Wednesday, March 4, 2009

Workers Victims of Doctor’s Ignorance/ 医生缺乏职场卫生意识

Recently, there has been a lot of publicity about doctor’s ignorance on occupational diseases. Hence, the employer goes scout-free while workers loses out on compensation, treatment and disability benefit.

Occupational health is a highly specialized course. There are a lot of diseases related to your working environment, what we call work related diseases.

This may include heavy metal poisoning, skin disease, cancer, bronchitis, asthma, and babies with abnormalities. These are some of the common diseases associated with the employment. Many of these diseases may have originated from their work place.

Malaysia employees take on average of 4.2 days of medical leave per year. This is higher than most other countries. However, the number of cases related to occupational diseases is about 500 cases annually. This is extremely small number of occupational diseases reported yearly.

Based on projection, Malaysia should have about 60000 workers afflicted with occupation related illness every year.

This should be of great concern to the workers and the authorities. Who should take the blame? I would say the employers and doctors should shoulder the blame.

Employers in order to reduce cost often cut corners on safety measures and often if there are any occupational diseases linked to their work place, rarely workers report to the authorities. The employees of course for fear of discrimination and dismissal normally do not report on their employers.

Doctors should take the major portion of the blame for the underreporting of occupational diseases in the country.

Most general practitioners are ignorant about occupational health and hence are unable to link diseases and health problems to work place.

Often doctors treat patients based on symptoms and because of ignorance, doctors find it difficult to link diseases to work.

Doctors should undergo training on occupational health so that they get better acquainted with the potential danger posed by working environment.

It is often said that doctors don’t think about a disease, they often miss the diagnosis.

A very casual history taking and examination will in no way detect occupational diseases. Often it needs detail understanding of illness and work place.

So, the call to have specialist in the Socso panel clinics is justifiable. Most of the time, when the most common occupational disease reported to Socso, it is grossly underreported. Employees should demand their rights according to the Socso Act.

There is a need for emphasis on health and safety of workers in their work place. An employer should be directed to provide safe and healthy working environment for their staffs.

Doctors obviously need better training on occupational health, otherwise this severe underreporting of occupational related disease will continue.

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近来出现不少批评医生对职场疾病懵懂无知的报道,因为医生缺乏对有关方面的认知,以致雇主没有履行职责,为在职场染病的雇员提供赔偿、治疗和残障福利。

职场卫生是一项高度专业的领域。我们工作的职场其实暗藏许多疾病,统称为“工作相关疾病”。这其中包括了重金属中毒、皮肤疾病、癌症、支气管炎,哮喘和诞下畸形婴。这都是与工作相关的常见疾病,大部分可能源于病人的工作场所。

马来西亚雇员平均每年放4.2天病假,这数字其实比很多国家要高。然而,我国每年却只有接获大约500宗职场病例,相对来说是非常小的病率。

根据预测,马来西亚每年会有6万人患上与职业相关的疾病。这是值得雇员和有关当局关注的现象。那么,谁该承担责任?我认为,雇主和医生须共同承担。

为了削减成本,雇主往往偷减安全措施,而雇员也很少向当局投报与职场相关的疾病病例。这是因为雇员害怕被排斥或解雇而不敢向雇主报告。

医生必须为漏报职场疾病病例或没有发出警惕负责。一般的医务人员显然对职场卫生这科专业懵懂不知,而医生基本上是根据病人的症状施诊,由于缺乏认知所以无法即时链接病症与职场的关系。

医生应该接受职场卫生与安全的培训,以更了解和熟悉职场或工作环境所潜在的卫生危机。

医学上有一句话,如果医生错误推断,则容易误诊。草率的病历诊问及检验是无法诊断出职场疾病,除非医生本人对该病症及有关的职场具有更深的了解和知识。

因此,社险机构指定诊所必须有专科医生坐诊是一项合理的要求。很多时候,尽管是最常见的职场疾病,呈报给社险机构后却未被重视。在这种情况,雇员应该要无惧行使社险法令赋予他们的权利。

雇主必须加以关注雇员在职场的健康与安全,确保为其员工提供一个安全和卫生的工作环境。医生显然需要更多职场卫生与健康的培训,否则,人们将持续忽视职场疾病的问题。

8 comments:

呉 和豪 said...

Dato Seri Dr chua,

your's comment on this issue is very much welcomed , I will make use of this as a teaching material in next semester. We have to take care of money , mateial as well as man.不能单单只要马儿好而不给马儿吃草,同样的员工也必须得到适当的医药治疗机检查

hotburger said...

Dear Dr. Chua,

I hope you could publish this in your Blog if it is not offensive to you.

An Open Letter from CSK:

Why as a doctor I want this government to go away??

