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Update:
According to @zurairi, this is similar to the Klinik Kesihatan in the more rural areas which also do not have doctors, but instead, only senior nurses.
I’m still not convinced about legalities of prescribing drugs (even for the common cold or fever) by anyone other than doctors and pharmacist.
That said, I think we are quite spoilt in that we often run to doctors for every single thing. When I was living in Australia, seeing a doctor was a previlege (and expensive). You needed to make appointments days in advance, except in emergencies. Instead, many people went to pharmacists who would be able to kind of diagnose basic illnesses and prescribe some drugs.
Excuse my ignorance, but what the heck?
I just received an SMS for The Star’s SMS News Alert that read:
1Malaysia clinics to continue without doctors; patients with serious illnesses will be referred to hospitals and polyclinics: Health Mister.
Er, what?
When I read the headlines last week about the launch of these clinics around the country – only costing patients RM1 – I was thinking, wah, quite interesting. But I thought that was all to the story so I, ahem, didn’t continue reading.
Of course, the cynic in me (which emerges every now and then) scoffed at it wondering how is a clinic 1Malaysia, shouldn’t all clinics serve people from all races etc etc etc but I didn’t think much about it. After all, at least the Government isn’t doing something about healthcare right?
Little did I know that these clinics do not have doctors!
I mean, I don’t know much about health and medicine but surely doctors are essential to clinics? So, what exactly is the purpose of these clinics again then?
This news nugget from The Star online reads:
Patients with serious illnesses would be referred to hospitals and polyclinics, said Health Minister Datuk Seri Liow Tiong Lai.
If I still need to go to a hospital or polyclinic, why would I go to the 1Malaysia clinic in the first place? And who exactly are these health assistants and how much will they be able to help me if they are not doctors?
I dug out a previous article on the clinic which explained what sort of illnesses can be treated at these places:
The 1Malaysia Clinics offer treatment for common illnesses like fever, cough and cold, and follow-up treatment for well-controlled diabetes, hypertension and asthma as well as dressing and stitch-removal procedures.
Are these health assistants qualified (they claim to have at least five years experience, but does this legally hold?) to even treat a patient? What about prescription of medication etc?
I stand to be corrected if any of my information here is inaccurate but I can’t for the live of me fathom how a clinic can exist without doctors.
Can someone please enlighten me?
12.32pm Malaysian time (+8 GMT)
Tags: 1malaysia, 1malaysia clinic, healthcare, liow tiong lai, Malaysia, Najib Tun Razak
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errrr say what again?!? lolz! sad but true … my dad used to go to these clinics and all the patients that are there are really old or really poor! I guess they have no choice but to be there since it's RM1 for treatment … but really, this is what Malaysia comes up with?
Yes, I’m not sure if it’s the best solution.
Hahahaha You were featured in TheStar blogger section! Back to the post. Useless clinics. This is part of the govt's publicity stunt!! 1Malaysia.
'Oh, look we have a new policy,it's called 1Malaysia!'
Haha I wasn’t featured in it. I write for the column.
when in nz last time, health clinic also no doctors, only nurses. they prescribe ubat, but you have to buy on ur own in pharmacies.
That’s interesting, never knew that.
Only pharmacists or doctors can prescribe drugs (medicine).
I’ve heard otherwise, philip
i think it's unfair to just bash the whole idea without knowing the system…yes it's weird to for a '1Malaysia Clinic' when all should be treated fairly whatever race they come from….still, the fact that most government-run clinics have no doctors and patients are only treated by medical health assistants and senior nurses are not a new thing and the same happen in countries like UK…
public has to accept the fact that there are very few doctors to tend to them and if one wants to see a doctor, yes, you have to make an appointment early on and that is if the problem has persisted for a while. if one simply goes for walk-in to any government-run clinics, they will be seen by medical health assistants and health nurses. this happens in the uk as well. they will be referred to doctors if their problems are truly chronic. this way doctors can spend more of their time helping patients with really chronic disease
with regard to the competency of medical health assistants and senior nurses, they should have enough skills to cover the basic procedures like taking blood and measuring blood pressure because that is in the part of their training. and they should also have enough knowledge to prescribe drugs for common diseases like fever and cold because they're are so common enough that people don't really need to go to clinics because they can get advice from pharmacist or get over-the-counter medications themselves. the whole idea of public health (all the brochures and posters about diseases) is about educating public about common diseases so that they will recognise the symptoms themselves and get the drugs at the pharmacy to reduce the amount of people going to clinics to get help. then again, public health in malaysia is not really working either due to lack of exposure or because the public don't really care themselves.
