01 Sep 2004

Berita Anestesiologi - September 2004


Editor : Dr Ng Kwee Peng
Newsletter of the Malaysian Society of Anaesthesiologists and the College of Anaesthesiologists,
Academy of Medicine of Malaysia

Malaysian Society of

College of Anaesthesiologists,
Academy of Medicine of Malaysia

Editor: Dr Satber Kaur
Executive Secretary: Ms Y M Kong
Academy of Medicine of Malaysia
Tel: 603-2093 0100 Fax: 603-2093 0900
email: acadmed@po.jaring.my

Table of Contents


Click here to Download Berita Anestesiologi in PDF Format (8.6 MB)



Ask What The Society Can Do For You...
Prof Chan Yoo Kuen, President, Malaysian Society of Anaesthesiologists

Taking the cue from issues raised during the last AGM in April 2004, the EXCO has worked very hard to settle some of those very important issues. Among the pertinent issues that were highlighted were the fact that members of the society working in the periphery and with the Ministry of Health are financially not capable of keeping up with their journal reading and the problem of the anaesthetic fees being one third of the surgeons fees.

In this current message, I would like to update members on these two issues and also another one which most professional societies are also grappling with i.e. that of credentialing and the maintenance of professional standards. The aim is not only to showcase how much the EXCO has done but to plead with you to help us help the Society so that we can mutually benefit from the Society!

We have shopped around the medical libraries of the various institutions and found out that the terms and scope offered by the University of Malaya was the best. For a subscription of RM 4000 per year, we will be given three cards which will allow three members at any one time to access the online library of the University of Malaya. We will start the subscription in January 2005 as the financial year starts then. Passwords are necessary for each of the cards and these will be made available through the Societys web page. Besides access to about 30 anaesthetic related journals it will also allow access to other medical and non-medical journals in the University. In fact the University of Malaya is reputed to have the largest collection of journals in the country being the oldest university! The most important thing we ask of members would be to limit access of passwords only to themselves and not to share these with non-members. Remember, access is limited to three members at any one time and if you happen to be the fourth person, wanting to access the library at the same time, you will have to wait. We expect that the three cards will be sufficient for our membership and hope that members will use this privilege responsibly. We will also change passwords frequently to try to minimize abuse and misuse of this library membership.

The other important issue raised was how not to have our fees tagged at one third of the surgeons fees. Dr Mohamed Namazie has written a very comprehensive article in this issue of the bulletin, on how various members of the Society have fought the battle of said fees. We have come a long way from the one third surgeons fees arrangement and if anyone of you have read the 4th schedule of the MMA fees you will agree that the fees schedule have taken into consideration that we anaesthesiologists are doctors in our own right and, in this particular schedule, are very independent of the surgeons! There have been requests from our editor for feedback from you, to enable the Society to update the MMA Committee so that the 5th fee schedule coming up next year will be fair and acceptable to us. Sad to say there was almost no feedback - it either shows that members of the Society were so happy with the fee schedule that they cannot think of anything that can be improved upon or they are just not interested. I am inclined to believe that the latter is probably true. The battle cannot be fought unless we have the
soldiers to do it and I am pleading with you members to volunteer information or strategies that may help us come up with new ways to improve the 5th fee schedule. The EXCO needs to transmit this to the MMA Committee very soon. We have also got in touch with the very active surgical group that is having discussions under the umbrella of the College of Surgeons. This group is going to present its views to the MMA committee and we may use this vehicle to put forth our views as part of a cohesive medical force.

Perhaps many members may not be aware that the fee schedule is only one facet of the issue that has caused many anaethesiologists to be unhappy about their payment from patients and the insurance companies. Talking to the grassroots, I have found that the arrangements some private anaesthesiologists have with the hospitals they work with allow the hospital to dictate terms occasionally to the disadvantage of the anaesthesiologists. These individual arrangements with the hospitals prevent the full application of the MMA schedule, which I must say is a fairly just schedule for everybody. So, even if the MMA schedule is improved upon, it will be useless if this schedule is not adopted by all concerned. And this matter is out of our hands. We can only hope to prevent it by being united in our stand and negotiate appropriately with hospitals and insurance companies to enforce the MMA schedule. In fact the chairperson of the MMA fee schedule says that his job is done when he comes up with an amicable schedule but the enforcement part of it is almost nobodys territory.

