Blame The Doctor?

9:04 AM


When I first read the title, my knee jerk response was "WHAT absurdity is THIS? Marah kan nyamuk, kelambu di bakar." Is it really the doctor's fault?


Lets look at this scenario:

A patient with a severe back pain due to paravertebral muscle spasm went to a private hospital. On assessment by the MEDICAL OFFICER there is no neurological deficit (no numbness or weaknesses of the limbs) but pain score is 8/10. If the patient goes to a very busy government hospital with limited facilities and staff (and don't forget to pay RM 1!), all he will get is an intramuscular injection of analgesia (commonly diclofenac sodium) maybe do a lumbosacral x ray, less than an hour of observation, then discharge. And maybe an MC.



If the same person goes to a private hospital in the middle of The Golden Triangle of KL, he will be greeted by smiling faces at the counter. He will be assessed by an MO at the emergency department and referred to the orthopedic CONSULTANT. Since he is there and they DON'T HAVE A WAITING LIST, MRI was done. Then, the best analgesics will be given. Admission is required so that the muscles can get adequate rest. The physiotherapist will come and see the patient the next morning and offer some great massages and heat therapy. Food is awesome; premium butter croisonts for breakfast, smoked salmon with basmati rice for lunch. Two days later he will be discharged feeling refreshed and gets tablets analgesics in the form of ARCOXIA or CELEBREX (which cost A BOMB!).

While the guy admitted in the private hospital feels great after 2 days, the guy who went to the government hospital may still feel some residual pain. RM 1 versus RM 5000. Which one do you prefer? BMW 5 series versus Proton Accordana. Tune Hotel versus The Marriot.

I am not saying that the government hospital is giving sub optimal treatment. But as government servant working at the GROUND LEVEL, we have to work around the budget constraints. Want to order an MRI? That will take at least 3 months. Physiotherapy appointment? Maybe next week. Want Arcoxia instead of voltaren? That will take FIVE years, the time it takes for me to become a specialist!

On the other hand, there are some unscrupulous doctors out there who are out to make big bucks. Some doctors do perform unnecessary investigations and advice for unnecessary admissions. I have had patients coming to the Emergency Department demanding for admission because a paediatrician at a private hospital wanted to admit their child because of Influenza A. Not H1N1 or Mers-CoV, but a NORMAL Flu. The child was not in respiratory distress and the temperature was just 37.5 C. OK lah kot, nak prevent outbreak kata kan.

A nephew of mine was admitted for a 2 cm laceration wound just below the left knee. It was a clean cut, no muscle exposed. Just a superficial wound. Suturing was done under general anaesthesia to "cause less trauma" to the child. Was it really warranted? Yes, it was less traumatic for him but wouldn't there be less risk and less cost if it was done under local anaesthesia? What surprised me more was the fact that they did not use sutures but glue stitch instead. General anaesthesia for a GLUE STITCH! Total cost RM 2000!

With the rising cost of everything, of course people will melenting. An increase in fee, even though warranted can be perceived as unnecessary. The public will still REFUSE to see that the medical fees was only revised after such a LOOOOOOOONNNNNGGGG time. They will picture doctors driving nice cars and live in big houses.

"Doctors can't do that. They shouldn't be rich. They are supposed to be serving the public. Only businessmen and politicians get rich!"

......Never mind the fact that doctors are humans too and also have families to feed and also suffer from the rising cost of living.

The public have to realize that medical equipment and drugs are EXPENSIVE. After being pampered so long with medical subsidies, the public hasn't been able to see the exact cost of things. I still keep on hearing some people say;

"Saya dah pergi klinik kerajaan tadi. Saya datang nak ambil ubat lain. Klinik gomen kasi ubat murah je."

Not all the amount paid goes to the doctor. Most of it will be used to bear the cost of investigations, food, accommodation and other hospital facilities. I am not sure how the billing is done by insurance companies, but the last time my wife was admitted to a private hospital, the bill indicated the exact breakdown of payment details.

In the letter, the writer gave an example of the cost of an appendectomy. 10 years ago, open appendectomy was the norm. Nowadays, laparascopic appendectomy is commonly performed. The cosmetic outcome is better and the recovery period is reduced. The RM1,800 surgery 10 years ago might have resulted in a 5 cm scar at the abdomen and higher risk of adhesion colic (resulting in recurring abdominal pain). With the 400% increase in cost to buy the trocar, laparoscope, the cautery and HD monitor, the result outcome is far better with just 2 small scars (one hidden at the umbilicus) and less risk of adhesion colic. Would you pay for a better outcome or not?

Open Appendectomy Scar


Laparoscopic appendectomy scar

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10 comments

  1. health is the fast growing industry in our country.. the govt sector cant cope and catch up.. we do our best with what ever we had.. just pekakkan telinga and smile..

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  2. it's actually 3 scars brother for lap appendicectomy..1 for the camera and 2 for the operating ports =)

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    Replies
    1. What I meant was 2+1. The one at the umbilicus is usually not visible :)

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  3. Honestly it's true

    Boleh kaji apa yg jadi kat industri medical dgn insurance kt US

    Harga insurance melambung naik sebab harga medical melambung naik, simply sebab hosp cuba untuk maksimumkan profit melalui segala jenis keselesaan, teknologi baru, dll

    Apabila yang membuat bayaran adalah pihak ketiga, maka xde price rationing berlaku antara yg meminta bayaran dgn yg terima bayaran

    Of course ni kes hosp swasta, bkn gov

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  4. As a medical officer at a private hospital (not quite so swanky and not in the Golden Triangle) I have to agree thst most of what you mentioned above is very correct. I do worry sometimes as I don't have a medical card or medical insurance for myself or my family. Because nowadays the norms are changing. Almost everyone has a medical insurance of some kind. I'm not even taking about middle class or above, but literally everyone... difference only being the amounts you are paying for the policy that eventually will entitle you to 4 bedded or deluxe single or limited coverage or no limits. But the truth is, and it pretty much boils down to this... the treatment accorded atcthe private centre is slightly better, no not even that primarily, but just faster treatment or faster access to investigations or imaging or physiotherapy or mere waiting times and so on. If these services could improve on the govt side, then they will match the private sector anytime, and then peoples confidence will improve. I was a govt MO too like you.. frus habis like you as well...

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  5. Here's MMA's reponse in Friday's 2nd May opinion column

    http://www.thestar.com.my/Opinion/Letters/2014/05/02/Dont-make-doctors-the-scapegoats/

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  6. It's true that some specialists in private hospitals will order all sorts of scans and investigations.
    Especially CT scans, as though these are very benign machines.
    Perhaps they are trying to help their hospitals to recoup their investments as soon as possible.
    Machines that are left to gather dust don't make any money!!

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  7. Do not believe in only one doctor alone, try to find another doctor opinion.
    Regards too from Young Entrepreneur
    Tangki Fiberglass
    Jual Septic Tank

    ReplyDelete

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