PETALING JAYA: The hand, foot and mouth disease (HFMD) endemic spread increased to 1,468 new cases from May 6 to 12 compared to the previous weeks 1,147 cases, but most cases are mild.

Health Ministry director general Datuk Seri Dr Hasan Abdul Rahman said this week, Selangor had the highest number of HMFD cases (354 cases), followed by Sarawak (343 cases), Johor (195 cases), Penang (128 cases), Kuala Lumpur (100 cases) and Sabah (91 cases).

Other states reported less than 60 cases.

Most of the cases reported are mild. This week, 180 cases nationwide have been hospitalised for observation and rehydration treatment and no deaths were reported, he said in a statement Friday.

The increase in cases had been observed since January this year, and 17, 221 cases were reported since.

Dr Hasan added the ministrys measures to curb the spread were to temporarily shut down premises or institutions where HMFD was spreading, and urged medical practitioners to report HFMD cases to the ministry.

He also advised the public to take precautionary measures through maintaining cleanliness, taking children with HFMD symptoms for treatment and keeping the infected children away from public places.

SERDANG: A member of the Visitors Board of Serdang Hospital wants the hospital to remain under the Health Ministry and not handed over to Universiti Putra Malaysia (UPM).

Board secretary Dr Mahendran Maniam said the hospital’s management should not be changed as it never had problems since the hospital was established.

“If Serdang Hospital is handed over to UPM, it will be hard to control the treatment fees and on this basis, the hospital management must remain under the ministry,” he said.

He said the hospital catered to one million people living in the vicinity, especially the heart patients.

Several UPM associations want to turn Serdang Hospital into a teaching hospital.

It is understood that UPM students had to do practical training at Kuala Lumpur Hospital, Kajang Hospital and Kuala Pilah Hospital although Serdang Hospital is nearby.

Dr Mahendran said it was not true that Serdang Hospital did not accommodate UPM students wanting to undergo practical training.

“Serdang Hospital has given adequate places for students to do practical training in accordance with the memorandum of understanding signed by both parties.”

He explained that only psychiatry is not provided by the Serdang Hospital and students taking the course have to undergo training at other hospitals. – Bernama

TAPAH: The Health Ministry has identified 22 public and private universities which will provide specialist medical services in 22 district hospitals nationwide.

Minister Datuk Seri Liow Tiong Lai said the universities were among 33 public and private universities in the country that offer medical courses.

He described it as a smart partnership as the hospitals would provide all the necessary facilities while the universities would send their lecturers who are also medical experts with various specialisations.

He said the collaboration would result in more patients receiving specialist treatment with a shorter waiting period.

“It is a win-win solution for the ministry, universities and the public,” he said after witnessing the signing of the smart partnership between the ministry and nine universities at the Tapah Hospital yesterday.

The ministry was represented by its secretary-general Datuk Kamarul Zaman Md Isa while the nine universities were represented by their vice-chancellors or top officials.

The nine universities that inked the partnership agreement were Universiti Tunku Abdul Rahman that would provide specialist medical service at the Tapah Hospital, Management and Science University (Kuala Kubu Baru Hospital), Perdana University (Bentong Hospital), Universiti Malaysia Sarawak (Serian Hospital), UCSI University (Dungun Hospital), Lincoln University College (Lahad Datu Hospital), Allianze University College of Medical Sciences (Kepala Batas Hospital), Melaka Manipal Medical College (Jasin Hospital) and Mahsa University College (Tanjung Karang Hospital).

Liow said the signing ceremony with the remaining 13 universities would be held later.

“The partnership will help ease congestion at main hospitals and increase the bed occupancy rate at district hospitals,” he said, adding that priority areas include internal medicine, general surgery, paediatrics, obstetrics and gynaecology, orthopedic and anaesthesiology.

Report from The Star

KUALA LUMPUR: The Health Ministry will conduct checks on the shift system for housemen in hospitals in the wake of reports that trainee doctors are still being overworked, bullied by seniors as well as suffering from depression.

Under the Graduate Medical Officer Flexi Timetable system, introduced last September, housemen can only work up to 60 hours a week with two days off. But implementation has been reportedly poor at some hospitals.

Health director-general Datuk Seri Dr Hasan Abdul Rahman said the ministry would seek explanations from hospitals found overworking their housemen, adding that the ministry was willing to help them implement the system effectively if they were facing a shortage of housemen.

