BACKGROUND: The College of General Practitioners of Malaysia and the Royal Australian College of General Practitioners held the first Conjoint Member of the College of General Practitioners (MCGP)/Fellow of Royal Australian College of General Practitioners (FRACGP) examination in 1982, later renamed the Conjoint MAFP/FRACGP examinations. The examination assesses competency for safe independent general practice and as family medicine specialists in Malaysia. Therefore, a defensible standard set pass mark is imperative to separate the competent from the incompetent.
OBJECTIVE: This paper discusses the process and issues encountered in implementing standard setting to the Conjoint Part 1 examination.
DISCUSSION: Critical to success in standard setting were judges' understanding of the process of the modified Angoff method, defining the borderline candidate's characteristics and the composition of judges. These were overcome by repeated hands-on training, provision of detailed guidelines and careful selection of judges. In December 2013, 16 judges successfully standard set the Part 1 Conjoint examinations, with high inter-rater reliability: Cronbach's alpha coefficient 0.926 (Applied Knowledge Test), 0.921 (Key Feature Problems).
INTRODUCTION: Cardiovascular disease is a major cause of morbidity and mortality. Primary care doctors as general practitioners (GPs) play a central role in prevention, as they are in contact with a large number of patients in the community through provision of first contact, comprehensive and continuing care. This study aims to assess the adequacy of cardiovascular disease preventive care in general practice through a medical audit.
METHODS: Nine GPs in Malaysia did a retrospective audit on the records of patients, aged 45 years and above, who attended the clinics in June 2005. The adequacy of cardiovascular disease preventive care was assessed using agreed criteria and standards.
RESULTS: Standards achieved included blood pressure recording (92.4 percent), blood sugar screening (72.7 percent) and attaining the latest blood pressure of equal or less than 140/90 mmHg in hypertensive patients (71.3 percent). Achieved standards ranged from 11.1 percent to 66.7 percent in the maintenance of hypertension and diabetic registries, recording of smoking status, height and weight, screening of lipid profile and attaining target blood sugar levels in diabetics.
CONCLUSIONS: In the nine general practice clinics audited, targets were achieved in three out of ten indicators of cardiovascular preventive care. There were vast differences among individual clinics.
Despite time, mobility, knowledge and other constraints, it is still possible for General Practitioners to play an active role in Palliative Care. This article offers various roles where GP can play. Differences between hospice, palliative medicine, palliative care are discussed. Suggestions are made on where to seek formal or informal education on palliative care. Key Words: role, hospice, palliative medicine, palliative care, illness, sickness
Recognizing barriers to managing sexual issues makes it more likely that effective ways to overcome them will be found. In Malaysia, where discussion of sexual issues is taboo, sociocultural factors may influence how physicians manage patients with these types of problems. This article focuses on the challenges encountered by 21 Malay family physicians when women experiencing sexual problems and female sexual dysfunction (FSD) attended their clinics, an uncommon occurrence in Malaysia, despite their high prevalence. This qualitative study employed a phenomenological framework and conducted face-to-face in-depth interviews. Three main barriers to managing women with sexual problems were identified that can hinder assessment and treatment: insufficient knowledge and training; unfavorable clinic environments; and personal embarrassment. Some barriers were associated with physician characteristics but many were systemic. These were further evaluated using social cognitive theory. Professional attitudes appear important as those physicians with an interest in managing women's health seemed to make greater effort to explore issues further and work to gain trust. Physicians who appeared indifferent to the impact of FSD showed greater reluctance to find solutions. Systemic issues included unfavorable clinical settings, lack of training, and lack of local evidence. Any strategy to address FSD needs to be underpinned by appropriate policies and resources.
A common bony protrusion that occurs over the hard palate is sometimes mistaken for a malignancy especially when it is large. This bony growth is a torus palatinus (TP), which is a benign bony prominence over the hard palate. It occurs most commonly in bilateral multiple form, and is often located at the canine to premolar area. A basic knowledge of the assessment and management of TP is important, particularly for the first-line family physician to ensure that the correct information is given to the patient.
Perception of healthcare providers who worked with family medicine specialists (FMSs) could translate into the effectiveness of primary healthcare delivery in daily practices. This study examined perceptions of public healthcare providers/professionals (PHCPs) on FMSs at public health clinics throughout Malaysia. This was a cross-sectional study in 2012-2013 using postal method targeting PHCPs from three categories of health facilities, namely health clinics, health offices and hospitals. A structured questionnaire was developed to assess PHCP's perception of FMS's clinical competency, safety practice, ethical and professional values, and research involvement. It consists of 37 items with Likert scale of strongly disagree (a score of 1) to strongly agree (a score of 5). Interaction and independent effect of the independent variables were tested and adjusted means score were reported. The participants' response rate was 58.0% (780/1345) with almost equal proportion from each of the three public healthcare facilities. There were more positive perceptions than negative among the PHCPs. FMSs were perceived to provide effective and safe treatment to their patients equally disregards of patient's social background. However, there were some concerns of FMSs not doing home visits, not seeing walk-in patients, had long appointment time, not active in scientific research, writing and publication. There were significant differences in perception based on a respondent's health care facility (p
Osteopoikilosis is a rare bone dysplasia which is inherited as an autosomal dominant trait with a prevalence of less than 0.1 per million.1 It is characterised by dense ovoid or circular spots in cancellous bone which may appear at birth or during skeletal growth. It is usually found in the metaphyseal and epiphyseal regions of long bones, the carpals and tarsals, the end of large turbular bones and around the acetabula. It is clinically asymptomatic and occasionally associated with hereditary multiple exostosis and dermatofibrosis lenticularis disseminata. It is not associated with spontaneous fractures and treatment is unnecessary. However a case of osteosarcoma developing in a man with osteopoikilosis has been reported. The first case of osteopoikilosis was reported in Malaysia four years ago in a 25 years old lady who is also of Indian descent. It would be interesting to know if these two patients are related. Since the bone lesions could easily be mistaken for metastatic disease, it is important that family physicians be aware of the benign nature of this condition.
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.
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.
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.
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
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.
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.