I am a local graduate and have been in practice for 31 years. I am
basically a physician by training and received my qualifications from
the Royal Colleges in 1985. I see mainly kidney ailments and their
predisposing illnesses which usually are high blood pressure, diabetes and heart ailments.
>
I was in government service for twenty years and the remainder now in private practice. I run a clinic in Penang and have visitation rights to private hospitals.
>
When I was in government service, yes, there was much bureaucracy. But nothing of the sort we see today. There was a greater deal of
camaraderie. And although there were differences with private
hospitals or clinics, generally everyone learned to work together.
>
When I first opened my clinic, it was fairly a straightforward affair.
>
Apart from my APC (Annual Practicing Certificate), it wasjust
ensuring the clinic was adequately equipped to treat the type of patients which I knew I would be treating, and making certain I had
the type of medication I wanted to prescribe to my patients generally.
>
My first brush with the law, if you can call it that, came when a
group of government medical assistants and health inspectors walked into my clinic without notice and brusquely gave me a warning regarding a new rule regarding toxic waste and how we should dispose them in yellow containers recommended by the ministry. I complied.
>
About two years later, there were problems regarding my X-ray machine, when third parties who appeared not so knowledgeable but
apparently approved by the Ministry of Health, started walking in and out of my clinic for purposes of calibration and licence renewals. I could not quite understand why the supplier or manufacturer himself was not
allowed to service or calibrate these machines. The cost ran into
thousands of ringgit which I had to pay.
>
To add insult to injury, I was forced to attend Continuing Medical
Education (CME) programs run by what looked like staff who didn't know much about the programs they were conducting despite myself having a qualified radiographer to do the X-Rays. The cost of the CME programs again had to be borne by me.
>
And then came the PHFSA (Private Health Care, Facilities and Services Act). No one understood the need for this Act. In this
respect I must praise ex-Health Minister, Chua Jui Meng, for putting this nonsensical Act into cold storage. However Chua Soi Lek and a couple of not so clever ministry staff, typically without the approval of the very people it was going to affect in the private sector, got together and convinced the government to pass this Act in parliament.
>
They say that an idiot is a stupid person with a mental age below
three years, while a moron is a stupid person with a mental age of
between seven to twelve years. I am uncertain which category the
Ministry staff who conjured these laws belonged to. Even the opposition didn't or could not make much noise.
>
Doctors were forced to register clinics, made to pay hefty registration fees, comply by doing expensive renovations and buy
unnecessary equipment unrelated to the type of practice they had. And
despite this, the authorities can still choose to provide or not
provide a license as and when they please. Many unnecessary trips had
to be made to the Ministry which these days seemed to be staffed by
Indonesian and Manipal graduates or by doctors who have not worked a
single day as an independent doctor in a clinic of their own.
>
Politics was certainly not standing at the door of my clinic anymore. It had come right in and engulfed my practice with a red tape which I could not keep up with any certainty.
>
Despite all the noise regarding a Dr. Basmullah who pparently was
jailed pertaining to this Act, the Pakatan Rakyat has not made any clear statements if they would repeal this law and the many other
restrictions placed on medical practices by qualified, fully
registered Malaysian doctors if they came to power.
>
It is uncertain if Malaysian doctors would be squeezed out first by our own government or by AFTA (ASEAN Free Trade Area) when
full implementation with regard to the liberalization of medical services takes place soon.
>
As for now, at least, I think I have heard and seen enough. Despite
the scandalous mortality and morbidity the country faces due to the largely ignored dengue scourge and possibly many other illnesses, and despite knowing from past and current experiences regarding the tacky standards in government hospitals, they appear to be above
the law without accountability nor transparency.
>
For now, I have decided to take more time off from my medical practice and spend sometime now instead to focus on helping remove
this government. As a doctor in private practice, I just want
this government with all its Little Napoleons and conniving,
corrupted, incompetent, and unproductive civil servants gone.
>
I believe now that this government is incorrigible and beyond
redemption. The time to work as friends within the system has long
since passed. If we are to save this once beautiful and free country, it is apparent at least to me now that this government must first be removed.

CSK

Low said...

From what hotburger said and if that is all true, the government is very sick and need a doctor more than the people.

Why isn't send the same article (by hotburger) to current health minister ?

good to see the internet serve it purpose again.

Mike said...

