Patient-doctor social contract must prevail

FPMPAM PRESS RELEASE
31 May 2011

 



The social contract between patients and doctors must prevail in Malaysia as it is a time-proven model for quality, affordability and compassionate care for patients, says Dr. Steven Chow, president of the Federation of Private Medical Practitioners’ Association, Malaysia (FPMPAM).

The traditional social contract governing the patient-doctor encounter guided by the simple dictum of Sir William Osler ie, to cure sometimes, to comfort always, but never to harm, is increasingly eroded by the dictates of commercialized medicine driven by bottomline turnover, profit and return on investment.

Private practitioners in a dilemma

“Today,” Chow said, “medical care is being touted as a lucrative business commodity to be bought and sold, with corporate visions of exponential growth and billion-dollar turnover.”

In the current healthcare scenario, the basic needs of patients and the aspirations of compassionate doctors are no longer a contractual priority. Instead, the turnover generated by doctors and their corporate patients has become the implicit driver of business-driven contracts. This is the cross-road that now faces both the public and doctors, he explained.

Paradoxically, the reason for the need for this change being marketed to the public is the so-called rising cost in healthcare and the dire need for cost-containment to ensure sustainability.

On the contrary, the evidence paints a different picture – healthcare cost is on a rising trend that will seriously overtake our ability to provide basic quality, affordable healthcare for the less fortunate, Chow emphasized.

Over the years, we have seen the progressive commercialization of all aspects of healthcare, starting with medical education, all the way to the delivery of tertiary and primary care. In tandem with this is the alarming rise in the cost of providing medical care, which affects both private and public sectors, he said.

“There is, thus, some important fundamental issue regarding the way our healthcare system is being regulated. It is important that this issue is addressed urgently. FPMPAM finds this trend extremely alarming.”

The public is of the perception that a high hospital bill is due to hefty doctors’ fees. Hence, they call for more regulations to oversee the practitioner rather than the business of medicine. However, in reality, the professional fees for doctors have already been capped by law. It should also be noted that the average doctor’s professional fees account for about 10 to 15 percent of the overall private hospital bill.

In contrast, there are no provisions in the Private Healthcare Facilities and Services Act (PHFSA) 1998 and Regulations 2006 to regulate hospital bills, Chow said.

“Doctors trained in the traditional mold of medical care will have problems coping with this change. The new laws and regulations regulating the so-called business of medicine, with its countless threats of massive fines and imprisonment for non-compliance, do not augur well for the traditional genuine, compassionate social contract-based patient-doctor relationship.”

Thus, he called on the Ministry of Health (MOH) to uphold the spirit of the PHFSA 1998 and Regulations 2006, which states that medical care should be in the hands of doctors eg, Part XIV states that the Board of Management of any private hospital is the ultimate authority governing all aspects of medical care in that hospital. Two members of this board must be doctors appointed from the Medical/Dental Advisory Committee (MDAC), which is supposed to represent all doctors practicing in hospitals and whose function is to ensure that the medical management of patients vests in registered medical practitioners. “Hospitals have many ways and means to dilute the implications of this requirement,” said Chow.

Moving on to Part XV of the PHFSA, Chow said contracts between healthcare facilities and managed care organizations (MCOs) must not alter the power of the doctor in providing medical care. Most doctors in the private sector are bound by contracts with hospitals or MCOs, or directly with employers and companies.

The dilemma now is that when doctors start work at private hospitals, the hospitals themselves may have already entered into contracts with MCOs in which some of the contractual provisions are in contravention of the PHFSA. The doctors themselves have no access to these contracts but, nevertheless, are involuntarily bonded to them by virtue of their contract with the hospital.

“We advise doctors that it is their right to refuse any contract that interferes with their independent medical care of patients. Should they be coerced, FPMPAM will fully support their action to refer such contracts to the MOH,” Chow emphasized.

“The onus is on the MOH to act its part as the regulator. However, the major hospitals are now mainly owned by government-linked companies (GLCs) ie, the government, being the regulator, is also an operator in the industry via its GLCs. In a situation like this, there is clearly a blurring of the line between the regulator and the operator,” Chow commented.

In addition, as a measure to boost profits, some hospitals, MCOs and other third parties in healthcare have resorted to extracting mandatory discounts from doctors’ professional fees in their contracts. The FPMPAM calls this ‘fee-splitting,’ an exercise which is in contravention of the PHFSA and Regulations. “FPMPAM is committed to initiate all action necessary against any party trying to extract such discounts from our doctors.”

