Gun without bullets

I was brought up to believe, traditionally a doctor is such a noble being. He/she is able to diagnose an illness and prescribe as well as to "dispense" medicine to relieve symptoms or to cure the disease. The Sinseh or Chinese Physicians do also diagnose, prescribe and dispense their own traditional medicine. Where would one find Sinseh diagnose a condition and ask the patient to get the medicine from someone else or herbalist (if ever such profession exist)?

So, what happen if someone owns a gun but doesn't have bullets?

Here are some questions and answers related to my posting:

What is the hottest topic among health care providers these few days until even LKS and Malaysia Today blog about it?
The dispensing rights between the doctors and pharmacists.

What is dispensing (medicine)?
To give out or to distribute (medicine).

Who has the rights to dispense in Malaysia currently?
1) Doctors. 2) Pharmacists.

What has the pharmacists been demanding for the past 20 years and now?
The exclusive rights to dispense medicine, no one else.

Why is the rights so important?
Pharmaceutical industry is an extremely profitable business. There is a huge market out there. One can become rich (like doctors?) with such rights. This can be equate to automobile companies with APs (exclusive rights to import certain cars).

Who are practicing separate dispensing currently?
1) All the government hospitals and clinics in Malaysia (Actually not entirely true as many of the dispensing role are done by "dispensers" because there are shortage of pharmacists in the country).
2) All the private hospitals in Malaysia.

Who are not practicing separate dispensing?
All private General Practitioner clinics and most of the individual Specialist Clinics.

Why are they not practicing it?
1) There are not enough pharmacists.
2) Smaller clinics could not afford to hire pharmacists to dispense.

Why are pharmacists unhappy about it?
They are losing income or business for not been able to get enough prescriptions for them to dispense. That is why they are resorting to selling all sort of stuffs (like supermarket), such as health supplements, milk powder, self-grooming stuffs and even food stuffs like mineral water.

Why are doctors refuse to give away their rights?
Primary care or General Practice in the private sector is very profitable (one can not denied) and very competitive as well. Many GPs resort to lower their consultation fees in order to get the patient volumes and gain from dispensing medicines. Take for example, many GPs lower the cost to charge per patient (in a package of consultation plus medications) in order to get accepted as "panel" for many companies. This lowers the cost of health care.

What happen if doctors loose the rights?
Many will raise the consultation fees and health care is going to cost more with the separate dispensing of drugs.

While John Chang and Dr. Khoo Kah Lin can go and debate who and why pharmacists should be or not given the exclusive rights, I am more concern if implementation would be successful if ever the pharmacists won the rights.

This patient has been buying the above three medications from the pharmacy for the past two years without a doctor's consultation and prescription for frequent joint pains.

My few concerns:
1) Will patients ever understand the danger of not consulting the doctors for their problems and to buy medicine from the pharmacies because they are cheaper?
2) Will enough enforcement be there to make sure pharmacists only dispense medicine with only prescription from doctors?
3) Will patients willing to spend more on separate prescription and dispensing (higher cost of health care)?

Meanwhile, few possibilities I could imagine if doctors and pharmacists want to cooperate to share the pie:
1) Doctors to hire pharmacists and pay them accordingly to dispense in the clinics.
2) Doctors and pharmacists to open joint venture and share the profit accordingly.

Related links:
MMR

Good news doc

Locum.

The recent announcement by our new health minister about the Cabinet's approval on the new incentive for medical officers who work after office hour, got everyone so excited about it. There seems to be a big jump from the current locum RM30/hr to RM 80/hr (increment of RM50).

While this is a piece of good news, I wish to hear that the increment for medical officer who is on-call after office hour should also be paid at least comparatively.

Currently, MO who is on-call after office hour is being paid RM150/day (RM9.30/hr) on weekdays and RM170/day (RM7.08/hr) on weekends (much cheaper from KFC/McD).

