Heathcare cost 2

From our esteemed Health Minister. Here.

This is how healthcare costs will rise. How can you ask for a "will not cause death" warranty for a vaccine? Many important drugs, present and in the past have caused death before, either directly or indirectly. For example many antibiotics are associated with fatal idiosyncratic reactions. How can one guarantee a vaccine is 100% safe???

If I'm the supplier, my response would be "I cannot guarantee 100% safety for any drug/vaccine. Take it or leave it. Your choice."

I think statements like these are uncalled for. In medicine, it as ALWAYS benefits vs risks. Many new drugs or vaccine although have passed phase 1, 2 and 3 clinical trials will still need post marketing surveillance. Many new side effects are found during the post marketing surveillance. Unless you want a trial to run for decades /centuries to ensure long term safety before marketing. Then again which company will develop a drug/vaccine which needs decades of clinical trial? It doesn't make economic sense. Even if they would, the costs would be exorbitant and ultimately passed down to consumers.

What next? Will he be saying "I want a 100% warranty this treatment will not cause death or else I'll sue". Anybody wants to treat him?

I'm a bit worried with this Health Minister.

Then our DG said this.
I have no qualms doing any test/every test for any/every patient. If the patient is paying for it, no problem. But who is paying for it? Can the country cope with all the demands? Financially and physically? Does it make economic sense to screen everyone with mild, self limiting symptoms? I say since the DG says so, just take the swab-lah for everybody. I just wonder, what if the many overly worried public lie about their symptoms, if any, just to get tested? After all it's "free"!

Just don't ask me when the specimen collection kit is depleted or if your result is still not ready after a month. Ask the DG.

Another example on how to raise healthcare costs. Clinical judgement goes down the drain.

I'm also a bit worried with this DG.

Another day...another year

Time flies. Another year has passed. As I remember correctly, I might have passed this day at work a couple of times already.

Anyway got home fast. My other half and me went out together and ate something nice for a change. It was a really nice dinner. Near the restaurant was a nice shopping complex and an international squash tournament was held there in a nice glass court erected just for the tournament. Our national players and some international players were playing.

And I looked with a little envy...the young athletic, agile and fit players retrieving those shots so effortlessly. And I felt a little sad. I might have passed my peak...sigh. I remember those years when I could do so effortlessly as well. Anyway it was an enjoyable sight. Far better than tennis or football.

How I miss those competitive games...the sweat, the exhilarance of better endurance and tactics and the friendship that comes with it. Something money cannot buy. Now the only thing I do most of the time is exercising my fingers signing on a piece of paper while listening to complaints.

Don't ask me

Not been in the best of mood these few days.

Don't you freaking hate it when people ask you ;

1) "why my investigation results take so long?"
2) "I sent my blood already, how come the results are not here?"
3) "why my records are not here?", followed by
4) "why can't you get my stuff from xxx hospital over to here?", followed by
5) "why you ask so many questions, can't you look at my records?"
6) "why this hospital hasn't received my what and what"
7) "I already gave this to so and so"
8) "Can I do this there and ask them to send over here?"
9) "Why must I repeat this again?"
10) "How come..."

First of all, I don't personally receive anything you sent. Proof of sending is never proof of receipt. I don't bloody know why it's missing. I don't bloody know why it was not sent. Whatever stuffs you may give so and so should end up somewhere. If not, I don't bloody know where it is. I'm not begging you to repeat any damn thing. If you b***dy trust the system, don't look for me if it's missing. Why it's missing? Well, I'm as baffled as you. Don't ask me, ask someone else. I'm not your safe deposit box. I don't keep your stuffs at home. You want to send something? Do it yourself. I'm not Fed-Ex. Do I look like a courier service?

I don't control the system. I'm not the courier boy, I'm not the safe deposit box, I'm not the office boy, I'm not the typist, I'm not the IT administrator, I'm not the record office. Go look for them and ask.

There...I feel a bit better now.

"The 11 commandments"

Wonder how to get promoted? Wonder how to make it to the top? How to survive and thrive?

This is the government service guide which you cannot buy off the bookshelves, nor learn from your classroom. This is accumulated from years of observation, experience and a little bit of common sense. And mainly accumulated from people who had excelled in it and lived to tell the tale.

Note : This is not for entrepreneurs, nor people seeking excellence. But for people who simply want to get the best out of government service. Ok, let's go.

1) Don't be a smart alec. Stay low. After all bosses don't like smart alecs. Makes them look stupid. If your boss says jump, ask how high?

2) Never criticize. Keep acquainted with phrases like "Wow, this is great!" or "I'm sure this will take the world by storm!" or "You're so smart!". If you use it often enough, you become a valuable "team player".

3) Don't be too efficient. The more work you do, the more you'll get.

4) Never aim to get top marks for anything. After all if you're at 100% this year, the only way you can go from there is down! Better start off with 10% and double it every year. Then you'll have 100 % improvement for the next 4-5 years. Very useful for that SKT thingy. You might even get the best improved employee award!

5) Always do your paperwork. It's all in the numbers. That's all anybody sees.

6) Read your general orders like a bible. Do you know you're entitled for tea time?

7) Do your work slowly and keep asking stupid questions. It makes you look conscientious and hardworking. And of course it makes your boss appears supremely clever.

8) Always grab any opportunity to leave office. Be it for courses or "volunteer work" or even some stupid programmes. None of this is real work. But it appears legitimate and will even earn you extra brownie points.

