MMANEWS MALAYSIAN MEDICAL ASSOCIATION BERITA octoBER 2023 For Members Only World Mental Health Day Mental Wellbeing Matters
Berita MMA Vol. 53 No. 10 • October 2023 3 Editor’s Message President Dr Azizan Binti Abdul Aziz [email protected] Immediate Past President Dr Muruga Raj A/L Rajathurai [email protected] President – Elect Dr Kalwinder Singh Khaira [email protected] Honorary General Secretary Datuk Dr Thirunavukarasu Rajoo [email protected] Honorary General Treasurer Dr Vasu Pillai Letchumanan [email protected] Honorary Deputy Secretaries Dr Arvindran Alaga [email protected] Dr Sivanaesan Letchumanan [email protected] Schomos Chairman Dr Sivabala A/L Selvaratnam [email protected] Pps Chairman Dato’ Dr Parmjit Singh A/L Kuldip Singh [email protected] MMA EXECUTIVE COMMITTEE 2023/24 Editor Dr Edwin Ho Jim Huang [email protected] Ex-Officio Datuk Dr Thirunavukarasu Rajoo [email protected] Editorial Board Members Dr Punithavathy Shanmuganathan [email protected] Lt Col (Dr) Eugene Tan Choon Li [email protected] Dr Sarah Jane Khong Mey Leong [email protected] Dr Aw Tsung Wai [email protected] Dr Anand Kamalanathan [email protected] Dr Leeynesh Sooriyapiragasam [email protected] Dr Suresh Subramaniam [email protected] Dr Eunice Oh Jia Ying [email protected] Publication Assistant Nurul Zulaikha [email protected] Editorial Board 2023/24 This Berita MMA is a publication only for the members of the Malaysian Medical Association. The Malaysian Medical Association does not warrant, represent or endorse the accuracy, reliability or completeness of the contents of Berita MMA (including but not limited to the advertisements published therein). Under no circumstances shall the Malaysian Medical Association be liable for any loss, damage, liability or expense incurred or suffered in respect of the advertisements and/or from the use of the contents in the Berita MMA. Reliance upon any such advice, opinions, statements, advertisements or other information shall be at the readers’ own risk and the advertisers are responsible for ensuring the material submitted for inclusion in Berita MMA complies with all legal requirements. The advice, opinions, statements and other information does not necessarily reflect those of the Malaysian Medical Association. Nothing in this disclaimer will exclude or limit any warranty implied by law that it would be unlawful to exclude or limit. Dear readers, the time has come for me to step down from the post of Editor of Berita MMA. I do so with some regret, for I did enjoy the job – especially the interesting articles from contributors and email exchanges with readers. It can be hard sometimes, wondering if anyone reads what we put out each month, so I appreciate all the feedback (negative and positive). At least it proved that we were making a small impact here and there. Though I could doubtless have continued in this post for longer, I feel that it is very important to avoid stagnation. Younger people, with perhaps a better feel for how their peers interact best, should come to the fore. I am pleased, therefore, that the Council have nominated Dr Edwin Ho to succeed me. He has been on the Editorial Board for several years, and I have always found him to have an analytic mind and new ideas. More importantly, perhaps, he has a sense of humour, which he is going to need. I would like to thank the Exco and Council for their trust and unwavering support during my term. My thanks also go to my Editorial Board members for their cheerful backing, and to the Secretariat staff, especially Nurul Zulaikha and Maha, not to mention the IT team. Most of our meetings were online, so their support was invaluable, especially given the parlous state of the laptops they used. Thanks are also due to our business partner from VersaComm. The partnership has proven to be mutually beneficial, and the relationship is a strong one. Finally, my thanks go to you, the readers, the reason for our existence. Please continue to support Berita by sending in your articles, bouquets, and brickbats. Now let me hand over to Edwin… So long, and thanks for all the fun… Please continue to support Berita by sending in your articles, bouquets, and brickbats. ‘‘ ’’ Dr Ashok Philip Editor (2022/2023) [email protected] ______________________________________ The presence of those seeking the truth is infinitely to be preferred to the presence of those who think they’ve found it. – Terry Pratchett
4 Berita MMA Vol. 53 No. 10 • October 2023 The views, opinions and commentaries expressed in the Berita MMA (MMA News) do not necessarily reflect those of the Editorial Board, MMA Council, MMA President nor VersaComm, unless expressly stated. No part of this publication may be reproduced without the permission of the Malaysian Medical Association. Facts contained herewith are believed to be true as of the date that it is published. All content, materials, and intellectual property rights are owned and provided for by Malaysian Medical Association and its members. Published by Malaysian Medical Association 4th Floor, MMA House, 124, Jalan Pahang, 53000 Kuala Lumpur Tel: 03-4042 0617 Fax: 03-4041 8187, 4041 9929 Email: [email protected] / [email protected] Facebook: https://www.facebook.com/ malaysianmedicalassociation Website: www.mma.org.my © Copyright Reserved ISSN 0216-7140 PP 1285/02/2013 (031328) MITA (P) 123/1/91 Consultant Contact us for advertising enquiries 12-A, Jalan PJS 8/4, Mentari Plaza, Bandar Sunway, 46150 Petaling Jaya, Selangor Darul Ehsan. Tel: 03-5632 3301; Fax: 03-5638 9909 Email: [email protected] VersaComm makes no guarantees or representations whatsoever regarding the information contained herewith including the truth of content, accuracy, safety, or the absence of infringement of rights of other parties. In no circumstances shall VersaComm be held liable for the contents, materials, advertisements contained in this publication. VersaComm has no influence over the contents of Berita MMA and all opinions, statements and representations made do not in any manner reflect that of VersaComm or its employees. Printer Percetakan Osacar Sdn Bhd No. 16 Jalan IDA 1A, Industri Desa Aman, Kepong, 52200 Kuala Lumpur, Malaysia. Tel: 03-6279 9474 / 03-6263 1856 ExCo 6 President’s Message 10 From the Desk of HGS 14 HGT Update MPS 20 Patient Consent 24 MMA Convention & Scientific Congress 2023 & 63rd MMA AGM 26 SCHOMOS 28 PPSMMA general 30 WHR 2023 (pt 2) 32 Fall Prevention CPD 34 A Historic Event branch news 40 Strengthening Ties Between Doctor, Leadership and Healthcare 44 What’s Trending 46 Mark Your Diary Greetings to All Many thanks, Dr Ashok for the kind introduction, and I sincerely appreciate your leadership as our Editor for the past two years. I’ve personally gained so much from your calm demeanour, extensive network, and leadership style that empowers others around you. I also want to extend my sincere appreciation to the MMA Exco and Council for their trust and empowerment in me as the Editor for the upcoming term. I pledge my commitment to continue the forward thrust and together with the EB members, we will give our best to serve all our loyal readers. My EB days started under Prof Dr Jayakumar, who reached out to me and offered me this unique opportunity to join him in the EB board back then. His eye for detail and gentleness while leading made it easy for me to adapt and excel in. During my early days in EB, I also had the pleasure to work closely with Dato’ Dr Mohan, who also had his own unique leadership style largely based on his experience in the armed forces. It was an honour and pleasure to have served as an Editorial Board (EB) Member under these great stewards over the past few years, but it also really means I have big shoes to fill! I want to take this opportunity to welcome back EB members from the last term, and welcome new EB members who have volunteered to serve in the coming term. Also acknowledging the hard work and support from our trusted partners, VersaComm, we look forward to our continuous partnership. Together, our experiences coupled with your fresh ideas will be valuable as we look at reinventing how Berita MMA will take shape in the coming year. I will share more about myself in the next edition, including my plans for Berita MMA. To our dear patrons, we look forward to your continuous support through your contribution of articles, feedback, and views. To our Exco and Council, we wish you all the best and success in the coming term for all of us associated with MMA to be proud of. BMMA Dr Edwin Ho Jim Huang Editor [email protected] Editor’s Message
