Adolescent pregnancy is associated with long term medical and sociological problems. For intervention, it is important to have information on their profile and obstetric outcome. A study was conducted in 1999 on teenage mothers compared to mothers in the 20-34 year age group. Antenatal records of all these mothers registered in a Malaysian semi-rural Health Clinic in 1998 were reviewed and the relevant information was analysed using descriptive statistics and chi-square for comparison in SPSS 7.5. Only 402 (80.9%) of the 497 antenatal records could be included. There were 40 (9.95%) adolescent pregnancies and 362 (90.05%) pregnancies in mothers aged 20-34 years. Pregnant adolescents were more likely to be Malays (85% versus 66%), unmarried (65% versus 5.5%) and less educated (32.5% versus 12.1%). They have a significantly lower rate of contraceptive usage (2.5% versus 20.2%) and tend to come late for their first antenatal visit (55% versus 18.5%). Their pregnancy complications of anaemia and pregnancy induced hypertension were no worse. But they had a significantly higher preterm delivery rate (37.5% versus 21.8%) and their babies were more likely to have low birth weight (32.5% versus 9.9%). Based on this preliminary finding, further investigations should be carried out and polices should include programmes targeted for this group.
This is a prospective study of clinical questions generated in primary care consultations and a comparison of two approaches to answering those clinical questions. Twenty-one doctors in a university-based primary care clinic submitted 78 clinical questions arising from patient consultations during 24 clinic days (0.01 question per patient encounter). These doctors subsequently found answers to 40% of their questions but were satisfied with only 67% of these answers. The investigators were able to provide answers for 95% of the questions asked and the doctors rated these answers as satisfactory in 86% of instances. Answers obtained by investigators had significantly higher satisfaction score than those obtained by doctors' search (p = 0.002). The two main findings of this study are (1) almost all questions arising in clinic setting could be answered by intensive search; (2) answers found by intensive searches were judged to be more satisfactory than those found routinely by doctors. Provision of an information retrieval service in addition to training in the searching and appraisal of medical literature are possible solutions to the information needs of busy clinicians.
Study site: Primary Care Clinic,
University Hospital Kuala Lumpur i
There is universal concern on the current inequitable coverage and low quality of health care. The lead roles of medical practitioners in health care and how they are prepared for such roles are being re-examined in many countries. This paper attempts to rationalise the need to reorientate medical education towards primary health care, and to suggest possible emphasis and direction for change.
We assessed the effectiveness of an educational intervention in reducing antibiotic prescribing in public primary care clinics in Malaysia. Twenty-nine medical officers in nine clinics received an educational intervention consisting of academic detailing from the resident Family Medicine Specialist, as well as an information leaflet. The antibiotic prescribing rates were assessed for six months - three months before and three months after the intervention. A total of 28,562 prescriptions were analyzed. Among participating doctors, general antibiotic prescribing rates for pre- and post-intervention phases were 14.3% and 11.0% (post-intervention vs pre-intervention RR 0.77, 95% CI 0.72 to 0.83). The URTI-specific antibiotic prescribing rates for pre- and post-intervention phases were 27.7% and 16.6%, respectively (post-intervention vs pre-intervention RR 0.60, 95% CI 0.54 to 0.66). No significant change in antibiotic prescribing rates was observed among primary care practitioners who did not participate in the study. This low cost educational intervention using both active and passive strategies focusing on URTI produced a statistically significant (and clinically important) reduction in antibiotic prescribing.
Study site: Klinik Kesihatan, Negeri Sembilan, Malaysia
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
Evidence thus far still supports the contention that fish derived omega-3 fatty acids, EPA and DHA, are good for heart patients. But this controversy tells us something about the medical research, and the acquisition and application of medical knowledge. Being scientists, doctors try to perform studies as rigorously as possible with randomised, placebo-controlled trials and using tests of statistical significance. But since the studies are on humans, with all their individual differing habits and inconsistencies, different results are produced by different researchers. And so while medicine is a science, in that the trials are scientifically conducted, the interpretation of the results, and in particular its application for the individual patient, is very much an art. A good doctor, like the good artist, must spend much time, energy and effort sieving through the good from the not so good data before coming out with the correct picture. Only by keeping an unbiased, inquisitive mind can the evidence be reviewed to solve the problem at hand. Almost always, the balance of data will favour a particular stand. In this day when newspapers are full of medical articles, a family physician has to be educated, interested and inquisitive to be a source of accurate and relevant information for the patients.
