Introduction:

How often have we come across disturbing questions and statements regarding MMA from some of our own colleagues such as: “What has MMA done for doctors?”, “Why join MMA?”, “MMA has done very little, so why join?”, and more recently one doctor has commented in an internet discussion forum for doctors: “The silence of MMA over several important current issues in the media….”?  Such baseless remarks are untrue as MMA did try very hard to serve our doctors. Some doctors, unfortunately, are only interested in MMA solving their personal problems and unfairly judge MMA this way. Some judge MMA only by certain types of deeds they personally regard as important. They are rather uninterested in what MMA has done for the doctors in general. But some are genuinely unaware of what MMA has done. However, I feel that MMA should take note of all these remarks and accusations of MMA and analyse them rather than simply brush them aside and just label those who made such comments as born critics or those who just cannot be pleased no matter how hard we try.

In this article, I shall try to list out some of the creditable work MMA has done to the benefit of the doctors. Before doing that, let me mention and discuss a few actual examples of the grievances I have come across very recently.
 
 

Some Grievances:

Recently, in a doctor’s internet discussion group web site, one doctor wrote: “I used to wonder why most of the doctors I know do not want to join the MMA. Now I can see their reasons…” and “……are they simply ignoring this issue with the hope that it will disappear or be forgotten? An organization which claims to represent the welfare of doctors simply chooses to ignore such humiliating attacks on our profession….” This is in response to a report in Berita Harian and MHI (TV3) on the 21st October 2003 with comments made about how it would be better for patients to buy drugs from pharmacists rather than getting them from the doctors.

Apparently, among the unfair accusations were that clinics charged 20-30% more than pharmacists, You pay extra consultation when seeing a doctor, patients are better counselled about medication by the pharmacists than doctors, Doctors know less about medication than pharmacists, Doctors overcharging their patients whereas pharmacists charged patient much less for the same medication, patients were given choices whether to take original or the cheaper generic / bioequivalent whereas doctors do not give this choice to patients.

I have taken the liberty to provide a personal reply to this accusation: “It is not fair to accuse MMA of not doing anything for doctors in the past. Such news usually receives very dramatic response from MMA. The writer should also does his part to contribute by informing MMA of such an incident rather than simply believing what some doctors said of MMA. Some people are just impossible to please. Even if you work your heart out for them, they will still think you are just having fun and not doing anything! Unless MMA hears about it, MMA cannot respond properly”. Anyway, what the doctor wrote sounded so naïve but the fact is many doctors just are unaware of what MMA has done for them. On this issue alone, MMA has in the past responded with positive results umpteen times. Sometimes MMA did not respond because the President was not aware of it or for fear of repercussion which will make the situation even worse. The MMA Constitution only allows the President or with his approval to make press release. This is a good thing so that there will not be confusing statements made to the press on behalf of MMA as had happened before in the past. In fact MMA secretariat screens through all major newspapers daily for important medical news like this which needs responding. So instead of hitting at MMA for not responding, that doctor should do his part by informing MMA of such issues.

Very recently, there was another rather unfair posting in Malaysian Doctors Bulletin Board in the internet: “...I do not think MMA is doing its job either. A lot of money seemed to have been spent on having a grandiose office and very little have been spent at all to protect its members....let alone life members. Presidents feel it is unnecessary to reply to important personal letters by members and his duty is carried out by the Hon Gen Sec. Something is drastically wrong with the association when such situation is reached.”  This angry member must have met with a frustrating situation where his call for help has not been adequately dealt with. But is it fair for him to rationalize and generalize the whole situation and accuse all Presidents of not personally replying such letters? My response to his accusation is that I know many MMA Presidents did take pain to try to solve members’ problems personally and also replied to their letters personally and in fact made that a priority. I for one always personally replied to all letters addressed to me when I was MMA President and have not relied on the Hon Gen Sec for such matters. Sometimes, I may have to reply that I need to refer certain matters to certain specialized committee of MMA for help. If necessary, I tried to remain involved. Practically everyday, I received a big pile of letters couriered to me to Penang by my very efficient secretary in MMA, Rissa, and I spent more than an hour everyday dealing with them. Everyday, there were also a few faxes on more urgent matters for immediate attention. I even personally typed all replies to speed matters up and sent by email or fax to MMA to be posted out. In my opinion, in an association, members are the most important and should take priority. That is also the reason why I have the names of all the MMA Executive Committee members (including myself) with their contact telephone numbers published in every issue of Berita MMA during my term of office for the benefit of the members and I have never refused to take calls or made it difficult for anyone to contact me. I have also kept members informed of all current major important issues in the President Page of Berita MMA which I took special effort to write.