Breast Cancer @kpjrawang KPJ Rawang Official KPJ Rawang Official @kpjrawang 03-6099 8999 [email protected] kpjhealth.com.my/rawang Care for Life What is Breast Cancer (BC)? Breast Cancer is a malignant growth arising from breast tissue. There are different types of breast cancer. The most common types are either ductal or lobular. • Ductal carcinoma starts in the cells that line the milk ducts. This is the most common type of BC. • Lobular carcinoma starts from the lobules (milk gland). It is the second most common type of BC. Malaysia has high prevalence of BC, 1 in 19 woman is at risk of BC. It is the most common cancer in woman of all ethnic group. BC can also affect man. Woman to man ratio is 42:1. BC can affect all age groups from 20 years old, however it commonly affect women age 40 to 60 years old. Who are at risk for breast cancer? The vast cause of BC remain unknown, however a number of established risk factors can be divided in to modifiable and non -modifiable. • Non-modifiable factors – Increasing age, female gender – Family history of BC – Menarche <12 years old – Late menopause >50 years old – History of neoplastic breast disease – Increase breast density • Modifiable factors – Nulliparous – Lack of breast feeding – Older age > 30 years old to have full-term pregnancy – Usage of oral contraceptive pills and Hormone replacement therapy – Obese and overweight – Less exercise, alcohol consumption Screening for Breast Cancer Mammogram is use as a screening tool to detect BC in woman more than 40 years old. MRI breast is use for a known genetic mutation such as BRCA1 and BRCA 2, PALB2 and T53. What are the symptoms? General symptoms: palpable mass, pain and nipple discharge. Symptoms of malignancy : hard and fixed mass, asymmetrical thickening and nodularity, skin changes i.e, peau d’orange, ulcer, satellite nodule, bloody nipple discharge, nipple eczema and imagedetected suspicious lesion. Assessment and diagnosis Triple assessment which consist of clinical assessment, imaging and pathology (cytology or histology) is an established method for the diagnosis of BC. Treatment for Breast Cancer Treatment usually involve multimodalities depending on the stage of cancer. Treatment modalities includes surgery, chemotherapy, radiotherapy hormonal therapy and other targeted therapy. Prognosis (5-year survival rate) Stage 0, 1 – 100% Stage 2 – 93% Stage 3 – 72% Stage 4 – 22% Conclusion Early detection with appropriate treatment of BC can save life. Therefore all woman are encouraged to have screening for breast cancer and be aware of early symptoms. Reference: 1. CPG Breast cancer Management 2019 3rd Edition. 2. Management of Breast cancer Diseases, Lippincot 2002. Dr Suraya Othman Sessional Consultant, Breast and Endocrine Surgeon KPJ Rawang Specialist Hospital
exco A word from the President President’s Message Dr Azizan Binti Abdul Aziz President [email protected] Thank you very much for making time to attend the Annual Banquet in conjunction with the National Convention and Scientific Meeting and the 63rd Annual General Meeting. Before I begin my speech, let me briefly introduce myself and my background I am a mum of three married children, my two older daughters are medical doctors and are working overseas. My older daughter is the 2nd of three pioneer doctors in Malaysia who have completed all the requirements of doing the parallel pathway and obtained the Fellowship of the College of Anaesthesiologists of Ireland or FCAI. My second daughter is among the first batch of contract doctors. So I know what it feels like as a parent watching them go through their challenging journey and giving them the moral support. My son, the youngest, is a dentist. My husband, Dr Razak is a paediatric surgeon attached to KPJ Damansara Specialist Hospital. I graduated with a MD from UKM in 1986. I joined MMA (Malaysian Medical Association) as a houseman in the same year too and later became a life member! I am a MMA Wilayah member and active in the committee till I became the first female chairperson of MMA Wilayah in 2010-2012. 6 Berita MMA Vol. 53 No. 10 • October 2023 Thank you to all MMA members for your support and trust in me as the President. ‘‘ ’’
GENERAL SURGERY, HEPATOBILIARY-PANCREATIC SURGERY, ROBOTIC SURGERY Dr Yoong Boon Koon Bachelor of Science (Med), Medical Bachelor and Bachelor of Surgery (UNSW Australia), Master of Surgery (University Malaya), Clinical Fellowship in Hepatopancretobiliary Surgery and Liver Transplantation, (QMH Hong Kong China) Dr Christopher Lee Kheng Siang read medicine at UNIMAS, trained in General Surgery in various tertiary hospitals and completed Masters of Surgery (General Surgery) at HUKM. Dr Christopher is certified by the Malaysian Board of Urology and awarded Fellow of the Royal College of Surgeons of Glasgow (Urology). He held the post of Clinical Fellow in Urology at The Alfred Hospital in Melbourne (Australia), gaining vast international experience in the management of numerous urological conditions. Dr Christopher is widely experienced in minimally invasive surgery and robotic surgery, and played an integral role in developing robotic surgery services in UPM Teaching Hospital. Besides robotic surgery, he has a keen interest in benign and malignant prostate conditions and is one of the pioneers of prostate Fusion Targeted Biopsy in Malaysia, an innovative technology in prostate cancer diagnosis. He was also among the first to introduce Rezum water vapour therapy for benign prostatic hyperplasia (BPH). Dr Christopher Lee’s other key interests are in the use of laser for treatment of stone disease and BPH, the latter for which he received tutelage in Berlin, Germany. Dr Yoong Boon Koon did his Bsc (Med) and MBBS degree at the University of New South Wales in Sydney, Australia and then pursued his Master of Surgery at the University of Malaya. Following that, he completed Clinical Associate Fellowship in Hepatopancreatobiliary (HPB) Surgery and Liver Transplantation at the Queen Mary Hospital, Hong Kong. Apart from general surgery, Dr Yoong has vast experience in hepatopancreatobiliary surgery, laparoscopic surgery, robotic assisted surgery and liver transplant. His areas of special interest include cholecystectomy, hepatectomy, distal pancreatectomy and pancreaticoduodenectomy (Whipple’s procedure). He is currently the President of the Malaysian Society of Hepato-Pancreato-Biliary Surgeons, Chapter Chair of HPB surgery for the College of Surgeons and Malaysia National Chapter Chair for Asian Pacific Hepato-Pancreato-Biliary Association. What are the treatment options available in treating pancreatic cancer patients? The treatment of pancreatic cancer largely dependent on the stage of the cancer. Surgical resection remains the only chance for cure for pancreatic cancer. Open resection remains the most common procedure with minimally invasive surgery (MIS) being increasingly practice. For stage 1 to 2 disease, surgical resection with regional lymph node clearance is recommended. For pancreatic head and body/tail cancer, pancreaticoduodenectomy (with regional lymph node clearance) and radical antegrade modular pancreaticospleenectomy (RAMPS procedure) respectively are the recommended choice of surgeries. For stage 3 locally advance diseases, especially with great vessels involvement, neoadjuvant chemotherapy is recommendation as litmus test before resection. Should the tumour response well to chemotherapy, surgical resection with subsequent adjuvant chemotherapy are showed to have better outcome. For stage 4 disease, palliative chemo radiational therapy with symptomatic treatment should remain the choice of care. Biliary obstruction could be treated with percutaneous drainage, endoscopic stenting or surgical bypass. Intestinal obstruction can be treated with endoscopically or with surgical bypass. What are the deciding factors for urologist for considering the suitable treatment to the patient? There are several factors to be considered when deciding on a treatment option, namely: Diagnosis and Stage / Severity Urological problems can be broadly classified as benign or malignant. Benign diseases are usually less harmful and treatment is more straightforward. Malignant diseases usually require major surgery and adjuvant therapy. Patient factor I always offer several suitable treatment options to the patient, and they will choose based on personal preference. Major surgery should be reserved for patients of a sufficient physical fitness level. Surgeon factor As a Urologist, my field of expertise may differ slightly from other Urologists based on training background. As such, I would always offer treatments in which I have abundant experience. Hospital factor Many complex and new procedures require cutting edge technology and surgical equipment. I am fortunate to be equipped with a comprehensive selection of advanced equipment at Sunway Medical Centre, Sunway City. A-5-26, Level 5, Tower A +603-7491 9191 (Ext. 16485/ 11472) Subject to changes, Please call the individual clinics for appointments/enquiries Monday - Friday : Saturday : 9.00 am – 5.00 pm 9.00 am – 1.00 pm UROLOGY, ENDOUROLOGY, ROBOTIC SURGERY Dr Christopher Lee Kheng Siang MD (UNIMAS), Doctor of Surgery (UKM), FRCS (Urology) (Glasgow), Malaysian Board of Urology Certified Urologist, Fellowship in Urology (Melbourne) C-1-08, Level 1, Tower C +603-7491 9191 (Ext. 21702) Subject to changes, Please call the individual clinics for appointments/enquiries Monday - Wednesday : Thursday & Friday : Saturday : 9.00 pm – 5.00 pm 2.00 am – 5.00 pm 9.00 am – 1.00 pm
