Materia Medica Malaysiana

August 24, 2007

Patients need right docs

Filed under: Uncategorized — malaysianmedicine @ 12:05 pm

Star: PUTRAJAYA: A specialist can treat a patient outside his specialty in an emergency, but subsequently he has to refer the patient to the right specialist, Health Minister Datuk Seri Dr Chua Soi Lek said yesterday.
Commenting on a recent case of a boy who died after being treated by a nephrologist for dengue and typhoid, Dr Chua said he was under treatment for almost two weeks without being referred to an infectious disease specialist or physician.
Specialists should not disappoint their patients as they put total trust in them, he said, adding that doctors had a moral and professional responsibility to refer patients to the right specialist.
Dr Chua was responding to doctors who had written to newspapers and argued that sub-specialists with their background training and experience in general medicine were qualified to treat most infectious diseases.
The Council of the Malaysian Society of Nephrology had said diseases did not always manifest in a specific compartmentalised manner that delineates which particular specialist should address it.
On Aug 9, Dr Chua said three cases of specialists giving treatment outside their field were reported to the ministry and the Malaysian Medical Council (MMC) recently, and that two of the patients had died.
Asked if MMC would take action against one of the specialists concerned, he said it was difficult for MMC to take any action because the specialist said he was trained to look after the patient.
“But if he was trained to look after kidney patients, why was he looking after an infectious disease case? Why was he keeping the patient to himself? MMC is looking into the case and the hospital has to come up with a better explanation,” he said.
Malaysian Medical Association president Datuk Dr Khoo Kah Lin said the association shared the opinions expressed by specialists in the press recently.
While doctors should treat patients as whole persons and not as isolated organ systems, it was not possible for specialists to keep up with the latest developments in fields other than their own, he said.
“In a patient who has many diseases involving several organs, we have to differentiate between patients who are acutely ill and those who have several chronic stable conditions.
“In the latter case, he should be seen by a general practitioner who knows the patient as a whole and follows up with the patient regularly and refers him back to relevant specialists when the condition is not well-controlled,” he said.
In the case of an acutely ill patient, there should be one main specialist taking care of the patient and other specialists called in for consultation according to changes in his condition, he said.

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August 23, 2007

AIDS awareness lacking

Filed under: Uncategorized — malaysianmedicine @ 12:06 pm

Star: COLOMBO: A survey among a small group of HIV+ widows who have remarried found that their uninfected husbands do not use condoms consistently when engaging in sex with them.
“The women said they always reminded their husbands to use a condom but they do not always use it because they dislike condoms, do not have one at hand, or want to have a child,” said Malaysian AIDS Foundation advisor Datin Paduka Marina Mahathir at the Eighth International Congress on HIV/AIDS (Icaap) here in Sri Lanka at a session on married women’s vulnerability towards HIV/AIDS.
At the conference, married monogamous women have been cited as an emerging group most vulnerable to HIV infection, and among the most silent sufferers of the epidemic.
Marina was citing a study that she carried out with University Malaya post-graduate student Sumathi Govindasamy of 56 HIV+ widows in Kota Baru, Kelantan, to explore the issues and challenges they face.
Out of those surveyed, six have remarried and their husbands know about their HIV+ status.
However, remarriage is not an option considered by most of the HIV+ women surveyed as they will have to disclose their HIV+ status to their intended husband, and they are not prepared to take that step.
“All of the women surveyed were infected by their late husbands, and 80% were married to injecting drug users. However, they continued having unsafe sex with their husbands even after learning about their injecting behaviour, said Marina.
“Some 53% of these women were still not sure if it was the drugs, or the act of injecting that caused the HIV infection. It was evident that basic knowledge on HIV transmission risk is low even now among these women,” she added.
Only 10% of those surveyed have ever used a condom, and it was usually for “experimental reasons” rather than for protection.
The rate of infection among women in Malaysia has gone up from 1.2% in 1990 to 9.4% in 2000.
At the Hospital Raja Perempuan Zainab in Kota Baru, eight or nine women are newly diagnosed with HIV every month, and most of them are infected through heterosexual sex.
Some of the remarried HIV+ women were concerned that their uninfected husbands might choose to take another wife without informing the intended co-wife of the first wife’s HIV+ status.
“Even with mandatory premarital testing, only the couple getting married will be tested,” reported Marina.
“There is a risk of HIV transmission from the HIV+ first wife to the husband to the second wife, especially if he continues to have sex with both women,” she said, adding that this indicated that mandatory premarital testing would not be effective in protecting people from HIV infection, especially in polygamous marriages.