Recently in Penang during a doctors’ so called “Gourmet Club” dinner where I had a chance to meet some young doctors who have attended the function for the first time, I was told straight in the face by a young female doctor that “MMA does not do much for doctors” ! We then started to discuss and bring out problems like Pathology labs’ unethical practices, Problems concerning Traditional and Complementary Medicine, SOCSO, FORMEMA, Countering unfair remarks of doctors in the press, Sole dispensing right, Privatisation of hospitals, Problems doctors encounter when ask to attend court, Medical insurance, Pharmaceutical trades, Managed Care, Effects of Globalisation, etc, etc. I explained as the discussion went along what contributions MMA has made in each case in the past and how a strong MMA with full membership of doctors can make a difference and make our work easier since many institutions always use this weakness of not representing all doctors when dealing with MMA to make it difficult for us. Some of our contributions have even led to Acts being implemented by the government. The young doctors at the dinner were not aware of most of what I have explained and began to understand and acknowledge MMA’s contribution. In fact one young specialist asked if I can get him a form to become a MMA member straight away!
 
 

MMA as the National Association

The Malaysian Medical Association is the umbrella body for doctors in Malaysia. It also serves as a watchdog on health issues in the country. Other professional bodies also respect MMA and often invite the President of MMA to their functions and some of their more important meetings. Very often, organizers of big exhibitions and seminars seek endorsement from MMA.

MMA is well known among foreign Medical Associations and the President is often invited to the Annual General Meetings of many International Medical Associations including the British Medical Association, Singapore Medical Association, Chinese Medical Association, Indian Medical Association, Australian Medical Association and more recently the American Medical Association.

MMA also represents Malaysia to many international meetings such as the MASEAN (Asean Countries), CMAAO (Asia and Oceanic regions), CMA (Commonwealth countries) and WMA (The World). MMA is also affiliated to the British Medical Association (BMA), Chinese Medical Association (CMA), Indian Medical Association (IMA), Australian Medical Association (AMA), New Zealand Medical Association, and Singapore Medical Association (SMA). It also has contacts with Medical Associations of G15 nations with impending affiliation.

MMA has gained even more prestige after it was accepted into the World Medical Association in 1998. In view of globalization, this has become even more crucial. We have even hosted a MASEAN meeting and a Commonwealth Medical Association (CMA) Assembly in Penang a few years back.

A strong MMA will benefit not only the doctors but also our government especially the Health Ministry and all Malaysians. MMA can and has contributed in many areas including promoting a high standard of medical practice in terms of both ethics and Continuing Medical Education. MMA also acts as a vehicle to disseminate essential information to doctors. MMA certainly has the resources and financial backing to achieve its objectives.

In addition to this, MMA has after years of existence created 30 Committees including AIDS Action Committee, Ethical Committee, Action on Smoking and Health Committee, Substance Abuse Committee, Accident Prevention Committee, National Health Plan Committee, Managed Care committee, Plantation Medicine Committee, Continuing Medical Education Committee(CME), Health Insurance Committee, Care of the Elderly Committee, Committee for Women’s Health Issues, Committee on Adolescent Health, Committee On Rehabilitation of Victims of Violence, CPR Committee, and Committee on Avoidable Disabilities. There are also six Societies within MMA namely the Societies of Ophthalmology, Occupational and Environmental Medicine, Public Health, Physicians for the Prevention of Nuclear War, Sports Medicine and the Society of Medical Students. The committees and societies consist of members who are experts or have interest in that field and thus are able to help look after many important issues of medical importance. Each committee has contributed significantly over the years.