8 Berita MMA Vol. 53 No. 10 • October 2023 Subsequently in Central MMA, I was the Hon. Deputy Secretary and then the Hon. Gen. Treasurer (2013/14) before I took a break to take care of my mum who has Alzheimer’s Disease. Concurrently I was also active and life member of two societies & holding posts in the Society for the Advancement of Hormones & Healthy Ageing Medicine Malaysia (SAHAMM), where I am also one of the founding members) and also in the Medicolegal Society of Malaysia (MLSM). For my career background, I have served in the public and private hospitals for many years before becoming a solo GP in 1999. My goal is to give the best patient care when I was a solo GP in TTDI, KL till I decided to end my well established private clinic practice at the end of 2015 to focus on personal health consultation and wellness. Ladies and gentlemen, I would like to thank the Immediate Past President of MMA, Dr Muruga Raj Rajathurai for addressing and championing many issues during his term. During my one-year term of being the President, I would like to address several issues regarding the well-being of doctors in the public sector, ranging from contract doctors to burnout. The primary dimensions that characterise physician burnout are emotional exhaustion, depersonalisation, and a reduced sense of personal accomplishment. These factors have profound implications that can affect the physicians quality of care toward his/her patients, their own mental/physical health, and even professional relationships within their team. BMMA Scan QR code for the rest of the speech
From the Desk of the Hon. General Secretary Datuk Dr Thirunavukarasu Rajoo Hon. General Secretary [email protected] exco HGS Leadership in healthcare is crucial; it’s not just a fancy term we throw around. Every doctor needs to embrace it because it impacts not only clinical excellence, but also shapes the future of healthcare and impacts patient outcomes. The idea is to acquire not only a leadership skill set, but to blend it with our medical knowledge; thus driving quality, safety, and policy, a concept backed by esteemed platforms like Forbes and the Harvard Business Review. As doctors, we are often in positions where we guide and mentor the next line of medical professionals. Our leadership ensures the well-being of patients is prioritised, errors are reduced, and overall patient satisfaction is high. And yes, these skills are essential for fostering the next generation of healthcare professionals. Our role as leaders include: • clear and empathetic communication with patients and colleagues • being adaptable in our constantly evolving field • advocating for our patients, even when it’s tough. By doing so, we ensure the highest quality of care. So, how do we enhance these skills? Getting involved in committees, seeking mentorships, exploring leadership literature, engaging in teaching activities, and welcoming feedback from peers are good places to start. These strategies help us navigate the intricate healthcare system and mitigate the risk of burnout. 10 Berita MMA Vol. 53 No. 10 • October 2023
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12 Berita MMA Vol. 53 No. 10 • October 2023 Here are four ways to be better leaders: 1. Be self-aware: Understand your actions and words to communicate effectively and build cohesive teams. 2. Show empathy: It strengthens the bond with patients, leading to better outcomes. 3. Listen attentively: Despite hectic schedules, it’s essential to listen to patients to enhance care. 4. Be an advocate: It’s our duty to stand up for our patients, ensuring the best treatment possible The impact of leadership on patient outcomes and the quality of care is undeniable. Yet, it is often overlooked in medical training. It’s high time robust leadership development programmes are integrated into our learning to foster excellence and equip us with skills to face industry challenges. Strong leadership is our guiding compass in providing unparalleled care in this ever-evolving healthcare scenario. Let’s step up, not just as doctors but also as leaders in healthcare, thus shaping policies and ensuring a safer and quality-driven healthcare environment. A doctor with leadership skills is like a captain who not only knows his ship but also how to navigate it through the stormiest of seas. Professional Medical Indemnity (PII) MEDEFEND Some of the Malaysian courts’ decisions in awarding Aggravated Damages: a) Failure to treat patient immediately after the incident b) Suppression of medical records c) Blemished entries on medical records d) Giving plaintiff false hope that he would recover e) Embarrassment, humiliation and discomfort suffered at the workplace and in public due to the injury MEDEFEND covers Aggravated Damages which is inclusive in the Limit of Indemnity that you purchase with no sub-limit. Don’t forget to apply/renew your 2024 Indemnity coverage on time at https://online.medefend.com.my. Call us at 03-2723 3226 or email medefend.my@marsh. com for more info. BMMA “Do not follow where the path may lead. Go instead where there is no path and leave a trail.” – Harold R. McAlindon GENERAL PRACTITIONER with membership of the ‘Academy of Family Physicians of Malaysia’ is now registerable in Australia Position available in an accredited group practice clinic located in Darwin, Northern Territory. Pathology service on-site. Terms to be discussed. Contact ‘Mediclinic’ [email protected] Ph: +61415062862
From the Desk of the Hon. General Treasurer Dr Vasu Pillai Letchumanan Hon. General Treasurer [email protected] exco HGT I would like to thank all delegates that attended AGM for the support and trust given to me, enabling me to be reelected as treasurer for another term. The AGM was conducted smoothly and many had a chance to visit Sabah and capture good memories. My gratitude goes to all the delegates for attending and making this AGM another memorable and successful event. We plan to hold MMAC 2024 from 3-5 May 2024. Book your dates and plan accordingly as this will likely be a fully physical event. Other additional features include e-poster, oral presentations competition, and pre-congress workshops as well (topics will be decided later). The audited accounts for year 2022 were presented in recent AGM. We thank both our auditors, Dato’ Prof Dr Lekhraj Rampal and Dr Rajmohan for their contributions all these years in auditing the accounts of MMA. The finance team is eager to work and co-operate with the new two internal auditors who had been elected in the recent AGM. To summarise the last three years: • we took steps to reduce tax payments, i.e. looking into expenses that benefit members such as bereavement payment for deceased members and Group Personal Accident Insurance. • due to As an increment in overall income, our taxation has also increased. A resolution to increase the quantum for bereavement payment for deceased members has been passed. The benefit is now RM10,000 for life members and RM5,000 for ordinary members; this will be reviewed periodically. Statistics from the Group Personal Accident(GPA) Insurance showed that few members benefited from it in last three years compared to the amount we paid. There were also third party issues when handling claims, delay of claims and complicated claim process. Thus, the mandate was given during the AGM to discontinue the GPA insurance from 2024 onwards. The benefit is still available till mid-January 2024. The proposed budget was presented and passed recent AGM. Due to the worrying global economic situation, an increase in the prices of goods and overall inflation is expected to cause an increase in our operating cost and expenditures for activities. We also expect our income will not increase according to the expected expenses. I took measures to balance out the proposed activities by many committees, thus controlling the expenses within our limits of expected income. The council may approve additional activities and new expenditures based on availability of budget and importance of the activity as necessary. I hope all the committees take into consideration these factors when organizing activities. Accounts and Taxation for 2022 Updates from AGM MMA Medical Congress 2024 14 Berita MMA Vol. 53 No. 10 • October 2023