Improper healthcare screening may give wrong impression

Filed under: Uncategorized — malaysianmedicine @ 12:06 pm

Star: PETALING JAYA: A proper healthcare screening must be related to a particular concern over a person’s health condition or it could lead to high costs and unnecessary “panic” or “a false sense of confidence.”
“The first step is to simply not screen for no reason at all because it has very little medical basis,” Academy of Medicine College of Pathologists president Prof Dr Looi Lai Meng said.
She said this when asked to comment on Health Minister Datuk Seri Dr Chua Soi Lek’s statement that health screening by untrained individuals or at hotels or shopping centres was illegal.
She said that indiscriminate screening, unrelated to a health condition, could cause the individual to panic and end up with a “huge medical bill” if the results were not good.
Alternatively, if the results were good the person could have a false sense of confidence.
She added that a person should first visit his doctor who must determine which test was relevant for him.
Dr Looi also urged people not to take the risk of illegal testing that might done by untrained people or those using questionable methods.
She said the role of pathology labs was important because health-screening tests required the use of proper techniques and the expertise of trained pathologists.

August 22, 2007

A first for Malaysian hospitals

Filed under: Uncategorized — malaysianmedicine @ 9:16 am

NST: PETALING JAYA: The long queues for X-rays at Hospital Tengku Ampuan Rahimah (HTAR) in Klang will be reduced. And patients who are not mobile can even be X-rayed in bed, thanks to the portable X-ray scanner Canon Malaysia has donated to the hospital.
The company is celebrating 20 years in Malaysia and the 70th anniversary of the setting up of the global firm that produces high-tech imaging products.
Canon Marketing (Malaysia) Sdn Bhd president and chief executive officer Liew Sip Chon said the Canon CXDI-50C portable flat panel digital radiography system was the first to be installed in the country. With its speed and capacity, it reduces waiting time for X-rays.
“The diagnostic quality is also increased, allowing doctors to come up with the best medical solutions for patients’ ailments,” he said.
Lightweight and portable at less than 5kg, the compact X-ray scanner can be used to capture detailed X-rays from virtually any position and angle.
Hospital director Dr Yahya Baba said the portable unit would improve the hospital’s delivery system.
“Our hospital is one of the busiest in the country, treating some 160,000 patients a year. The device will make it faster and easier for our radiographers and radiologists,” he said.
Deputy Health Minister Datuk Dr Abdul Latiff Ahmad, who witnessed the handing over, said Canon’s gesture should be emulated because it increased the accessibility to quality health care.
The CXDI-50C, part of Canon’s CXDI digital radiography system first introduced in 2000, costs RM350,000 per unit. More than 6,000 units have been sold to hospitals worldwide.
Canon Opto Malaysia has invested RM800 million to aid technology transfer over the years. It has created 6,500 jobs here and 95 per cent of its workforce is Malaysian.

Dubious distinction for ‘doctor’