With this big increment, I foresee more and more Dr would be fighting to get a slot in the locum clinic. Who wants to be stay-in 24 hours for a chicken shit, while one could get better by sweating it less for few hours in the clinic?

Similarly, I wonder if the private clinics would pay a bit higher than the current RM30/hr. Previously, before the government came out with the locum clinic, the private clinics were paying RM25/hr.

I suppose all those good news are part of the government's effort to keep doctors in the public service. If it is true, government docs would get RM7000/month in two years, which is comparable to private GPs, unless, the private sectors mark up their offers as well.

More reasons to become Doc.

Related:
RM6000/month after two-year Housemanship

Malaysian doc donates organs to European patients

Latest news from Malaysiakini:

Mar 29, 08 1:31pm

Malaysian doctor Dr Tan Bee Hooi, 37 who died in Paris on Wednesday following surgery, has done Malaysians proud by donating her organs to patients in France and other European countries.

Tan was an anaesthetist with the Penang Hospital.

"She was truly a remarkable woman. Even in death, she has given life to others," Malaysian Ambassador to France S Thanarajasingam said of Tan, who had succumbed to complications arising from surgeries related to arteriovenous malformation (AVM) in her brain.

In a statement issued to Bernama in Kuala Lumpur today, the Malaysian Embassy in Paris said Dr Tan's father, Datuk Tan Gin Soon, believed that her daughter would have wanted him to donate her organs, given her "deep and abiding interest" to serve fellow human beings.

Died from complications

Her family has donated her organs, including her corneas, heart, kidneys and liver, to patients in France and other countries of Europe.

The statement said Dr Tan had undergone treatment at the Fondation Rothschild, under the care of Professor Jacques Moret, a world-renowned interventional neuro-radiologist.

It said the complicated procedure of the embolization of the AVM on March 11 went well but Dr Tan's condition took a turn for the worse and she died on Wednesday due to complications from the follow-up surgeries.

Dr Tan's remains will be flown from Paris to Penang today.

I am so sad to hear this piece of news.

I have also read all the accounts posted in Chev's Facebook leading to the unfortunate event.

My condolences.

Update links:
Star
MAF
Flickr
Star
Star

Rise

Morning Sun Rise.

I want to be more:

Reverent
Independent
Seductive
Enthusiastic

New leaf

Turn over a new leaf.

It has been four months now, and I don't feel anything moved. The atmosphere is so stagnant. Bored gets along the way.

It is just inspiring to note that this Bodhi tree which was devoid of any leave last month, has sprouted new leaves.

It signifies new hope and progress.

I need a change, a sprouting new life.

A new ATTITUDE.

JPA scholar

Dinner in Beautiful Rainbow Garden again.

These few days, LKS's blog published a few letters written in by some 'medical' persons ranting about their problems in the healthcare services.

Dr. LMK, an eye specialist oversea who lamented about his inability to come back to serve the country because his specialist qualification is not recognized here.

This was followed by LTT, who sympathized with Dr. LMK and went on to elaborate on the politics behind the issues with racial intonation. Related MMR link. Interesting to read at.

The latest letter by Frustrated JPA scholar really disgusted me of knowing that there is still indeed some selfish freak who thinks the whole Malaysians, especially the tax payers owe him/her a favor. Not satisfied of getting a more than half a million Ringgit to go to Ireland to study Medicine, he/she still complained that JPA being unreasonable and ridiculous for imposing ruling that requires the medical scholars to come back to serve the country upon completing their studies in overseas.

His/her writing showed the arrogance side of one of the country's top scorers who managed to secure a prestigious scholarship to study abroad. This medical student is outright rude and ungrateful and should not have been given such scholarship in the first place.

Our country, especially the east coast of Penisular Malaysia and east Malaysia, is very short of medical doctors and yet his/her concern now is on how he/she been able to improve him/herself by continuing to work in overseas to get the so-called 'first world' post-graduate specialist training.

He/she also looked down on the local health care services, local medical graduates and locally trained House officers, as well as sees his/her own country as inferior, that there is no purpose for him/her to stay on to serve or treat the sicks.

