Monday, February 16, 2015

Pharmacies to dispense medicines if proposal accepted. Sunday Star 15th February 2015

Oooooooooooooooooooooooh they published my letter today.
Letters to editor.

Thank you.

WEEKEND SEMINAR IN CARDIOLOGY N DIABETES FOR GPs 2015



WEEKEND SEMINAR IN CARDIOLOGY and DIABETES FOR GPs 2015                                                 
                                                    PROGRAM

Saturday
28th March 2015
12.45-13.50 pm
 LUNCH SYMPOSIUM.                              Abbott
1400-1415

Opening of Weekend seminar. ( President PMPASKL )
1415-14.45 pm
Management of Diabetes in the Clinic – HbA1C and beyond
                     Goal of therapy and how to achieve the goal   
           Speaker    :  Prof Shirene
14.50 – 15.50 pm
Case study on Diabetes – Problem solving ( Interactive pads )
                               MH : Prof Shirene, Studio RM : Dr Vijay / Dr Wong Ming  
1550-1620
TEA BREAK
16.30-18.00 pm

ECG tutorial  -  Self assessment.  ( Interactive pads )
                              MH   :  Dewi  Ramasamy        Studio Rooms  Yee KM / Chua SK                           
18.10  18.40 pm
Managing dyslipidemia in the clinic – The “statin” intolerant patient.
      How to recognize the problems and what to do? 
           Speaker    : P Kannan
1840
DINNER SYMPOSIUM . Pfizer


Sunday
29th March 2015
08.00-0810hrs
WELCOME
08.10-08.40 am
Heart Failure – Is there a Paradigm shift?   
             Speaker      : TamilSelvan
08.50 – 10.10 am
Case study on Atrial Fibrillation and CCF  - ( Interactive pads )
                   MH  :  Dr L Chan      Studio  rooms : E.Ng  / Wong TW
10.10-10.40am
TEA BREAK
10.50-12.10 noon
Case study on hypertension – Pills and life style    ( Interactive pads )
                      MH    :  Prof Imran                Studio Rooms :   Yeo CK  /  Ed Mah
12. 20 – 12.50 pm
Hypertension  – Is combo pill the answer?                                                                   
                          Speaker       :    Prof YC Chia
12.50- 13.00 pm
                                             CLOSE            
13.00-14.00 pm
LUNCH SYMPOSUM             BI

PLEASE REGISTER EARLY. 

Sunday, February 15, 2015

Pharmacies to dispense medicines if proposal accepted. Sunday Star 15th February 2015

This is my letter to the editor of Star, send this morning, after reading the article.

Dear Editor,

I have just read your lead article in your Sunday Star, entitled " Pharmacies to dispense medicines if proposal is accepted".  Pharmacies have always been allowed to dispense. Your headline is misleading. It gives the impression that pharmacies had not been allowed to dispense. Nothing is further from the truth.

However, I appreciate that Ms Christina Chin is trying to highlight the coming Pharmacy Act which proposes to stop doctors from dispensing, so that Pharmacist only can dispense, something we call "Dispensing Separation". Yes, this debate had been on for the last 30 years or more. It was the wisdom of the many previous ministers that prevented it ( Dispensing Separation ) from being made into law. I sincerely hope that this present Minister of Health will also do likewise, and not try and change a system that has stood the test of time.
Of course, there are advantages and disadvantages if doctors only can dispense, and advantages and disadvantages if Pharmacists only can dispense.  If Pharmacists dispensing has so many advantages, example price advantage, drug range advantage and safety advantage, then surely the smart patient will know where to go for their medication. However, if the smart patient wishes to get his/her medication from his/her  doctor, why stop him / her? Patient's right to choose must not be taken away by laws. 
Under the current system, both can dispense, so that patient has the choice and the right, where to get their medications from. The best of both worlds. The current system is good for Malaysia. Why change it and make the system worse for patients, removing their right to choose. 

We however welcome the move by pharmacies to offer a wider range of drugs then doctors. This is a step in the right direction. They can do so even now. Why later?

It is also highly contentious and disputable to say that a Pharmacist knows all about drugs and has a monopoly to knowledge about drugs. It smacks of arrogance. We have seen many many many examples of Pharmacist errors.

It is a shame to see governments make laws just to protect some business and businessmen. It is for good and capable businesses and businessmen to fight the headwinds, seize the opportunities and overcome the business threats and bring success to their business. Not by working with their "friends in government", behind the backs of other stakeholders, to make laws to favour them. This is an abuse of the process.  

