Cost to patients

Granted medical care in Malaysia is heavily subsidised but we must remember there is still cost to the patient which some cannot afford if we are to do unnecessary bloods. This is all found the Medical Fee Order of 1982 Amended in 1994 and 2003. The 2003 Amendment is the controversial New Charge for Foreigners. It has been the law of the land since 2003 but just not enforced so if anyone has a problem against it they should fight for repeal. Anyways the following cost are only applicable to the Third Class Ward. If you go into First Class the payment is higher. On another note it should be noted that the in the 1st paragraph and 2nd section of the 1982 Order it is maintained that it is only applicable in West Malaysia which means my friends in East Malaysia can credibly maintain that the law does not apply to them however on this I am not totally sure so you will need to consult the lawyers. The cost are as follows:

1. General Outpatient: RM1/visit
2. Specialist Clinic: RM5/visit
3. General Ward stay: RM3/day
4. Maximum charge of a 3rd class patient: RM500
5. Caesarean section: RM100
6. Vaginal delivery: RM10
7. Physiotherapy: RM5
8. CAPD: RM100/month
9. Haemodialysis: RM25 if new filter RM10 if reuse approximately RM150/month
10. Chest X-ray: RM10
11. CT brain: RM60
12. ECG: RM5
13. Echocardiography: RM20
14. EEG: RM5
15. Mastectomy: RM100
16. Hysterectomy: RM100
17. Appendicectomy: RM50
18. Circumcision: RM10
19. Blood investigations:
• Group A: RM25/test
• full genotyping of blood group
• Group B: RM 20/test
• HLA-B27
• Group C: RM12/test
• acid blood gas
• blood culture and sensitivity
• Group D: RM10/test
• lipid profile
• liver function test
• renal profile
• full blood picture
• Group E: RM7/test
• C-reactive protein
• T4
• TSH
• urine catecholamine
• ANA
• Group F: RM5/test
• UFEME
• CSF biochemistry
• tissue culture
• Rheaumatoid factor
• VDRL
• TPHA
• ferritin
• folate
• B12
• Group G: RM2/test
• serum calcium
• serum uric acid
• cross matching
• LDH
• amylase
• glucose
• magnesium
• calcium
• MCV
• MCH
• PCV
• total white and differential count
• Group H: RM1/test
• Coomb's test

In summary, a lot of cost can be incurred on a patient especially long-staying ones and though the cost is capped at RM500. The employment to population ratio is 58%, which means for a population 30 million 17.4 million are eligible to work. However only 1 million are eligible to pay income tax which means only these people earn more than RM3060/month. For the rest RM500 would represent up to 16% of monthly income which would be catastrophic for 90% of the population. Moral of the story: Do not order unnecessary bloods.

Fever clerking in Bengali and Burmese

Rather correcting old broken links I might as well repost them. The Bangladeshis speak Bengali. They are the Muslim cousins of the Hindu inhabitants of West Bengal. The first Asian to win the Nobel Prize for Literature was Rabindranath Tagore who is a Bengali who wrote in Bengali and English. Below are the links.
Fever Clerking in Bengali
Fever Clerking in Burmese

I would like to thank Fakrul the Radicare worker in ward G2 for his kind assistance in Bengali and Brother Oliver for his assistance in Burmese.

Practising for the Clinical Stations

Dear House Officers,
When a person merely practises by repeating an action many times without thinking and analysis one does not get better but instead will develop bad habits. In order to become better one must use deliberate practise. One of the ways to deliberately practise is to have a script which is checklist to make sure that you have gone through all the steps. As you deliberately practise you will get better, be more familiar, rely on the script less and soon it will be second nature.
Please find the Checklists for Clinical Examinations at the link which I based on Ryder and others.

Model Formal Referral Letter

Dear House Officers,
Due to the Heartbleed Bug some of the older Dropbox links are not useable and I am still in the process of modifying the old ones. Here is a Model Referral Letter
Basically you must have:

1.  A history of what happened to the patient and what treatment was given.
2. The latest list of medications.
3. The latest investigation results be it blood or imaging.
4. The reason why the patient is being referred to the centre.
5. Be polite and courteous.