I am indeed very eager to see him/her come back soon to the country to serve his/her poor fellow family members or relatives, and to show us how his/her 'first world' undergraduate degree makes him/her better than the rest. Show us how you function as 'first world' houseman first before even thinking yourself been 'first world' specialist!

I am proud that I am 100% locally trained and been given the opportunity to upgrade myself without the need to go overseas. Although I am not a straight As scorer, I am also proud that I did better than many straight As fellows in medical school. Despite taking the JPA RM30,000 scholarship and get bonded for 10 years (!!!), I have no regret and I am still very grateful that I am able to continue doing the things that I wanted to do, to heal the sicks and to serve mankind irrespective of their status.

Tebrau

Tebrau City is a developing township that attracts a lot of shoppers over here, particularly Sporean. Well, this particular shopping centre is the only place where one can call 'shopping'. There are a lot of branded stuffs to browse at and many dining shops to experiment the taste bud.

A friend came down all the way from north and she wanted to give me a treat since she passed her exam recently. So, I tried out this rather unusual (at least for me) sizzling marinated chicken cooked over a hot metal plate with fried rice, RM14.90.

Jalanx2

Spent the whole afternoon exploring the city from south to north, and back to south.

I was in this Beautiful Rainbows Garden again looking for food to fill the stomach. Many of the shops were not opened during lunch. We then found this Tea Garden full of patrons.

Steamed Duck Rice, RM6.00.

Though a bit out of routine, still I had rice with egg.

Ice Kacang, RM3.00; Ryan's Cendul RM2.50.

Southern Komtar in City Centre.

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I hate

Evening

Things I hate:

I hate to wake up at 6.30am.
I hate the morning walk.
I hate facing the computer all day.
I hate speaking Mandarin.
I hate those bloody phone calls.
I hate going out for lunch.
I hate ta pau.
I hate sleeping early.

I hate ROUTINE.

Thank God, tomorrow is holiday!

Refreshing

I am at the brink of loosing it all,
While I am at the verge of giving up,

In full bloom.

While the sky seems grey,
and the rainbow has lost its colours.

I am back,
but with determination.

I need to refresh,
and re-look into my direction,
and perhaps,
REINVENTING myself.

I want to break away from this cycle of BOREDOM.

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Tim Sum dinner

Some Tim Sum for dinner before I left Ipoh.

Ipoh, here I come

Sayonara Pg.

And I am in Ipoh now for a weekend course.

It will not be complete without having Ipoh's special bean sprout.

Ipoh Famous Claypot Chicken Rice near Jusco.

I am back to stay here again. It is within walking distance to the course venue. For RM 99 per night, it comes with free spa entry, Astro and Wifi.

Kidney

Wonderland

This cheap cheap buffet lunch at Wonderland Komtar cost RM10.50.

Oo, my favaorite Pg Assam Laksa.

On leave still

I was in my previous work place today to settle some document issues. Apparently, my promotion got stuck because the JPA did not receive some relevant documents. So, I have to personally go to the office to sort things out, otherwise, it would not get done.

This is something I learned after so many years in service. I was once like many other doctors who didn't care more about the salary and stuffs like that, as most of the time, I was busied with clinical works, until one day I realized I did not get pay rise for two years. This was all resulted from the clerk who didn't do her work.

So, it seems to be our own responsibility (and I hate it) to check on them and demand things to be done accordingly. As one of my colleagues who always used to say, our office is so full of people with low IQ and low intelligence.

New World

So, I am back here in Swatow again at NW Park since the last one. Looked like there are more food outlets over here beside the hawkers.

This performance stage is so cool. I wonder if there is any live band at night, which would be nice to watch.

I really like the space.

Since I already had a very heavy breakfast at 11.00am, I ordered something light, Chai Kuih and Yam Kuih, beside the Mango Ice Kacang, topped with ice cream.