Unfortunately, majority of the claims we received did not include the required nominations of the deceased members. Recipients would need a court order (either a grant of probate or a letter of administration) which takes between 6-12 months. Incomplete contact information has led to failure in reaching some of the deceased members’ families. Statistics show that nine claims were paid in 2021, and 19 claims in 2022. The bereavement payment can be processed expeditiously and released in five (5) working days only if members take the initiative to submit a nominee with the required particulars. We request your kind consideration and cooperation to provide the necessary details – you can update these details via the MMA mobile app. The option of filling a form manually was also given through email blast. This is one of the important benefits for the members and we really hope the members will take the necessary measures to benefit from it. We also hope that members (or state MMA) informs MMA on the details of deceased members. MMA had made payments for those families who had submitted all the documents required, following proper procedures. Update on Bereavement Payment for Deceased Members 16 Berita MMA Vol. 53 No. 10 • October 2023 How to Improve MMA Future Income? The MMA mobile app developed during my tenure as Computer Technical Committee chairman is a good choice. The recent MMA election for office bearers was successfully conducted through the app. It was also used to vote on resolutions during the AGM. Now, we will plan to incorporate advertisement and marketing packages into the app. The planning is in progress, and with estimate earnings of between RM30,000- RM500,000. As a KOOPMMA board member, I initiated ‘Office Orthopaedic Workshop for GPs’, which is meant to train GPs for clinic procedures while also earning some income for KOOPMMA. MMA will receive commissions from KOOPMMA’s profit, calculated yearly. The 2nd series of Office Orthopaedics has started in Kuala Lumpur, whereas the 1st series has started in the Northern region in September 2023. MMAF has resubmitted the required documents Melaka land office, obtained the Chief Minister’s approval and obtained LHDN’s consent as well. The last step will be obtaining approval of Ministry of Domestic Trade and Consumer Affairs. Once approved, the Foundation’s lawyers will proceed to complete the sale process. Our income has been diversified by tenanted two properties at Plaza Sentral. The developer is still in the process of acquiring Strata title for all three properties purchased by MMA, and they stated that the legal process with relevant authorities is ongoing; it is expected to be completed by early next year. Property Issues Due to global factors, equity and bond investments are still rather labile. We hope to see this portfolio eventually reap a good return in the long-term and will closely monitor its performance. We have also invested in Bradbury Fund for a fixed 3-year period. The profit is paid half yearly. Kenanga Fund Investment MMA has endorsed two indemnity insurances; MPS and MEDEFEND. The insurance committee ensures smooth relationship with these two entities and monitors and discusses doctors’ benefits from the policies. MMA also endorses other insurance products, i.e. car and clinic indemnity insurance. For further details, visit our website or contact MMA secretariat. MMA Other Products under MMA
The renewed plans are takaful scheme for Muslim members (65 years old and below) and conventional scheme for all the other members. Please note that the takaful scheme is not available for members ≥66 years old, leaving the conventional scheme as the only option to enjoy the same benefit as others. Under these two schemes, we were able to insure doctors up to 99 years old. Claimants need to provide adequate information and documents as stipulated by the insurer within a time period, thus we sincerely hope for the kind cooperation of claimants on this matter. We do face claimants who fail to provide adequate details for claims. As HGT, I’ve proposed amendments to increase the bereavement payment for members overall. This can be done by removing GPA as not many benefited from GPA. Also many claims were delayed due to the requirement for many documents, whereas bereavement payment is handled by finance team of MMA itself. For any queries on claim purposes, please contact our finance team. Group Personal Accident insurance (GPA) Financial Governance As usual, income and expenditures are monitored closely, with rigorous adherence to financial guidelines. As HGT, I’ve improvised the financial guidelines with the council approval, and follow them strictly. Please contact us at [email protected]. my for any queries or suggestions. BMMA
Professional medical indemnity with over 300,000 members and a 91% satisfaction score*. You come first with Medical Protection, the world’s leading member-owned, not-for-profit protection organisation for doctors and healthcare professionals. • 100% member-owned • 24/7 emergency medicolegal support • Professional development courses – at no extra cost • Wellbeing support and confidential counselling reasons to join 300,000 Find out more Always there for you *91% from 10,007 members around the world who responded to the 2022 Medical Protection Society Ltd (MPS) Member Satisfaction Survey. Medical Protection is part of the MPS Ltd group of companies. MPS Ltd has over 300,000 members around the world. 2305044995 09/23 The Medical Protection Society Limited (“MPS”) is a company limited by guarantee registered in England with company number 00036142 at Level 19, The Shard, 32 London Bridge Street, London, SE1 9SG. MPS is not an insurance company. All the benefits of membership of MPS are discretionary as set out in the Memorandum and Articles of Association. MPS® and Medical Protection® are registered trademarks. medicalprotection.org/mma
20 Berita MMA Vol. 53 No. 10 • October 2023 Patient Consent and Thorough Exploration of Options MPS Insights shared by Peter J Mordecai (Claims Manager at Medical Protection) and Dr Katie Grant (Risk Prevention Medico Legal Lead at Medical Protection), underscore the potential medicolegal repercussions when a doctor fails to discuss alternative treatment and investigation options with a patient, as showcased in a notable case. A scenario unfolded where a patient saw a consultant surgeon with suspected cancer. The surgeon’s decision to conduct a diagnostic laparoscopy came with an inherent risk of bowel perforation, a detail unfortunately omitted in the communication with the patient. Furthermore, the surgeon did not present alternative investigation strategies, which may have been less reliable but were also reasonable less invasive. Regrettably, the surgical procedure led to a bowel perforation, necessitating subsequent treatment, and triggering a clinical negligence claim. What could the surgeon have done differently? Fundamentally, the patient should be informed of all available reasonable treatments and investigative avenues, even if some bear lower efficacy. Without a detailed discussion, informed consent cannot be obtained because a patient cannot truly be informed unless they know of all the reasonable options available to them. Failing to do so not only undermine informed consent but also exposes the physician to potential claims of trespass. Furthermore, the patient remained unaware of the significant risks inherent to the specific investigative approach the surgeon recommended. While the occurrence of this complication was infrequent, its severity was undeniable if it did occur. The absence of such information about procedural risks not only jeopardised the patient’s well-being but also exposed the surgeon to claims grounded in the realm of negligence.