Lastly, our Society has decided to take up the project of allowing members to update regularly their continuing medical education details in the form of a database known as Maintenance of professional standards. A computer company has taken over the project and this database will be launched in the 2nd National Conference on Intensive Care in September. Currently updating ones details is on a voluntary basis but it is better to participate fully so that it becomes part of our culture and is less taxing when it is finally imposed as part of the credentialing process which is now becoming an important issue in specialist recognition.

The EXCO has allowed you to ask what they can do for you. They have diligently worked towards fulfilling their pledge to improve the Society for all members (with some measure of success) and delivering the goods. May we now throw the ball into your court and ask that you help us deliver what is best for the Society so that we go on to have another successful year&

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More about the Maintenance of Professional Standards (MOPS) pro g ra m m e. In order to facilitate the successful implementation and encourage participation of all MSA members, the Exco has approached Amorphous Health Telematics Sdn Bhd, a softwa re company, to design and maintain a website which will, among other things, enable members to register with the MSA as members, maintain a diary of their CME activities for the MOPS programme as well as link to other afilliated sites. This website will allow members to check the status of their membership, keep track of their MOPS points and access the pre-existing MSA web page. Arrangements are being made to subscribe to the University Malaya Medical Virtual Library corporate membership, which will give 3 members access at any one time, starting on the 1 January 2005.

The website can be reached at www.msa-mops.org.my and the official launch will be held during the 2nd National Critial Care Conference at the Hilton Kuala Lumpur, KL Sentral, from the 24 - 26 September 2004. Those among us who are not yet in possession of an e-mail address might want to seriously consider getting one soon. Those who have not registered with the MSA or wish to check or update their membership data will be able to do so online at the NCIC.

Congratulations to &..

  • Datuk Dr Alexius E Delilkan for having been conferred Emeritus Professorship by the University Malaya in July 2004.
  • Professor Wang Chew Yin of the Department of Anaesthesiology, Medical Faculty, University Malaya for having been awarded a Datoship by the Sultan of Perak in HRH Birthday Honours this year.

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Evolution of the MMA Schedule of Fees

In the early 1980's the Ministry of Health of Malaysia (MOH) commissioned Westinghouse Corporation to study the desirable healthcare financing for Malaysia following an initial study by a WHO consultant from Australia who was funded by the Asian Development Bank. The Council of the Malaysian Medical Association formed a Health Insurance Committee (HIC) in 1986, which was chaired by Dato' Dr G A Sreenevasan to make proposals to the Westinghouse group and the MOH, which was then expected to introduce a National Health Insurance scheme to reduce Government spending on health care.

The first HIC had 11 members, including one anaesthesiologist (Dr Jenagaratnam). The HIC felt that a Schedule of Fees was necessary as its initial survey of general practitioners and specialists had indicated there was much disparity in what was being charged to the patients. There was a widespread perception that doctors charged fees at their whims and fancies, and indeed the Minister of Health at the MMA AGM in 1987 in Malacca was reported to have said in his speech that doctors probably decided each month how much money they wanted to make, and then tailored their charges and work to meet their target.

A Schedule of Fees was necessary if health insurance was to be introduced to enable the insurance providers to do the calculations of the premiums. A Schedule of Fees agreed upon by the doctors would be better than a schedule thrust upon the profession by the government or by the insurance companies as had happened in other countries (e.g. United Kingdom)

The Schedule of Fees which the HIC set out to create was meant to first protect the patients (who were not in a position to negotiate fees) from being overcharged. It would provide a guideline for both the doctors and the patients on reasonable charges for various services and procedures, based on factors which include complexity, time taken and likelihood of complications and litigation. The Schedule of Fees was not meant to be a mechanism for guarantee of income for doctors.

After studying the fee schedules from Australia and the Californian Relative Value Studies, and their methodologies as well as the existing Schedule of Fees in the MOH governed by the Fees Act 1981 (are you surprised? - the development of this schedule is another story!), the HIC called the various specialist societies and associations to discuss the Schedule of Fees that was being proposed. The Exco of the Malaysian Society of Anaesthesiologists (MSA) appointed three members of the Exco to present the views of MSA to HIC.

