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(the voice of private medical specialists)

Vol 8 April 2006 for circulation to members only


Committee 2005/2006

President Dato' Dr Abdul Hamid Abdul Kadir
Vice President Dr Robert Jalleh
Hon Secretary Dr M V Kudva
Hon Treasurer Dr Gurcharan Singh
Committee Members Dr Ranjit Singh Gill
Dr Kok Choong Seng
Dr S Mahendra Raj
Hon Auditors Dr A Damodaran
Dr Liew Fah Kong
Editor Dr Kok Choong Seng

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Message from the President
by Dato' Dr Abdul Hamid Abdul Kadir, President

"Life's A Bitch"

I have exercised liberty in taking this title for this message from the last line of an article in the Opinion page of NST (March 11, 2006) written by Kalimullah Hassan. It is a down-to-earth, heart-wrenching read.

The question of money influencing the provision of health care in this country has often arisen in the media when patients have had to pay hefty deposits before receiving emergency care in private hospitals, or when patients have been turned away from clinics because they couldn't pay.

The code of medical practice underlines the moral, ethical and professional need to provide compassionate emergency, life or limb saving care when patients in dire, desperate situations turn up at our door. No questions about payment should be discussed before providing such urgent care. And, it is expected that the grateful patient, once treated, would do all in his earthly power to pay the clinic or settle the hospital bill without undue delay and without evasive, illogical excuses or, worse, unmitigated arrogance. At times doctors have had to resign to the satorial enlightenment that they would probably be awarded in heaven.

Doctors in private practice sometimes address patients with: "We are not running a charity service", and this seemingly severe posture, however, is a fact. The high cost of putting up a clinic or hospital, installing expensive equipment, maintaining and running the facility is an undeniable fact and doctors and hospital administrators have a major problem balancing expenditure with income. But the margin of “profit” to satisfy share-holders and owners of these facilities should not be measured in the same reckoning as, say, real estate or the car industry. Healthcare may indeed be a business, and the conflict between being humane and making a respectable living is a never-ending challenge.

The humane nature of doctors is sometimes a quality seriously doubted and questioned. A few doctors (enough to give the profession a bad image) do believe and behave as if the major concern in their practice is to make money. They feel that the service and care they provide is more than what money can buy and should be reasonably be rewarded. They constantly compare their fees to what lawyers, architects and other professionals charge for their services which are ostensibly less physically and mentally demanding.

Driven by such arguments, they are known to stretch their professional fees to the limit, and sometimes beyond, often with questionable justification. They often throw the Fee Schedule to the wind with the excuse that the schedule is "unrealistic" and therefore does not merit compliance.

Surgical procedures are at times "unbundled" to include multiple fee categories, and patients are sometimes not told the estimated total cost nor warned about possible adverse outcomes which may require intensive or high-dependency care.

A few specialists are known to visit their in-patients at night because the fee for night rounds is higher in the Fee Schedule than day visits. As a member of the public has lamented in his Letter to the Editor NST (March 23, 2006), "Hello, how are you today?" is reflected in the doctor's bill as RM100.00 fee. I knew of a long-stay patient who used to seek refuge in the washroom when he suspected that his doctor was coming around on his rounds and waited inside till the doctor left the ward. Are we not compromising care by our own selfish act?

Doctors are known to order investigations and tests just to cover all possibilities of diseases even when the clinical impression does not warrant such extensive exploration. Most often, the patients are in the dark about what they are being investigated for. Doctors retain patients in wards longer than necessary, and inter-disciplinary in-house referral to colleagues is often based on some flimsy ground.

All these pale into insignificance when patients succumb, or become severely handicapped, because of the doctors' failure to provide appropriate, timely emergency care. Their alleged malpractice reaches the high court, and the mental and emotional agony, professional uncertainty and financial loss suffered by the doctors make them take stock of themselves and ask if their misguided adventure in the world of patient care was worth it.

They may ultimately grudgingly nod in agreement that Life is a Bitch.

