Patients sometimes ask doctors a wonderfully difficult question: “Doctor, what is the best test to check everything?”
The medically accurate answer, “There isn’t one”, is far less exciting than an advertisement offering dozens of tests in one package.
That captures one of modern healthcare’s uncomfortable truths: What is easiest to sell is not necessarily what is most valuable to health.
Income vs clinical judgment
Private clinics exist in the real world.
There are salaries, rent, medicines, equipment, software, indemnity, regulation and taxes to consider.
A clinic that cannot remain financially viable cannot continue serving patients.
So there is nothing wrong with saying that healthcare must be economically sustainable.
But another truth must immediately follow.
A clinic may be a business, but medical judgment cannot become an ordinary commercial product.
A patient may not know whether a blood test is necessary, whether an antibiotic will help, or whether an expensive scan will change treatment.
The patient depends on the doctor’s expertise to distinguish what is useful from what is unnecessary.
That creates professional responsibility.
Because patients place that trust in us, we must never exploit it.
The pressures are real.
Patients want speed.
Insurers want costs controlled.
Clinics need revenue.
Technology platforms want scale.
Doctors need sustainable livelihoods.
None of these is inherently wrong.
The problem begins when they quietly rewrite clinical judgment.
A rushed consultation becomes attractive because throughput improves.
A test becomes easier to recommend because it generates income.
An antibiotic becomes easier to prescribe than spending five more minutes explaining why it is unnecessary.
A medical certificate risks becoming a transaction rather than a professional certification.
Good medicine therefore sometimes has a terrible sales pitch:
“You don’t need this test.”
“You don’t need this antibiotic.”
“You don’t need this medicine.”
“You don’t need a specialist for this yet.”
“You cannot safely manage this only through WhatsApp.”
Telling someone not to buy something is an unusual business strategy.
It can, however, be excellent medicine.
Doing the right things
With effect from April 2 (2026), Malaysia’s statutory consultation fee range for private general practitioners (GPs) was revised to RM10-80.
But the deeper question is not simply whether a consultation costs RM10, RM30 or RM80.
It is whether we recognise that the consultation itself has value.
Listening has value.
Clinical reasoning has value.
Explaining why a test is unnecessary has value.
Reviewing multiple medicines has value.
Preventing disease has value.
Coordinating care has value.
If payment systems mainly reward medicines, tests, procedures and speed, healthcare will naturally drift towards more medicines, tests, procedures and speed.
If we want prevention, careful reasoning and continuity, those must also be valued.
But value must come with accountability.
If GPs ask for greater responsibility, our follow-up must improve.
If we ask for stronger integration, our referrals and documentation must improve.
If we criticise inappropriate antibiotic use, our own prescribing must also be able to withstand scrutiny.
If we ask society to trust our judgment, that judgment must remain independent of unnecessary commercial influence.
Patients have a role too.
They should ask:
- Why do I need this?
- Will this test change what you do?
- What happens if I do nothing?
- When should I come back for a follow-up?
Those are good questions.
But medicine is not shopping.
The best doctor is not necessarily the doctor who gives everything requested.
Sometimes the doctor who protects you tomorrow is the doctor prepared to disappoint you today.
Exercising trust
Across this series, we have moved from the neighbourhood clinic to chronic disease, fragmented care, digitalisation, artificial intelligence and healthcare financing.
Yet almost every road leads back to one word: trust.
Trust when a doctor listens before prescribing.
Trust when uncertainty is admitted.
Trust when referral occurs before ego gets in the way.
Trust when an unnecessary investigation is not ordered.
Trust when technology supports judgment without replacing responsibility.
Trust when the patient’s interest remains more important than the transaction.
The Malaysian GP of the future cannot simply be the old family doctor with newer software.
Nor should the GP become an anonymous healthcare vendor delivering faster transactions through better platforms.
The GP must become a modern community physician: clinically capable, preventive, digitally fluent, connected to the wider healthcare system, economically sustainable in practice, yet professionally independent enough to put the patient first.
Malaysia will need better hospitals, stronger specialist services, better technology, new financing models and smarter regulation.
All these matter.
But healthcare will still be experienced one patient and one decision at a time.
Perhaps the future of Malaysian general practice should ultimately bring us back to one simple sentence: “I am going to see my doctor.”
Not my provider.
Not my platform.
Not my panel.
Not my algorithm.
My doctor.
Not because Malaysian medicine refuses to modernise.
But because, through all that modernisation, it remembers what medicine is for.
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 final article 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.