However, he said he had checked timetables in Kuala Lumpur Hospital, Ampang Hospital, Serdang Hospital, Klang Hospital, Selayang Hospital and Sungai Buloh Hospital but had not seen any houseman made to work for more than five days a week or to do double shifts.

Earlier, Malaysian Medical Association president Dr Mary Cardosa urged the ministry to review the shift system and conduct a study on the mental health of junior doctors.

On the death of Dr Lee Chang Tat, 29, who was found dead in a restroom of the paediatrics ward at Kajang Hospital with a used syringe beside him, she said there was no data to show the number of housemen who suffered from depression due to their long working hours and stress.

“There should be some kind of mechanism to assist troubled doctors, whether they have personal or work-related problems or can’t handle the stress.”

The Malaysian Medical Council, meanwhile, reviews an average of five cases of doctors with mental health issues each month. It is learnt that there were 20 cases last October.

“Most of them are housemen, but we have also heard cases on medical officers,” said former Health director-general Tan Sri Dr Ismail Merican.

“The types of issues range from psychiatric problems to anxiety and coping problems,” Dr Ismail said.

Dr Ismail, who is also former MMC chairman, said the working hours for housemen may not be as demanding as before the shift system was implemented, but they were exposed to other sources of stress in their work including demands from patients, their superiors and other colleagues,” he added.

KUALA LUMPUR: A trainee doctor was found dead in a restroom at Kajang Hospital.

Police believe he had overdosed on an unidentified drug.

Lee Chang Tat, 29, was found dead in the men’s room of the paediatric ward at 7am yesterday by hospital staff who went looking for him after they noticed that he was missing.

He was found with a used syringe beside him, which police believe he had used to inject himself with a drug to fight off fatigue.

It is learnt that Lee, who had been working at the hospital for the past three years, had been working on call for five consecutive days.

Selangor health director Datuk Dr Azman Abu Bakar said hospital staff, who found Lee, tried to resuscitate him but were unsuccessful.

“He was rushed to the emergency room but it was too late,” he said.

Lee, he stressed, had no previous medical problems.

A security guard at the hospital said they found him when someone tried calling Lee on his handphone and heard the ringing tone coming from the restroom.

“We broke into the toilet cubicle and found him lying there with the needle,” he said.

Kajang OCPD Asst Comm Abdul Rashid Abdul Wahab said Lee, who studied medicine in Uruguay, had been complaining to his family about the hectic working hours.

“His family said he had also been planning to go on a holiday to Cambodia soon with friends,” he said.

ACP Abdul Rashid confirmed that an initial post-mortem indicated that Lee had died of an overdose, adding that the case was being investigated as sudden death.

Editor’s Note: A few things concerned us at this time.

Firstly, it was reported that this trainee doctor actually was on call for 5 consecutive days prior to his death. Was this truly the case? I find it surprising when the latest Director General’s directive was for house officers to work on a shift system. If it was truly the case, this should never have happened.

Secondly, if he was found with drugs, drug addiction among healthcare professionals can be a worrisome trend considering the ease of access to certain drugs. Being trained in Uruguay itself creates suspicion as to whether this habit was picked up there. South American countries are notorious for drug addiction and trafficking.

Correction: It has come to our attention that the news report about Dr Lee graduating from Uruguay may be inaccurate. Nevertheless the issue of sending students to some countries may not be justified under the current circumstances.

This case could highlight whether there is a need to send medical students all the way to countries that are dubious in their medical training as well as being put into a risky environment for many years. Without a good social support, succumbing to drug addiction is high.

This case needs the attention of the Ministry of Health and Higher education apart from the police. From the wide choices of medical schools in Malaysia, there should not be any more need to go to countries that may pose a danger and hardly a conducive environment to study medicine.

A study below is one of the many articles that highlights the problem and attempts to rectify it.

Substance Abuse Among Physicians: A Survey of Academic Anesthesiology Programs
John V. Booth, MB ChB, FRCA*, Davida Grossman, MD†, Jill Moore, BS‡, Catherine Lineberger, MD*, James D. Reynolds, PhD*, J. G. Reves, MD* and David Sheffield, PhD§
+ Author Affiliations

*Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina; †West Jersey Anesthesia Associates, Marlton, New Jersey; ‡School of Medicine, East Tennessee State University, Johnson City, Tennessee; and §Division of Cardiology, Department of Psychology, Staffordshire University, Stoke, United Kingdom
Address correspondence and reprint requests to John V. Booth, MB, ChB, FRCA, Box 3094, Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710. Address e-mail to booth006@mc.duke.edu.