The brief given to us was that the anaesthesiologists' fees should be independent of the surgeons' fees and must be represented in a separate listing. Even if the fees were to be a percentage as was being widely practiced then, the listing of anaesthesiologists' fees should be separate from the surgeons' fees. We put forward this concept to the HIC which unfortunately was not prepared at that time to tolerate the streak of independence being displayed by the anaesthesiologists. It must be remembered that half the membership of the HIC consisted of doctors from the surgical specialties. There was strong objection to an independent anaesthesiologists' schedule and certain vociferous members of the HIC insisted on continuing with the existing practice of anaesthesiologists being paid a percentage of the surgeons' fees and their views prevailed. Their contention was that percentage fees was the norm and customarily practiced in Malaysia. The surgeons were the primary doctors who negotiated the fees with the patients and they were not prepared to accept a separate anaesthesiologist's schedule of fees. What struck me as being odd at that time was that we were preparing a Schedule of Fees for health insurance purpose as well and here we were being told that the surgeons would not accept a separate anaesthesiologist's schedule of fees. We informed the HIC that on principle a separate anaesthesiologist's schedule of fees was not a negotiable issue and a blanket percentage fee would not be acceptable to the anaesthesiologists. Since there was no sign of HIC relenting or finding a compromise, the MSA representatives left the meeting without agreeing to the HIC's proposal of a percentage fees. It left a deep impression on some of us at that time that the surgeons expected us to be subservient to them at all times. The financial implication of a separate anaesthesiologist Schedule of Fees to the surgeons was obvious as then most of the private patients were self paying. Hence the reluctance to accept an independent anaesthesiologist schedule of fees.

On 15 March 1987, the then President of MMA Dr Abu Bakar Suleiman released the "Report on Health Assurance and Health Insurance for all Malaysians and the first Schedule of Fees for Medical Services". The schedule was noted for the absence of the anaesthesiologists' fees due to the reluctance of HIC to agree to the terms proposed by the MSA.

Though this schedule created an uproar in the media then, in reality it was not a satisfactory schedule because it was hastily created and published to fit in with the MMA's agenda to provide something tangible in time for the President of MMA to present, before he vacated office. There were inadequate public relation activities to soften the impact of new concepts of charging fees before the release of the schedule. What created the greatest concern to consumer groups and politicians was the novel idea of general practitioners charging a consultation fee separate from the charges for drugs and other services. As expected no one mentioned anything about the absence of anaesthesiologists' schedule.

The deficiencies and the inadequacies of the first schedule became evident soon and the HIC proceeded to look at ways to improve it. It also had to deal with the issues arising from the report on health insurance and the Schedule of Fees, which had created widespread public debate and discussion and strong opposition from consumer and political organizations as well as several medical professional bodies. Certainly the anaesthesiologists were disappointed and extremely unhappy with the schedule as it did not recognize the specialty in its own right.

In 1991 the HIC studied the British United Provident Association (BUPA) relative value system (RVS) and adopted it for the next edition of the MMA Schedule of Fees. The procedure code used by BUPA had been worked out by the United Kingdom Office of Population Censuses and Surveys (OPCS). A license was obtained by MMA from BUPA and OPCS to use the RVS and the procedure codes and thus the next MMA schedule of procedures was created.

The MSA was once again called to present its views on the Schedule of Fees to the HIC for the second edition of the Schedule of Fees. The MSA representatives for this meeting consisted of Dr Vignasen who was then president of MSA, Dr K Mohandas and I. We presented the views of MSA, which was to insist on a separate listing for the anaesthesiologistsÕ fees, just as we had requested in 1987, and we presented the stand taken by the Association of Anaesthetists UK to have a separate schedule. We pointed out that no other specialists were paid a percentage of someone else's fees, and there was no justification for the anaesthesiologist fees to remain a percentage of the surgeon's fees anymore. We further told the HIC the percentage mechanism was subject to abuse, suspicion and created unhealthy relationships between the surgeon and anaesthesiologist in many instances.

The second edition of the MMA schedule (1992) was the turning point in anaesthesiologists' fees schedule. The BUPA had adopted a separate listing for the anaesthesiologists' fees in 1990. This time around the HIC accepted the fact that the anaesthesiologists are specialists in their own right and deserved a separate listing in the Schedule of Fees just like other specialists and we have much to thank the anaesthesiologists in UK and the BUPA for this!


