Ask an elderly patient what medicines he is taking and the answer may sound familiar.
“Doctor, the small white one in the morning, the yellow one after food, and the half-tablet the heart doctor gave me.”
The general practitioner (GP) smiles.
Somewhere in Malaysia, three doctors, two hospitals, one pharmacy and perhaps one very organised daughter may each hold a different piece of the answer.
It is amusing only until the wrong medicine is doubled, stopped or combined.
This is the danger of fragmented healthcare.
Nobody necessarily has to do anything wrong, yet, the patient can still fall through the spaces between competent providers working separately.
Who’s the overseer?
Malaysia’s problem is not simply a lack of healthcare doors.
We already have a substantial public primary-care network, thousands of private clinics, hospitals, specialists, laboratories and pharmacies.
The deeper problem is that too many of those doors still open into different rooms.
A patient may see a private GP, undergo blood tests elsewhere, later attend a government clinic, be admitted to hospital, see several specialists, receive new medicines and eventually return to the original GP.
At every stage, appropriate care may have been provided.
But who sees the whole journey?
Who notices that one medicine was stopped in the hospital before another doctor restarted it?
Who follows up on an abnormal test result six months later?
And when everybody assumes somebody else will follow something up, who makes sure somebody actually does?
Working together
These questions become more important as Malaysians live longer with multiple illnesses and multiple medicines.
For too long, public and private healthcare have been discussed as opposing camps.
Malaysia needs both.
The public sector provides broad access and a vital social safety net.
Private GPs add capacity, accessibility and a network embedded in communities.
The better question is: How do we make both sides work around the same patient?
Imagine a simpler journey.
A patient has a primary care doctor or team who knows the important health history and manages prevention, monitoring and stable chronic disease.
When specialist input is needed, the referral contains useful clinical information.
When hospital treatment is completed, meaningful information returns to the doctor continuing the patient’s care.
Medicines are reconciled.
Abnormal results are followed.
The patient knows what happens next.
Nobody assumes somebody else will handle it.
That is not glamorous reform, but it is powerful reform.
Continuity of care
Malaysia’s Health White Paper already envisages stronger public-private collaboration and interoperable health records to improve continuity.
The principle now needs to become everyday reality.
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This does not mean turning the GP into a gatekeeper whose purpose is to block specialist care.
A better word is navigator.
The GP manages what can safely remain in primary care, recognises when specialist expertise is needed, helps the patient understand what happens next, reconciles medicines and continues follow-up afterwards.
When five medical opinions begin to sound like five different languages, somebody helps translate them back into one understandable plan.
Good primary care should make specialist medicine work better, not harder to access.
Consider what happens after hospital discharge.
A patient admitted with heart failure returns home with medicines changed and several instructions.
At home, he cannot remember which tablet was stopped.
His daughter is unsure whether he should continue another medicine prescribed elsewhere.
His ankles begin to swell again.
The hospital treated the acute illness.
But someone still has to help the patient live safely with what happens afterwards.
That is where continuity matters.
Needed changes
Technology can help.
Interoperable records could allow a GP to know what happened during a hospital admission, reduce medication duplication and make follow-up more coherent.
But connecting computer systems alone will not create continuity.
Someone must still take responsibility for what the information means and what happens next.
Financing must recognise this work too.
If policymakers want GPs to manage chronic disease, prevention and care coordination, payment models must recognise the time and professional judgment involved.
A system cannot ask for 21st century primary care while purchasing it as though every encounter were a five-minute transaction.
This is where value over volume matters.
We should increasingly ask whether disease was controlled, dangerous symptoms were referred promptly, medicines were used safely and follow-up occurred.
But value must come with accountability.
If GPs ask for a larger role, our documentation, referrals, prescribing and follow-up must improve as well.
Government-funded collaboration with private GPs should not be built merely around obtaining the cheapest consultation.
The objective should be to purchase good care efficiently.
The public sector must purchase care fairly; the private sector must demonstrate quality and accountability.
A patient-centred system
Institutional boundaries matter far less to patients than to healthcare organisations.
The person with diabetes does not have a “public-sector kidney” and a “private-sector heart”.
There is only one patient.
And there should increasingly be one understandable journey of care around that patient.
Because the goal is not to create a better public system or a better private system in isolation.
The goal is to create a better Malaysian healthcare system around the same patient.
And once healthcare becomes more connected, another transformation follows.
Records communicate.
Smartphones monitor.
Teleconsultations become routine.
Artificial intelligence enters the consultation room.
The next question is whether medicine can use that technology without surrendering judgment, responsibility and the human relationship at its centre.
Dr Carollyn Kek Chee Yen is president of the Private Medical Practitioners’ Association of Selangor and Kuala Lumpur (PMPASKL), Dr Chang Chee Seong is the honorary secretary, and Dr Eugene Chooi is the immediate past president. This is the third in a five-part weekly series on the future of general practice in Malaysia. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
