Friday, June 27, 2008

Does Government Have Killing License?

Last post I discussed about doctors' killing license, and now I would like to share about government role in Malaysia health care. Recently our PM claimed that our country facing financial crisis and need to cut down fuel subsidy and a lot of government project and expenses for example minister entertainment allowance. This sounds quite fair as whole country need to work together while facing financial crisis. However when I realized that ministry of Health also need to cut budget for 10% I start wondering what the hell that our leaders are thinking about. Let me explain how does it affect our health care service from the point of view of a MO from a district hospital.

1. Not enough budget to buy medical equipment and medicine. Though government never order formally stop buying new equipment and medicine, but it'll issue notice that no more extra budget for buying medicine/instrument, if u want to live with limited budget, the only way stop using expensive medicine and start using the cheaper medicine. It may not be as good but government doctor need to face it. Recently one patient organized a press conference complaining that H Seremban not giving the expensive psychiatric drug which he usually given by UM Medical Center and was replaced with cheaper drug which worry him the cheaper drug may not work for him. And oh yes, don't u doubt why he stop getting medicine from UMMC? It's because UMMC start to "half-privatize" its service and patients need to pay in full amount for medicine (few hundreds dollars)instead of paying subsidized price as before(RM50 per month) in order to cut down government finance burden. So don't u agree that our government have some " license" to allow them to provide cheaper and may be substandard treatment to his people but letting front line staffs like doctors taking all the blame?

2. Over time claim: our health care workers are always insufficient. We may need 6 ambulance drivers,5 medical assistants(MA) and 4 nurses per shift in a district hospital Accident and Emergency Department. In fact, we may only have 3 drivers, 1 nurse and 3 MA working(why always insufficient in health care?because health care workers work the hardest compare to other government department with similar salary. Thus lots of health care workers leave government when they feel that "it's enough."). When patients are too many to handle at any time, driver,nurse, MA need to work extra shift and claim OT. However there is a rule in government law that states "government servant can't claim OT more 30% of their basic monthly." when hospital budget is enough, H. Director will allow these claim even it exceed 30 % (as 30 % is only few hundreds dollars that can be easily exceed after few extra shift.) Now? PM cut down every budget and H. Director found that there is not enough money to
pay for salary+ OT, so Director announce that OT will be allowed only up to 30 %. So what will happen? No pay? Then no work! When ambulance driver not enough but we still have patient awaiting ambulance to rescue them, no driver is willing to come work extra shift. When nurse and MA not enough to handle big amount of patient load, no one willing to come and work extra shift, thus shortfall and negligence will happen. So who is the loser? It's the patient and the health care staffs! Patients may be dying and the staff will be burden and take the blame. All these can be avoided, if our government care more about its staff and its people. Increase health care staff salary (equivalent to their workload), hire more staff, pay their OT in full as a token of appreciation for their hard job. Our government sure have other better way to save money (eg stop sending Monkeys for space traveling, investigate those corrupted politician and freeze their illegal asset, stop saving not performing GLC like MAS and Proton.) But to sacrifice our people life and health? PM and ministers, what the hell that u are thinking? This sound like our government have the Killing License to kill his people just because they want to save some penny with price of patients life and welfare. Please do something, our politicians, if u are really caring about our people.

Saturday, June 21, 2008

Does Doctor Have Killing License?

I was upset when our Deputy MOH claimed that doctors actually "have the license to kill". Well, may be he tried to say that doctors may have the right to decide when to stop resuscitation (which does not equal to "killing" someone) when they feel the chance of survival is dim. However, this doesn't mean that doctor has the "killing license" to cover his negligence upon patient's death.
As a doctor, I've encountered many death which sometime I/my colleagues suggest to family members for No Active Resuscitation as the prognosis was poor. Sometime they agree, sometime they don't. However, so far I haven't encounter any miracle, all passed away inevitalby.
Sometime, I learn from previoius patient's death and choose another type of treatment when encounter similar clinical picture and sometime the patient survived. The previous death do help me to improve my judgement to handle similar problems in the journey of practising medicine. However, I wouldn't agree that this is so called " Killing License".
So, do u think that doctors have killing license? Share with me please.

Thursday, June 5, 2008

RM2.70 for petrol now....


Are u one of these unlucky one last night? In order to save some dollars in pocket to fight inflation?
What happen to our country? A fuel exporting country now refuse to subsidy fuel and yet continue burden the citizens with HIGHEST import tax on cars. I'm not sure the government is ready to change their habit (eg. using small cc car, less visiting oversea using public money, reduce "Space Traveling" and so on) but i'm sure all of us is going to have very tough time from now. Sigh again.