doi: 10.1213/?01.ANE.0000026379.66419.DB A & A October 2002 vol. 95 no. 4 1024-1030

Abstract

Efforts to reduce controlled-substance abuse by anesthesiologists have focused on education and tighter regulation of controlled substances. However, the efficacy of these approaches remains to be determined. Our hypotheses were that the reported incidence of controlled-substance abuse is unchanged from previous reports and that the control and accounting process involved in distribution of operating room drugs has tightened. We focused our survey on anesthesiology programs at American academic medical centers. Surveys were sent to the department chairs of the 133 US anesthesiology training programs accredited at the end of 1997. There was a response rate of 93%. The incidence of known drug abuse was 1.0% among faculty members and 1.6% among residents. Fentanyl was the controlled substance most often abused. The number of hours of formal education regarding drug abuse had increased in 47% of programs. Sixty-three percent of programs surveyed had tightened their methods for dispensing, disposing of, or accounting for controlled substances. The majority of programs (80%) compared the amount of controlled substances dispensed against individual provider usage, whereas only 8% used random urine testing. Sixty-one percent of departmental chairs indicated that they would approve of random urine screens of anesthesia providers.

Article Date: 08 Apr 2012 – 0:00 PDT

The study, conducted in Paris from 2007 to 2008, found that participants who shop at discount supermarkets, in supermarkets in areas with poorly educated consumers, or in supermarkets far from their own neighborhood had higher body mass indices (BMI) and waist circumferences. As Basile Chaix indicates, “shopping at discount supermarkets was more strongly associated with higher body weight and abdominal fat among low educated than among high educated participants.”

Supermarket size and produce quality, on the other hand, were not correlated with either BMI or waist circumference.

Previous work of this type has largely focused on general neighborhood characteristics instead of specific personal behavior, but the current study, which included 7,131 participants, revealed that only 11.4% shopped for food primarily in their residential neighborhood. This result emphasizes the importance of evaluating personal food environments.

The authors, led by Basile Chaix of INSERM in France, conclude that supermarkets may be a useful site for public health interventions to change food purchasing behavior.

Editor’s comments:

Supermarkets should work hand in hand with the health authorities. Stating content of foodstuffs is still not universally done at our local supermarkets. Apart from canned or packaged foodstuffs, the rest do not have labels on the caloric content. Perhaps supermarkets can drive healthy eating campaigns, something we hardly see.

Read here : Support from Pharma essential

As the economies tighten its grip on the finances of these companies, they must stay on the cause to help doctors get to places that they will otherwise have no opportunity to. Although guidelines can be tightened with regards to what these companies can fund, removing it altogether is abandoning their responsibility to patient care.

By LOH FOON FONG and LEE YEN MUN
newsdesk@thestar.com.my

KUALA LUMPUR: Malaysia’s effort in providing free TB treatment and integrating it in primary care is remarkable, said United Nations secretary-general Ban Ki-moon.

“I am humbled and encouraged that the patients are given free and kind service,” he said after visiting the Institute of Respiratory Medicine yesterday where he also spoke to two patients in the ward and handed them medicines.

In commemorating World TB Day on March 24, Ban said he had made it a mission in the UN to eliminate TB with the theme “Stop TB in our Lifetime” and equated his name to the phrase “TB Ban” or “TB banished.”

He called for intensified global solidarity to ensure that all people were free from fear of TB and its devastating effects.

TB is the second top infectious killer of adults worldwide, he said, adding that last year, 8.4 million people were infected with TB, while 1.4 million died from it.

Health Minister Datuk Seri Liow Tiong Lai said he was encouraged by Ban’s positive affirmation on Malaysia’s fight against TB.

Liow said TB was a communicable disease that had persisted for a long time and while Malaysia managed to contain it in the 1980s and 1990s, there was a slight increase in TB cases in recent years 72 per 100,000 population compared with 64 per 100,000 in the last decade.

from The Star

Why do doctors treat hypertension then?

We know that an elevated blood pressure puts one at risk for stroke, heart attacks and kidney failures. These complications are serious and can leave a patient debilitated for the rest of his/her life. It can potentially be fatal as well. It can hit you without warning and leave you permanently disabled. Lowering your blood pressure reduces this risks significantly.

Therefore monitoring and treating blood pressure is not merely about reading the systolic and diastolic pressures. It is about routinely checking the heart and kidneys. It is about proper counselling to ensure compliance and understanding of hypertension. It is about changing or escalating the medications when needed.