在树下的停车场召开州议会,这应该是全世界头一遭。州议员不准进入州议会大厦开会,也应该是我国头一遭。但这些第一次,对于我国霹雳州的政治局势,绝对不是什么光彩的事情。

这是语言可以形容的事吗?很多马来西亚子民,包括霹雳州子民,相信内心都搀杂着愤怒和伤感的情绪,因为人民票选出来的议会代表,竟然落得如此凄凉的境地。

州议会已经通过所提呈的所有议案,但至于是什么动议,这已经不重要了,因为州议会已经变得有名无实,在极尽羞辱的情况下,通过没有人去执行的议案。

支持原任州务大臣尼查的动议被通过了,解散州议会的动议也被通过了,特权委员会对7名国阵议员的禁足惩罚也通过了。是的,接下去呢?州议会到底要解散吗?纵然人民承认这个州议会,但是国阵不承认,一切都等于“零”。

倘若树底下的州议会是“非法”的,而州议长的权力也是非法的,那么人民应该要感到担心,因为今天发生在霹雳的事情,即人民不尊重权力单位,议长也有名无实,将来在其他的权力单位上,也可能出现同样的情形。例如,在下一届大选,某方面赢得中央政权,而警方和公务员都不高兴的话,并违抗命令,那么权力到底属谁?

发生在霹雳的情形,其实解决方案很简单,只要解散州议会,重新寻求人民的委托,一切都不再是问题。但为何有些政治人物却不敢这么做?难道他们怕了人民,难道人民的选票,从来就不是给予他们权力的基础?

NEIL said...

There are many registered who are so poorly trained that they even don't know how to take blood pressure or read simple english.I have personally come across these nurses and I personally ask them some simply questions which they only shake their heads.I don't look down on these nurses but I do pity some patients who are left at the mercy of this not well trained nurses.Some patients who have life threatening disease are been care by this nurses and a slight mistake will cost them their lives.Many death,I bet are not reported and just passed as 'natural death'.So many mistakes are being make during the course of being treated by this nurses.
It's high time that these nurses needed to be retrained before our hospital are been called a hospital of death.

anil said...

QUOTE
"...Through the last week, Malaysians have borne witness to a shameless display of belligerence and arrogance.

Violence has been done; to the Federal and State constitutions, to the Rule of Law and to all that these fundamentals represent.

War has been waged on Democracy itself. I can think of no other way to characterise events.

The Executive laid siege on the Legislature.There is no law that allows police officers to deny members of a legislative chamber access to that chamber for the business of Legislature.

An inability to resolve the imbroglio to advantage, the Barisan Nasional at the State and Federal level collectively took the law into its own hands.

That all affairs will be conducted to the exclusive convenience and the advantage of the Barisan Nasional and its leaders is more suited to a Dictatorship, in which the Rule of Law means nothing.

And if it could do this in one state (Perak), what is to stop it from acting in the same way in other states or at the federal level. Judging by the way in which it has responded to criticism over its actions these past few weeks, it would seem nothing much.

It is manifest that the Barisan Nasional considers itself a law unto itself.That is the painful truth that lies at the heart of Tengku Razaleigh’s declaration that the Constitution is dead.
-Malik Imtiaz Sarwar

Anonymous Says said...

Dear Dr. Chua,
Occupational health is part and puzzle of the general health of an individual. Diseases caused by occupations can also be caused by other factors. Patients whether they are on SOCSO or not should receive the best of care, if Malaysia wishes to be a first world health deliverer. Sometimes the patient receives the due care but his or her SOCSO claim is not given quickly or not given at all. Imagine how sad it is if a worker were to go for an amputation and can never work again because of occupational hazard and he or she is not eligible to receive SOCSO, even though he or she has that coverage when he or she was working before the accident. In Malaysia, government doctors are overworked. Government wards all over filled with patients. The refusal to open up an empty ward is because of financial constraint. In that case, how can a particular hospital be accreditated ? There are not enough proper equipments to go around. There is a need to improvise. Sometimes medicine are not in stock. Sometimes there are interunit quarrels between doctors because one unit may be using a particular medicine and the other unit is refused an order for the same medicine. Some doctors are really good in head knowledge. No problem if the patient is seen by him. But he does not have good communication skill with his patients. The MOH is right about this. The doctor will be playing around with his handphone while the patient is sitting there waiting for him to ask the first question. This is not a dumb doctor. This is one of the cleverest doctors but no communication skill. Then there are doctors or medical students who look like beauty queens and entertainers. That is why there are so many complaints from the public. Or there is no linkage between one hospital and another regarding the care and follow up of the patients, even though there is teleprimary conferencing or internet. The doctor is more concerned about keying in information into the computer rather than really looking at the face and really examining him. As for the poor quality, well if Maths and Science is going to be taught not in English, then what sort of medical professionals will you get ? In fact, it is ridiculous if a university graduate cannot talk in another universal language, English that is, because he or she can never be competitive. Try telling their scientific research findings in Bahasa Melayu to the international delegates or do they expect an interpretor ? Is Malaysia progressing or is she digressing ?

呉 和豪 said...

YB Dato Seri Dr.Chua Soi Lek
"This may include heavy metal poisoning, skin disease, cancer, bronchitis, asthma, and babies with abnormalities. These are some of the common diseases associated with the employment. Many of these diseases may have originated from their work place."
I think you had missed out the mental related illness which might be caused by working environment, perhaps you should make comment on that also.

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