Monday, June 2, 2008

Malaysia Public Health Care

Health care is an expensive welfare that every country facing funding problem. (Including Japan/Taiwan/China/US). Currently Malaysia government subsidies 90% cost of the health care system. Government hospital charge RM1 for every patient who visit Accident and Emergency (A&E) or government clinic (Klinik Kesihatan) and Klinik Pakar for RM5-15/visit including dr's consultation/investigation/treatment. For those who admitted hospital charge RM 10/day including 4 meals(breakfast/lunch/tea time/dinner), nursing care, dr's consultation, investigation and treatment. Medical equipment and treatment is expensive, for eg MRI cost RM600-1000/scan, ordinary blood investigation (full blood count/renal or liver profile) cost RM50-150, drug for lowering blood pressure/cholesterol/sugar cost RM0.50-5.0/tablet (1-3 tablets/day). The cost may be terribly high if public need to pay in full amount. That's the reason why people always shocked with the bill when they seek treatment at private hospital.

It's important to create a SAFETY NET for the poor as everybody has the right accessing Basic Health Care Service. However, under current condition, as government reluctant to increase the funding(due to financial/political reason), the Imbalance of Supply/Demand causing a lot of problem which MOST OF THE TIME is the FRONTLINE HEALTH WORKERS taking the BLAME.

As government providing low cost service, the amount of patient load is terrifying. Everybody (including poor/middle class/rich) seeking treatment from gov hosp but the resources are limited(reasons as above). Supply/Demand is imbalance. Government refuse to raise funding and unable to raise charge (the VOTE is important), health workers welfare is sacrificed (UNDERPAY, not enough man power, struggling with limited resource) hence patients best interest also affected.

REAL SCENARIO:
Anyone can visit any government hospital medical ward (Seremban/KL/Penang/Klang/Kajang) which is patient overload, filled with extension beds until no space for people to walk/stand.
3-5 nurses/shift looking after 30-50 patients per ward with quite a number of them need closed monitoring. 1-2 specialist (only main hosp), 2-4Medical officer, 1-3 House officer (only main hosp)per ward. Imagine if u were the medical staff nurse, how can u look after so many ill patients at the same time? eg 4 nurses looking after 40 patients at H. Seremban?Come on, if our government got the money to send astronaut to aerospace for "Space travelling", why don't u spend the money like hiring more nurses? Thus, shortfall will present no matter what with limited man power.


I strongly believe that,
ONE mistake is personal fault
2 errors are incidental
3 errors are occasional
REGULAR errors is SYSTEM FAILURE!

How can our PUBLIC/POLITICIAN blaming individual medical staff for SYSTEM FAILURE?
In every field there will be 'Rat Shit spoiling the porridge", I don't protect those medical staff who is not performing (as i observe there are ALOTS especially those HIGHER POST SENIOR STAFF using MOUTH only not moving their ass to work), I'm depressed as medical doctor serving public in government hospital struggling with various limitation, the PUBLIC nowadays only pointing finger and not appreciating our good job/effort.

Waiting hours too long at government clinic/A&E?
-My colleague come review patient at 7am daily till 10-11am then go medical clinic see patient with number of patient 100/clinic and only 2-4 dr working(which the OFFICIAL CLINIC HOURS IS 9AM-1PM), and being complained by patient for coming late. REMINDER: NO extra doctor sitting in clinic only. U need to running around within hospital as clinic/ward always looking for doctors, eg patient collapse in ward, patients complaining/yelling at clinic for long waiting time. Do our new MOH Dato Liaw know this (never serve as a DOCTOR in Gov Hosp) who is so ambitiously want to cut down the waiting time? Provide ADEAQUATE DOCTOR please! Before start talking Hoo-Haa, study the real problem and work it out. If keep on saying" the doctor without loving kindness please leave gov hosp bla bla bla", i'm sure more doctors are leaving soon and HE who is not even a doctor should be sitting in hospital seeing patient himself in the near future.

My dear minister and our Public, do u think that 3-5 doctors seeing 100 patient in 2-3 hours is reasonable? This is SPECIALIST CLINIC eg. Medicine, Rheumatology, Nephrology. These patients need adequate examination and review (unlike the common cold or cough) which need 20-40 minutes/patient. Should we compromise these patients best interest in order to "SEE but not REVIEW" these patient at clinic? If that's the case, why don't we send them back to Klinik Kesihatan? What's the difference between Specialist Clinic and ordinary gov clinic?

Offering gov doctor with Salary of RM3-4k but working like a Cow does not make any sense. Our country is wasting money for those gigantic "White Elephant" project but not able to raise the health worker paycheck to a REASONABLE rate. Doctor's on call for 24 hours got RM170=RM7/hours, Foot Massage cost us RM60 for 60 minutes, don't u think that the on call rate is humiliating this profession as if the knowledge/professional skill can't even compare with a foot therapist? Money is not the MOST IMPORTANT factor, but be fair and reasonable. U can't keep on subsidy those BIG GLC like MAS/Proton but continue sacrificing those people who did their hard work to serve the country and people.