Aftermath of a Tsunami

What a nice sunny Sunday to start the day with. Totally quiet and calm. Totally, far true from some malicious SMSes circulating what depict the state is in chaos. Wonder why are some people really don't have better thing to do or money to spend than to spread some naughty rumours?

Even yesterday about 7.30pm, before any official results were out, news have been circulating everywhere about a major fall of the BN candidates in the state, especially the hot seats in mainland.

I received calls from a friend in mainland telling me that all the BN candidates had lost the battle including the Mr. Ex-CM in Batu Kawan. I was warned of some riot would happened and was advised to go to the supermarket to stock up all the essential items especially rice and milk powder.

Of course I did not believe her at that moment and chided her for spreading such rumours.

One friend even went to the extreme of stoking up 24 tins of baby milk powder few days before the election, typical kiasu Penangites?

As the anxiety set in, I sat in front of the TV trying to catch the latest update of the results. After watching for an hour, switching between TV1&3, I realized that these stations were totally useless in their role of disseminating information. Unfortunately, I didn't have the internet connection with me, or else I would have logged in to Malaysiakini.

On and off, I got update from my sister who was sitting in front of the computer throughout the night before been told, Malaysiakini was blocked from internet after past midnight. Even until now I have not been able to assess it.

I am still in total shock and disbelief with the unimaginable wind of change that was happening in the political scenes of Pg. People described this as some major Tsunami that swept Pg overnight and what left the Penangites still in a total daze.

Pg created history yesterday with few significant big changes:
1. DAP won all the seats they contested, and with biggest majority as well.
2. CM will be from the opposition coalition.
3. MCA and Gerakan were completely wiped out.
4. Blogger won in election.

This really come to show how Penangites in whole, particularly the Chinese, wanted a big change, a significant one that would bring opportunity, fairness and justice to all irregardless of skin color, race or religion.

While some excitement still not fading, I am thinking what would the new state government do to make Pg a better one in the next 4 years and what would the future of Pg be in view of this unexpected aftermath of political Tsunami that swept Pg clear of BN dominance.

Men in blue

Today, I casted my very first vote. I looked so dumbed, but then this was my first time. There were not many people, so I didn't have to wait or line up for too long, contrary to what was told to me. I was so blurred until I forgot to fold the voting papers and inserted right straight into the transparent boxes for everyone to view! So embarrassing.

I was told by my staffs that, I could actually claim back the money for my traveling back here. I was told that the money was already given out, if I don't claim, it would be "masuk poket" by the officers in-charge. I was also told, the Chinese papers mentioned that voters in Kelantan would be given RM200 if they travel back to vote.

So, after the voting, I went looking for the "claim" counter. I asked the EC officers, one guy shyly whispered that I need to go to certain "booth" set up by certain "people". I then walked out from the school compound, and I saw many men in blue, absolutely no other colors seen!.

I was been referred from one man to another, and finally one guy brought me in his motorbike to a camp set up some 200 meters away. According to him, that was the MSeeA camp. So, I asked the two Chinese guys sitting there about the said claim. I was told, "No, there is no such claim. You need to go back to your original work place to enquire". "Huh? Go back to my work place to ask? Ask who?" Obviously, these MSeeA guys did not understand what I asked them, or were they just pretending?

Backed to the school, one chap then offered to bring me to another camp belonged to @MNO, which was a bigger one. I was asked to go into the office, and there I saw few others were already lining up.

So coincidently and embarrassedly, I bumped into a nurse who actually recognized me, but I didn't know who she was. And, she had such a thick face to ask me who I voted for.

Didn't my appearance show it all?

Anyway, least to say, my trip back this time was worth it.

Back to vote

Myuho arrived from KL at midnight. We are going to cast our votes coming morning. Both of us are first time voters. In the three previous elections, we did not even bother to vote, cause we were too preoccupied with work. I don't know what made me want to vote this time, for such a long journey I had to travel. Just then, I wonder, with my one vote, would it make any difference?