22 Berita MMA Vol. 53 No. 10 • October 2023 Key Considerations When Obtaining the Patient’s Consent 1. The various reasonable treatment and investigation procedure options should be explained to the patient, including the option of doing nothing. It does not matter if the option you are recommending has a 75% chance of success and the second-best option only has a 25% chance of success. The patient still needs to be made aware of the reasonable alternatives. 2. The material risks, benefits, and alternatives of the above should be explained to the patient as far as practicable and fall into four broad categories: a. Colleague consideration – what various procedure options along with their associated risks and benefits would your colleagues discuss if this was an average patient? b. Risk consideration – what are the standard risks in performing these procedures, e.g. infection? c. Severity consideration – what serious risks are there in performing these procedures, e.g. a procedure may carry a 1% chance of a loss of limb, but this is a serious outcome if it occurs and therefore should be explained. d. Patient consideration – are there any risks that are likely to be material to this patient? The law takes a patient-centric position and if there is a risk that a reasonable person in the patient’s position would be likely to attach significance to this then the risk is deemed to be material and should be brought to the patient’s attention (e.g. the risk of a loss of sight during cataract surgery would be more significant to a patient with sight in only one eye instead of two). Thus, gather what is significant to a patient by considering the risks of information that: i. the patient has communicated about – if they have specifically asked, then it would be deemed important to a reasonable person in the patient’s position. ii. can be implied to be important to the patient – if the patient’s records contain concern about loss of hair and this is a risk then it would be deemed important to a reasonable person in the patient’s position. 3. The timing of consent matters. Obtaining the patient’s consent on the day of a surgical procedure is likely to be deemed inadequate unless the procedure is an emergency. Aim to discuss all the above key considerations before any procedure, and offer different sources of reliable information about these options and document these steps. This allows the patient time to consider and reflect on the options discussed. 4. Repeat the information and try to have more than one discussion before the procedure. This will show you have made efforts to obtain the patient’s informed consent and given the patient time to consider their options before they decide. On the day of the procedure, you should re-confirm the procedure option the patient has selected, the risks and benefits of this, along with the alternative procedure options and their associated risks and benefits. 5. The consent form is not enough. While it is required, it does not show that informed consent has been obtained. There should be a clear record of the discussion between yourself and the patient going through the various procedure options and the material risks and benefits of each of them. Revisiting consent throughout the patient’s journey is important. For example, consider asking the patient to review and sign the consent form before the day of the procedure and then reaffirm it on the day. 6. Documenting the discussion in detail is vital because Medical Protection has seen several cases where doctors could not defend claims against them due to a lack of documentation. While time is limited, a detailed consultation note can be the thing that prevents a protracted litigation or disciplinary process. 7. Any coercion? Consider whether there are any factors that could be unduly influencing the patient’s decision and ensure these are removed. For example, obtaining a patient’s informed consent for a surgical procedure whilst they are in the operating room could be deemed to be coercing them into having the surgery and this should be avoided. You can perform the best procedure in the world, but a legal case can still be made if you have not obtained the patient’s informed consent. It is important you take plenty of time to explore the risks and benefits, and the reasonable alternative procedure options, with the patient and to document your discussions. BMMA
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24 Berita MMA Vol. 53 No. 10 • October 2023 MMA Convention & Scientific Congress 2023 & 63rd MMA AGM 63rd MMA CONVENTION AND SCIENTIFIC CONGRESS 2023 Day 1
Berita MMA Vol. 53 No. 10 • October 2023 25 Day 2 Day 3
The World Medical Association’s definition of “junior doctor” is a doctor who has graduated from medical school within the first 10 years. Having completed my 11th year just a few months ago, I am no longer one. Here are some of my concise thoughts on surviving (and enjoying) the “junior doctor” period: 1. Junior doctors are doctors Congrats on making it through medical school! Words such as “first posting house officer” and “day one of life” are merely milestones in one’s career pathway and should not in any way imply that you are inferior to a “senior house officer” or a medical officer that has been in a department for years. Chin up and don’t let anyone else talk down on you. Speak up and give input, e.g. in the management of patients – it is perfectly okay to disagree with those who are more “senior” to you. 2. Have no expectations One of the main survival methods I found helpful was not to have any expectations at work. If you expect to have wonderful colleagues, perfect teamwork, adequate manpower to take leave whenever you like, getting your ideal department and hospital, patients that never collapse just before your shift ends, being able to attend all parties and functions (the list goes on and on but you get what I mean) – you will be sorely disappointed. 3. Celebrate small wins A successful intravenous cannulation, a patient’s grateful handshake, a family member’s appreciation because you cared to explain something in detail – you deserve a pat on the back for all this. Do not underestimate the impact and power of your actions – a small gesture can go along way in a patient’s life! 4 Efficiency and time management Saving time and getting your work done fast (and accurately) means that you have time to eat, drink and rest. Making sure that forms are correctly filled means not wasting precious time because you won’t have to make an extra journey to the pathology department for that “rejected test”. 5. Be humble Often confused with “the boss is always right”, true humility is to have a spirit of teachability. Realise that no matter how much you “achieve” in your journey as a doctor or how “high” you climb, there is something to be learnt from every member of the healthcare team you work in. Listen (especially) to differing views from others, even if they are not on the “same level” or pay grade as you; swallow your pride and apologise when you realise your mistakes. The journey ahead is long and may seem intimidating and arduous; but the rewards are deeply fulfilling. Embrace and enjoy every step of it and most importantly – never forget the Oath we all took. Best wishes! BMMA Dr Timothy Cheng is the current Vice Chairman of MMA SCHOMOS. He is also the editorial secretary of the Malaysian Orthopaedic Association; President of Persatuan Ortopedik Sandakan and head of the orthopaedic surgery department in Hospital Duchess of Kent, Sandakan. He also dabbles in organising events and has a passion for community programmes such as cycling for charity and functional fitness/ marathon events for the public. He welcomes correspondence at [email protected]. SCHOMOS Dr Timothy Cheng Tsin Jien Vice Chairman, SCHOMOS [email protected] 26 Berita MMA Vol. 53 No. 10 • October 2023 A Junior Doctor’s Journey
RUMC is a Foreign University Branch Campus of Conducive Working Environment Impressive Salary Package Excellent Annual Leave Group Hospitalisation & Medical Insurance RUMC (RCSI & UCD Malaysia Campus) was established in 1996 as Penang Medical College. As the branch campus of the Royal College of Surgeons in Ireland and University College Dublin, two Irish institutions renowned for the study of Medicine, RUMC is recognised by the Malaysian Medical Council (MMC) and Irish Medical Council (IMC) and graduates high-performing and service-ready doctors. Come join us and be part of our growing team now. ASSOCIATE PROFESSORS / SENIOR LECTURERS / LECTURERS in MEDICINE Possess an MBBS or medical qualification recognised by the Malaysian Medical Council and a Postgraduate qualification in the respective discipline or equivalent. Proven track record in undergraduate and postgraduate teaching and research. The successful applicant will be appointed at the level commensurate with his/her postgraduate qualifications and experience. Applicants must be currently registered with their country’s Medical Council and / or with the Malaysian Medical Council when applying for clinical teaching positions. Applicants must be registered or willing to be registered with the National Specialist Register (NSR) and possess the latest and valid Annual Practicing Certificate (APC). The remuneration package will be commensurate with the background and experience of the candidate. The positions available are based in Penang, Malaysia. Successful candidate will be expected to take up their position by the second half of 2023. Please submit your CV with complete contact details and contact details of three (3) referees to: THE HUMAN RESOURCE DEPARTMENT rcsiucd.edu.my /RCSIUCDMalaysia @RCSIUCDMalaysia Transcend borders, transform lives. [email protected] +604 217 1999 +604 217 1888 #RUMC RCSI & UCD MALAYSIA CAMPUS 4, Jalan Sepoy Lines, 10450 George Town, Penang, Malaysia. +604 217 1999 /RCSIUCDMalaysia @RCSIUCDMalaysia rcsiucd.edu.my Copyright © 2023 RCSI & UCD Malaysia Campus. All rights reserved. PENANG MEDICAL COLLEGE SDN BHD (265542-K)
