Vol 19 No 4
Table of Contents
Message from the Master
Professor Victor Lim
Recently, the British government launched an inquiry into the care provided by the Mid Staffordshire NHS Foundation Trust between 2005 and 2009. It had been alleged that poor standards of care provided by the Trust endangered the lives of patients and that between 400 – 1200 more people died than would have been expected in a three year period between 2005 and 2009. An earlier independent report had revealed that patients “were robbed of their dignity” while relatives had to clean lavatories and public areas themselves. Staff were “uncaring” and managers were “in denial” about the problems.
What was of equal concern is that this unsatisfactory state of affairs had been allowed to continue for so long unchallenged and undetected. Often, serious malpractices that endanger patients’ lives are not rectified because staff are too afraid to speak up or indulge in whistle-blowing. Whistle-blowing has been defined as the act of raising concerns about misconduct within an organization or within an independent structure associated with it.
Health care professionals, including doctors are often reluctant to publicly raise concerns about their colleagues’ practice even though such issues may be the subject of conversation in doctor’s lounges and staff canteens. They may feel that it is not their responsibility to do so or that it is unbecoming to snitch on a colleague. They also fear the repercussions they may have to face when reporting on a more senior colleague. Whistle-blowing and whistle-blowers have also often been regarded negatively by society. In school, snitchers are often ostracized by their classmates. It is therefore not an appealing activity.
In medicine, whistle-blowers had in the past, suffered loss in career progression, ostracisation, transfer to another facility or even worse, dismissal. In April 2009, two nurses at a Texas health facility, Anne Mitchell and Vickilyn Galle, alerted the Texas Medical Board about patient safety concerns as the result of the practices of a certain Dr Arafiles in their hospital. The doctor used and sold herbal medicines which were not listed on the formulary. When the board contacted Dr Arifiles about the allegations, he informed the Sheriff County who was his friend, who then charged the nurses with misuse of official information with intent to harm Dr Arifiles, a third degree felony which could lead to a 10-year jail sentence. The hospital also dismissed the two nurses. The charge against Nurse Gaille was subsequently dropped but Nurse Mitchell was brought to court. At the trial she was acquitted by the jury in less than an hour.
In another case, Dr Sanford Klein, the head of anaesthesiology for some 16 years in a New Jersey university hospital became increasingly concerned for the safety of patients in the radiology department. Beginning 1999, he repeatedly complained to the hospital authorities that insufficient staff, space and resuscitation equipment were endangering the lives of patients. In 2001, he sent a memo stating that unless conditions improved he would refuse to work in the department. For his effort, the hospital responded by removing him from clinical duties. Although his clinical duties were later reinstated, he was required to work under supervision.
These and other cases, illustrate the perils of whistle-blowing and it is not surprising that many health care workers will want to refrain from it. Yet, whistle-blowing is crucial to patient safety and should be considered as a responsibility of all health-care workers.
Governments around the world, are now increasingly aware of the need to protect whistle-blowers. In the US, many states are enacting whistle-blowing laws. Some states have adopted or introduced legislation to protect health care workers who report incidents involving patient safety. State medical societies in the US, are also starting to investigate cases of retaliation against doctors who expose lapses in patient safety. In the UK, Andrew Lansley, the Health Secretary had declared that he aims to bring a cultural shift in the NHS to make it easier for employees to highlight failings in their health care facilities. Staff will be expected to raise concerns on safety, malpractice and wrong-doing as soon as possible.
All organizations including health care institutions should establish policies and procedures for whistle-blowing. Such a policy will encourage staff to play their part in improving the overall effectiveness and success of their organizations. Such policies will help to eradicate unethical and illegal practices in the organization. Early exposure of an undesirable practice can prevent a larger and more catastrophic event in the future. Knowing that the organization has a policy and proper procedures for whistle-blowing will deter employees who may be considering an illegal, improper or unethical practice.
In Malaysia, our government is planning to introduce an allencompassing Whistleblower Act primarily to stem corruption. Such legislation will address the following issues:
Such legislation coupled with appropriate organizational policies and procedures, will play a major role in enhancing patient safety in Malaysia.
MERRY CHRISTMAS AND A HAPPY 2011.
