Showing posts with label Healthcare in Malaysia. Show all posts
Showing posts with label Healthcare in Malaysia. Show all posts

Thursday, 8 September 2016

Introducing the concept of Family Doctor in Malaysia

It is not easy to introduce something like the UK National Health Service system in Malaysia especially with the current economic climate however, to introduce the concept of a "Family Doctor" is not impossible. Most of us have a family doctor whether we call it that or not. The doctor that we often go to whenever we have some medical complaints is in essence our family doctor. When I was growing up, I had a family doctor who was also a neighbor so most of us will do.

The role of a family doctor towards the patient starts even at birth. After 6 - 8 weeks of giving birth, all mothers should go for a post-natal check up and it is also around this time that the baby will be due for another immunization schedule. At this check up, the family doctor will do a post-natal check up for mom and 8-week check for baby. 

The family doctor is also the one that mom (and/or dad) will go to if baby has any medical problems or is unwell. Otherwise mom and dad will bring the baby for routine immunization as well as developmental check up until the age of 3 and half. 

So, the family doctor gets to know a person from birth and looks after the whole family for any medical or indeed social issues. Imagine a child who has been seeing his/her family doctor with the parents and goes on to reach adolescent age. Some families are fortunate to be open and informative to their children about adolescent issues but sometimes adolescent may want to speak to someone professional, non-judgmental and a neutral third party. The child / adolescent may have acne problems, issues of self-esteem, peer pressure, or sensitive issues such as relationships, sexuality, body image, sexual abuse or bullying. The parents may want to bring the child to see someone who can educate and give further information with regards to these issues or to handle sensitive issues and to refer the family to appropriate services. The family doctor is a good place to start. Hence, part of the training of a family doctor is in communication, being non-judgmental, handling sensitive cases and to be the neutral / impartial person as well to coordinate patient care by referring to appropriate services. 

If a person is going through a difficult time in life or stressed out due to marital issues / work environment / bereavement or perhaps suffering from depression or some other mental illness, the family doctor has a role in listening, advising, making a diagnosis and if required to start treatment or refer to another specialty. The family doctor can also offer advice and emotional support for carers as well as referral to appropriate services e.g. counseling, hospice / respite care. 

Couples who are wanting to become pregnant may want to go for preconception counseling and the family doctor whom may have known them for years may be the first medical personnel that the couple would approach for advice. Older patients may require cardiovascular screening and management of chronic diseases such as diabetes and high blood pressure. Chronic disease management requires a continuity of care by a family doctor who knows the patient's medical background and pattern of illness in order to achieve good control. The family doctor gives education to the patient, encouragement for lifestyle change as well as medication monitoring. 

Therefore, in a day there is never a dull moment as a family doctor because of the variety in the cases seen. The cases may range from a simple sore throat due to viral infection up to serious conditions such as a person coming with chest pain suspected of a heart attack. The family doctor's challenge is to identify patient's verbal and non-verbal cues, to make a provisional diagnosis sometimes based on non-specific or early symptoms and most importantly, in decision making. Making a decision about treatment is an important skill for a family doctor because a family doctor works in a clinic and there is no observation ward or 24-hour monitoring to observe the progression of the disease. 

Hence, in countries like this one where there is not yet a system that dictates patients to register with one family doctor, patients can still understand the concept of a family doctor and how having a family doctor may improve their health quality. 

Wednesday, 10 June 2015

Ex-smoker confession (quit smoking clinic)

May was world no tobacco month. I was invited to give a talk at a health carnival in Sungai Buloh since I am also one of the doctors running our quit smoking clinic. The patients who come to see me are usually those referred to us from Cardiology clinic. Those who have suffered a heart attack and have been told to reduce their risk factors lest...they return to the Cardiology ward with another blocked artery.

My patients who attend the quit smoking clinic often asked me, "Doctor, do you used to smoke?" I have no qualms in saying "Yes" to them. You know how you never quite know the purpose for you doing something until the time comes when everything is revealed to you? Well...the first time a patient asked me that, I felt like my years of burning tobacco suddenly had meaning.

Yes, I was a smoker. I started at the age of 15 and quit at the age of 25 years old. People often misunderstood. They thought I smoked due to peer pressure or was 'influenced' by friends. Truth was, my uncle (who has also quit smoking) was a chain smoker and one day, he left his packet of cigarette at my house. I kept that packet and I even asked my mom if it was okay for me to try one. She gave me the green light. It took me a while before I lighted my first cigarette. Believe it or not, I was actually scared of lighting up a match. My first experience didn't go too well but after that, I tried a few more times and then, I found it rather therapeutic. I felt it was a stress reliever. Well, of course now I know the reason is due to the nicotine that comes from tobacco leaves itself. Nicotine is the active ingredient or the drug that mimics Acetylcholine, a natural neurotransmitter in the brain. Nicotine binds to the Acetylcholine receptors and does more or less the same job as the original chemicals. Nicotine also releases Dopamine, oh...that lovely chemical that makes one happy and relieves stress.