Dr Ng Swee Choon ( Voice for the consumers )
75, Jln SS 15/5A Subang Jaya
47500 Petaling Jaya

Tel : 5634 6035

Friday, February 13, 2015

ANNOUNCING 'WEEKEND SEMINAR IN CARDIOLOGY AND DIABETES FOR GPs 2015. 28-29th March PULLMAN HOTEL

Since my return from the Sibu Health Camp, I have been busy organising this "weekend seminar", the number 14th in the series.

This year we will feature, Management of Diabetes and the role of Hb A1c, the paradigm shift in the management of heart failure, current concepts in the management of hypertension, introducing the "Coupler" device that the English have discovered, besides the compulsory ECG tutorial. Again, all sessions will see minimal lectures and maximal use of the interactive pads, which most doctors prefer.

Pullman Hotel gives us the best rates, as we are rather poor and have to stinge and save. CME must be effective and affordable.

THE IS AN APPEAL TO ALL GPs AND SPECIALISTS. DO REGISTER AND JOIN US FOR A WEEKEND OF FUN IN LEARNING TOGETHER.

Monday, February 09, 2015

FPMPAM SARAWAK MEDICAL CAMP - IN CALLOBORATION WITH IMPIAN SARAWAK

The Camp is over and we have been thanked many many times, and feted and congratulated. It is time to reveal the results of our work

( I tried to insert the table from word document. I failed So I photo and insert as picture image ).

In 3 days, we extracted 130 teeth. No wonder my dentist was so tired and on the last day, told me that she had enough.

This is the state of health  in the semi urban Sarawak long houses.

Saturday, January 31, 2015

FPMPAM SARAWAK HEALTHCAMP, 19th - 21st Jan 2015- IN COLLABORATION WITH IMPIAN SARAWAK




As usual, bright and early on 21st Jan, YB Ting, the ADUN of Bintangor came to the Hotel to fetch me and the advanced party to Bintangor, about 1 hour away, to set up the Camp site. On the way,, as we were discussing, she informed us that her office had already registered 248 patients from the surrounding long houses, for the clinic. BUT, while we were working in Sg Aup on 20th Jan., rumours were being spread in Bintangor that we were not coming. In fact a police report was made by one of the residents of the long house where we were due to set up Camp. However, ADUN Ting managed to speak to the household who made the Police report to allow us to hold our Camp there. On the way to the Camp site, we saw a Police Car on the main road outside the Camp.

Anyway, the long house chosen by ADUN Ting was a large long house and with more than adequate space. We were all on the ground floor, from Registration to Glucometer, BMI, GP triage, paeds, physician, surgeon, skin, pharmacy. The dental clinic was at the kitchen, and the eye clinic at the main hall downstairs. The OG and breast examination were in the privacy of the dining hall.

The stats are being worked out, so I will insert it later. I think we saw 308 patients ( despite the false rumours ). They came early and despite the rain.

It is true that on all 3 days of our trip, we were given good press coverage in the local Borneo Post. One politician called us "touch n go" people. There were other names too, but who cares. We were there to render healthcare and provide a service.

After the Camp at about 9pm, we packed up and left for the long house for dinner and also to sleep over at the long house.

I then learned that there were two types of long house, namely the original long house ( those deep in the Kalimantan jungles ) that were on stilts without water and electricity supply. The long houses for us in Bintangor were modern long houses in the semi-rural area. These long houses were long, but had electricity ( TV and air con ) and also water supply, except that each long house had only one bathroom cum toilet. That meant that were had to queue up for toilet and bath. The last person had bath at almost 1 am. I had to sleep on a 4x2 sofa for the night. I was tired, so I slept and work up with a painful neck. Hahahahhaaa.

Tomorrow, we leave for home. I have to be in Singapore at 9am for Asia PCR / SingLive.

FPMPAM SARAWAK HEALTHCAMP - IN COLLABORATION WITH IMPIAN SARAWAK. 19th-21st Jan. 2015

This is the second Camp at Sg Aup Church.



I arrived at Sg Aup with the advanced party, to set up the Camp. The place offered was a Church annex ( which was a two storey building ). There were some space constrain but adequate for our purpose. The pastor was very kind and came out early to help us set camp. I decided that the screening, physicians, paediatricians, eye and pharmacy  will remain on ground floor, and the skin, OG, breast examination and dental clinic will be on 1st floor.