[ Back to top ]
1st AMM-AMS-HKAM Tripartite Congress / 44th Malaysia-Singapore Congress of Medicine
"Benefits and Risks of Recent Medical Advances"
12th - 14th November 2010 - Hong Kong Academy of Medicine Jockey Club Building
The first Tripartite Congress of the Hong Kong Academy of Medicine (HKAM), Academy of Medicine of Malaysia (AMM) and Academy of Medicine, Singapore (AMS), was held on 12th - 14th November 2010. The Congress hosted by the HKAM, which was also the 44th Malaysia-Singapore Congress of Medicine, was held at the HKAM Building. It attracted over 300 participants from Hong Kong, Malaysia, Singapore and other countries.
The Honourable Dr York Chow, Secretary for Food and Health of the Hong Kong SAR Government, graced the Opening Ceremony with his presence as Guest-of-Honour and delivered a short speech after officiating the opening of the Congress.
The Halnan Lecture (HKAM), entitled “Changing Concepts On Medical Ethics”, was delivered by Professor K H Lee, Honorary Professor, Faculty of Medicine, Hong Kong University. Professor E K Yeoh, Professor of Public Health and Head of Division of Health System, Policy and Management of the Chinese University of Hong Kong, spoke on “Medicine – Back To The Future, Beyond Science” for the 18th Tun Dr Ismail Oration (AMM). The Opening Ceremony and named lectures were followed by a Welcome Reception during which the masters and president of the three academies exchanged gifts to celebrate the collaboration. There was also a singing performance by a local group of young Hong Kong doctors.
On 13th November, the HKAM President hosted a dinner at the Hong Kong Country Club in honour of guests from Malaysia, Singapore and other overseas countries. The highlight of the evening was the “unrehearsed” singing and dancing acts performed by talented doctors one after another, bringing cheers and excitement from the audience.
The Councils of the three Academies had a joint Council meeting on 13th November 2010 to share views and experience mainly on training and CME. It was unanimously agreed that the tripartite collaboration was a meaningful activity providing a vibrant and engaging platform for the exchange of knowledge, clinical experiences and fruitful discussion in post-graduate medical training and continuous professional development. Participants were all invited to attend the next Tripartite Congress to be hosted by AMS in Singapore in 2013.
The Congress successfully ended with a simple Closing Ceremony on 14th November, with prize presentation for the Best Young Investigator’s Award. This year’s winner is Dr Colin Graham of Hong Kong.
[ Back to top ]
During the last Annual General Meeting of the Academy, a workshop on Strategic Planning was conducted. It was attended by members, representatives of the various colleges and several past Masters. It was a successful event and there were many suggestions and inputs from the participants.
The idea for a strategic plan for the Academy was mooted several council meetings ago. The Academy in several ways was in a transitional state, and hence, the need for a renewed vision and mission. There were a number of developments in the last few years that directly impact on the Academy’s activities which prompted this strategic planning. The Academy enjoys the confidence of the Ministry of Health which has increasingly been involving it in a number of activities. Amongst these, is the National Specialist Register. One of the proposed amendments to the Medical Act of 1974, is the establishment of the Specialist register. While waiting for the amendments to be passed by Parliament, the Malaysian Medical Council has given a grant to the Academy to develop the Register. This has been successfully done and specialists now apply to the NSR to be credentialed. Another development is the Continuing Professional Development programme. Again, the MOH entrusted the Academy to handle the Specialists CPD activities. In its own activities, the Academy has also expanded the scope of its activities. The Malaysia-Singapore Congress of Medicine has now become a tripartite meeting with the involvement of Hong Kong’s Academy of Medicine. The Academy is increasingly taking an active role in the training of Specialists. Recently, the Academy after so many years, has finally got a building of its own (it shares the building with the Academy of Family Medicine which owns a third of the property). The building is the result of many years of planning, fund raising and hard work. It is the pride of the Academy but at the same time, has increased the financial burden of the Academy.
In the light of all these developments, the council decided to develop a strategic plan to take the institution to a higher level. Dr Zaki Morad, the Deputy Master was delegated the task of organising the workshop. The Council did consider engaging a consulting firm to help develop the Strategic plan but as the price of such a service was costly, it was decided to do it in-house.
