The newly appointed president of the Malaysian Medical Association is keen to see the organisation maintain its principal aim of not compromising when it comes to the care of patients and the way doctors work.
Dr H. Krishna Kumar is a home-grown and trained doctor. He graduated from Universiti Malaya and has worked in two countries, five Malaysian states and many hospitals.
He is currently a maternal and foetal medicine specialist, and trains undergraduates, postgraduate and sub-specialty doctors.
Although he had worked as a consultant in the United Kingdom and was offered a permanent job there, he chose to come back to serve his country.
Dr Krishna, who hails from Seremban, is a proud alumnus of St Paul’s Institution.
He is quick to point out that his parents were his bedrock. They were both teachers who ingrained in him the importance of education.
“The Malaysian Medical Association (MMA) is the largest organisation that represents doctors in the country, thus, we have the largest voice among doctors in Malaysia.
“One of our core purposes is to ensure that health fees do not compromise the care of patients or doctors’ work quality.
“In order to build upon this principle, we lobby with the government to ensure that any policies that may affect doctors are addressed.
“The Health Ministry is more or less like our partner as they have similar principles,” explains Dr Krishna.
“For instance, the Malaysian Communications And Multimedia Commission with its Personal Data Protection Act (PDPA) – we are the only country that puts the health sector under this Act, while in Western countries like the UK, the health sector is excluded.
“The appearance of a third party and a new Act may in fact result in a breach of some of our ethical practices and affect the way we manage our patients.
“This is the reason why we do not support the PDPA and are in the midst of discussions with various ministers to try to get the health sector excluded.
“After all, data collected by the health sector is governed by our Medical Council and the Private Healthcare Act,” he says.
Dr Krishna also raised concerns over the current scenario where only doctors’ fees are being closely regulated, whereas there is little to no regulation of hospital fees.
“Unfortunately, this scenario is likely to go on indefinitely.
“If you look at the itemised bill from any hospital, you will find that the bulk of the bill comes from miscellaneous hospital charges while the professional charges (i.e. doctor’s fees) will only take up a small portion of it. Why this huge disparity?” he questions.
“As I do not work in the private sector, I have no vested interest in this, yet I am moved to take action because of my conscience,” he says.
Medicine is becoming a business
“If you look around, you will find that businessmen have realised that the healthcare industry is a highly profitable business.
“That is why you will find a lot of such clinics, as nowadays it’s all about making money,” Dr Krishna says.
“Gone are the days when the family doctor is in control. It has become increasingly difficult for family doctors to survive, especially in the face of numerous rules, regulations and acts that are being introduced that specifically target the health sector.
“All these are deterring independent practices as the family doctor will now have to contend with so many new conditions and administrative details that are necessary to ensure that they are not in violation of any of these new rules, regulations, and acts. They are slowly dying out as they have been squeezed at every turn,” he says.
“Every time a new ruling or law emerges, there will be a fee charged. Take the Personal Data Protection Act as an example – they would be charged RM600 a year for this. When there is an inspection of your clinic, it will cost between RM1,500-RM3,500.
“There is another charge for waste disposal; obviously, a clinic cannot throw its rubbish away in the ‘normal’ way.
“There is a charge for business practice registration, clinics that have radioactive materials orX-ray machines need to pay a fee, and employees at the clinic must also be qualified personnel.
“The cost of the fees and the increased salaries of hiring at least two to three qualified staff per shift would add to the running cost of owning and operating a clinic,” adds Dr Krishna.
“Take maternity centres as an example. In the past, you would have the option of going to a government hospital, private hospital or private maternity centres. The private maternity centre was more affordable than private hospitals, but the new rules now state that there must be a resident anaesthetist and a paediatrician.
“Since the majority of such maternity centres do not have a large volume of patients, they cannot comply with this new ruling, thus, many are forced to close down.
This new ruling also adds to the cost of having a baby as the charges will rise since there are now three professionals involved with delivering a baby instead of just the obstetrician (especially for normal deliveries),” shares Dr Krishna.
Looking back over the years, Dr Krishna notes that there have been many changes in the medical practice. For one thing, medicine has become increasingly complex, with technology taking over many aspects.
Prices of drugs have also increased, and all these factors have led to an unfortunate increase in the cost of healthcare.
“The most obvious thing that has gone up is the expectations of our patients. For instance, in the past, deaths in the wards were often taken in stride, whereas nowadays, any death (even if it is a 90-year-old with all kinds of health complications) are often greeted in an accusatory manner,” states Dr Krishna.
“The Internet has also been both a boon and a bane for the health sector. Many patients often self-diagnose by surfing the Internet for information about their condition.
“The problem we often face is when they seek information from unreliable online sources as they will then approach their doctor with this dubious information and challenge them with it.
“This is a worrying trend as many patients often visit unreliable online sources, become convinced by it, visit a doctor, challenge their doctor, and refuse to believe their doctor even when asked to do their own research (but using reliable online sources that their doctor provides). Many such patients will ‘doctor-hop’ until they find one who will give them the diagnosis that they expect to hear,” he says.
There are other problems that need to be addressed as well, including the shortage of places for new graduates who wish to do their housemanship.
This situation is not confined to just doctors, but is occurring across all the various disciplines in the healthcare industry, such as dietitians, radiographers, and so on.
“They are all affected because there has been a gross increase in the number of colleges providing the training. Unfortunately, there is also a shortage of good teachers, which has led to many universities or colleges producing inadequately trained professionals.
“This situation is especially bad as many of these graduates are then unable to find employment due to their inadequate training,” says Dr Krishna.
“This is the reason why at one time there was a shortage of nurses, yet at the same time there were 30,000 unemployed nurses, all of whom graduated from certain universities or colleges.
“In contrast, nurses that were trained by the Health Ministry can easily find a job anywhere, even in the Middle East. Similarly, I anticipate that this scenario will be repeated with the current batch of doctors who have graduated and/or are graduating,” he says.
President for a year
Dr Krishna is quick to admit that as the president of MMA, he has to shoulder a heavy responsibility.
He comments: “For most of us, this is not our primary job, rather it is a voluntary position. For an individual to take time off to run the association for a year is enough. To bear this burden for more than a year is difficult.
“Although a year may not sound like enough time, bear in mind that before becoming president, one has to spend a year as president-elect, followed by a year after one’s term as president serving as past president, so in total, one year will be around three years.
“Just as it is for any other post in MMA, you may finish what someone else has started and someone else will finish what you have started. While the focus may change from president to president, the principles will remain the same.
“This has helped ensure that there is a continuity of purpose within the association, and this ensures that the direction of MMA remains constant, although how it is approached may be different,” he says.
“It is my fervent hope that I will be able to achieve positive changes in how healthcare is practised in this country, and to do so in a manner that benefits both patient and doctor.
“After all, if the doctors are not taken care of, how will they take care of their patients? Similarly, if our patients are not cared for, it will have negative repercussions for doctors too,” he concludes.
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