MMA is also represented in 35 government and non-government organisations such as the Poison Board, Traditional/Complementary Medicine Committee, Road Safety Council, Malaysian AIDS Council, Drug Control Authority, MOH Committee to study the Problem of Sexually Transmitted Disease, Malaysian Adverse Drug Reactions Advisory Committee, Malaysian Association for the Prevention of Tuberculosis, Health Tourism Board and Radiological Advisory Committee. Our government often seeks cooperation and help from MMA. The President or its representative is invited to various government policy-making meetings including dialogue with the Minister of Health and Director-General of Health. The President of MMA represents MMA to the Malaysia Plan Committee. MMA has often held seminars on many important issues pertaining to health which are often helpful to the government. Before each new budget is planned, MMA is given an opportunity for recommendation on tax concerning health care.

MMA also publishes an internationally recognized Medical Journal and a very high standard monthly newsletter circulated free to its members. MMA is proud to be given the role of allotting CME points to doctors.
 
 

A Few More Recent and Significant Contributions of MMA

It is not possible to name all the contributions MMA has made to the benefit of doctors and health care as a whole. Below are just some of those I am aware of and find them significant. Each Past President will certainly be able to tell you more of the dedicated jobs MMA has done for the benefit of doctors during his tenure. It is important that MMA has the support of all doctors. Often, excuses against MMA was expressed that we are not representative of all doctors. It will be so much easier to win over many issues concerning doctors if we are strong and well represented. We need to be united and have as near 100% membership as possible so that whatever we fight for will be more likely to succeed. Unity is Strength. One good example is that when we tried to demand a significant rise in the fee paid to doctors by SOCSO, they threatened to deal with some other medical institutions claiming we do not represent all the doctors and should not be so demanding. Fortunately, they were asked to get back to us by the Ministry. MMA (and thus doctors) would not have been bullied this way if we are more united.

An important role of MMA is to act as a watchdog for doctors. This leads to many rules and regulations being implemented with the doctors in mind and thus to our advantage.

Members must know that the subscription of membership is very small and will not be enough for MMA to do their work effectively and efficiently. Luckily, we have other income to supplement this due to the far sight of some Past Presidents.

Some of MMA’s past contributions include:

In 1961, MMA sent a memorandum to the Prime Minister urging the establishment of a Medical School similar to King Edward VII College of Medicine in Singapore. Through MMA’s efforts, a new medical faculty at the University of Malaya, Kuala Lumpur began to function in 1964 with Professor Danaraj as the first Dean.

In the 70s, MMA launched the first anti-smoking campaign which led to the government banning anti-smoking advertisements on radio and television.

The government decided to start implementing compulsory service for doctors from January 1971. MMA agreed to compulsory government service on some conditions such as the number of postgraduate awards be increased, the first year of compulsory service be served in a recognized training hospital and there is increased remuneration.

In that same period MMA made a declaration for the target of “Health for all by 2000”.

In 1984, MMA formed an Estate Medicine Committee to look into the appalling conditions in estates which included poor housing and sanitation, inadequate medical and health facilities as well as poor transport. MMA is committed to bringing the healthcare delivery of the plantation sector into the mainstream of national development.

In 1986, MMA started the public health care awareness campaign which included organising National Health education programme.

MMA has also negotiated with the Ministry of Health regarding employment for foreign spouse who are also doctors. The Ministry responded by offering employment on contracture basis for those with recognized degree.

In 1990, MMA worked out with FOMCA a Charter of Patient’s right and also cooperated with APHM and FPMPA to come up with a Formulation of National Health Plan.

The 90s also saw an increase in the number of business orientated private hospitals. MMA with APHM called on the government to regulate foreign participation. Some recommendations which were agreed upon were that foreign investors in private hospitals should adhere to existing Malaysian Government policy on investment: e.g. (1.) not more than 30% foreign share, (2) joint venture locally registered, (3) all hospital staff must be local except for four approved subspecialties.

Managed care was a big issue in the mid-90s and MMA was actively involved.

The government initiated two important committees in 1998; one dealing with Health Tourism and the other with Traditional and Complementary Medicine. The President of MMA was invited to attend and contribute at the inaugural meetings of both committees. Health Tourism is now important to boost up our country’s economy. The Standing Committee of Ministry of Health dealing with Traditional and Complementary Medicine was even more important owing to the present uncontrolled practise of Traditional and Complementary Medicine in the country. A new Act drawn up by this committee is scheduled to be implemented in 2006 to curb this problem.  MMA now continues to send representatives to these two very important committees.

The late 90s also saw the implementation of FOMEMA, a private company approved by the government to screen the health of foreign workers in Malaysia. MMA played a big role in many important issues regarding FOMEMA which concerned doctors.