In the two months preceding the workshop, three workgroups were formed, each to look into specific areas in preparation for the workshop. Professor Victor Lim, the Master, led a group that looked into the Vision and Mission statement. Dr Zaki Morad chaired another group that looked into the Academy’s activities, while Dr Chang Keng Wee’s group studied options for a new organisational structure and ways to improve the financial standing of the Academy. At the AGM on the 8th August of 2010, the suggestions of the groups were presented. There was an active discussion led by several members. Past masters including Tan Sri Dato’ Dr Abu Bakar Suleiman, Dato Dr Yeoh Poh Hong and Professor Dato’ Dr Kew Siang Tong made a number of suggestions, most of which were incorporated in the final draft.
A draft vision statement and a draft mission statement were adopted with minor alterations. The new vision of the Academy states “ensure the highest standards of specialist health care in a professional, ethical and socially just manner for the well being of Malaysians”. The Mission of the academy is ‘‘The Academy of Medicine is dedicated to promoting the highest standards of health care in Malaysia through – professional and ethical practices; placing the interest of patients above all else
To achieve this mission, it was proposed that the Academy embark on a number of CME/CPD activities in collaboration with the MOH. It was also felt that the Academy should have more say in Medical education in the country. The Academy should also take the lead in effecting changes in medical practice. There should also be an outreach programme for doctors and public.
There was a consensus that the organisational structure of the Academy be strengthened and upgraded in anticipation of the increased responsibilities and workload of the Academy. This may include the appointment of a CEO, executives for finance, administration, programme and also to look into the affairs of colleges. A suggestion to appoint eminent members to the Council, in addition to elected officials and College representatives, was not accepted as was the suggestion to change the election system where officials are elected en bloc for a three year term. An interesting suggestion which was accepted by the members present was that, two members under the age of forty be nominated to the Council.
There were a few other suggestions which the Council will have to look at in follow-up actions.
Dr Zaki Morad
[ Back to top ]
The 9th Annual General & Scientific Meeting - College of Pathologists, Academy of Medicine of Malaysia
Universiti Putra Malaysia 25th - 28th June 2010
The 9th Annual General & Scientific Meeting – College of Pathologists, Academy of Medicine of Malaysia, was co-organised by Universiti Putra Malaysia, College of Pathologists, Academy of Medicine of Malaysia and Ministry of Health. It was hosted by the Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia from 25th to 28th June 2010.
The Annual General Meeting was conducted at the Palm Garden Hotel, IOI Resort, Putrajaya on the 25th June 2010 where the Annual General Meeting as well as a general election was carried out. Professor Cheong Soon Keng was elected for another term as President of our college. A K Prathap Memorial Lecture entitled “A coming of Age of Gene and Cell Therapy” was delivered by Prof John Rasko from the Centenary Institute of Cancer Medicine and Cell Biology, Royal Prince Alfred Hospital, Sydney, Australia. The meeting closed with a dinner for members and invited guests at the Resorts.
The Scientific meeting resumed on the 26th June 2010 and was attended by 153 participants and officiated by the Deputy Dean (Academic), Faculty of Medicine & Health Sciences, UPM Associate Prof Dr Jalil Nordin. The theme of the meeting was “CURRENT ISSUES IN PATHOLOGY”. A total of 15 speakers delivered their lectures. These included ten local experts from various fields of Pathology, i.e Anatomic Pathology, Haematology, Chemical Pathology and Microbiology. The topics covered issues such as virtual autopsy, H1N1 outbreak, HPV vaccine, ApoE, cytogenetics, management of haematologic malignancies and important GIT biopsies. Representatives from the Royal College of Pathologist Australia (RCPA) delivered on RCPA fellowship, EQA programmes and training opportunities. A plenary lecture by Prof John Rasko “Science and Serendipity in the Era of Molecular Pathology” was also delivered. The afternoon sessions closed after a general forum on the “Future Direction of Pathology” moderated by senior consultant pathologists and experts from local institutions.
A total of 45 abstracts were submitted for poster presentation from participants of the Scientific Meeting. Abstracts of all lectures and poster presentations were submitted for publication in a supplement of the Malaysian Journal of Pathology. The meeting also has eight booths set-up for exhibitors and these were mostly taken up by established companies providing laboratory support.