9) Always buy some cheapo stuffs for the guards, clerks and generally anybody who can make your life more pleasant. Buy a RM1 nasi lemak for the security guard and rest assured you will have unopposed entry at all times. Sometimes even free entry to carparks. For eternity.

10) Get pregnant yearly and breastfeed continuously. You are assured of maximal maternity and medical leave. None can be questioned.

11) And lastly don't forget, buy that punch card machine off some junkyard. It's priceless. Coupled with a handphone, you could be working and holidaying in Hawaii.

More shall be revealed in time to come...

Dance of joy

I never knew this festival existed in Malaysia for the past 33 years. Bon Odori. A friend asked me to come along and all of us went armed with our digital SLRs like hunters out for a kill :) It was an interesting sight with many stalls set up selling Japanese food followed by performance of drums and dances. Plenty of people attended until there was no place to sit and hardly any room to take photos.

And the number of cameras (and photographers with more than 1 camera) exceeded the number of participants by many many fold. It was astounding. I guess many came to shoot the kimono clad girls. The were many Japanese wannabes hanging around too. It was a pretty interesting sight.

Anyway, managed to purchase a Japanese alcohol free beer! It tastes sweet and nice, unlike the usual beer. Got some Japanese green tea in bottles too. I bought the tea because they came in very unique bottles. What a sucker I am ;)

Anyway some of the photos here. I'm sure there will be hundreds of blog postings about the same thing.

Cost of healthcare

Had an interesting scenario today at work. Maybe this exemplifies how healthcare costs have spiraled up these days...

A patient had suspected acute appendicitis. I think the diagnosis is a clinical one. A more experienced colleague thinks the patient should get an ultrasound. An even more experienced colleague thinks a CT scan should be done.

I was trained in a "jungle". The first colleague worked in various towns/cities before. The most experienced colleague works in a big city hospital where "cost is no objection" (and where perhaps legal repercussion is the highest).

The manner and place we were trained and the available facilities determined our approach. The fact is if there are more "sophisticated" and expensive tools available to us, we will use it. Why not if it might save us from a lawsuit? It will give the impression that "the best tools at our disposal has been offered. If something goes wrong..well the best has been offered". Will this translate to better patient care? I doubt it...

I think better patient care comes from better human touch rather than the use of more expensive tools per se. And that is kinda more difficult to achieve.

A dilemma

I always wonder, is it ethical to let patients wait for their appointment even if though it is urgent?

I mean if there are 20 urgent new clinic cases for a doctor per day and the doctor can only see 5 new cases a day, then there will be patients who will only be seen months later assuming there are 5 working days per week and everyday is a clinic day with 20 new cases per day. Do the maths- it's a geometrical increase everyday with no end in sight.

Would you prefer a proper consultation with an appointment 3 months down the line or an immediate consultation of "Hi ma'am, what's the problem, take this med and goodbye".

It is not unheard of on appointments 8 months down the line. However administrators will NEVER side with the doctor if a complaint is made over the long appointment time. And frequently these administrators will "order" the patient to be seen stat. After all, complaints from patients will be more detrimental to promotion prospects of the administrators rather than complaints from their own doctors. Because the adminitrator's SKT do not take into account of the doctors' opinion of the administrator's performance.

So what's the solution? Force doctors to work faster? Waiting time can be measured. Quality of consultation cannot, and in any case is the doctor's fault. On paper it will look good, no waiting time. Administrators doing fantastic job. Go figure...

At the end of the day, I pacify myself to think this not about ethics but demand and supply. You want to buy 20 apples but I only have 5 to sell. What to do?

'Plug n Play"

Just when we thought we are going forward, we are actually going backwards.

If the BM subtitles in our movies are not bad enough, now we are aiming to expand science and technical terminologies. Here.

Let me give you an example which we were laughing our heads off in office. "Plug and Play devices" = "Alat cucuk dan main". "Install hardware" = "Masuk perkakasan keras". Accurate translation but hilarious at best. Unless we want to be a laughing stock of the world...


I remember during med school days, there we bilingual questions during anatomy exams although ALL the books were in English. "Internal jugular vein" = "Vena jugular dalaman". " Common peroneal nerve" = "Saraf peroneal sesama". Nevertheless to say I never read the BM translation any further. No idea what the heck it meant.

To add salt to injury, we have an MP who said "People in the Philippines are proficient in English, but many have landed up only as maids". Here. Wow, this is an intellectual at it's best. I'm concerned the way we are going, we won't be able to even export maids!!Maybe we should just ask the MP to translate all our science and technical books.

He further said "The Philippines, took pride in their peoples’ ability to speak English but had only succeeded in exporting many maids, whereas Japan has produced many international award-winning scientists who could not even utter a word of English". So he thinks that Malaysia will produce many award winning scientists like Japan if we all revert to Bahasa Malaysia. Wow he needs psychiatric treatment. This is called "delusion". If he doesn't understand the English term, the best translation I can think of is "menipu diri sendiri". Or maybe use a favourite translation method - get rid of the last two letters, delusion=delusi, illusion = ilusi. Is it still Bahasa Malaysia ? Or we just plagiarized the English version so that we can proudly say "Made in Malaysia". Deluded.

I've got absolutely no reservations assisting any persons who cannot understand English terms but to regress to a Taliban like state is unthinkable.

So do I have a dirty mind? Maybe I do....hahahahahaahaha...