BUPA as a health insurance provider was formed in 1948 in the United Kingdom to reimburse professional fees to NHS Consultants who were doing private practice as well. It had produced a schedule of procedures in consultation with the British Medical Association. In the early days the BUPA did not have a separate anaesthesiologist's benefit level. It introduced a separate list for anaesthesiologists in 1979 till 1982. For some unknown reason it reverted to a single combined fee for both surgeons and anaesthesiologist again in 1982 till 1990! The anaesthesiologists then had to negotiate with the surgeons for their fees during this period.

You would now understand how our fees came about as a percentage of the surgeons' fees since nearly all our surgeons and anaesthesiologists were then trained in Britain and they brought to our shores what they had learnt over there. The scenario would have been different if our anaesthesiologists and surgeons had been trained elsewhere (e.g. USA).

The Association of Anaesthetists of Great Britain and Ireland (A&A) was not too pleased with the state of affairs of the private practice fees for the anaesthesiologists and it published a list of recommended fees which the anaesthesiologists should charge for their services. The list of recommended fees was published at two yearly intervals from 1982 to 1990. Perhaps as a result of this BUPA recognized the anaesthesiologists as being a distinct medical service provider and reintroduced the separate benefit levels for them after extended discussion with the Association of Anaesthetists in 1990. It was largely due to the untiring efforts of the A&A and the bold step taken by it to publish its own schedule that the anaesthesiologists in Britain we re able to achieve a separate schedule. This separation of fees was also made possible as the British Medical Association had earlier endorsed the separation of surgeons' and anaesthesiologists' fees and had adopted this policy in its own guidelines on fees which was first introduced in 1989, two years after MMA had published its First Schedule of Fees.

During 1990 it became clear that publication of the A&A's own recommendations had largely achieved the recognition for a separate anaesthesiologists' reward which the A&A had been seeking and on a basis that was generally acceptable. As a result of this further publication of A&A list of recommended fees wa s discontinued in 1990.

The BUPA schedule of procedures and relative values had undergone several revisions and the current BUPA schedule of relative values consists of 25 groupings for surgeons and 25 groupings for the anaesthesiologists. The BUPA schedule of relative values has a minimum value for the anaesthesiologists from which the minimum anaesthesiologists benefit level is calculated. In the 2nd Edition of MMA schedule this translated to RM 175.00 and applied to the 5 sub-groups in the Minor category.

An analysis of the anaesthesiologists' fee reveals that the anaesthesiologist's fees were fixed between 35 to 41% of the surgeons' fees. The relative values for the anaesthetic procedures had not been clearly worked out and there were significant anomalies. It was therefore still a percentage based Schedule of Fees with most of the procedures at the 35% level of the surgeon's fees. Those procedures which had an apparently higher percentage we re those with the minimum anaesthetic fees. Nevertheless, the concept of an independent Schedule of Fees for the anaesthesiologists had been introduced which would allow the anaesthesiologists to charge fees according to the schedule without taking into consideration the surgeons' fees.

The anomalies in the anaesthesiologists benefit levels and the complexities of providing anaesthesia for different surgical procedures were studied carefully and adjustments to the relative values were made in the BUPA schedule. These adjustments were reflected in the 3rd Edition of the MMA Schedule of Fees.

The 3rd Edition of MMA Schedule of fees is another significant welcome depart u re from the previous schedule as far as the anaesthesiologists' fees are concerned. Following the previous experience of using the BUPA schedule of relative values and the OPCS code for procedures, the HIC once again adopted the same for the new edition of the MMA Schedule of Fees. The surgeons' and anaesthesiologists' fees continued to be listed separately and independently. The 1997 BUPA scale of relativevalues for anaesthesiologists' fees reflects for the first time the complexity of the anaesthetic given rather than that of the surgical procedure and this concept was adopted for the 3rd Edition of MMA Schedule of Fees. This has resulted in differing categories for surgeon and the anaesthesiologist in many instances. (e.g. bronchoscopy, change of burns dressing). An analysis of the anaesthesiologist fees in the 3rd Edition indicates that the range of percentage (against the surgeon's fees) has widened significantly from 12% to 220%. Further detailed analysis is discussed below.

The 3rd Edition consists of 3 parts: Part A contains the consultation fees, ward visit fee for various specialties and procedure fees unique to each specialty. There is a section for Anesthesiology in which the fees for procedures like obstetric epidural services, intensive care unit management are listed. It must be highlighted that consultation and preoperative assessment fees are stated as that for the physicians, and this is a significant recognition of the anaesthesiologist as an independent specialist.

