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: 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
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.
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
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: 11-15
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: 23-26
This study determined the costs associated with tuberculosis (TB) diagnosis and treatment for the public health services and patients in Sana'a, Yemen. Data were collected prospectively from 320 pulmonary and extrapulmonary TB patients (160 each) who were followed until completion of treatment. Direct medical and nonmedical costs and indirect costs were calculated. The proportionate cost to the patients for pulmonary TB and extrapulmonary TB was 76.1% arid 89.4% respectively of the total for treatment. The mean cost to patients for pulmonary and extrapulmonary TB treatment was US$ 108.4 and US$ 328.0 respectively. The mean cost per patient to the health services for pulmonary and extrapulmonary TB treatment was US$ 34.0 and US$ 38.8 respectively. For pulmonary and extrapulmonary TB, drug treatment represented 59.3% and 77.9% respectively of the total cost to the health services. The greatest proportionate cost to patients for pulmonary TB treatment was time away from work (67.5% of the total cost), and for extrapulmonary TB was laboratory and X-ray costs (55.5%) followed by transportation (28.6%).
Matched MeSH terms: Primary Health Care/economics*
As Electronic Medical Records (EMRs) have a great possibility for rising physician's performance in their daily work which improves quality, safety and efficiency in healthcare, they are implemented throughout the world (Boonstra and Broekhuis, 2010). In physician practices the rate of EMRs adoption has been slow and restricted (around 25%) according to Endsley, Baker, Kershner, and Curtin (2005) in spite of the cost savings through lower administrative costs and medical errors related with EMRs systems. The core objective of this research is to identify, categorize, and analyse meso-level factors introduced by Lau et al, 2012, perceived by physicians to the adoption of EMRs in order to give more knowledge in primary care setting. Finding was extracted through questionnaire which distributed to 350 physicians in primary cares in Malaysia to assess their perception towards EMRs adoption. The findings showed that Physicians had positive perception towards some features related to technology adoption success and emphasized EMRs had helpful impact in their office. The fuzzy TOPSIS physician EMRs adoption model in meso-level developed and its factors and sub-factors discussed in this study which provide making sense of EMRs adoption. The related factors based on meso-level perspective prioritized and ranked by using the fuzzy TOPSIS. The purpose of ranking using these approaches is to inspect which factors are more imperative in EMRs adoption among primary care physicians. The result of performing fuzzy TOPSIS is as a novelty method to identify the critical factors which assist healthcare organizations to inspire their users in accepting of new technology.
A proportion of patients with acute viral fever with thrombocytopaenia does not necessary have dengue infection. Managing them indiscriminately as dengue infection may not be appropriate. The prevalence of this problem is not exactly known. The objective of this study is to determine the prevalence of acute non-dengue febrile thrombocytopaenia among adult patients presenting with acute non-specific febrile illness in an outpatient setting. This was a clinic-based cross sectional study. Consecutive patients presenting with non-specific febrile illness of less than two weeks were selected from the Primary Care Centre of Hospital Universiti Kebangsaan Malaysia (HUKM) and the Batu 9 Cheras Health Clinic. Full blood count was done on the day of visit and dengue serology was done on day five of illness for all patients enrolled. Seventy three patients participated in this study from May to November 2003. Among the patients, 35 (47.9%) were noted to have thrombocytopaenia. Fourteen (40%) patients with thrombocytopaenia were serologically negative. The prevalence of non-dengue febrile thrombocytopaenia was 19.2%. A significant number of patients with acute non-specific febrile illness with thrombocytopaenia were negative for dengue serology. These patients should be differentiated from those with acute febrile thrombocytopaenia, as they might differ in their natural history from those with dengue infection, and hence require different management strategies.
Study site: Primary Care Centre of Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM) and the Batu 9 Cheras Health Clinic.
Neck mass is a common condition in primary care. The most common affected area is the cervical lymph node. The neck region is also prone infection as structurally the nodes and spaces are in close contact with the upper respiratory tract and the alimentary tract. Oral cavity is one of the most common route for harbouring infection. Poor oral hygeine and periapical dental problems are the main causes. Thus, it is important to perform a complete oral cavity examination even when trismus is present. Besides dental caries, floor of the mouth should be inspected for oedema that may impose threat to the upper airway. We report a case of Ludwig's angina originating from a periapical lesion of the lower molar stressing the importance of oral examination in patient with neck mass.