Monday, January 04, 2010


The last week, over the internet and also on my handphone sms, there has been much cyberspace traffic about the setting up of the 1Malaysia clinic, which will be launch by the Prime Minister on the 7th Jan 2010. When these clinics were first announced under the budget speech by the Finance Minister, I wrote a protest note to the STAR newspaper, pointing out that these clinics were running afoul of the Private Healthcare Facilities and Services Act 1998.
In fact, one of my colleagues pointed out to me that, they were not. You see when we were negotiating the amendments to the PHCFS Regulations 2006, the then Minister and DG agreed with us that the Act was wrongly named. It should have been called the " Malaysian Healthcare Facilities and Services Act. Alas, the last Minister was replaced and all our agreements and negotiations seemed to have gone to not. As it stands, the 1Malaysia Clinic is not exactly illegal.
Over the last week, the MMA president have been soliciting opinions as to what to do, to show their disgust at launching of the 1Malaysia clinic. The suggestions varied from seeking a dialogue with the PM and Minister of Health, sending a petition to the MOH, holding placards and demonstrating in front of Putrajaya. I suppose the first two suggestions have some merit. To show our disgust and try and protect our GPs who felt that their " rice-bowl " will be affected. The last suggestion must be a joke. " Doctors demonstrating, in Malaysia "? Firstly, my experience tells me that no one will show up ( the apathy is so strong ), and secondly, we will be the laughing stock of the public. What will the public think about us, demonstrating like " orang kurang ajar " in public over a government clinic, which may have some merit.
If you see the " Private Healthcare Facilities and Services Act 1998 " as solely for the private sector, then what the government is doing is proper and maybe good.
Firstly, it is true that in some western countries, nurse-techs and paramedics are running healthclinics in urban areas through Walmart and the like, to renew prescriptions, vaccinate, check blood sugars, and also do simple medical procedures, in an attempt to cut down healthcare cost. Some technologists are even taught to do endoscopies and echocardiograms. The danger here is that with the 1Malaysia clinic, the hospital assistants and nurses, may not have sufficient training and skills to be safe. And of course, there is the temptation to do and take more responsibilities than they should. We would certainly like to see the terms of reference and terms of conduct of these clinics ( what they can and cannot do ).
Initially, I wrote in my short piece, that if the government wishes to help the rakyat, these clinics should be in the rural areas. I thought that there should be greater need for these in the rural areas. Again, I was corrected by my colleagues there in the rural areas, there is a government day-care center within easy reach, in every community ( I suppose except Sabah and Sarawak ). There is greater need amongst the urban poor, like the inner cities in the US.
I have also begin to realise more and more that the the medical scene is changing and that doctors cannot be protected forever. They must be prepared for competition ( and I hope that it is fair competition ), and that the public must be served, as best as we can, as an individual and as a country. The " subsidy mentality " and "the government will protect me mentality", must go, sooner rather than later. If there are three new clinics in my housing estate, I must work harder, treat patients better, provide better service, so that I can compete, and not just cry and shout blue murder and hope that everyone else will help you out and protect your rice bowl. There is a need, and the government, for their own reasons, have come to fill up that need. Of course, they have their political agenda.
Whatever it is, and whatever we say and do, protest notes, petitions, meeting with PM / MOH, placards and demonstrations ( I hope not ), on the 7th Jan 2010, the Prime Minister will be launching their 1Malaysia clinic, and we have to live with that. GPs arise, and compete. Your hallowed ground is being invaded, somewhat. This is the practice trends of the 21st century.

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