One friend was even more worried. He called to ask if whether his citizenship would be revoked if he doesn't cast his vote this time, the forth time he is eligible to. Obviously, he could not just leave his clinic even for one minute.

But, truly , the more obvious reason is, I get to "balik kampung"! How I always miss the food over here. It is like 100 years ago I last eaten.

So, we headed to our old hang out place, Taman Free School, where the food stores open till past midnight.

Curry Mee, RM 3.00 (Large).

Wan Than Mee, RM 2.50 (Small).

Myuho lamented about the smaller portion this time, but then where can one still find hawker food at such a price?

Back home

What a great feeling to be back again.

Driving along the Bayan Baru elevated highway.

The first thing I opened my post box was to see this post card by Rocket inviting me to the poll centre.

Mr KarpalS (Star).

My post box was also full of other election junk, among them this little booklet about Pg progress report.

Take a look at some interesting facts:

Anyway, some of the very familiar words I hear when I am back here is this word "Hau Siau". This is a rather 'rough' word (some consider it vulgar) we use here to denote something inferior, unhealthy or bad. Another similar word is 'Auta'.

Here was some interesting quotes I read in the paper today:

"Barisan Nasional is hau siau (lying)"
"Chandra a celaka (condemned person)"

Penangites are so full of "rojak" words that are so distinct.

Other notable vulgar words are "Tulan" (pig's dick) = very annoyed, "Kap Siau" = talk nonsense.

So, DAP supporters are very Tulan with BN because they Kap Siau a lot.

Big joke

Image source: BlueBallot'o7.

I find the latest big joke hard to swallow. After spending RM2.4 million on indelible ink, the EC canceled such move at last minute based on 4 police reports on the threat of such ink being use illegally to sabotage the election process. Based on 4 reports? And how would these jokers knew which finger to stain with the ink in the first place? Can't the EC have a secret way of staining the fingernail reviewed only on the polling day?

So, what would the EC planned to do with the 48,000 bottles of the ink?

Dinner talk

As the polling date is getting closer and closer, the election campaign has become more intense. I simply didn't have the time to even think about the political issues happening around.

But, this is not an election campaign.

Tonight, I couldn't believe myself (and not embarrassed) to have wasted spent my evening attending a ceramah drug talk in a hotel, just to get a free dinner. Not entire free though, cause I paid 3 bucks for the parking.

Well, of course the main reason I attended the talk was that I am still a very 'physician' person, and I needed to update myself on the latest management on various medical conditions or even new product available in the market.

Second reason, of course, I wanted to break away from my routine 'ta pau' dinner, and try out the hotel food once in a while.

Drug talk over here is not as often as in Pg, where we used to have them almost once a week. Here, we had it like once a month, and the attendance was overwhelming.

Different people may have different perception, some see it as an exploitation of doctors and consider it a waste of the doctors' time. But, I always look at things from different or even multiple angles.

I attended these talks to make new friends (though majority are GP uncles), meet old friends (some are 'kaki' dinner talk), meet Leng Lui (most drug reps are pretty girls), collect CME points (for promotion I suppose) but of course lastly is to eat out at expensive hotel restaurant, which we doctors are too stingy to spend the money.

I love drug talk.

W@Anjung

After a two-day locum marathon, I was too zonked out to think of what to eat for dinner. Ryan suggested some Malay food nearby.

Here's some nice food over @njung W@risan:

Traditional musical play.

Claypot Seafood Rice, RM 5.00.

AW Specialty Fried Rice, RM 5.00.

Rainbow Garden

I really wanted to say no, but....

Here, I am helping out a friend who is in KL attending a conference. I was quite surprised that his clinic is so well-equipped, with tablet PC and computerized system. He has wide range of medicine and most of them are original.

So, I've been introduced to this place, some 30 minutes up north. Looked like a rather new establishment named Beautiful Rainbow Garden. There are a lot of Chinese hawker shops over here, numbering over 50s plus. A good place to dine but a bit too far. I think this is the haven of all food in this region I discovered so far.