Filed under: Uncategorized — malaysianmedicine @ 9:16 am

NST: PUTRAJAYA: Indian national Surinder Pal, 34, has the dubious distinction of being the first foreign bogus doctor to be convicted and jailed for abusing his work permit.
Surinder was charged at the Semenyih detention centre’s special Immigration court yesterday. He pleaded guilty and was sentenced to five months’ jail, commencing from the date of his arrest on Aug 11.
He was charged under Section 39(b) of the Immigration Regulations 1963 for contravening his employment pass. The offence carries a maximum penalty of a fine not exceeding RM1,000, or imprisonment not exceeding six months, or both.
Immigration authorities found that Surinder did not have any valid qualifications to be a doctor and that he was not registered with the Malay- sian Medical Association.
Immigration deputy assistant director Kasthuri Bai Venugopal, who was also the prosecuting officer, asked the court for a deterrent sentence given the seriousness of the offence and its implications on the public as he was an unqualified doctor.
Surinder was arrested while treating a patient at Klinik Amar, 13G Jalan Orkid 1A, Section BS2, Bukit Sentosa, Rawang, Selangor, at 7pm.
He had been issued an employment pass to work at Edaran Anggun Sdn Bhd, a company in Taman Selatan Klang, as a technical director.
Immigration officers found documents, including salary vouchers, which showed that Surinder had been on the clinic’s payroll since March, and was earning RM25 per hour.
Also arrested was a Malaysian man, believed to be the owner of the clinic.
Immigration enforcement director Datuk Ishak Mohamed said investigations on the local man were nearing completion and he would be charged soon with employing foreigners without approval.

Health labs to be monitored under Act

Filed under: Uncategorized — malaysianmedicine @ 9:12 am

NST: PETALING JAYA: Some businessmen offering free medical tests at hotels or shopping complexes are in cahoots with doctors to make money from the public.
This is how it works. On handing over tests results to individuals, the businessmen recommend certain doctors.
But anyone insisting on going to his own doctor may see the withdrawal of test results on a host of complaints, including blood pressure and blood sugar.
The doctors in question usually offer patients a health package at their hospital at nothing less than RM400.
It is understood that the businessmen are given a “commission” for their services.
Health Minister Datuk Seri Dr Chua Soi Lek came across this recently when a person complained to him of free health screening with a catch.
He said it happened at a hotel in Malacca after an individual was handed the test results and then referred to a doctor at a private hospital for a check-up.
“When the man said he could not afford to go to a private hospital, the person conducting the free screening tore up the results and threw it in a dustbin.
“When I asked him why he did that, he said that the individual did not need the results as he was not going to the doctor being referred to,” he added.
He got the name of the doctor and confronted him, only to be told that he had nothing to do with the matter.
Dr Chua said these shenanigans would soon be a thing of the past.
The Pathology Act that will come into force next year will see all such laboratories, including those in private hospitals, being monitored by the ministry.
“At present, anyone with a business licence can run a laboratory with people walking in and asking for tests to be done,” he said after launching the 24th World Congress of Pathology and Laboratory Medicine here.
The laboratories will also have to be managed by either a doctor, a pathologist or a scientific officer, depending on tests conducted.
“Patients cannot walk in as they like and ask for tests to be conducted. They have to be referred by doctors.”
Dr Chua said it was wrong to allow individuals to decide what they wanted to do after getting the results of the screening.
On hotels and shopping complexes used by the businessmen, he said they needed approval from the ministry for such activities.
He said they could be charged under the Private Healthcare Facilities and Services Act and fined RM300,000 or six years’ jail, or both, if found guilty.
Earlier at the function, Deputy Prime Minister Datuk Seri Najib Tun Razak, whose speech was read by Dr Chua, said about 240 million pathology laboratory tests were done in Malaysia last year, working out to 650,000 tests a day.
He said 46 per cent of the tests were done in government hospitals, 10 per cent in university hospitals and the remaining 44 per cent in private laboratories.
He said Malaysia had always been mindful of the pathology’s practice standards, considering there were only 300 pathologists in the country.
“When we consider how important each test result is to patients, we can appreciate the importance of first-rate pathology laboratories.”