Part B contains schedule of surgical procedures the surgeon's fee code and the separate anaesthesiologist's fee code. This section also contains procedures for pain management and the fees for these procedures. A detailed analysis of this section and how the fees have changed from 1992 to 2002 is presented below.

Part C contains subspecialty surgical procedures not found in Part B.

As per the terms of reference given to the HIC by the Council of MMA, HIC was required to revise the Schedule of Fees every five years. The 4th Edition of the Schedule of Fees was published in 2002. Some new procedures were added in Part B and Part C. There were no changes in the relative values for the anesthesiologist's fees. The HIC recommended a 10% increase in the fees for all categories including the anaesthesiologists' fees and this was accepted by the MMA Council.

No fee schedule has been received without criticism and so it has been for the MMA Schedule of Fees. Besides the public outcry in 1987 and doctor bashing by the politicians and consumer groups, there have also been criticisms from medical organizations as well as individual doctors. Most of them were about inadequate fees for their particular procedures and their desire to charge fees as they felt fit. The HIC is currently addressing some of these issues raised by the College of Surgeons.

An analysis of the changes in the anaesthesiologists' fees over ten years from 1992 to 2002 shows that significant changes in fees occurred only in the Major Plus and the Complex Major (1 - 4) categories which show changes from 56% to 126% in the 4th Edition of the Schedule of Fees. Fee changes in all other categories varied from 24% to 40% over the same ten year period.

The ringgit value for each category was arrived at by using a factor of 3 for the original BUPA value which was given in pound Sterling. For instance the Minor 1 category in the BUPA schedule had a value of 70 pounds Sterling. The same category in 3rd Edition of MMA Schedule of Fees had a value of RM 210.00.

It must also be noted between 1992 and 1997, the relative value for anaesthesiologist's fees had changed for some procedures and this has caused the wide range in percentage vis-a-vis surgeon's fees. For those anaesthesiologists who are still using percentage for billing their services this may not be acceptable as many of the complex surgical procedures which are of long duration carry a fee less than 35% of surgeon's.

Below is an analysis of anaesthesiologist's fees as a percentage of the surgeon's fees in the 4th Edition of MMA Schedule of fees for 1214 procedures in Part B of the Schedule.

Percentage Fees No. of Procedures In Schedule
12% 1
15 - 34% 256
35% 60
36 - 100% 859
101 - 165% 37
220 1

Majority of the 257 procedures with less than 35% fees belong to the Major 4 to Complex Major 5 of the surgeon's category. The anaesthesiologists' fee for these procedures has been downgraded in category or the surgeons' fee category has been upgraded compared to the 2nd Edition of the MMA Schedule of Fees, thus resulting in a lower percentage. However, the number of procedures for which the anaesthesiologists' fees has been significantly raised in terms of percentage is 897.

The logical question that would arise from such an analysis is how does it affect the income of the anaesthesiologists. This of course would depend on the institution in which they are working and the type of contract they have signed with the management. For those who have followed MMA Schedule the effect would have been
noticeable if they had used the 3rd or the 4th Edition of the MMA Schedule and earlier 2nd Edition. For those who frequently provide anaesthesia for major plus and complex procedures there would a loss in terms of percentage but for those who deal with procedures belonging to the intermediate and major categories there would be a gain. Further study need to be done to evaluate the effect of this and this can only be done if one is able to obtain more data from members of MSA in private practice. This is one area the sub-committee I am proposing (see below) could look into.

The methods of charging fees by anaesthesiologists in Malaysia is varied according to the nature of practice, place of practice, region and cities. Very of ten the anaesthesiologists have no control on the fees as these are either set by the surgeons, administrators of the hospitals through contracts or by the fee schedule provided by the insurance companies and of course, most importantly what the self-paying patient can afford.

The most common method was the percentage method which as I mentioned earlier was subject to abuse, caused suspicion and distrust between the anaesthesiologist and the surgeon. Certain private hospitals allowed independent fees subject to the fee
schedule set out by the management. Till very recently the MMA Schedule of Fees was not used by any of the involved parties for paying for the services of the anaesthesiologists or for that matter the surgeons. However, there are two notable exceptions in the Klang Valley I know of that used the MMA Schedule albeit at a discounted benefit level.