so, the way i see it, there's nothing wrong with the way the clinic is run. as it is, you won't get a diagnose of cancer on the first meet with a doctor. when you go to clinic, all that will happen is that you will get treatment to treat your presnting symptoms and have tests done to you. blood samples will be taken and tests will have to be run and all these happen in labs and nurses and medical assistants should have enough skills to gather the samples and that's what they are there for, not to diagnose diseases. if the symptoms persist and there's abnormalities to test results, then you will get to see a doctor.
then again, i might be wrong. i'm simply speaking from experience watching how my father was treated for his minor stroke in malaysia and also as, myself, a patient and a 2nd year medical student in uk. understand the system before you start bashing it.
if one really needs to see a doctor on the first meet without appointment, then they'll have to go to private clinics and they will have to, eventualy, refer you to government hospitals if you have really chronic diseases that requiere expensive equipments. the wait will be long because you will have to wait for your turn but you can choose to go to private hospitals and you have to pay. that's how the system works and it's all about resources.
we lack doctors and it takes time to for one to fully-graduate from the course (7 years) and even after they graduate, not all will want to be general practitioners (they are doctors that work in clinics to deal with common diseases) as many will want to specialise and do something else. as for equipments, they are expensive. everytime i hear about the cost of machines and equipments in my lectures, i convert them into our currency and then i realise how hard it is for healthcare systems in malaysia to meet the demands. the government ideas might not always be the most brilliant but at least they're doing something and i don't think criticising the system without thorough understanding of the system will help raise the fund to improve the system.
I don’t want to seem defensive, but I thought I was pretty clear about being uncertain about the whole system and was willing to be corrected. In fact, I even corrected myself via an update before you posted this comment.
That said, ignorance is common when people are misinformed – or uninformed. If they were going to implement something like this, they should at least explain themselves instead of expecting people to just take it as it is.
Moreover, having spoken to friends who are doctors – both locally and abroad – I must say that I am still concerned about the same issues.
I know that the system is not uncommon but we cannot just live by the status quo if there is a flaw in the system.
Sure, there are other issues which come into play – the lack of doctors, etc – but surely, we can’t compromise for the sake of solving our current problems. What happened to looking ahead?
Hey Niki. Thanks for highlighting this.
It is utterly shameful, pathetic and just about any other words with similar meaning will describe this situation justfully.
The other day, I saw a beaming D.S. Najib on the TV heralding the govt. achievements in opening these clinics.
What a kick in the arse for them this is.
Dear all, I've written more on this issue to explain the situation for those less informed on our public health system. Read “On 1Malaysia Clinic and Their Lack of Doctors (and Why It Shouldn’t Matter Much)” here: http://wp.me/p5jCM-eT
Thanks for the response. Good to have different points of views, no?
[...] bit of a commotion among Malaysians online. For example, fellow blogger Niki Cheong in his article 1Malaysia Clinic has no doctors? claimed: If I still need to go to a hospital or polyclinic, why would I go to the 1Malaysia clinic [...]
[...] a bit of commotion among Malaysians online. For example, fellow blogger Niki Cheong in his article 1Malaysia Clinic has no doctors? commented: If I still need to go to a hospital or polyclinic, why would I go to the 1Malaysia [...]
check out this link…
http://www.psnc.org.uk/pages/prescribing_rights...
it's a list of healthcare professionals who are allowed to prescribe drugs under the National Health Sevice. the NHS is kinda similar to kementerian kesihatan malaysia in regulating the healthcare system of the uk. the list also includes 3 different types of nurse that has prescribing authority and i'm sure nurses in malaysia follow similar system.
i think the public in malaysia tends to underestimate our nurses' ability and their profession. doctors, especially during their training years, are nobody without the guidance from the nurses.