Health screening at shopping centres illegal

Filed under: Uncategorized — malaysianmedicine @ 9:12 am

Star: PETALING JAYA: Health screening and checks cannot be conducted at shopping centres and hotels.
Health Minister Datuk Seri Dr Chua Soi Lek said those who carried out such tests were doing so without the approval and support of the ministry.
“They are not recognised or endorsed by us. They are illegal,” he told reporters yesterday after representing Deputy Prime Minister Datuk Seri Najib Tun Razak at the opening the 24th World Congress of Pathology and Laboratory Medicine here.
Dr Chua, who warned Malaysians against undergoing such checks at shopping centres and hotels, said there was an “unhealthy development” in which some untrained individuals were in cahoots with private hospitals to refer patients to the establishments for treatment after claiming that the tests showed they were at risk from certain illnesses.
Those who went for such tests would not get a correct interpretation of the results, he said.
Dr Chua cited an example where the people would get a telephone call informing them that they would get a free health screening. Basic tests such as measuring the weight, height and a urine check for glucose level are carried out.
“Then, they’ll say you have a risk of getting diabetes or high blood pressure and should be referred to a doctor and pay RM400. So, the doctor will get additional income and he will give a kickback to them,” he said.
An estimated 240 million pathology laboratory tests were carried out in Malaysia last year, which translates to 650,000 tests daily.
The cost for tests ranges from RM5 for a simple haemoglobin test to a few hundred ringgit, depending on the complexity.
The ministry had in the past two months received two written complaints on the matter, Dr Chua said, adding that in another incident, a woman sought his help after her test results were thrown away when she said she could not afford to go to the recommended private hospital.
He said the doctor involved, based in Kuala Lumpur, denied the allegations when questioned by ministry officers.
Dr Chua advised the public to go for health checks organised by the ministry or government hospitals.
The public can complain to the ministry’s private clinics complaint hotline at 03-8883-1484.
Dr Chua warned doctors that they could be referred to the Malaysian Medical Council if they were found to have committed such wrongdoings and cited for unprofessional conduct.
Action could also be taken against shopping centres and hotels under the Private Healthcare Facilities and Services Act 1998 for renting out their premises for such activities, he said.
Dr Chua said that under the Pathology Laboratory Act, patients could not just “walk into” pathology laboratories to be tested.
“It is wrong for the labs to do it. They can have packages but the patient should be referred by a doctor,” he said, adding that only a doctor would be able to diagnose and treat based on the results.
This, he said, was to prevent patients from “being their own doctor” by ordering and making a diagnosis.
He said that the Act also specified the type of tests the laboratory could conduct according to their licence while the person in charge would have to be either a doctor, pathologist or scientific officer.
The pathologists at the laboratory are only allowed to carry out tests which they are licensed for, he said.
Dr Chua said the ministry would also control the advertisements posted by the laboratories besides having a mechanism for the public to file complaints. A scheduled fee will also be enforced.
He said there were more enforcement officers in the field, totalling 100 now, adding that the ministry would seek to get more next year.

Ministry wants manufacturers to cut sugar content

Filed under: Uncategorized — malaysianmedicine @ 9:11 am

Star: PETALING JAYA: The Health Ministry wants carbonated drink manufacturers to reduce the sugar content in their drinks from 15gm to 5gm per bottle.
Minister Datuk Seri Dr Chua Soi Lek said there had been discussions with multinational and local food and beverage manufacturing companies, and “initially, an agreement was reached by all parties”.
“The ones we are having problems with now are the beverage manufacturers.
“We want the drinks to not have more than 5gm of sugar, they only want to reduce it to 9.5gm,” he told the press at the launch of the books Fruitastic!, Fruitastic! Malaysia, and Vegemania! here yesterday.
He added that the ministry set up a technical committee earlier this year to go through the contents of food and beverages in Malaysia with the aim of reducing sugar, salt and fat content.
“We want to have a label called ‘Healthier Choice Food and Drinks’.
“If these companies don’t agree, we will drop drinks from the list of food considered as the healthier choice,” he said, adding he would meet them for the last time next week.
Dr Chua explained that the beverage manufacturers were reluctant to reduce sugar content as Malaysians have “a sweet tooth”.
“They are worried that if the sugar content is reduced too drastically, Malaysians may not want to drink carbonated drinks anymore.”
He also said that the average Malaysian consumed 125gm of sugar a day, when only 50gm was needed.
He said a survey conducted in 1996 found only 11% of Malaysians exercised and 20% of them were overweight, but a survey conducted in 2004 found that while 13% exercised and 37% of the population was overweight.
“If we are not careful, this will translate into a rise in diseases such as hypertension, high cholesterol levels and diabetes,” he said.
On the books authored by Mohana Gill, Dr Chua said the timing of the launch was “excellent”, as it was in line with the Government’s health promotion.
In her three books, Mohana describes the benefits of various fruits and vegetables, and also shares her personal recipes using these ingredients.