PPSMMA Introducing the Junior General Practitioner (GP) Network On 16 June 2023, our past PPS Chairman Dr Balachandran Krishnan created a new initiative called the Junior GP Network. The aim of this initiative is to connect with junior doctors who are currently in private practice and create a forum for discussion between PPSMMA and private junior doctors so that the issues facing these doctors can be highlighted and acted upon by PPSMMA. Since its inception, the network (which is currently on a Whatsapp Group Platform) has managed to gather close to 300 junior GPs, many of whom are new clinic owners. The forum was utilised to gather information on unique issues facing this group of doctors and following points are notable: 1. Firstly the transition pathway from government service to private clinical practice lacks guidance from MMC and KKM. Many junior doctors leaving government service lack guidance or any checklist (from either MMC or KKM) which highlights the necessary conditions that need to be fulfilled e.g. obtaining a letter of completion of compulsory service. This letter is vital when applying to become a PIC of a clinic or when setting up their own clinic and many only find out during the early process of CKAPS Borang A Application that they would not be able to apply to become the PIC as they lack the necessary transition documents. 2. Secondly, when transitioning to private primary care, these young doctors have options of either (a) setting up their own practice or (b) being employed by an existing clinic practice or performing locum clinical work at private primary care clinics. The financial challenges faced here are unique. For those setting up their own clinical practice, various funding methods are currently being utilised. These include personal savings, investments from family and friends, and personal loans (whether through financial institutions, individuals or corporate financing/investment). We have been informed of several cases where the doctors resorted to borrowing from loan sharks to set up and maintain the operations of the new clinic – which opens up a whole new can of worms. The lack of clear funding options and the lack of awareness and training to set up and maintain new clinics are fuelling these issues. With regards to doctors who are under employment in a private setting, the lack of clear employment guidelines, salary ceiling, work hours and lack of awareness of labour law leads to bullying and harassment at the workplace including long work hours for minimal pay issues. Many young doctors claim to naively sign unfair binding agreements. Junior GP Network 28 Berita MMA Vol. 53 No. 10 • October 2023
3. Delay in obtaining Borang B and lack of communication with CKAPS. The average time for the approval of an application for a new clinic set up to getting clinic operational license (Borang B) is 6-8 months. Junior doctors have to come up with large sums to pay for rent, and staffing and operational costs during the time spent waiting for their license. This cost piles up and by the time the new clinic begins operations, the operational cost would have skyrocketed and there is no method to recoup the loss from consumers due to the limit on consultation fees and services. The current timeline is very ineffective and there needs to be a more transparent process. Stringent renovation requirements have also resulted in junior doctors having to fork out large amounts. The cost of basic clinic renovation in Klang Valley is currently between RM100,000-RM150,000 and does not include other set up costs such as medical equipment and medication. 4. Lastly, the lack of professional development and career path. Many junior doctors are leaving government service due to the lack of career pathway and opportunities, however they face the same dilemma in their private practice as there are currently no requirements for private primary care physicians to have any form of postgraduate qualifications. These issues are only tip of the iceberg and needs urgent attention and action from the Ministry of Health, which would also benefit from PPSMMA’s input. We believe our continuous engagement with junior GPs at the grass-root level over the next coming term can help foster good relationships with them, and moving forward, we will be able to better advocate for this group of doctors. BMMA For enquiries contact: Mdm Gan Tel: 04-734 2888 Fax: 04-734 8882 SPECIALISTS Human Resources Department 888, Jalan Sekerat, Off Jalan Putra, 05100 Alor Setar, Kedah Email: [email protected] PUTRA MEDICAL CENTRE is 170 bedded hospital strategically located in the centre of Alor Setar. We would like to invite applications for the following positions: • Nephrologist • Ophthalmologist • Urologist • Neurosurgeon • Orthodontist • Rheumatologist • Interventional Radiologist • Obstetrician & Gynaecologist (Malay Female Doctor) • Vascular Surgeon • Colorectal Surgeon & Respiratory Physician • Breast & Endocrine Surgeon • Any Sub Speciality • Geriatrician • General Surgeon • Neurologist • Gastroenterologist • Endocrinologist • Maternal Fetal Medicine HOSPITAL POSITIONS • Medical Officers • Nursing Director • Nursing Manager • Nursing Supervisor • Staff Nurse • Cardiovascular Technician • Physiotherapist • Radiographer • Sonographer With Post Basic Qualification Based at Alor Setar & Kulim Clinic > > Dr Gokilavani Sekar Chandran Hon. Asst Secretary, PPSMMA [email protected]
2022 was truly a crisis-filled year – the continuing COVID-19 pandemic, Ukraine war, global inflation and the havoc of climate change.[1] Nevertheless, the changes were only slight when comparing the happiness scores for 2017-2019 with the 2020-2022 pandemic years, i.e. western industrial countries were slightly lower, and the rest of the world were slightly higher. This was due to the cushioning effect of growth of pro-sociality – people rising to the occasion to care for each other in difficult times. Pandemic Control When SARS-CoV-2 was still called novel coronavirus (2019-nCoV) in January 2020, it was already known to have high transmissibility requiring stringent personal and community measures, as well as isolation/lockdowns.[1,2,3,4] Unfortunately, most countries failed to limit transmission, hence breeding more infectious variants, rendering problematic the elimination of COVID-19, like in the case of SARS. WHR 2023 states “The eliminator countries helped to reduce the space for variants to develop. This global benefit depended on country size, with China as the largest eliminator.” and “If elimination strategies had been quickly enough implemented everywhere, then the genie might have been put back in the bottle and the virus kept out of general circulation.” General World Happiness Report 2023 Lessons from the Pandemic 30 Berita MMA Vol. 53 No. 10 • October 2023 Much avoidable morbidity and mortality followed, affecting severely noneliminator countries. The Omicron variant emerged in late 2021. While less virulent, it gradually became clear that its super-transmissibility made the current elimination strategy infeasible everywhere. Vaccination became available in late 2020. Developed countries (mostly non-eliminators) had the advantage of early and abundant availability of vaccines. But taken together years 2020-2022, their COVID-19 mortalities remained highest (see Fig. 1). Countries in the WHO West Pacific Region (WHOWPR), having learned from their SARS experience in 2002-2004, were the eliminator countries achieving low COVID-19 mortality. Nordic countries (all among the first seven happiest countries in WHR 2023) with the exception of Sweden, were also initial eliminators. Sweden’s COVID-19 mortality was markedly higher. The whole wide world is now field for evolution of further variants. The main defences are personal hygiene, adequate ventilation, improved vaccines and treatments. Henceforth out of the non-modifiable and modifiable factors determining success in COVID-19 control[5], only two factors remain in play on how countries will perform. 1. Institutional trust 2. Age profile Fig. 1: COVID-19 Deaths Per 100k Over Three Years (2020 – 2022)
Dr Yap Foo Ngan Life Member, Perak Branch [email protected] Benevolence World happiness has remained resilient throughout the pandemic because of the continued high levels of benevolence. Measures of benevolence, especially helping a stranger, surged worldwide during 2020-2022 (see Fig. 2). In Malaysia, the White Flag Campaign signalling distress drew generous help.[6] Global and Malaysian healthcare workers, following their calling, rose to the occasion, especially among the youth. Lest we forget, please revisit the following short videos. – 18/2/2020: Video in https://www.bbc. com/news/world-asia-china-51540981 – 15/7/2020: Thank You Health Care Workers & First Responders | 3M https://www.youtube.com/watch?v=0qgaMIvvEIs – 10/5/2021: Belaian Jiwa 2021 By Healthcare Workers Of Malaysia (Raya Version) https://www.youtube.com/watch?v=T3rPJtGJr6g – 13/7/2021: Air mata ‘frontliner’ melawan pandemic https://www.youtube.com/watch?v=odBfsN_YeV0 Healthcare The COVID-19 pandemic has awoken us to the importance of preparedness for the emergence of more variants, other pandemics and health crises (climate change, non-communicable diseases, ageing). A well-staffed and well-equipped healthcare system is vital, covering preventive, therapeutic, investigative services and research. WHR 2021’s tribute to front-liners is worth repeating. “COVID-19 has exposed many acts of heroism, notably among frontline workers and healthcare workers who have battled the disease at great peril to their own safety, often without the benefit of even rudimentary personal protective equipment.” BMMA References 1. WHR 2023 Chapter 2 2. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia. Z Feng et al, https:// www.nejm.org/doi/full/10.1056/ NEJMoa2001316, 29 Jan 2020 3. The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases – China, 2020. Z Feng et al, https://weekly.chinacdc.cn/en/article/id/ e53946e2-c6c4-41e9-9a9b-fea8db1a8f51, 17 Feb 2020 4. Coronavirus: Largest study suggests elderly and sick are most at risk https://www.bbc.com/news/world-asiachina-51540981, 17 Feb 2020 5. World Happiness Report 2021, Covid-19 Pandemic In 2020 – Why Some Countries Did Better Than Others. FN Yap. Berita MMA, Aug 2021 6. The White Flag campaign – where to go. 01 Jul 2021 https://www.freemalaysiatoday.com/ category/nation/2021/07/01/flying-startto-white-flag-project-as-malaysians-riseto-help-the-needy/ Berita MMA Vol. 53 No. 10 • October 2023 31 Fig. 2: Percentage Increase in Population Performing Benevolent Acts: 2020-2022 (Compared to 2017-2019)