Patients were arriving even as the floor was being mopped and the stations were being readied.  Sg Aup is essentially in the outskirts of Sibu town ( about 45 mins journey away ).

In Sg Aup, the 4 SBs were there bright and early.

We saw 204 patients, took out 44 teeth, screen 55 eye cases and picked up 19 cataracts. 47.8% had BMI < 25, 46.5% were overweight with BMI >25 but <35 .="" 5.6="" bmi="" obese="" were="" with=""> 35. With regards to the FBS, 40.1% were normal, 29.5% had FBS between 5.8-7.0 mMols/L and 30.3% had FBS in the diabetic range.

This Camp was over by about 9 pm also. We were bussed to a nice Chinese Restaurant for dinner at about 9 pm, and returned to the Hotel at about 10.45 pm. This dinner was sponsored by FPMPAM, as we were leaving YB Oscar Ling's constituency.
Tomorrow we proceed to Bintangor, which was ADUN Ting and YB Andrew Wong's constituency.

FPMPAM SARAWAK HEALTHCAMP. 19th-21st Jan 2015. IN COLLABORATION WITH IMPIAN SARAWAK.

I have been rather busy 2 months. After ICF 2014, I began to organise this FPMPAM-IMPIAN SARAWAK Health Camp.
We left KLIA on the evening of 18th Jan 2015, and returned after a very successful HealthCamp, on 22nd January 2015. I then proceeded to Singapore to take part in SingLive / Asia PCR as a faculty on 23rd Jan 2015.
So it has been quite hectic.

I organised a team of doctors, including 2 GPs, 2 physicians, 2 paediatricians, one surgeon, one dermatologist, one ophthalmologist, one OG and one dental surgeon. To support us, we had an admin officer, and 8 nurses.
In all the sites, we had glucometer service and BMI measurement. The two  GPs to triage, and we provided dental services, eye check-ups, paeds consult, physician consults, surgical consults, OG consult, skin consult and breast examination by a nurse. Quite comprehensive.

The clinics were in two sessions, 9am-1pm and 4pm-8pm ( to cater to residents coming back from work ).

I would like to share with you all some of the moments in Sibu area long houses in Sarawak.
These are some of the pics from the first Camp, sited at a church in Bawang Assan next to the mighty Rajang river.

At Bawang Assan, we saw about 137 patients. Age range from 2 months old, till 82 yrs old. There were 1.6 female to 1 male. We extracted that day 31 teeth for dental caries ( some had more than 1 tooth extracted. About half those examined had BMI . 25 and half less than 25. By fasting G/M testing 71.9% had FBS of <5 .7="" 13.4="" 14.6="" 5.8-7.0="" and="" fbs="" from="" has=""> 7. We had about 20 samples of non-fasting BS.

It began to rain in the afternoon and at about 5pm the Rajang river ( we were on the banks of the Rajang ) began to overflow and the river water began to encroach on the Campsite, ponding up the waiting area and below the church which was on a stilt. So there was some patient inconvenience.

At about 9 pm on 19th Jan 2015, we had dinner in a Long House and had fellowship with the long house, who welcomed us. Tauk was free flowing and the local food taste good.
We thank our host before we left to go back to Sibu to rest for the night.

We learned that over the next 3 days, beginning with Bawang Assan, PDRM had assigned 4 SB ( special branch ) officers to shadow us whenever we went. We welcomed them.

The whole trip was incident free.
.




Tomorrow we go to Sg Aup.
It was a good day, despite the rain and mild flood.

Tuesday, January 13, 2015

FPMPAM-CARE SARAWAK HEALTH CAMP. in collaboration with IMPIAN SARAWAK DAP

Sometime in Nov 2014, I met up with YB Tony Pua. In the midst of discussion on other matters, he discussed their Impian Sarawak program. My patient form Sarawak has also given me a feedback that this Impian Sarawak program by DAP has caught the eyes of the Sarawak state government. YB Tony suggested if we doctors would be interested in running a healthcamp in the interior of Sarawak. The answer is of course a big YES. We have always felt that without the support of the people of Sarawak, it would be almost impossible to change the tenant at Putrajaya. It is in this light that I began working on this project. The understanding was that DAP will be our logistics partner as they have a set-up in Sarawak that can help facilitate the organisation of the Camp.
         Following the meeting with YB Tony, I met up with Dr Steven Chow ( President FPMPAM ) and he also was in support of the idea. He agreed that we could use the FPMPAM-CARE banner. I began recruiting doctors and raising funds. God was kind. I managed to recruit 10 doctors of various specialties, including 2 GPs. There were also 7 nurses and 1 administrator. One of the doctor will double up as our official photographer. We intend to capture this event, both for our sponsors sake and also for FPMPAM branding sake.