The bad thing is Nicotine is addictive. Once your brain has 'tasted' Nicotine, it just wants more and more and more...and will keep calling for Nicotine every few hours.

When I actually went public with my smoking, there was a bit of an uproar. Well...in the 1980s women don't smoke especially teenage girls. Although I often see grandmothers smoking, like really old ladies who are frail and looks like they're about to collapse at any second, coming out of taxis holding a cigarette. Anyway, women smoking was considered 'indecent'. I hated that cultural mentality. It made me feel that I had to smoke in public even more and to make a stand, a statement, to uphold a principle!

I asked myself, if smoking is bad for health (which it is) then why is it only bad for women. Then I asked again, if smoking is haram (as some fatwa say) then again, why is it only bad for women? I mean...as far as I'm concerned when Islam says something is haram a.k.a BAD...it is bad for both genders. I mean just pick any haram thing, eating pork, drinking alcohol, having sex without marriage, gambling, dealing with interest...ALL HARAM THINGS ARE HARAM TO BOTH MEN AND WOMEN.

The only things that have some differences in rules are pertaining to what we should do for example, it is obligatory for men to attend Friday prayers but it is optional for women, it is obligatory for men to fight and protect the land or lives in jihad but it is optional for women, it is obligatory for men to support their family (working) but it is optional for women. Even when it comes to covering the awrah (parts of the body that needs to be covered) are applicable to both men and women, the only difference is the definition of the parts.

For argument sake, so men are allowed to marry up to four women but women are not allowed but still, that is about God giving men permission to marry up to four. However, when it comes to things that are NOT allowed...that are haram a.k.a BAD things...it is bad for all. Hence, I felt disgusted by the double standards that was practiced in society. I hated the mentality that some things are bad for women or seen as 'tak manis'. URGHHHH! so what if women are 'tak manis'. I hated the mentality that it is bad for women to not be a virgin but it is okay for men to not be virgins.  I held on to the principle that societal rules must be applied to all so, if women are expected to be virgins than men too are expected to be virgins. There should be no bias, no prejudice and no double standards. I wanted justice and equality when it came to application of 'good' and 'bad'.

I wasn't looking for equality in the sense of what men can do, women can do better. No! I didn't want to compete with men or be a feminist. I just wanted people to realize that their view towards good and bad or what society considered as 'acceptable' for men but not for women is based on flawed emotional responses rather than concrete evidence. Telling me I shouldn't smoke in public just because 'tak manis di pandang orang' (not sweet) is not good enough. Tell me I shouldn't smoke in public because it is bad for my health and all the people around me due to passive smoking then, I can accept because that would apply to all smokers and not just because I happen to be born with XX chromosomes.

Remember when this country was covered with haze due to forest fire in Sumatera last year? At the time, everyone frowned upon smokers because they were being terribly selfish, adding more pollutant to the already toxic environment. I saw some smirks and pulling faces from smokers but to me, that is dumb rebellion. If you want to rebel, rebel with a purpose. Don't rebel for self-gratification. Well, you can argue, the air quality at the time was bad anyway...so adding more carbon monoxide and another 4000 toxic chemicals from your one burning cigarette will probably not make much of a difference but, if 1.6 million people smoke and they smoke on average 10 cigarette per day then, you do the maths. How much toxic chemicals are we adding to an already suffocating poor air quality?

Anyway, I quit smoking because I had a scare. I started having this haemoptysis (coughing blood) every morning and thought I was like you know, dying from the big C. Thank God, it wasn't.  On top of that, one of my patients who suffered from COPD (chronic obstructive pulmonary disease) which is caused by smoking had a near death experience. She was in the wards and she couldn't breath. We had to resuscitate her, you know using intubation and everything. The next day, I came to work and I was looking for her and actually found her smoking at the bicycle shed. She inspired me to quit smoking. I thought to myself, no matter what happens I will not become like that. So, I took my last cigarette and then kept the rest in its box as a reminder.

Now, let me inform you that once you're a smoker, you can never truly quit. What I mean is that you may never touch another cigarette in your life but you do have the cravings from time to time. Even after so many years, I do get cravings maybe once or twice a month, depending on how stress I'm feeling. However, the craving only lasts for a few seconds or a minute (max) and goes away once you're busy doing other things. I keep telling myself, that's my brain receptors calling for Nicotine. Forget it...I don't need it.

Besides, my principle self wants to prove that nothing can control me. I am not a slave of Nicotine. the reason why I used to smoke is not because Nicotine has power over me. So, there you go. Successful quitters are those with strong self discipline and motivation. People who have some dependent personality trait may find it more difficult to quit. However, it is not impossible. If you want to quit but find that you might need some help either from counselling or medication, get yourself enrolled in a quit smoking program.

Wednesday, 23 January 2013

Becoming a Family Medicine Specialist in Malaysia

Lately a few friends have approached me with regards to becoming a Family Medicine Specialist in Malaysia. I hope the information here will be beneficial to all.