It was announced recently that the Ministry of Health would adopt the MMA Schedule of Fees in the regulations of the Private Healthcare Facilities Act 1998. This Act requires a fee schedule which has to be adhered to. When the regulations are expected to be gazetted by the end of 2004, barring any further politicking, the MMA Schedule would receive the due official recognition which it had been lacking so far. However, it must be stated here that the MMA Ethics Committee had always used this Schedule as a reference whenever there were complaints against doctors of overcharging patients.

The MSA has always responded to requests by the HIC for input and views for the MMA Schedule of Fees. Some of its members have served on the HIC in their individual capacity with distinction. Other members have represented MSA in presenting the position of MSA and its members at meetings with the HIC. From the way MMA Schedule has evolved it must be acknowledged that these members have safeguarded the interests of the anaesthesiologists. The situation now is a bit uncertain as the MMA Schedule of Fees is on the verge of receiving official recognition. At the risk of sounding like an alarmist, I understand that there may be moves to amend the anaesthesiologists benefit level to the archaic percentage level. Certain insurance companies are lobbying for such changes in anaesthesiologists fees while accepting the surgeon's fees in the MMA Schedule. The MSA has to take a stand and send clear message to the HIC of its views. For this all members of MSA whether in government service or private practice should respond to the MSA president's request for comments and proposal for changes if necessary.

The Exco of MSA should consider forming a standing Anaesthesiologist's Fees Sub-Committee which can deliberate and come up with proposals for the MMA Health Insurance Committee to consider for its 5th Edition of the MMA Schedule of Fees which is under preparation now and also future revisions.

The need to have a standing committee has become quite acute now, since the health care scenario has changed. Many patients are opting for health insurance and the number of cash paying patients is decreasing. If we do not have a united stand in the matter of our remuneration, the anaesthesiologists will be "bull dozed" both by the hospitals in which we work, as well as by the insurance companies, to accept fees that may not be to our liking and in the long run be detrimental to our specialty.

I have written about this in an article in Berita MMA under the title of "Anaesthesia in the Doldrums" many years ago when Dr Lim Say Wan was the Editor of Berita MMA. In that article I highlighted the fact that anesthesiologists we re being shortchanged when their remuneration was a percentage of the surgeons' fees, and that this would eventually influence the decision of younger doctors when deciding which field to specialize in.

Furthermore the HIC of MMA plans to review the Fee Schedule every three years instead of the present five years, so we need to be studying the trends quite closely in order to be able to put in new proposals to the HIC of MMA as quickly as possible for future revisions of the fee schedule. This MSA sub-committee should consist of both senior and younger members who are in private practice and should include one from the University and one from the government sector. The University doctors are also doing private practice and the MOH is considering private commercial wings in public hospitals as well.

The College of Surgeons have a Fee Schedule committee comprising of private specialists who have been in private practice for more than 10 years, and they are coordinating all the fee schedules of surgical disciplines through that committee. I believe that the Gynaecologists too have a committee for fees.

The members of the Fees Schedule Sub-Committee of MSA should be appointed for a period of three years so that there will be continuity in the work they are doing. Every subsequent new sub-committee appointed should have at least half the number of members from the previous committee so that they can guide the new members in the functioning of the sub-committee. I hope my suggestion will receive a fair hearing by the MSA Exco. A fair and equitable remuneration for anaesthetic services is too important for the anaesthesiologists (private or public) to let it be decided by a few members of the HIC or by the hospital management or by the insurance companies.

(Source: MMA Annual reports)

Dr S Jenagaratnam 1986 - 1991
Dr Sylvian Das 1990 - 1991
Dr A Damodaran 1991 - 1992, 1996 - 2004
Dr K Mohandas 1996 - 2003
Dr M Namazie Ibrahim 2004 -

Members of MSA who represented MSA in deliberations with HIC of MMA
Dr S Jenagaratnam (Ipoh)
Dr Lim Teik Ghee (KL)
Dr Vignasen (Late)
Dr M Namazie Ibrahim (Ipoh)
Dr K Mohandas (KL)
Dr Aiyaroo (Malacca)
Dr Vijayan (Johor Baru)

Any omissions are regretted. Kindly let the editor know if there are any errors and omissions. The views expressed in this article by the author are personal and do not represent the views of HIC of which the author is currently a member.