Comparing the charges and the service/treatment offered by gov hosp, i think it's good enough even u comparing it to other country. Remember, U Get What U Pay. If the service is so good (air condition ward, plenty of nurses/doctors, most advance technology/treatment) and the cost u need to pay is merely RM1, what will happen? Everybody will rush to gov hosp and end up flooding the whole country gov hosp with patients.At the end, it'll back to the same situation with Supply/Demand Imbalance.

Nothing is free, other than BASIC HEALTH CARE SERVICE, we should take care of our own body. Will u blame others if u not taking good care of your car and finally the engine just break down? Same line of thinking, how can public blaming others/doctors/government if u are over-eating, overweight, smoking non-stop, drink alcohol like water, drunk and drive, taking Ecstacy, careless driving, sleep late wake up late, never exercise? U should responsible for your OWN BODY/OWN GOOD HEALTH. I never sympathy for those who drunk then accident as they DESERVE it.

We can't neglect the poor by privatising WHOLE HEALTH CARE SERVICE. It's a nightmare and inhuman for the poor. We need to provide SAFETY NET for the poor with BASIC HEALTH SERVICE. If u are badly injured in an accident which need emergency operation, GOV should provide this with minimum charge. If u are unlucky and was diagnosed having Cancer, GOV should provide treatment with minimum charge. If u are pregnant and going to deliver, GOV should provide mid-wife/doctor's aid with minimum charge.

If a country/society doesn't provide Basic Health Service to the poor, it's not only inhuman but it'll cause society instability. The poor losing hope/faith in gov will create chaos/riot and eventually everybody will be in big trouble. (Can't we imagine similar condition Myanmar/Africa?)

However, Basic Health Care has its limitation. For example, we don't provide the latest therapy but the most cost efficient therapy. Quantity supervene quality. Like ordinary chemotherapy for cancer may cost RM1000-3000/ cycle of treatment, compare with the latest chemotherapy with less side effect (Nausea/Vomit/Hair drop) and more efficient (may or may not prolong patients life for 6 months-1 year compare to ordinary chemotherapy) which cost RM10,000-30,000/cycle, ordinary regime is the choice. Another example, we know that Impotence (Man unable to erect) is a Disease, but should we include Viagra (around RM50/tablet) in Basic Health Service?


Sadly, I think Life Isn't Equal, Not Even Same PRICE (Though we always claim that life is PRICELESS). U Get What U Pay, that's the principle. Europe country providing marvelous welfare is based on the expense of High Tax Rate (around 40-50% for income tax, compare with M'sia, no tax for those earning less than RM25,000 annually and Max is around 24%). However, they also facing problem with rising cost of health care and running out of budget. (No country should spend all their budget in Health Service alone Right?)

For those who can afford the medical expenses, u should consider private service as Basic Health Care should never full fill everybody demand, eg. air-condition ward, plenty of dr/nurse who attending your every single complaint (non-urgent), immediate response for non-urgent call, complete/routine but may not truly indicated test like X-ray/Scan/blood test any or every time u visit dr. And for the rich one, why should u fighting with the poor for our limited Health Resources?

That's why i STRONGLY AGAINST providing 1ST CLASS in Gov Hosp. Patients who admitted to 1st class pay the full room fee only (around RM200-350/day) but still enjoying the subsidy treatment/investigation. For those who want and can afford 1st class, u should go to private hospital. And OUR GOV/ Minister should revise the policy, make those who admitted to 1st class in Gov Hosp pay in full amount for the treatment/investigation/doctors and nurses service as they can afford to pay more. By serving these 1st class patients now (Usually POLITICIAN/SUPER VIP/and some middle class, eg our Ex-PM Dr.M, some Big Businessman) who can afford the full cost of health care, it's unfair to the poor as OUR GOV ALLOW THE RICH "SHARING"(sometimes it's ROBBING the poor, eg Dr M can have immediate heart operation at Institut Jantung Negara when he need while the rest of the public, or the poor, need to wait for 6-12 months for their slot of operation) THE LIMITED RESOURSES WITH THE POOR.

I'm sure we can do better to improve our Health Service. But our public, please don't abuse our limited resources by visiting A&E for non-emergency condition, asking for unnecessary investigation. And please don't blaming/complaining the front line health worker for not serving u up to your heart content. WE(front line health worker) serve and sacrifice because of good faith, not because WE OWE U, or We Should Serve U Like Master and Slave. Be grateful and respect. If not, more people will leave government health care service and it's not the POLITICIAN/VIP/RICH will suffer, it's THE POOR AND THE PUBLIC.

I'm looking forward for that time of change to come.