Doctors are trained in counselling and talking to patients. They are trained in monitoring for potential complications of hypertension as well as recognising potential underlying causes of hypertension eg hyperthyroidism or Cushing’s syndrome. They are trained to examine the patients to look for causes that are treatable which can lead to hypertension. They are adequately trained in pharmacology to understand the effects of the drugs prescribed and its common side effects.

Pharmacists have no training in evaluating patients. They are not trained to recognise or diagnose medical conditions. They in fact have no training in taking blood pressure readings using a mercury sphynomanometer, hence most use digital ones. Most importantly, they are not allowed to dispense anti-hypertensives without a valid prescription.

So to the general public, please do not visit a pharmacist to monitor your hypertension, just for the sake of convenience. This can be detrimental to your health. To pharmacists, please consider the well being of the patients that do seek your help and advise them appropriately to follow up with their doctors. To doctors, please examine your patients and counsel them appropriately and not disregard their concerns or relegate hypertension to just BP readings and drug prescriptions.

February 8, 2012 — Roughly 1 in 10 physicians admits to having lied to a patient within the previous 12 months, and 35% do not completely agree that they should tell patients about their financial relationships with drug and medical device companies, according a study published in the February issue of Health Affairs.

These and similar findings about physician honesty “raise concerns that some patients may not receive complete and accurate information,” write lead author Lisa Iezzoni, MD, and coauthors, who present data from a 2009 survey of almost 1900 physicians.

To medical ethicist Linda Emanuel, MD, PhD, from Northwestern University in Evanston, Illinois, the survey results represent a “welcome wake-up call” for her profession.

The study “is an indication that our medical culture needs a recess,” Dr. Emanuel told Medscape Medical News. “We need to do some serious interventions to return to our ethical values.

“I don’t think there’s any situation where a physician is justified in telling an untruth.”

The study attempted to determine how closely the medical profession adheres to the Charter on Medical Professionalism, which sets forth standards on physician honesty and openness with patients. The charter received the endorsement of more than 100 professional groups and the Accreditation Council for Graduate Medical Education.

Roughly 83% of the survey respondents completely agreed with the statement that physicians should never tell a patient something untrue. The rest either agreed somewhat or disagreed. When it came to actual ethical performance, 11% said they had told a lie to an adult patient or a child’s guardian in the preceding 12 months, and 55% said that they had described a patient’s prognosis in a more positive manner than was warranted.

Two thirds of respondents completely agreed that physicians should disclose all significant medical errors to affected patients. In practice, 20% said that they had not fully disclosed a medical mistake to a patient in the last year because they were afraid of being sued.

The reluctance to tell patients about errors is a symptom of a medical liability system that “puts physicians in a terrible bind,” said Dr. Emanuel. “It’s not just a matter of cultural or personal fiber. It’s the way the system is designed.” Dr. Emanuel noted that early and full disclosure tends to make patients less likely to sue, a point emphasized by the patient safety movement.

Women, Minority Physicians More Prone to Embrace Truthfulness

In their article, Dr. Iezzoni and coauthors report that honesty and openness among physicians vary on the basis of demographic factors, specialty, and practice setting.

Women and underrepresented minorities in medicine are more likely to follow the principles laid out in the Charter on Medical Professionalism. Roughly 86% of female physicians, for example, fully agreed that they should never tell patients something untrue compared with 81% of male physicians. In addition, female physicians (8%) were less likely to report telling a lie to a patient than their male counterparts (13%).

The authors surmise that in a field historically dominated by white men, women and minority physicians “may feel more compelled to comply with articulated professional concepts” to avoid any attitude or behavior that jeopardizes their standing. Dr. Emanuel added that the tendency of female physicians to be more “relationally oriented” may make it more comfortable for them to level with patients.

Cardiologists (96%) and general surgeons (94%) were most likely to say they had not lied to a patient in the past year, whereas pediatricians (85%) and psychiatrists (86%) were the least likely. Physicians practicing in medical centers or universities (78.1%) were more likely to completely agree with the imperative to disclose serious medical errors than physicians in solo or 2-person practices (61%).

More research is needed to understand the specific reasons why physicians fail to fully support the communication principles contained in the Charter on Medical Professionalism, according to the authors.

“Examining circumstances in which physicians feel justified in not complying fully with charter precepts is especially important,” they write.

The Institute on Medicine as a Profession at Columbia University provided external financial support. The authors have disclosed no relevant financial relationships.

Health Affairs. 2012;31:383-391. Abstract