The author welcomes comments, criticisms, brickbats, praises etc and can be contacted at mnamazie@hotmail.com

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Past Event

25 - 28 AUGUST 2004
5th MOH-AMM Scientific Meeting
(Incorporating the 7t h NIH Scientific Meeting)
Sunway Lagoon Resort Hotel, Petaling Jaya

This meeting passed by making barely a ripple in the consciousness of the anaesthetic community. That, despite there being some anaesthesia related topics in the programme and the conferment of Fellowship upon two of our colleagues, namely Datin Dr S Sivasakthi from Hospital Melaka and Dr Yee Meng Kheong of Hospital Fatimah, Ipoh. The Minister of Health, Dato Dr Chua Soi Lek, who was there to officiate the opening of the conference was conferred honorary fellowship by the AMM.

After dexterous twists of the imagination (the theme was Quality and Professionalism you know), and more twists of some arms, the anaesthetic content of this meeting became based mainly upon intensive care and M&M related issues. Here, I would like to thank the speakers, Assoc Prof Choy Y C (HUKM), Dr Shanti R D (HKL) and Dr J Tong (Hospital Seremban) for consenting to speak and delivering the goods. Mention also to chairpersons Datin Dr Sivasakthi and Dr Lela Mansor for their goodwill and support. The symposium on the Perioperative Mortality Review (POMR) heard presentations from both surgical as well as anaesthetic points of view. This important M&M data provides information on the current state of affairs of our practices, pinpoints areas of weaknesses, and allows us to achieve better patient care and safety. Problems related to lack of postoperative care facilities, proper equipment and junior doctor supervision were also then identified and addressed. Similarly, the National Audit on Adult Intensive Care Units, a collection of data from ICUs in the MOH by a group of intensivists, produced enough information to stimulate increased funding, more efficient bed management and optimize utilization of resources among other things. The first step, data collection, has been made and has unleashed a deluge of action, all aimed at improving the standards and quality of the healthcare provided to the people. In the run-up to the publication of the Consensus Statement on Withdrawal of Life Support in the Critically Ill by the Academy of Medicine, a talk by Dato Dr Inbasegaran was to have been given at a symposium but was cancelled due to unforeseen circumstances. However, I believe a consensus meeting on this matter will be held at the forthcoming 2nd National Conference on Intensive Care in September, to allow everyone to air their views and say their piece. Dont miss it.

Besides the anaesthesia related topics, I personally was much enlightened at sessions dealing with clinical governance and quality assurance. I admit that my ignorance in these matters is probably unrivalled, despite having been in the fringes of maniacal activity during hospital audits. Having incessantly heard these terms as well as ISO, MSQH, CPD, etc, etc, ad nauseum, being bandied about, I have finally discovered what they mean and their far-reaching implications to all of us who practise medicine. Those of you who dont know what Im talking about should have attended the conference. Bureaucracy is upon us and no amount of wishful thinking will make it go away. Measures are being put into place that will enable the quantification of our standard of practice, and affect all else related to our work in time to come. The framework for data collection is there, the data is being collected and eventually steps will be taken as seen fit, ostensibly for the good of the consumer, to ensure that we practise safe, current medicine at the lowest cost and most efficient manner.

The first step is the learning of medicine, then comes the practice of good medicine and finally, the never-ending maintenance of standards of practice. I came away from the meeting slightly discomfited because I had picked up the faintest hint that the days of the practice of medicine being an art are numbered in Malaysia. Medicine is a profession and a service and thus subject to all the rules of management and indignities of a business.

YBDato Dr Chua Soi Lek, Minister of Health, and the Academy Councillors on stage.

Future Events

24 - 26 SEPTEMBER 2004
2nd National Conference on Intensive Care
Theme : Challenges in ICU
Hilton Hotel KL, KL Sentral
Besides the expectation of another educational and interesting foray into Intensive Care issues, this event will also see the launching of a new, improved MSA website where all members will be able to log on to find out about Society events, go to affiliated sites, maintain their MOPS data and access a virtual library (next year).

16 OCTOBER 2004
National Anaesthesia Day
Kuching, Sarawak
This time around, the event will be hosed by Dr Norzalina and colleagues in Kuching. Unfortuantely details are not available at this time but we hope that all of us who are able to will lend their support to this important event if not through participation, then at least through moral support.

24 FEBRUARY - 1 MARCH 2005
6th South Asian Conference of Anaesthesiologists,
2nd Conference of the South Asian Regional Pain Society and the
21st Annual Scientific Session of the College of Anaesthesiologists of Sri Lanka
Colombo and Kandy, Sri Lanka

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