50-50

Only about 2 more weeks or so and I will be on my way home. Excited..yes you bet. However I do have mixed feelings about how I will be adapting to work in Msia. Various things came to my mind.

Firstly, I will have to start writing in patients notes and not have them typed out by the secretaries (from my dictation). It would be a disaster trying to figure out the long list of medical problems from patients because;

a)almost always they are not aware of their own personal health problems

b)they are only aware of a single miracle drug called 'the white pill of KK' (Kementerian Kesihatan's famous pill)
There are other reasons of course...

In terms of Obstetrics, some of them includes;

a)Back to the good old days of limited antenatal scans for dating in all patients. I will be expecting patients coming in fully pregnant and ready to labour away without any antenatal care at all. This including no routine 20 weeks anomaly scans, so a number of patients would turn up with fetuses with spinal tube defects, heart defects, etc.

b)Screening? In terms of detecting trisomy or chromosomal defects? Well, again...none, as i believe its illegal to perform termination of pregnancy so there is no point in doing it. Moreover..it is so expensive to perform amniocentesis that only the private sectors are able to offer such services.

c)What about patients choices?? As in caesarean sections? I can just imagine myself giving an hour of counselling on the benefits and risk of a vaginal birth after c-section as well as a planned elective c-section to be followed by a response of 'Tak tahu lah. Doctor rasa apa paling bagus saya ikut sajalah' or 'Suami saya cakap potong sajalah' and perhaps just a blank face?

d)No community midwife to lend a helping hand for the continuity of care for the obstetric patients. i.e we doctors see all patients in the clinics.. so hm mph...100 odd per clinic..busy busy busy. Hence..the 10 minute consultation for a patient who had travelled 3 hours from her home (1 hour walk, 1 hour boat ride and the remainder 1 hour of bus journey to the clinic) requesting to be seen first bypassing the 30-40 odd patients ahead of her because she need to make her way back.

Gynaecology,

a)Although we have the cervical screening programme, but we do not have (i feel) a good recall system where patients are automatically reminded to attend the health clinics for repeat smear test. And hence...I am sure I will be seeing many cervical cancer patients within a year (I have not encountered a single one here after two years).

b)Conservative management for ectopic pregnancies would be very difficult as patients need to pay for the test done (beta hcg) and hence would be way too costly for them as compared to surgical or medical treatment. Follow up would not be feasible and the risk of them collapsing in a kampung somewhere is a possibility.

c)Although NICE has issued a guidance on the management of menorrhagia using the MIRENA as the first line of treatment, I doubt many would be having this as again it comes down to cost. So it would still be the reliable tranexamic acid or norethisterones...

d)There isn't any proper primary care trust where patient health information are constantly shared with the hospital or made available partly because patient do a lot of 'GP shopping'. Perhaps the GPs may want to group together and form a trust?

These are just the tip of the iceberg of my concerns. Lastly, I have always wondered how one become a consultant in Msia. I do not recall we have a system to promote someone from the specialist status to consultant status and correct me if i am wrong but it appears that if you are in the service long enough and grow some white hair, then perhaps you can then be promoted in such a manner. Do enlightened me...

Just my thoughts. You may disagree or perhaps miraculously agree with me but I welcome all comments..

Hehehhe