Quality programs are difficult to implement where social support for healthcare costs are inadequate and there is no institutional support for quality programs to guide and assist the doctor in pratice. ‘Quality’ is not the good intention to do better, but the process of measurement of behavioral change against set targets. For the majority of the doctors of this region who practice under great constraints, this article outlines some quality activities that are entirely within their personal initiative and responsibility, but should make a real difference to the quality of care provided.nd responsibility, but should make a real difference to the quality of care you provide.
Republished in: Republished in: Teng CL, Khoo EM, Ng CJ (editors). Family Medicine, Healthcare and Society: Essays by Dr M K Rajakumar, Second Edition. Kuala Lumpur: Academy of Family Physicians of Malaysia, 2019: 68-74
Citation: Rajakumar MK. Chapter 13. The Emergence of Family Practice. In: Fry J. Yuen N (ed). Principles and Practice of Primary Care and Family Medicine: Asia-Pacific Perspective. Radcliffe Medical Press. 1994:301-310.
Republished in: Teng CL, Khoo EM, Ng CJ (editors). Family Medicine, Healthcare and Society: Essays by Dr M K Rajakumar. Kuala Lumpur: Academy of Family Physicians of Malaysia, 2008: 61-73
Omitted in Second Edition (2019)
Citation: Rajakumar MK. The family physician in Asia: looking to the 21st century. Family Medicine Education in the Asia-Pacific Region. Core Curriculum for Residency/Vocational Training and Core Content for Specialty Qualifying Examination. The Philippine Academy of Family Medicine, 1993. [Originally published in the Filipino Family Physician in 1993]
Republished in:
1. Republished in: Teng CL, Khoo EM, Ng CJ (editors). Family Medicine, Healthcare and Society: Essays by Dr M K Rajakumar, Second Edition. Kuala Lumpur: Academy of Family Physicians of Malaysia, 2019: 40-45
2. An Uncommon Hero. p354-360
Republished in:
1. Republished in: Teng CL, Khoo EM, Ng CJ (editors). Family Medicine, Healthcare and Society: Essays by Dr M K Rajakumar, Second Edition. Kuala Lumpur: Academy of Family Physicians of Malaysia, 2019: 103-107
2. An Uncommon Hero. p361-365
Republished in:
1. Republished in: Teng CL, Khoo EM, Ng CJ (editors). Family Medicine, Healthcare and Society: Essays by Dr M K Rajakumar, Second Edition. Kuala Lumpur: Academy of Family Physicians of Malaysia, 2019: 91-98
2. An Uncommon Hero. p345-353
Republished in: Republished in: Teng CL, Khoo EM, Ng CJ (editors). Family Medicine, Healthcare and Society: Essays by Dr M K Rajakumar, Second Edition. Kuala Lumpur: Academy of Family Physicians of Malaysia, 2019: 108-111
Republished in: Republished in: Teng CL, Khoo EM, Ng CJ (editors). Family Medicine, Healthcare and Society: Essays by Dr M K Rajakumar, Second Edition. Kuala Lumpur: Academy of Family Physicians of Malaysia, 2019: 99-102
Republished in: Teng CL, Khoo EM, Ng CJ (editors). Family Medicine, Healthcare and Society: Essays by Dr M K Rajakumar. Kuala Lumpur: Academy of Family Physicians of Malaysia, 2008: 147-152.
Omitted in Second Edition (2019).
Republished in:
1. Republished in: Teng CL, Khoo EM, Ng CJ (editors). Family Medicine, Healthcare and Society: Essays by Dr M K Rajakumar, Second Edition. Kuala Lumpur: Academy of Family Physicians of Malaysia, 2019: 113-119
2. An Uncommon Hero. p221-240
A shared experience in Health and Education are essential ingredients of nationhood. In healthcare, it is constructive to think in terms of the characteristics of a healthcare system that a substantial majority of our people would be enthusiastic to claim ownership. It is useful to think in terms of the elements of a 'charter for health for all Malaysians towards 2020' a) Healthcare for all Malaysians, that is equitable, accessible, and comprehensive. b) Care of quality given with courtesy and respect for patients and their families, with no financial barriers at the time of need. c) A commitment to healthcare of a quality that is appropriate to a Malaysia as a developed country by the Year 2020. Each Five-Year Plan should move in that direction, guided by extensive consultation with the community on priorities and preferences. We have to overcome the 'colonial hangover' that still leaves its mark. Health investment is still concentrated in the capital city, Kuala Lumpur, and in other cities. It is a hospital-centred system. The colonial hierarchy persists with its apex in the Capital city. Government servants are separated from other citizens in access to healthcare. Finally, health has low budget priority. However, there is good reason for optimism. A remarkable consensus has emerged between health professionals and government experts on the shape of a future health system for Malaysia. This is a considerable achievement, in contrasts to the bitter divisions that have characterised changes in other countries. There is still a long road ahead, so it is most important that the leaders of the Malaysian community make clear their preferences and priorities. The Ministry of Health speaks of a 'transformation' of the health system, and advises the medical profession to prepare for radical changes in their behaviour, and in the delivery and funding of healthcare. Four strands of change can be discerned. One, all the professions of health will have to provide evidence of competency, and must learn to monitor the quality of service they provide. Second, the great divide between public and private sector will end, and we have to find ways to integrate our services. Third, a Health Financing Authority may be established, providing hope to all Malaysians that their basic health needs will be met. As citizens, we have the duty to ask that there will be no 'privatisation' of the Health Financing Authority, or of the health facilities of the Ministry of Health. There is a fourth change, arising from our entry into the World Trade Organisation (WTO). Foreign investors will demand access to Malaysian markets, under a so-called 'Globalisation'. All professions will be affected. More serious is the danger of commercialised health care that will damage the health of the less well-off in our country, and raise the cost of health for all of us. Health and education are most important concerns for all of us, yet it strange that as citizens we have contributed so little to shaping the sort of health system that we want for our families and for ourselves. I hope that this meeting is a new beginning.
Preliminary findings of a survey on the influences of institutional facilities on mothers in the post-partum period in hospital that affect breast-feeding were reported. It was observed that although advice on breast-feeding is now given, there is a conflict between advice and practice so that the advice has been ritualistic. There is a lack of follow-up on advice, and the mother is not helped and encouraged to breast-feed and to overcome her initial disappointment and difficulties. It was also pointed out that the artificial milk-food industry exercises a negative influence through maternity ward staff by provision of milk samples to maternity units and by visits of their sales staff to the mothers. It was emphasised that the hospital factor could be an important cause of failure of the mother to breast-feed.
Republished in: Teng CL, Khoo EM, Ng CJ (editors). Family Medicine, Healthcare and Society: Essays by Dr M K Rajakumar, Second Edition. Kuala Lumpur: Academy of Family Physicians of Malaysia, 2019: 27-30