The Sunday Interview: An improvement or obstruction?

NST: Federation of Private Medical Practitioners’ Associations Malaysia president Dr Steven K.W. Chow tells KOH LAY CHIN why the profession is uncomfortable at the prospect of doctors being fined or jailed for doing their jobs the best they can.

Q: Some private practitioners say the Act makes them feel like criminals.

A: Our feedback shows that the greatest discomfort for the medical profession is the introduction of unprecedented punitive elements into the Act.
For doctors out there making an honest living, these punitive clauses with fines of up to RM300,000 and jail terms of up to six years or both, are absolutely incomprehensible.
It is as if they are running gaming outlets and other potentially immoral activities.
What the punitive element of this law does is manifestly excessive. Imagine similar legislation for other professional services like teaching, accounting and law.

Q: Why are general practitioners complaining of the possibility of minor renovations to their premises?

A: Full compliance involves problems of renovating premises, relocation or perhaps even starting all over again.
It is wrong to dismiss it as a minor inconvenience. How can I renovate if I have to close down for two to three months?
Many of our practitioners have been efficiently practising medicine in premises that were designed to suit the needs of the day.
But with the new law, these premises and routines can be deemed sub-standard and sometimes unlawful. There is also the element of cost.
What about approvals from landlords and local authorities?

Q: Could cost of treatment go up as claimed by some general practitioners?

A: They fear that the abundance of specific regulations may help disgruntled patients resort to litigation. Their grievances may not necessarily be justified.
The law provides no protection whatsoever for the doctor against trivial and frivolous civil action.
At the end of the day, professional medical indemnity premiums will escalate. The legal advice to doctors is for them to protect themselves at all times and to minimise risk.
The end result unfortunately will be the increase of defensive medicine, which increases health-care costs.

Q: What of the argument that costs can be controlled by adhering to the professional Fee Schedule already in place?

A: If one looks at the prescribed Fee Schedule in the Regulations, it is clear that the fees charged by most private doctors are well below what is prescribed by law.
In cases of hospitalisation, the major portion of medical costs like hospital bills remain unregulated by the Act.

Q: Is it practical for private doctors to have equipment to conduct ECGs?

A: Good and caring doctors should not turn away patients coming to clinics in emergencies. But the basic equipment needed for the expected level of care, including the use of an ECG, should commensurate with the type of practice.
For most GPs, this is not an issue. Equipment like ECG machines and urinary catheters are inappropriate in clinics operated by psychiatrists, dermatologists or people in other sub-specialties who are not involved in acute primary care medicine. These specific differences should be fine-tuned in the regulations.

Q: Some doctors have said that the ministry should set its own house in order, with regard to public hospitals.

A: We believe our public hospitals are doing a great job. We know that the ministry has already set in motion the various quality programmes for public hospitals.
We look forward to being complementary partners in providing a seamless, integrated, public-private healthcare service in Malaysia.

Q: What do you feel about the move to involve practitioners in welfare and social contributions?

A: We believe patient’s rights should be safeguarded. We believe that patients should be allowed to see doctors of their choice.
We need the Ministry of Health to give us all the administrative and legislative support in this aspect.
But having regulations that prescribe details like the size of rooms and toilet paper holders, clearly have nothing to do with safeguarding patient’s rights.
In many instances, we hope that these requirements will be amended and crafted in general, rather than specific terms.
As far as welfare and social contributions are concerned, it is our view that such contributions have been regularly made by private doctors.

Q: Your members have complained about the harsh punitive action on errant GPs.

A: It is true that those who practise sound medicine have nothing to fear.
However, sound medicine can be practised in almost any conceivable situation, be it in a cramped mobile field clinic or in an attap hut in the jungle.
I think it is important that we project the correct view to the public as to exactly what we are safeguarding. The majority of doctors out there practise quality, affordable and compassionate medical care.
The law should administratively protect and nurture this group as they form the backbone of private healthcare. Regardless of how good you are or how careful you may be, things can go wrong.
The unfortunate thing is that when this happens, the doctor will also be judged not by the soundness of his medicine but by whether he has adhered to the many expressed provisions of the law.

Q: The ministry has met with your federation many times, indicating a consultative, co-operative approach. What do you hope for?

A: We hope to project the true spirit of the law by proposing amendments to specific cumbersome regulations.
We hope that at the end of the day, the law can, in addition to protecting the patient, protect good medical care and the doctor that dispenses it. It should also be able to act effectively against the minority who blatantly practise bad medicine.

Q: The ministry has said it will give time to those affected, for compliance and time to understand the Act better.

A: Many doctors have practised good medicine peacefully all their life without any enforcement officer knocking on their doors.
This Act introduces a new ball game altogether. From now on, good clinical practice alone is not enough.
It has to be packaged along with good administration processes and standard operating procedures.
The entire operation of their practice is now micro-managed by regulations and every infringement, however, small or irrelevant is theoretically punishable.