There were two post-conference workshops conducted. The first was on anatomic pathology: “Update on Prostate and Urothelial Tumors” held on the 27th & 28th June 2010. It was moderated by a distinguished Consultant Pathologist, Prof Dr John Pederson from Victoria, Australia. The second workshop was a hands-on laboratory session on ”Haematopoetic Stem Cells”, conducted on the 28th June 2010 and moderated by Prof John Rasko.
We received positive comments from delegates on the scientific content and conducive atmosphere of the venue from local and foreign participants. I thank the College of Pathologists, Academy of Medicine of Malaysia for giving UPM the honour in hosting this meeting and I also would like to record my appreciation to the team of committee members who have greatly contributed to the success of this event.
Associate Professor Dr Hairuszah Ithnin
The 9th Annual General & Scientific Meeting - College of Pathologists, Academy of Medicine of Malaysia
[ Back to top ]
At the recent Annual Meeting of the British Association of Endocrine and Thyroid Surgeons (BAETS) in Birmingham on 21st - 22nd October 2010, Datuk Dr Noor Hisham was invited to give the British Journal of Surgery Lecture, entitled “Investigation and Management of Retrosternal Goitre”. This is the first time a Malaysian surgeon has been invited to give this prestigious lecture. This is an honour and recognition for Datuk Dr Noor Hisham’s work in endocrine surgery and for Malaysia.
Datuk Dr Noor Hisham is currently the Deputy Director-General of Health (Medical) Malaysia. He is also the Head of the Department of Surgery in Putrajaya Hospital, which is the tertiary referral hospital for breast and endocrine disorders. He was the Senior Vice-President of the College of Surgeons of Malaysia until 2009, and was the 11th President of the Asian Association of Endocrine Surgeons (AAES). He was the Foundation Visitor to the Royal Australasian College of Surgeons Annual Scientific Congress in Hong Kong in 2008. Datuk Dr Noor Hisham’s surgical practice includes a broad range of surgical oncology with clinical interests in the area of breast and endocrine tumors namely adrenal, thyroid and parathyroid. He is international renowned for his work in endocrine surgery and has extensive publication in local and international journals with a chapter entitled “Multinodular Goiter” in the Textbook of Endocrine Surgery, 2009 (Hubbard and C Y Lo, New York) and a chapter entitled “External Laryngeal Nerve” in the Textbook of Thyroid and Parathyroid Surgery 2010 (Randolph G). He has been on the editorial review board for several journals, i.e. Asian Journal of Surgery, Malaysian Medical Journal and Word Journal of Surgery.
Locally, he has received medals and awards for excellent service to the country, with the KMN (Kesatria Mangku Negara - Federal) in 2004, the PJN (Panglima Jasa Negara - Federal) in 2007 and the DPMP (Dato’ Paduka Mahkota Perlis) in 2010.
British Journal of Surgery Lecture
“Management and Investigation of Multinodular Goiter”
Datuk Dr Noor Hisham Abdullah
Thyroid surgery for a simple and large endemic goitre is a common surgical procedure in Malaysia. Nonetheless, the challenge of thyroid surgery is in providing safe surgical benchmark for retrosternal goitres. The definition of retrosternal goiter is not uniform and varies among authors. Over the years, a multitude of classification systems has been introduced to categorize the retrosternal goitres.
Often substernal goiters are classified into two groups: A direct substernal extension and a truly intrathoracic or aberrant goiter. Goitres extending into the thorax frequently compress onto important vital structures resulting in significant compressive symptoms. These effects clearly increase the difficulties and hazards of surgery. Careful attention is paid to fundamental points of the classification, surgical technique and approach of surgery. Although in most instances, the operation is usually straightforward and accomplished without much difficulty, it is imperative that all surgeons understand the types and various approaches to retrosternal goiters. Most retrosternal goitres can be removed through an entirely cervical approach with a low complication rate. It is only on rare occasions a median sternotomy or postero lateral thoracotomy will be required to permit a safe and complete removal of retrosternal goitres.
[ Back to top ]
[ Back to top ]