The 18th Malaysian Congress of Geriatric Medicine (MCGM) 2023 played host to a weekend of enlightenment at the Setia City Convention Center (SCCC), Shah Alam, Malaysia. This annual event has been held with the 3rd Malaysian Falls Prevention Scientific Meeting. It featured a collaboration of multidisciplinary concepts and services, particularly for older adults population. These are enthusiasts who actively improving and developing the best care for older adults population. This year’s theme was “Embracing the Landscape in Geriatric Medicine”. The conference aimed at highlighting imminent substantial issues, ideas, information, and innovation acceleration. This platform showcased the latest geriatric care and management results. This was achieved through effective communications and networking around the Asia region. The Silver Tsunami is inevitably a raid to the current healthcare system. This conference has garnered nationwide public and private service geriatricians and caregiver experts for older adults. A spectrum of lectures were delivered by different experienced experts and educators to provide distinctive views in respective aspects. The geriatricians successfully collaborated with anaesthesiologists, 3rd Malaysian Falls Prevention Scientific Meeting General 32 Berita MMA Vol. 53 No. 10 • October 2023
cardiologists, dermatologists, endocrinologists, family medicine specialists, oncologists, colorectal surgeons, orthopaedic surgeons, neurologists, sport physicians, rehabilitation physicians, palliative physicians, pharmacists, dieticians, physiotherapists and occupational therapists in making this event a success. The speakers received immense praise from the audience for their insightful speech on instilling added values to approaches toward older adults. The audience reflected a mixture of different backgrounds throughout the entire nation who took the opportunity to clear their doubts during the sessions. The undeniably good researchers have presented amazing projects with explicit objectives. These researches were presented during a session on oral presentations of their studies. Some displayed their precious works via poster presentations. Despite the exciting talks, the conference ended with a concurrent MyFall workshop and health screening. The workshop lured enthusiasts who were interested in setting up inpatient falls intervention teams in their respective institutions. Dr Chung Wai Mun Life Member, Perak Branch [email protected] All in all, there are more and more entities that have become more aware of the importance of handling older persons in different ways compared to normal adults. Through various promotion pathways, this topic will hopefully draw more attention in the community for older persons care awareness. BMMA For Healthcare Professional Only 280823 _ OLOPAN_190mmx130mm.pdf 1 28/08/2023 3:49 PM
34 Berita MMA Vol. 53 No. 10 • October 2023 22 August 2023 marks an historic event for MMA. After more than five years since the inception of the Continuous Professional Development (CPD) points collection system between the Malaysian Medical Council (MMC) and the three administrators (Malaysian Medical Association (MMA), Ministry of Health, Malaysia (MyCPD) and the Academy of Medicine of Malaysia (AMM)), the Memorandum of Understanding was signed in the presence of Datuk Dr Muhammad Radzi Abu Hassan (the Director General of Health), at the Malaysian Medical Council. This MOU came into effect on the date of its signing and will remain in effect for five years. Thereafter, this MOU will be automatically extended for a further period of three years unless otherwise decided by the parties. CPD administration is nothing new to MMA as we have been handling this collaboration since 1994 and the MMC CME Grading System was launched on 11 January 1995 by the then President of MMC, Tan Sri Dato’ Dr Abu Bakar Bin Suleiman. At that time MMA was given the responsibility of being the Secretariat taking care of: 1. Registration of Providers. 2. Accreditation of CME Activities. 3. Allocation of CME points based on the MMC CME Scoring Schedule. 4. Collation of points accrued by Registered Participants and issuance of certificates of attendance. However, in July 2006 the name was changed from MMACME scoring schedule to MMC-CPD grading system. When the Medical Act 2012 came into effect on 1 July 2017, CPD points was made mandatory for fully registered medical practitioners to renew their annual practicing certificate. CPD From L-R: Dato’ Dr Kandasami Palayan, Dr Mohamed Anas Mohamed Hussain, Datuk Dr Muhammad Radzi Abu Hassan, Datuk Dr Thirunavukarasu Rajoo, Dr Koh Kar Chai, Dr Ravindran Naidu, Dr Hooi Lai Ngoh A Historic Event
36 Berita MMA Vol. 53 No. 10 • October 2023 Berita MMA Vol. 53 No. 10 • October 2023 36 Comparison Between the Previous and Current MMC CPD Grading System
Dr Ravindran R Naidu Chairman MMA CPD Committee Life Member, Perak Branch [email protected] Dr Hooi Lai Ngoh Member MMA CPD Committee Life Member, Penang Branch [email protected] 38 Berita MMA Vol. 53 No. 10 • October 2023 A minimum of 20 CPD points was required by a registered medical practitioner to renew his Annual Practicing Certificate. The Malaysian Medical Council appointed three administrators to carry out this exercise. The three appointed were MMA, MyCPD and AMM. In May 2017 during the 57th MMA AGM in Penang, a mobile application by MMA was launched for CPD Providers and Registered Medical Practitioners. The number of doctors using this mobile application has increased exponentially and currently exceeds 65,000 doctors. This MMA mobile app is available free of charge to all registered medical practitioners irrespective of members or non-members of MMA, specialists, and non-specialists as well as those in the public and private sector. MMA made this mobile app available to all Registered Medical Practitioners in Malaysia as part of its Corporate Social Responsibility (CSR) to all doctors in Malaysia. Using this mobile app, RMPs can check accrued CPD points in real time. Updated MMC CPD Grading System: The previous MMC Grading System had eight categories, 1A, 1B, 1C, 2, 3A, 3B, 4 and 5. However, in 2014 MMA collaborated with MMC on a major revision of the MMC-CPD Grading System which was adopted in 2015. Though the MMA has been handling the CPD Grading System since the ‘90s, the response was not very good. After further amendments, this schedule came into effect on 1 July 2020. The revamped MMC-CPD Grading System was more user friendly for RMPs, and the latest revision was launched on 1 July 2023. RMPs are encouraged to attend events to improve themselves and their knowledge rather than accumulating CPD points just to comply with the law. The following five domains in the latest updated schedule are: A. Formal educational activities Includes participation in activities to update knowledge and skills, such as attending lectures, seminars, scientific meetings, conferences, and skills training. B. Work-based learning It refers to professional development that takes place within the work environment in the medical practitioner’s current role. This includes learning activities and development opportunities including journal club meetings, audit/morbidity/mortality meetings, interdepartmental meetings, grand ward rounds. C. Scholarly activities Refers to work that enhances educational development and includes discovery of new knowledge and technology, dissemination of knowledge, supervision of training and participation in assessments. D. Self-directed learning Occurs when the individual takes the initiative in diagnosing learning needs, formulating learning goals, designing learning experiences, identifying and using available resources, and evaluating learning outcomes. This includes reading books, journals, and articles of a general nature, listening to podcasts and completing online learning modules. E. Professional activities Involves participation in activities that apply scientific expertise for the benefit of the wider community and activities that support professional development such as participating in the activities of a professional bodies, and learned societies, leadership role in medical societies/NGOs, serving in national, state and institutional level committees (institutional level committees are committees that represent the institution at the hospital/university or faculty level) and participation in selfdevelopment programmes such as leadership, management, communication skills training programmes. BMMA
FrieslandCampina Institute offers a number of e-learning modules that are developed by professionals, for professionals. They are free of charge and certificates are available upon completion. Available e-learnings Free e-learnings Sign up and start learning today! Follow us on social media • Sustainable diets Learn about the environmental impact of food, the composition of a more sustainable and healthy diet, diet modelling approaches and more! • Child development in the first 5 years Explore how children develop in the first 5 years, the role of nutrition during this critical period and the development of good eating habits. • Gestational weight gain Better understand the various aspects of gestational weight gain and how it impacts maternal and child health.
