Concerned over third-party interference in clinical decision-making for anaesthesia

THE Academy of Medicine of Malaysia (AMM), representing the collective expertise of its 13 constituent Colleges, expresses profound concern regarding a recent directive issued by a third-party administrator (TPA) concerning the use of anaesthesia for daycare surgical cases.

The directive in question mandates that medical practitioners must seek prior approval and provide written justification for the use of general anaesthesia, favouring local anaesthesia as a default.

AMM views this directive as a significant overreach that directly impinges upon the clinical autonomy of surgeons and anaesthesiologists.

The choice of anaesthesia is a complex clinical decision made by qualified professionals after a thorough assessment of the patient's medical history, the specific surgical procedure, and the patient's own informed preferences.

This decision-making process is fundamental to both clinical ethics and patient safety. To outsource this critical judgement to a non-clinical third party, which has not assessed the patient, sets a dangerous precedent.

Our core concerns are as follows:

1. Prioritising profits over patient well-being: We condemn any policy that prioritises profits over patient well-being. The choice of anaesthesia is a critical safety decision that must be tailored to the individual, considering factors like anxiety, procedural complexity and co-morbidities, none of which a TPA can assess. Upholding the principle that patient safety is paramount, we reject any measure that allows financial motives to compromise clinical integrity and patients’ fundamental right to receive the care best suited to them.

2. Erosion of doctor-patient relationship: The sanctity of the doctor-patient relationship is paramount. Introducing a mandatory approval step from an external, non-clinical entity undermines this trust and, inappropriately, delegates medical responsibility.

3. Ethical and medicolegal risks: Directing treatment plans based on cost-containment rather than clinical necessity creates substantial ethical and legal pitfalls. Medical professionals could be held liable for adverse outcomes resulting from a suboptimal anaesthesia method chosen under administrative duress.

While the AMM acknowledges the need for sustainable healthcare financing and cost containment, such measures must not come at the expense of clinical standards and patient welfare. Policies that prioritise cost savings over sound medical judgement are ultimately detrimental to the quality of care.

The Academy of Medicine of Malaysia welcomes open and continuous engagement with all stakeholders in the healthcare ecosystem, including insurance providers, third-party administrators, and managed care organisations. We believe that through collaborative dialogue, we can address areas of concern without breaching the fundamental principles of ethical medical practice.

Our ultimate and shared goal must always be to ensure that all patients in Malaysia receive the safe, effective, and appropriate treatment they need and deserve.

ACADEMY OF MEDICINE OF MALAYSIA

(Prof Datuk Dr Hanafiah Harunarashid, master)

COLLEGE OF ANAESTHESIOLOGISTS

(Datuk Dr Yong Chow Yen, president)

COLLEGE OF DENTAL SPECIALISTS

(Datuk Dr Ahmad Sharifuddin Mohd Asari, president)

COLLEGE OF EMERGENCY PHYSICIANS

(Dr Izzat Ismail, president)

COLLEGE OF OTORHINOLARYNGOLOGISTS HEAD & NECK SURGEONS

(Prof Datuk Dr Philip Rajan, president)

COLLEGE OF OBSTETRICIANS AND GYNAECOLOGISTS

(Dr Premitha Damodaran, president)

COLLEGE OF OPHTHALMOLOGISTS

(Prof Dr Hajah Shatriah Ismail, president)

COLLEGE OF ONCOLOGISTS

(Dr Muthukkumaran Thiagarajan, president)

COLLEGE OF PAEDIATRICS

(Prof Dr Thong Meow Keong, president)

COLLEGE OF PATHOLOGISTS

(Emeritus Prof Dr Cheong Soon Keng, president)

COLLEGE OF PHYSICIANS

(Prof Datuk Seri Dr Paras Doshi, president)

COLLEGE OF PUBLIC HEALTH MEDICINE

(Dr Anita Binti Suleiman, president)

COLLEGE OF RADIOLOGY

(Dr Farhana Fadzli, president)

COLLEGE OF SURGEONS

(Prof Dr Liew Ngoh Chin, president)

The Academy of Medicine of Malaysia, embracing 13 Colleges and 26 Chapters, is a registered, non-profit professional organisation representing medical specialists in various specialities in the country in advancing the standards of medical practice, education and research in Malaysia. It serves as the collective voice for medical specialists across the nation.