up concerns that for each private hospital set up, about 10 senior medical experts would be 'pinched' from public hospitals.

"This will severely affect the standard of service provided at the government hospitals especially at a time when there is already a severe shortage of doctors to serve in the public sector," he added.

Health Care Reform and Plea for a return to better Clinical Culture

Health Care Reform and Clinical Culture

Posted by NEJM • August 26th, 2009 • 

It is a tired and cynical cadre of physicians who will implement health care reforms. Yet few published perspectives include the view from the factory floor. The usual platitudes about changing financial incentives, increasing efficiency, and delivering high-quality care sound naïve to clinicians who deal with the imperfections of human nature and the messy effects of illness on patients.

Doctors are already, by training, sophisticated decision-making machines, capable of achieving extreme efficiency through the use of heuristics and experience.


The main problems that clinicians face in achieving efficiency and reducing costs are, first, a perceived need for certainty in diagnosis and treatment — a need driven by secular expectations and malpractice concerns; second, gross inefficiency created by obligatory documentation to satisfy billing requirements that have little value for clinical care; and third, restrictions on the use of clinical judgment that could avoid excessive testing. None of these problems, whose solutions would save money and time, have been incorporated into the national discussion about reform.

One change that would augment the role of clinical judgment would be for the health care system to resist the temptation to require adoption of often-elusive “best practices.” There has been an assumption by analysts that published clinical trials provide a sound guide for therapy, but all reputable studies report odds, hazard ratios, and effect sizes, almost all of which are small or modest. Absolutes are discordant with the realities of sickness and health.

There may be guidelines and measurable outcomes for mundane problems, but for the vast majority of daily doctor’s visits and hospital decisions, incremental or recursive approaches to diagnosis and treatment are more effective and efficient.


A second reform should be to limit malpractice awards so as to reduce physicians’ fear of lawsuits. Regardless of the arguments of defenders of open-ended malpractice payments, this insidious concern is a major driver of overtesting and overconsulting.

A third key reform would be to eliminate the time sink of the comprehensive exam and its lengthy documentation required by Medicare — a requirement that is likely to be adopted or exaggerated in any new codified system. Immaterial information is already cluttering the electronic medical record.

My survey of neurology notes, which I presume would be among the most thoughtful in medicine, shows that less than one fifth of the average note is taken up with analysis and discussion of the patient’s problem; the remainder is part of the “waste” in modern medical care.

Fourth, payment codes should be reduced to “simple” and “complex” — or at least the numerous billing levels and codes should be conflated, and payment should be based on diagnosis and time expended. Physicians should also be paid for their expertise.

Health care reform can redress slowly accrued and detrimental cultural changes, particularly the loss of reliance on clinical judgment. It would be a missed opportunity if practicing physicians (as contrasted to their representative bodies and societies) were excluded from the center of the conversation. The efficient use of the professional workforce will be more powerful than rules.

Allan H. Ropper, M.D.
Brigham and Women’s Hospital
Boston, MA
This article (10.1056/NEJMopv0907607) was published on August 26, 2009, at NEJM.org