40 Berita MMA Vol. 53 No. 10 • October 2023 Dr Selva Ganapathi S/O Ganeson Vice Chairman MMA Negeri Sembilan MMA Life Member Leadership qualities can significantly contribute to the success of an organisation, especially in the healthcare system. Doctors, or perhaps more accurately defined as healthcare leaders, are able to motivate employees to achieve their potential for the benefit of patients, colleagues, and the medical field itself. MMA Negeri Sembilan branch understands leadership plays an important role in the healthcare industry which can help doctors to identify the characteristics and skills necessary to succeed in leadership positions. MMA Negeri Sembilan Branch keenly targeted ways to progress into a leadership role in healthcare by conducting one day course titled “Strengthening Ties Between Doctor, Leadership and Healthcare”. We appreciate the way doctors motivate our team by attending the course and making it successful. There were 35 doctors from various departments came for the course and shared their knowledge with respective speakers. Topics shared with doctors related to current model leadership and the healthcare system. MMA Negeri Sembilan course was represented by speakers like Dr Vikneswaran Sabramani, Prof Dato’ Dr Syed Mohamed Aljunid, Datuk Dr Kuljit Singh, Mr Rajen Devadason, Prof Dato’ Dr Tharmaseelan Sinnadorai, and Datuk Dr Thirunavukarasu. We were very grateful to have wonderful speakers who presented enthusiastically. Feedback from the doctors was great and indeed very beneficial to them and hoping to join more programs like this for their future development. So, we at MMA Negeri Sembilan branch proudly inform you that we will update “Strengthening Ties Between Doctor, Leadership and Healthcare 2.0” soon. BMMA The Link Between a Doctor, Leadership and Healthcare Branch News
42 Berita MMA Vol. 53 No. 10 • October 2023 Prostate cancer is one of the most common cancers among men worldwide. In Malaysia, it ranks third, after colorectal and lung cancer. The median age at diagnosis is 67 years. Like most cancers, prostate cancer can be treated and cured if detected at an early stage. The 5-year survival rate for men with localised disease is 99 percent, but this rate drops to 32 percent in metastatic disease. More than 95 percent of primary prostate cancers are adenocarcinomas. Other rare types include small-cell, ductal, and mucinous carcinomas. High-grade prostatic intraepithelial neoplasia (PIN) may be a precursor of adenocarcinoma. Symptoms Local growth of the tumour may cause obstructive urinary symptoms such as reduced urinary stream, incomplete bladder emptying, frequency and nocturia. However, these symptoms are more commonly associated with benign prostatic hyperplasia and hence usually treated as such. Unfortunately, prostate cancer itself has no specific symptoms, and this leads to 53 percent of Malaysian men presenting at an advanced stage. Diagnosis Prostate Specific Antigen (PSA) screening is the only avenue for early detection. A value of more than 4 ng/mL or a PSA density of more than 0.15 ng/mL2 (PSA density = PSA / Prostate volume) should prompt further investigations. Prostate biopsy is the only confirmatory test for prostate cancer. Traditionally, trans-rectal ultrasound guided (TRUS) systematic “random” biopsy was common practice, but currently, multiparametric prostate magnetic resonance imaging (MRI) is increasingly being used as an initial assessment. Technological advancement has allowed detection of suspicious lesions by MRI, making targeted biopsies possible by way of MRI-Ultrasound fusion biopsy. Staging and Risk Stratification Following a diagnosis of prostate carcinoma, staging can be done by performing a bone scan and computed tomography (CT) scan. Prostatespecific membrane antigen (PSMA) positron emission tomography (PET) scan is a more sensitive and specific alternative to conventional staging scans. Risk stratification is based on the patient’s PSA level, biopsy Gleason score and clinical prostate examination findings. Each patient is then assigned to a low, intermediate or high risk category, and treatment options are offered accordingly. Treatment For low risk patients, active surveillance is a safe option where the patient is monitored and regularly assessed for disease progression. Treatment can be promptly instituted at the time of progression without reducing the chance for cure. Low to intermediate risk cancers can also be treated with cryotherapy or high-intensity focused ultrasound (HIFU), although these techniques are largely still experimental. For all risk levels, radical prostatectomy and radiotherapy are both curative treatment options. Surgery is most effective for disease up to stage T3, while T4 disease is usually treated with radiotherapy. Surgical methods for radical prostatectomy include open, laparoscopic and robotic-assisted surgery, the latter becoming the most preferred option in recent years. Minimally invasive surgery has the advantage of lower blood loss, less post-operative pain, shorter hospital stays and faster return to normal physical activity. Despite being a major surgery, many patients are able to walk out of hospital 1 to 2 days after surgery. For patients with metastatic disease, comprehensive treatment can markedly improve prognosis and survival. Treatment consists of hormone manipulation by androgen deprivation therapy, chemotherapy and novel antiandrogens, commonly given in a double or triple combination, with the aim of lowering testosterone to castrate levels. Palliative radiotherapy can also be offered for control of pain at metastatic sites. Conclusion PSA screening is of utmost importance in early detection of prostate cancer. Many treatment options are available for all stages of the disease. Robotic-assisted prostatectomy is the most popular curative treatment for localized prostate cancer. For consultation or more information, please call +603-7491 9191 or visit https://www. sunwaymedical. com/en/doctor/ dr-christopher-leekheng-siang Prostate Cancer Early Detection Leads to Curative Treatment Dr Christopher Lee Kheng Siang Consultant Urologist, Sunway Medical Centre, Sunway City [email protected] MRI-US Fusion Targeted biopsy offers higher sensitivity in prostate cancer diagnosis. Dr Christopher has performed numerous roboticassisted prostatectomy surgeries. State of the art da Vinci Xi robot in prostatectomy surgery.
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mma Official Facebook What’s Trending d Most liked / commented 44 Berita MMA Vol. 53 No. 10 • October 2023 JEFFREY CHEAH SCHOOL OF MEDICINE & HEALTH SCIENCES AIMS & OPPORTUNITIES • To equip GPs, MOs, and Clinical Specialists with essential skills to treat diabetic-related foot wounds and pressure injuries. • Learn from distinguished faculty members from Monash University Australia, alongside wound healing experts from the Ministry of Health, Malaysia in the latest evidence-based wound management practices. BENEFITS Earn 16 Continuing Professional Development (CPD) points. WORKSHOP DETAILS For further details please visit our website: monash.edu.my/ jcsmhs/events/advanced-wound-care-workshop And register via this link: tinyurl.com/JCSMHS-Wound-Care-2023 CONTACT Any inquiries or need further information, contact us at E [email protected] T +603-5515 9664 /+603-5514 5646 Please share this invitation with your colleagues and trainees. Your support of this workshop will contribute significantly to a vibrant and collegial learning environment. SCAN ME ADVANCED WOUND CARE WORKSHOP Diabetes-related Foot Wounds and Pressure Injuries Managements for Doctors 18 – 19 November 2023 Monash University Malaysia
46 Berita MMA Vol. 53 No. 10 • October 2023 Mark Your Diary Nov 23-25 ENDOQE 2023 Venue : Queen Elizabeth Hospital Kota Kinabalu, Sabah Organiser : MSGH Jun 28-30 Asia Pacific Neurocritical Care Conference 2024 Venue : Borneo Convention Centre Kuching (BCCK) The Isthmus, Sejingkat, Sarawak, Malaysia Organiser : MSNACC & PEKA-HUS Apr 25-27 ENDO KL 2024 Organiser : MSOHNS Sept 27-29 Regional Airway Meeting 2024 Venue : Borneo Convention Centre Kuching (BCCK) The Isthmus, Sejingkat, Sarawak, Malaysia Nov 23-25 32nd Malaysian Urological Conference Venue : Berjaya Times Square Hotel Kuala Lumpur Organiser : Malaysian Urological Association Theme : Revisiting the Past, Reimagining the Future Jun 28-30 Asia Pacific Neurocritical Care Conference 2024 Organiser : MSNACC