Leaving a legacy

Tan Sri Dr Ismail Merican’s contract as Health director-general ended March 4. The passionate clinician and workaholic has left a deep mark in the Health Ministry, where he served for 35 years.

FORMER Health director-general Tan Sri Dr Ismail Merican was still busy finishing off his work at the Institute for Medical Research even after his contract had ended a week before.

Despite his previous challenging director-general duties and waking up at 5am everyday to go for his clinical rounds just after 6am, the dedicated 62-year-old hepatologist has not called it quits.

When asked what he would do next, he said he still wants to practise as a liver specialist, since there are few in Malaysia, and to combine it with teaching and entrepreneurship.

“I like to teach and train doctors. I love it. When you present a case to me, I will make it interesting. The way I approach a patient is very comprehensive due to my exposure in London,” he said, adding that he likes difficult cases.

He said he has not accepted any offer yet as he wanted to take a break first.

Penang-born Dr Ismail graduated from Universiti Malaya in 1975, and after a few years of practice, he was appointed consultant physician in Penang General Hospital.

He was awarded a Commonwealth Fellowship to pursue specialist training in hepatology at the Royal Free Hospital in London in 1991, and returned to Malaysia the following year to start the first specialised liver unit in the country in Kuala Lumpur Hospital.

He later headed the Hepatology Unit in Selayang Hospital, the national tertiary referral centre for liver and pancreato-biliary diseases.

He was conferred the prestigious Honorary Fellowship of the Royal College of Surgeons in Ireland in 2008. He has been overseas advisor for the Royal College of Physicians of London since 1997.

Dr Ismail was also responsible for setting up the network for clinical research centres, now established in all government hospitals, and the first national committee for clinical research where dialogues are initiated between the pharmaceutical industry, universities and researchers.

“We wanted to see if we could improve the timeline in facilitating research,” he said, adding that they had carried out as many as 100 clinical trials every year.

During his time, the Ministry paid more attention to the promotion prospects of doctors and specialists.

Dr Ismail was appointed deputy health director-general for six years before he retired in 2004. The Government took him back on contract and he was promoted to Health director-general the following year.

The Health director-general’s office was awarded a five-star rating for excellent public service performance from the Malaysian Administrative Modernisation and Management Planning Unit (MAMPU) in 2009 and 2010, while the Health Ministry as a whole received a five-star rating last year.

Here, he shares with us his thoughts about his work through the years.

How do you feel about leaving the Health Ministry after 35 years of service?

Whether I am prepared to move or not, if you look at my career development, I do different things every five years.

Normally, in five years, I manage to fulfil all the objectives and whatever I set out to do. When I first became a house officer, I wanted to be a specialist. After becoming a specialist, I wanted to be a sub-specialist; after sub-specialist, I became deputy Health director-general, and then director-general.

The health challenges remain, but we have managed to put things on track, and I hope that my successor will carry on where I left, and use the strategies and framework we have set out.

What were your vision and mission when you set out as Health director-general?

When I first became the director-general in March 2005, I introduced the 10 principles of branding. I wanted the Ministry to be respected, credible, and irreproachable.

For it to be that, we had to make sure that people trusted the Ministry, and for them to trust in the decisions we make, we must be professional and fair. If we had to say “no”, we had to justify it.

Then we looked at transparency, accountability, and professionalism. We are a technical Ministry and being a technical Ministry, there are things that we can do and can’t do.

The other thing was I wanted my officers to be motivated, have a sense of belonging, and to enjoy their work. For this to happen, you have to treat them fairly, take care of their welfare and career development. The achievements I have accomplished were not my effort alone, but with the cooperation and support of the Prime Minister, Chief Secretary to the Government, Health Minister, my own staff, and other agencies.

I wanted my officers to strive for excellence in their work and to respond to e-mails fast. My meetings were always on time. They were usually brief, but useful. I wanted my officers to be approachable. Some were shy to meet people from the private sector, and I told them that they should not treat them as enemies, but listen to their problems and issues and see how we could do things better for them, because they were also contributors to the economy.

This year and next year will be challenging for the Ministry and the Government because of the National Key Economic Areas that need to be achieved. The private sector plays an important role, so the Ministry has to work closely with them in order to fulfil the objectives and help the Prime Minister in the Economic Transformation Programme.

What are your thoughts on the concern that health tourism will lead to further brain drain in the public sector?

Not really, I don’t think so. Many people are coming to the public sector.

In the past, doctors left the public sector for the private sector because there was no opportunity for them to (do extra) work in the private sector. They had to do locum on the quiet.

Now, we allow locums and they can go to the private sector and do certain procedures on their own time.

They have the best of both worlds. It‘s difficult to understand why they want to leave since there are advantages working in the public sector as well.

Most of the health tourism activities are in the private sector. In the public sector, we have introduced full paying patients in Selayang and Putrajaya Hospitals, where specialists are allowed to see private patients. Some say this is not good because this deprives patients of specialist care, which is not true.

As for health tourism, people come and seek treatment from us, and this will contribute to the national economy. If you don’t do this is in Malaysia, they will go to Singapore and Thailand, so why not Malaysia?

What are the major obstacles in promoting health policies?

Some of the obstacles include the lack of understanding of Government policies. We need more dialogue and discussions with the stakeholders and the public if we want to introduce something new. That is why we are talking about the 1Care programme and engaging the public, professional bodies, and stakeholders.

Our society is also rather pampered and rely too much on the Government for healthcare. I think, at some point, the Government must take the bull by the horns to get the public to start paying a bit for their healthcare.

The public must also be made to take care of themselves better. The Government has been spending more on non-communicable diseases. It’s difficult to change people’s behaviour. When we talk about obesity and diabetes, people don’t want to exercise.

We have just begun to involve many ministries to get them to promote an environment that will stimulate people to exercise, such as the need for safe and clean parks, foot bridges and cycling paths, or parking places for bicycles for people to use public transport.

If we want people to change, we must provide an enabling environment.

Patients have also become demanding due to their access to knowledge and doctors must be able to handle that. That needs skills, patience, resilience and knowledge. Healthcare providers must invest in continuing professional development. They have to be up-to-date. What they learn in school is obsolete after some time.

On non-evidence based medicine, all kinds of therapies are being used without much evidence, and this is also a challenge for the Ministry to regulate.

Healthcare cost is also increasing and the Government must consider introducing healthcare financing at some point.

The private sector is complaining that their fees are too low while patients complain that hospital charges are too high. What’s your take on this?

There is always debate on whether it is due to professional fees or hospital fees. If you ask the hospital administrator, he will say it is the doctor who is charging too much, and vice-versa.

Perhaps there is a bit of both. It is true that the professional fees charged by some doctors and specialists are not as high as those in Thailand or Singapore, so doctors say they are not according to market rates. But that is debatable.

We were trying to see if we could increase professional fees by a bit. That is not the issue, but “unbundling” is – the way the cost of healthcare is broken down and handed to patients. The issue is more of lack of communication than over-charging.

If people are told beforehand as to what to expect, there will be less problems. On over-charging, the Ministry is in the process of getting hospital fees regulated.

What needs to be done about the long waiting-list, where some patients die before they could get treatment?

Due to escalating healthcare costs, the Government has to introduce a healthcare financing mechanism. We have to accept that. But we don’t want to have a society where only the rich can get the services, and not the poor.

That is why we have proposed a community-rated insurance. Whoever needs treatment will get the treatment.

For the long waiting list for outpatient treatment, 1Care was introduced where the people can get integrated public and private services.

Our people must be prepared for change, be prepared to pay a little for their healthcare.