Otitis media is a common disease presenting to family practitioners all over the world. There have been many changes in the way these patients were managed over the years. This article attempts to provide an overview to family physicians regarding the latest approach in managing this common condition. Keywords: Otitis, otitis media, otoscopy, eardrops.
Job satisfaction is defined as pleasurable or positive emotional state which results from the appraisal of one’s job or job experience. It is often determined by how well outcome meet or exceed expectations. There are many factors which are related to job satisfaction among family physicians. Data on satisfaction among family physicians varies from country to country. This study aimed to determine the level of job satisfaction among family physicians in Malaysia and its associated factors. A cross sectional study was performed among 117 family physicians in Malaysia between July 2012 and December 2012. A questionnaire consists of socio-demographic characteristic, professional and health clinic characteristics and Warr-Cook-Wall job satisfaction scale was used. The results showed that 85% of Malaysian family physicians are satisfied with their job. They are mostly satisfied with hours of work, colleagues and fellow workers, and freedom to choose own method of working. They are least satisfied with physical working condition, rate of pay and recognition. Female gender and less number of health clinics in-charged were associated with increased in overall job satisfaction. Most of the family physicians in Malaysia are satisfied with their job. However there are certain areas that should be looked into which are physical working condition, rate of pay and recognition. Malaysian family physicians should receive equal career opportunity, promotion and salary scale like other specialties
Principally, there are two problems in prescribing . They are prescribing decision and prescribing writing process, which contribute to 39% and 61% of prescription problems respectively. The first type of problem has more serious consequences and may even cause mortality. In that study, the issue is the appropriateness of prescribing antibiotics for upper respiratory tract infections (URTI). Over-prescribing of antibiotics in primary health care, especially for respiratory tract diseases is a problem worldwide . There are concerns about the rising prevalence of antibiotic resistant bacteria, cost and the potentially harmful consequences of unnecessary prescription such as drug interaction and allergy.
Primary care providers play an important gatekeeping role in ensuring appropriate referrals to secondary care facilities. This cross-sectional study aimed to determine the level, pattern and rate of referrals from health clinics to hospitals in the public sector, and whether the placement of resident family medicine specialist (FMS) had made a significant difference. The study was carried out between March and April in 2012, involving 28 public primary care clinics. It showed that the average referral rate was 1.56% for clinics with resident FMS and 1.94% for those without resident FMS, but it was not statistically significant. Majority of referred cases were considered appropriate (96.1%). Results of the multivariate analysis showed that no prior consultation with senior healthcare provider and illnesses that were not severe and complex were independently associated with inappropriate referrals. Severity, complexity or uncertain diagnosis of patients' illness or injury significantly contributed to unavoidable referrals. Adequate facilities or having more experienced doctors could have avoided 14.5% of the referrals. The low referral rate and very high level of appropriate referrals could indicate that primary care providers in the public sector played an effective role as gatekeepers in the Malaysian public healthcare system.
Aim: To explore primary care practitioners' experiences and feelings about treating their own family members. Methods: A qualitative study was carried out using focus group discussions. Five sessions were held among 22 primary care practitioners (five academic staff members and 17 medical officers). Results: Most participants treated their family members, especially their immediate families. They considered factors such as duration and severity of illness before seeking consultation with other doctors. Some participants felt satisfied knowing that they were able to treat their own families. However, most felt burdened and uncomfortable in doing so, mainly due to the fear of error in diagnosis and management. They were concerned that strong emotions may make them lose objectivity. Many were aware that negative outcomes resulting from their treatment may affect future relationships. Conclusions: While some doctors were comfortable about treating their own families, some faced significant conflict in doing so. Their decisions depended on the interplay of factors including the doctor, the family member and the relationship they share. A doctor needs to consider the potential conflict that may arise when carrying out one's professional role and at the same time being a concerned family member. Key words: doctors, family, Malaysia, primary care, self-treat.