       
 It was heartening to see support coming in from many well wishers. Some doctors donated drugs. Someone donated 1,000 tooth brushes for the residents. I had to buy about RM 12K of drugs ( we will have a rather large pharmacy ). The DAP have managed to organise for us to work in the Bawang Assan, Sungai Aup and Bintangor area. It is YB's impression that we will be seeing 300-400 patients a day. The camp dates are 19-21st January 2015.
          Coming along with us, is a senior dermatologist, a dental surgeon armed with a portable dental chair, adequate to perform dental extractions if necessary. The ophthalmologist is equipped with a slit lamp and tonometer to do full eye examination and screening. There is a senior OG with an abdominal ultrasound scan. We also intend to offer breast examination screening for breast cancer. Sounds exciting.

 
     
       Wish us well please. It is my first time in rural Sarawak. I have always been to Kuching and surrounding.
       Organising this project has kept me busy over the last 1 month.
       If what YB Tong and YB Oscar estimate is correct, I may also take this opportunity to do a rural health survey of the rural Sibu area.

Well, lets see how it goes.


                                                     MY APOLOGIES.
         PLEASE NOTE THAT THE VIEWS EXPRESSED IN THIS BLOG ARE SOLELY MY OWN AND ARE NOT NECESSARILY THE VIEWS OF THE FPMPAM COUNCIL. I APOLOGISE FOR ANY OVERSIGHT ON MY PART. I HAD NO INTENTION OF HURTING THE FEELINGS OF ANYONE WITH THIS BLOG. IT WAS PURELY TO LET MY READERS KNOW WHAT WE ARE DOING. 
                                                       MY APOLOGIES.








Friday, January 02, 2015

DOCTORS, PLEASE LET GO?

In my reading, in between all the other "rubbish" that I am doing, I came across this very interesting article about Medicine in the future. Of course, this thought provoking article is by non other than Dr Eric Topol. In his younger days, he was a learned Cardiologist ( often, a rather controversial one ). But in his senior years, he has taken on a role of senior physician mentor, and where medicine is going as we head deeper into the 21st Century. I must say that I agree with many of his thoughts and in particular, this article on " Doctor let go!" No he is not writing about terminating care in a critically ill patient or "NFR ( Not for Resus.) situation.
Doctor let go, challenges us doctors to let go of some of the sacrosanct areas of medicine, that we all hold so dear to, from our undergraduate days. There are 3 important areas to let go. Even if you do not want to let go, the patient will make you let go.

1. That doctors know best about my health. Doctors use to think that when patients visit them, the doctor does all the examinations ( tests ) and tell the patient the data. In this day and age, that is not necessary any more. There is a growing trend of " Patient Generated Data ( PGD ). Good examples are home BP monitoring, glucometer readings, exercise monitoring, weight monitoring, etc etc. Patients have learned to handle these facts, and also learn to understand them.  If you care to teach them, fine, if not, they will just "google" and search the "net". Doctors no longer have the monopoly of patient data and information. Doctors must learn to empower patients, share management strategies with patients, thereby getting better cooperations, complaince and better outcomes. Keeping patients in the dark is no longer an option. Doctors "must let go" of the monopoly to their knowledge about a patient. He must be prepared to discuss using PGD.

2. This is the I want what I want when I want in century, or "IWWIWWIW" century. This is the age of instant culture. I want an opinion now. I want to see you now. I want it at my convenience, not at yoyr ( doctor's ) convenience. This will be further enhance by telemedicine, so that patients can do a virtual consultation, without a physical consultation. Even in my small practice, I see more and more of these. Patients have my email, and they will email me complaints and lab  reports and ECGs. So doctors, you "must let go" of your convenience.

3. The third is most clear cut. Doctors "must let go" of the privacy of the patients case notes. The case notes is about the patient, is paid for by the patient, so it belongs to the patient. Sure, doctors can keep a copy, but when requested, doctors must allow patient to have a copy. Either you do it willingly and nicely, or you allow the patient to insist, with all the other consequences to you. Hospitals can have their recods, you can have yours, but when requested, patients also have a right to their revords. So becareful what you write there.

Interesting ideas. I believe that these issues will get more prominence as we move further into this decade.
                               HAPPY NEW YEAR 2015
                               to you and all your love ones too.