MMA also negotiated with the Ministry of Transport directly to set a reasonable fee for doctors performing medical Check ups on drivers of heavy vehicles without a third party involvement.

The late 90s also saw the setting up and implementation of the Private Healthcare Facilities and Services Act Bill imposed by the government. MMA was involved in the setting up. MMA published an important edition of the Fee schedule to control medical charges which hopefully will be acceptable by the government. The Fee Schedule is beneficial to both doctors and the public as it gives a guide of fair charges.

In 1998, our government was planning to privatise the public hospitals in Malaysia. MMA protested and felt that this should only be done when there is a working National Health Care Financing Scheme that will benefit even the very poor. Furthermore they should only be corporatised rather than privatised so that no one will profit financially from this exercise. The plan to privatize government hospitals has now been postponed.

Also in 1998, MMA came into agreement with the Bar Council on numerous past issues especially regarding court attendance, Medical reports and payment of Fee.

In the late 90s, MMA has also pushed for a Pathology Bill to control the large number of pathology laboratories that have sprung up every where. The Bill apparently has been created but yet to be passed and implemented. All these activities of MMA will certainly benefit our doctors and indirectly the public as well.

I must add that in addition to the above, each of the 30 odd committee of MMA has contributed to a great extend as well and of course the representations to the 35 various government and non-government organizations. MMA has also constantly fought for the welfare of doctors in government service under its SCHOMOS section such as over-time pay, promotions and other grievances. One other important contribution of MMA to doctors is its role in organising CME programs mainly at state level.
 
 

Effect of Globalisation:

MMA is capable of sending delegates overseas to foster good will and exchange information of mutual benefit between countries. Because of the globalization trend, this is becoming more and more important.

Malaysia is a signatory of WTO and has to abide by its rule. MMA has made every effort to soften the ill effects of this concerning Medical Practice. MMA is worried that foreign investments in Malaysia from highly industrialised countries like United States, Japan and Europe would escalate health care costs for Malaysians. As a Signatory of WTO, foreign doctors wanting to practise in Malaysia should be allowed to do so. This is fortunately restricted by our strict criteria for medical registration.

MMA feels that in the private sector, there are already more than enough doctors including specialists who are capable of practising high standards of medical care.  MMA also feels that local doctors who fully understand the unique situation in the country will best serve the cultural, religious and language sensitivities of the Malaysian Community in relation to health care.  MMA is against foreign participation of Primary Medical Care in Malaysia.  Such care should be left to our local doctors.

There is also a risk of an influx of doctors from developing countries (especially our neighbours) because of the higher wages and attractions that Malaysia can offer to doctors from these countries.  There will be no way of preventing this influx if Malaysia opens its doors to them. This will jeopardize the standard of medical practice in our country. The only factor in our favour is that Malaysians may not want to consult these doctors from another country due to language barrier. Unfortunately, there are still many Malaysians who have the mentality of still thinking foreign is better. Malaysia has therefore resisted pressure from foreign countries, especially the developed countries, in the liberalization of our medical services.

One of the issues which MMA has put to the government concerning trade is to control the price of imported drugs, which are escalating uncontrollably. A large proportion of medicine has to be imported due to patent protection.  Local manufacturers thus are unable to manufacture them.  Prices of such imported drugs are at the mercy of patented companies who hold the monopoly of manufacturing them. Prices of such drugs become unrealistically high and may not be affordable. We are paying drugs at the same cost as in developed countries which are unfair as our standard of living is not the same.
 
 

Conclusion:

To those doctors who are very critical of MMA, I would like to offer some suggestions. Do not just stay below with a stick poking up at the leadership. If you feel you are able to sacrifice your time and energy, do come forward and offer your help and expertise by getting actively involved in MMA. Join in the committees you feel confident you can contribute to or better still get yourself elected into the MMA council. If you come across anything which you feel MMA must respond, let MMA know about it rather then just criticise. If you feel that you are able to change MMA for the better, do come forward and offer your service. We need rational people who can lead without any personal agenda. Make MMA what you want it to be. We need a strong voice and a strong Association where our voice can be heard. We should not fight against each other but help each other to boost up the image of the only association that will be able to perform when given a chance and the only medical association that is recognised by others. Unity is Strength.