Sunday, June 1, 2008

Palm Centro


Just got my new toy, Palm Centro 1 month ago. I've been using Palm Zire 71, Z72 then Life Drive (which was driving me mad with 5-10 crashes/day) later switch to WM ==>Dell Axim 51V. Finally Palm manage to get me back to it with latest product, Palm Centro.I'm very happy with Centro as it handle my PIM and medical programs nicely. Anyone who is interested can read this review from Palminfocenter which is quite informative.

Doctors, Why Are U So Irritable?

Recently, I noticed that my fellow colleagues and even my girl friend who just completed her housemanship become more and more iiritable after joining medical field. When i look back in my medical life, I suddenly realized that Even I Myself also become easily irritated. May be i can share a few "Reality Problem/Factors" that causing this profession, Doctors, become more and more life taxing and less satisfaction.I was doing night shift alone (10pm to 8am) at Accident and Emergency department(district hospital does not have enough doctor, thus only one Dr per night). At 12am,after settling and admitting one old gentleman who just had an myocardial infarction (Layman: Heart Attack) which took me 2 hours, I looked at my desk, patients' cards are piling up. Let's see what kind of patients do we have:-a 20 y.o girl,c/o (c/o=complaints of) having fever + cough + RN (RN=runny nose) for 2 days-48 y.o man, c/o skin itchiness for 2 weeks-3 months old baby girl c/o crying while breast feeding and unable to sleep, normal temperature (and baby become very comfortable when i saw her)-17 y.o boy c/o diarrhea and abdominal pain-44 y.o man c/o headache and request for MC-22 y.o man c/o toothache (yes, it's toothache, I'm a DOCTOR, not dentist, and my A&E doesn't has any dentist around)- 33 y.o lady with another 2 kids (8 yo and 4yo) c/o fever+RN- and bla...bla...bla...many many more...... which WE medical staffs labeled as GREEN CASE (non-emergency) (Very typical picture of how our public abusing our A&E service, A&E should be only for EMERGENCY!)then my nurse inform me that the headache patient was yelling outside complaining he was wating for 2 hours. Though my nurse explained that there was an emergency patient with heart attack, he still shouting around saying "So u mean my headache is not emergency?If I die because brain cancer, can u responsible for it?" Finally, I saw him and discharge him with some pain killers and the MOST IMPORTANT--->MC.After struggling to finish all non-emergency patients, it's 4am. Then another mother brought in a 1 year old baby boy complaining that baby was having fever from 6pm, though visited a private doctor and was given some medication, but the fever still persist. With exhausted body/spirit, I told the mother that it's a normal course for fever to settle in 3-5 days, no matter what medicine u take, not even "bomoh" medicine. SO very unlucky or stupidly, I've mentioned an improper or so called "unprofessional" word---> "bomoh", the mother start yelling at me, "Don't u think I'm stupid! I come from KL and not like people here who are stupid !(only God knows why people staying here suddenly become stupid) What's your name? I'll complaint to your boss and Health minister for your improper language! I was looking for a private hospital with specialist which doesn't exist here. I'm so stupid to come here and see only ordinary doctor like u." Though I tried to apology, all effort in vain and she left with anger. So, I'll end up receiving complaining letter later and to write another explain letter for it then.After this angry mother left, suddenly I heard that another ambulance coming , apparently there were 3 young guys who had drunken and drive involved in an motor-vehicle-accident and were severely injured. 2 guys had open fractures of upper and lower limbs respectively and the last guys was unconscious with sign of head injury. Resuscitation was carried out immediately. 2 men were transferred to Town General Hospital for emergency operation while the last guy didn't look good. After one hour resuscitating, his blood pressure dropping and CPR (cardio-pulmonary resuscitation) was carried out. After another one hour, we failed and he passed away. Now the time was 7.30am.Police came and ask some questions, then request for a post-mortem for this guy to identify his cause of death. ( In Malaysia,All patient who pass away in the motor-vehicle accident require post-mortem to confirm cause of death.) so i quickly change and proceed with post-mortem, open his skull and examine his brain, hmm.....so there was some intracranial bleeding and skull fracture, so cause of death was confirmed= Severe head injury.After finish filling up all the documentation required (burial permit, death certificate and bla, bla, bla.....). Finally, i can leave my hospital. And now it was 9.30am. Rush back to my room took a shower and grasp something into my mouth, i totally collapsed onto my bed. So, that end my story of night duty. But wait! There will be another night duty tonight! So Wish Me Good Luck, ok?

I'm a Blogger now!


I never thought about to join blogger team as i know I'm lazy to update my blog consistently. However, my sisters and friends have started their blogs and invite me to join them. Since I've written some articles in some forums, I think I may just share those articles in my blog and recording my opinion and some personal stories as a doctor who serves in a government hospital. Please share with me if u have some thought about my post/articles.May all the being be well and happy and get the adequate aid from health care worker when they need.