Link doesn’t work lah
Niki,
In Sarawak, all of the rural clinics are manned by MAs and JMs, and from my observation, I think they have done wonderfully well to upgrade the health status of the communities they serve. MAs are better than the other categories of health personels (doctors included) when it comes to community health development. In the rural areas of Sarawak, they do not concentrate just on patient care, like diagnosing and treating minor ailments and recognising and referring the more serious cases to the nearest hospitals; they work alongside other government agencies, namely the Agriculture, Education, KEMAS, etc, to bring about the much needed developments – health, health-related and even non-health – to the poor communities. They identify community problems and recommend to the relevant authorities (YBs included) to make improvements, for example, recommending rural water supply projects, latrine construction, health teaching and creating awareness, encourage vegetable gardening and animal rearing and fencing, proper disposal of rubbish, etc..all with the intention of reducing morbidity and mortality and uplifting the general living standards of the rural poor. The doctors are not well-acquainted with these kind of problems. Their training are for the most part in medical problems and clinical intervention. Put a doctor in a rural clinic in Ulu Baram, Sarawak, where is no electricity, no road, etc.. and see how long can he stand and function. I bet most will abandon their station!
Thanks for adding a new perspective to this.
As I mentioned in my earlier comments, and blog post, I was willing to be corrected, as all I know of the issue is from what I have read in the papers.
I have some doctor friends who disagree with you, or with some of the comments written above, but they articulate it so much better than me – and can speak with more authority, so I won’t repeat what they said!
Again, thanks
FYI, a nurse can also run a clinic and see patients. i don’t see anything wrong in seeing a nurse for your health problems.
You should really fund your comments diplomatically and so what if you have doctor friends who beg to differ? Shall I hide in a corner and shed tears of shame/sorrow?
… hmm but then again perhaps in the malaysian scene, we are still behind the times..Hence, the subservience.
Niki,you sound extremely skeptical. Perhaps its high time you change your mindset.
1Malaysia Clinics sound like a step in the right direction. As a sociologist, its interesting to see how the Medical profession was allowed to dominate the healthcare industry globally; and everyone just went “yep, sure, doctors running the show, no problem”.
Firstly, how many “doctors” do you know have a PhD? Not too many? And yet, they call themselves “Doctors”? I think a psychiatrist might call that ‘narcissism’! But that’s a whole argument I wont get into here.
I’m from Australia originally and we’ve had something similar to the 1Malaysia Clinics for the past 20 years in rural areas and for close to 10 years now in urban regions. Having said that, we also have a advanced qualification for nurses (Nurse Practitioner) which entitles them to undertake some limited prescribing. Initially, the process with met with hostility from doctors, and even more hostility several years later when it turned out that the Nurse Practitioners were more popular with the community than the “doctors” and that the nurse practitioners made far fewer prescribing and diagnosing errors! In other words, you were safer seeing a nurse than a doctor!
That said, the isn’t Australia. I’m maintaining an open-mind on the issue; but I don’t think the nursing profession in Malaysia is ready for the 1Malaysia Clinics. I think these clinics will help push the profession towards that level of maturity; but there are still some changes that need to occur culturally in terms how how nurses are trained in Malaysia and the status of nurses (and women in general) in the patriarchal hospital environment.
Hi everyone!
Actually i think that dis is ur choice whether u wanna go through these clinics or not. Those who really need it, believe me, they go and happy now.
another thing is about shortage of doctors…They warn u people to start thinking about that,its not only the problem of 1malaysia,its ur problem. So, if malaysia doesnt hav doctors, they cant force u to study medecine,they juz giv a tip! Hello,malaysia,start studyng medecine,enough of business!
[...] a bit of commotion among Malaysians online. For example, fellow blogger Niki Cheong in his article 1Malaysia Clinic has no doctors? commented: If I still need to go to a hospital or polyclinic, why would I go to the 1Malaysia [...]