Although General Practitioners (GP) have been around for the longest time in Malaysia however, the recognition and training of Family Medicine Specialist (FMS) in Malaysia is a relatively new and began in 2003 or so.

The rules with regards to opening a private GP clinic in Malaysia has not yet changed although there has been some talks and attempts to ensure that future GPs will have some form of accredited training prior to working in General Practice. On the ground level, more and more new GPs are taking their own initiative to receive training in the field of General Practice.

I guess this is due to various reasons. With abundance of MBBS graduates being churned out per year...doctors are becoming aware of their need to specialise and to attain a postgraduate qualification. Modern medicine is rapidly changing. Research in the field of medicine is growing ever so fast and there are more available grants. Even I am involved in research...so that says something!

Patients are also becoming more health concious and aware of the new advances in medicine. The concept of patients 'blindly' following doctor's instructions are slowly shifting to a more 'patient centred approach'. Hence, there is an increase challenge for doctors to keep up with new medications, new treatments and new approaches in communicating to patients.

It is no longer acceptable for doctors to practice convenient medicine and continue in their management of patients based on their 30 years experience. Experience is no doubt exceptionally valuable and nothing can replace a highly experienced doctor. However, the educational component, structured learning and mentoring process of the postgraduate training is vital in ensuring a high clinical standard of all doctors and create a passion for life long learning. The exposure to different specialties is extremely valuable for GPs in order to equip them with the ability to diagnose and manage multiple complaints of various systems and origins.

To become an FMS or primary care specialist in Malaysia you need to have a postgraduate degree in either MMed Family Medicine, FRACGP or MRCGP.

MRCGP training is in the UK and it is a structured 3-year training programme. Although there is MRCGP [International] which candidates can sit for in various countries including Brunei, Sri Lanka and others. However, there is no structured training available, it maybe expensive and the passing rate is relatively low.

Candidates may enter the Diploma in Family Medicine (DFM) training conducted by Academy of Family Physician Malaysia (AFPM). The DFM is a 2-year part time structured course with examinations. After completing the 2-year DFM candidates may opt to continue with the Vocational Training Scheme (VTS) and sit for the MAFP/FRACGP which is a Malaysian/ Australian General Practice professional examinations to become a member of the Australian Royal College of General Pracitioners. At present, candidates who sit for this exams may also work in Australia.

Candidates may choose to join the Masters in Family Medicine training which is currently offered in University Malaya (UM), University Kebangsaan Malaysia (UKM), University Sains Malaysian (USM) and University Teknologi MARA (UiTM). This is a 4-year full time structured training with research component in year 4. This is an excellent programme and suitable for those planning to go into academic, teaching and research within a University setting or to work in the MOH Health Clinics.

We are seeing more GPs even those who have been practising for many years joining the DFM programme and venturing into FRACGP. We are also seeing more applications for the Masters in Family Medicine training. I believe even without the pressure or law by the MOH the trend is for future GPs to have postgraduate training and qualification in General Practice.

Friday, 12 March 2010

Our experience of government Hospital

3rd January 2010

I came home today after a day of sorting things out. Luqman was asleep and when he woke up he just cried and cried and cried. Hubby told me he hurt his arm earlier whilst playing. My baby just wouldn't stop crying and he wouldn't move his arm. It didn't look broken but we thought it would be best to get it checked out.

So, we drove to Hospital Besar KL (HKL) Emergency Department. On arrival, we parked the car and got down to emergency; there was a triage place at the front where you have to give the patient's ID card or passport. Within a few minutes we were called and was seen by a male nurse who took Luqy's pulse, Oxygen saturation and temperature. We sat down at the waiting area again and was called to the payment counter. The fees for any trauma is RM50.00. Otherwise it is only RM15.00 for non-citizens and much less for Malaysian citizens.

We were given a number and within 15 minutes our number was called; we saw the doctor who sent him for Xray. The Xray would have taken less than 10 minutes except Luqman was screaming his head off. The Xray films were ready within a few minutes, took it back to the doctor who looked at it, confirmed there was no fracture and mada a follow-up appointment in a few days. We were out of the hospital and on our way home within 45 minutes.

There was a notice board at the waiting area that guaranteed all non-critical patients will be seen within 90 minutes. This was HKL, one of the biggest and busiest government hospital in Malaysia. There were no drunks, no time-wasters, okay...there was one guy who looked like he was involved in a fight and was surrounded by his family members including brothers, sisters, mom and dad all shaking their heads at him. Anyway, I think RM50 which is about £10 is great value for tip-top service. I would give HKL 5 stars! Now, can we discuss about what is wrong with the NHS?

TOP TIPS ON MALAYSIAN HOSPITALS:

You can go to government or private, government hospitals fees are much less but you may have to wait slightly longer; private hospitals cost a bomb!!!

Government hospital will charge higher rates for non-citizens.

Make sure you bring your ID card or passport because you will need it to register.

IN SEARCH OF THIS TRUTH

  I am in a quest to search for THIS truth. People ask, 'why are you still searching for the truth?’  You have found Islam.  You believe...