Dato' Dr Abdul Hamid Abdul Kadir
Association of Specialists in Private Medical Practice, Malaysia

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by Dr Kok Choong Seng, Editor

Another season of festivities has gone by and before we know it the first quarter of 2006 is coming to an end. The challenges facing us in private practice remain the same. We seem to be making some headway in our discussions with APHM and the insurance industry but nothing concrete has materialized. Part of the problem is that the associations re p resenting the private hospitals and insurance companies do not have the power to compel their members to follow whatever recommendations they have agreed upon. Similarly our association can only recommend actions to be taken by our members.

The fees committee set up by our association has had 2 meetings to look for common grounds in negotiations with private hospitals and insurers. We need to have unity in dealing with this important issue. Wishing all members the best in their practice.

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Meeting of APHM-ASPMPM Joint Working Committee

The last meeting of the above was held on 22 December 2005 at Sunway Medical Centre. Among the issues discussed:

  • Contracts between doctors and management

  • The possibility of creating one common contract was discussed. However difficulties include:
    • Retirement age
    • Percentage of fees sharing or administration fee
    • Duration of contract (some contracts have no expiry date)
    • Fitness to practise ASPMPM

  • ASPMPM have been asked to get the view of its members in this regard. Please give us feedback.
    • Fitness to practise
    • Who should decide on the doctors' fitness
    • Thorough check of qualifications, role of the Specialist Register
    • Assessment criteria
    • Medical screening for infectious diseases

APHM will look up guidelines of other countries. ASPMPM members to provide feedback.

Retirement age

Current norm seems to be 65 years, with further extension on case to case basis on annual interval. Who should decide: management alone or in consultation with MAC. The introduction of a one year probation period was also discussed.

Doctor Representation on Management Board

The Private Healthcare Facilities & Services Act (1998) provides for representation by MAB at the Management Board. While the Act has not been implemented yet, APHM will recommend that its members comply with the above provision.

In-House Ethics Committee

The consensus was that such a committee is necessary to promote self-regulation amongst the doctors. The committee is an advisory body to the hospital management. The members to be nominated by MAB. Legal liabilities of members need to be looked into should a doctor decide to sue the hospital and committee over a course of action taken by the hospital management on the advice of the committee.

MMA Fee Schedule

The APHM will use whatever Fees Schedule recognized by the Ministry of Health / Govt of Malaysia. Procedures not in the current schedule will be added (mainly dental and aesthetic procedures). The doctors are also unhappy that discounts are being given on their behalf by hospital management. APHM will advise their members to be open, transparent and involve its doctors when negotiating deals with third parties.

(extracted from minutes prepared by Dr Chong Su Ling, Hon Secretary of APHM)

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Evaluation of Consultant's Contracts with Hospitals

Sixteen specialists completed the survey. They represent both senior and junior consultants in private practice, and are from various towns in Peninsula Malaysia.

Listed below are the areas of concern. These were brought up for discussion at the APHM – ASPMPM Meeting on 30 March 2006.

A) Factors to be included

  1. Defined tenancy – period and regulations governing these
  2. Consultation with doctors via Medical Advisory Committee (MAC) before admission of new doctors to hospital
  3. Proper and transparent process for disciplinary action on doctors and the non-renewal of contract
  4. Discussion with MAC/doctors regarding pricing for patients
  5. Fixed and transparent professional fees schedule, preferably current MMA Schedule. No fee splitting
  6. Defined medical benefits for doctors
  7. Non interference in clinical practice
  8. Provisions for maintenance of open communications between doctors and administration

B) Factors to be Excluded

  1. Clauses allowing dismissal of doctor without due process, including consultation with MAC
  2. Profit sharing – fee splitting
  3. Waiving or giving discounts on professional fees without consultation with individual doctor
  4. Admission (joining) Fee
  5. Retirement age
  6. Separation of doctors into different categories within each hospital
  7. Drug dispensing in individual clinics
  8. Doctors not allowed to collect fees and dispense drugs in clinic

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