August 21, 2007

Seek advice, young docs told

Filed under: Uncategorized — malaysianmedicine @ 10:23 am

Star: PETALING JAYA: Junior doctors need to change their attitude and ask questions from more experienced physicians when they are in doubt to ensure effective medical care is delivered.
In turn, those in senior positions, including specialists, should spend more time training junior doctors.
Health Ministry director-general Tan Sri Dr Ismail Merican said that junior physicians should know their limitations and ask for help.
“Don’t just simply do it,” he said in an interview with The Star.
“They do not open their mouths. They are either reluctant or very scared to interact with their senior colleagues. Maybe they are unsure when to ask for help.”
Senior doctors could also do their part by encouraging and motivating junior doctors to put aside the “fear culture” and ask them questions.
Another aspect of training junior doctors that needed to be looked at, he said, was how to ensure they gathered enough experience in treating patients.
He said greater effort needed to be put into teaching rounds and clinical case presentation by senior physicians and specialists such as having a “grand round” every week involving all doctors. He said while the practise was currently in place, more in-depth discussions were needed.
That was the best way to identify and discuss problems, although it was challenging to get all relevant parties to take part.
“Specialists must be reminded that their prime duty is to serve patients besides teaching house officers and young medical officers.”
Dr Ismail said Health Minister Datuk Seri Dr Chua Soi Lek and he were concerned about the training, experience and attitude of doctors and wanted to ensure the quality of service was further enhanced.
A clinical skills laboratory for practical training was being established at every government hospital in stages where doctors and nurses could increase their competence in handling procedures and make them more confident, he added.

August 17, 2007

Don’t try to self-cure erectile dysfunction

Filed under: Uncategorized — malaysianmedicine @ 9:08 am

NST: KOTA BARU: Many Malaysians suffering from erectile dysfunction (ED) resort to short cuts by refilling their prescription instead of having follow-up consultations.
They do this either out of embarrassment or to save on consultation fees.
Consultant urologist Dr Peter Ng, however, warned that short cuts would not solve the problem.
The problem might recur because of dosage changes.
“Patients often go to the pharmacist, thinking that they can save money and time. They fail to realise that check-ups are important,” he said after a lecture on male sexual dysfunction at the Sexual Health Conference here yesterday.
The two-day conference, attended by 200 medical practitioners, was organised by Universiti Sains Malaysia’s Family Medicine Association.
Dr Ng said patients often thought that their problem could be solved by taking drugs like Viagra.
Instead, he stressed that ED must be treated holistically, including counselling.
“Viagra is only half of the treatment. Doctors must examine the patient for heart disease, diabetes and high blood pressure, which contribute to ED.”
He said self-treatment and buying medication from street pedlars, especially among the lower income group, was another worrying trend.
“If the medication is fake, they are not only wasting money but also poisoning themselves.”
ED cases in Malaysia are also expected to rise because of unhealthy lifestyles, stress and other factors.
He quoted a study in Perlis, Kedah and Penang last year which showed that 48 per cent of the respondents as having some form of sexual dysfunction.
He said that the problem was not confined to the males as women, too, could be affected. The study indicated that 58 per cent of the women respondents experienced sexual dysfunction.
By 2025, 113 million people in Asia are expected to suffer from ED.
Meanwhile, USM family medicine specialist Associate Professor Dr Shaiful Bahari Ismail would be leading a three-year study on Tualang honey as the next miracle cure for ED.
“Locals, for generations, swear by honey to cure ED. We want to know if it does. We are still waiting for the study grant.”
He chose Tualang honey over the many kinds of local honey found on the market as it was certified as pure by the Federal Agriculture Marketing Authority.

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