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04 Jun 2011

Aku dan Unnecessary Test(2)

Satu pandangan dan penjelasan yang menyeluruh.
Doktor perlu tahu segala keputusannya,
adalah untuk pesakit dan bukannya untuk bisnes.
Pesakit perlu tahu juga hak2 mereka.
Hak untuk bertanya dan berbincang.
Hak untuk mendapat pandangan kedua.
Insurance company pun tak boleh campur tangan...

Docs’ testing dilemma

I READ with great interest and concern “Testing the patient” (Sunday Star, May 29), which was written from a business angle.

But when you are faced with a clinical problem, say fever, you can never know whether it is going to turn out as common viral fever, or malignant fever due to an occult cancerous process. Once the diagnosis is made, the disease process eradicated, everything becomes so obvious. In our fraternity, we say that hindsight is always 20/20.

It is true that as medicine becomes more complex, with many new modes of treatment, sometimes clinical tests are done not just for diagnosis but so that diseases can be better treated. Different stages of a disease may require a different approach. Doctors are also very concerned about the great number of tests that are sometimes done. It is true that, to be comprehensive, sometimes tests to exclude certain conditions are done.

Take headaches for example. Headaches are more often due to chronic tension, migraine, hypertension, sinusitis, etc. But brain tumours cause headaches, too. So brain scans are sometimes done. You may call this approach a defensive approach, or you may call this thoroughness.

What we are more concerned with are tests instituted routinely by private medical centres contractually upon doctors, meaning that, by a doctor’s contract, when he admits a patient, certain tests have to be done. So even if the doctor does not order the test, the staff will do it. We are also very concerned about routine tests for “executive screening profile”. It is virtually a licence to charge whatever the medical centre wishes.

We are very concerned about insurance agents who tell their clients that they must be admitted to a hospital if they wish to claim for a certain test that usually does not require admission, say a stress ECG or a brain scan. This is adding to cost. We are very much against insurance companies who question a medical judgement to do a test, when they are not qualified to do so.

It is important to note that:

  • Doctors have little to gain when more tests are done in a private hospital. The hospital does.
  • For everything that a doctor does, he is accountable.
  • Some tests are done by hospital staff without the medical consultant’s knowledge.

Hospitals must be more accountable. “Routine tests” by non-medics (hospital staff) must stop, by law if necessary. Insurance companies must improve on their insurance models and implementation. More medical professionals must be employed to act as medical consultants to insurance companies. They can better advise the insurance company on what is medically proper, not just business improper.

Doctors, of course, must be more judicious in their choice and need to do investigations. In an emergency life and death situation, where time is of the essence, he may decide quickly to go ahead, and explain the test to the patient/relatives later. When lives are not at stake, the doctor must explain all tests to the patient/relatives, especially if the test involves cost and risks. This we are all taught to do, and we should.

Patients must learn to ask about the purpose and need for a certain test, especially if the test involves cost, pain and risks. Unless the patient is satisfied, he/she does not need to agree to the test. He/she can always get a second opinion. He/she always has the recourse of complaining to the medical centre (there is a grievance mechanism in all hospitals), the Health Ministry or the Malaysian Medical Council.

We are quite well regulated. We do not condone unnecessary tests, but we also know that the word “unnecessary” is only known when the diagnosis is known and the patient is well. It is well for all to remember that no two patients with the same complaints are the same.

And hindsight 20/20 is always better than foresight.


Medical Affairs Committee,

Federation of Private Medical Practitioners Association of Malaysia.

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