In the past, Chow said, the FPMPAM had highlighted to the MOH the difficulties doctors were facing with contracts. “We hoped that the MOH would act swiftly and decisively. In 2006, we also proposed important regulations to the PHFSA and Regulations so that all the business components of healthcare are regulated synchronously to protect the public from over-exuberant commercialization.”


 

 

Go Back

Announcements

15 April 2018
Medico-Legal Forum on "Medical Manslaughter - Aftershocks from Bawa Garba 2018".
Flyer >>

8 Mar 2018
Specialist Medical Practitioners Continuing Professional Development (CPD) Policies and Guidelines
Read >>

21 Sep 2015
3 Ways to Let Your Doctor Know, You Care
Read >>

8 Sep 2015
MedicAlert®
Flyer >>

20 Aug 2015
5 Things You Did Not Know About Doctors’ Day
Read >>

2 April 2015
List of zero-rated drugs under GST
Download >>

3 March 2015

Draft Letter for Pengecualian dari pendaftaran GST
Download >>


Recent Events

Date: 25 Nov 2017
Insight Into Clinical Radiology
Details

 

Date: 8 Oct 2017
Doctors' Day Celebration 2017
Details

 

Date: 16 & 17 Sep 2017
1st FPMPAM/IPH Annual Scientific Convention
Announcement || Souvenir Programme

 

Date: 24 - 26 Aug 2017
Kuala Lumpur International Forum on Quality and Safety in Healthcare 2017
Website

 

Date: 8 & 9 Sep 2017
Nursing Conference 7.0 / Training Course for Clinic Personnel 9.0
Full details || Report

Date: 21-23 July 2017
10th ASEAN & 7th Perak Health Conference on Primary Health Care
Announcement

 

Date: 7 May 2017
Management of UTI in Primary Care Setting
Announcement

Date: 9 Oct 2016
Doctors' Day 2016
Registration Form | Sponsorship Form

10-12 Nov 2016
2nd FPMPAM Sabah Medical Camp
Venue: Sabah
More >>

8 Nov 2015
Resolution In Medico-Legal Disputes
Venue: Kuala Lumpur Regional Centre for Arbitration (KLRCA)
More >>

 

10 Oct 2015
Doctors' Day
Venue: Bayview Beach Hotel, Batu Ferringhi, Penang
More >>

 

30 July 2015
Mediation of Medico-Legal Disputes: Is It A Viable Alternative?
Venue: Kuala Lumpur Regional Centre for Arbitration (KLRCA)
More >>

10 Oct 2014
Doctor's Day
Details >>.


8 May 2014
Citizen’s Action in Response to Emergencies (CARE) Interview with RTM
On 8 May, Dr Steven Chow and CARE trainers from our partner St John’s Ambulance, Malaysia (SJAM) presented to RTM on the importance of AEDs for saving lives in the event of a cardiac arrest. Continue >>

 

Latest Newsletter


go to newsletter section

 

Latest newsletter of Perak Medical Practitioners' Society
Click here >>

 

 

Resources / Links

Specialist Medical Practitioners Continuing Professional Development (CPD) Policies and Guidelines
Read >>

 

Joint Integrated Healthcare Committee (JIHC) Term Sheet
Click here >>

 

Joint Integrated Healthcare Committee (JIHC) Terms of Reference
Click here >>

 

National Pharmaceutical Regulatory Agency
Click here >>

 

NPRA: Reporting medicinal problems
Click here >>

 

Makluman Kontraindikasi Penggunaan Ubat Yang Mengandungi Codeine Untuk Kanak-Kanak Beumur Bawah 12 Tahun Dan Ibu Yang Menyusu Susulan Risiko Respiratory Depression
Click here >>

 

Peringatan: Langkah-Langkah Pengurangan Risiko Bagi Kesan Advers Kulit Tang Serius Susulan Penggunaan Allopurinol
Click here >>

 

VALPROATE
Guide for HCP >>
Patient Information >>
Sodium Valproate (Guide for HCP) >>

 

NDST REport 2011
Click here >>

 

Garis Panduan Pemantauan Keselamatan Produk ESAs dan Pelaporan Kesan Advers PRCA
Click here >>

 

Report On Suspected Adverse Drug Reactions
Click here >>

 

MADRAC KE 146 - Traditional Medicine found Adulterated
Read >>

BPFK website: Cancellation of Registered Traditional Products / Notified Cosmetics
Read >>


Pharmacy Services Division: List of Adulterated Products
Read >>

 

Pharmacy Services Division: Press Releases
Read >>