When a doctor is required to go to court, he does so with some amount of trepidation. The degree of trepidation increases in direct proportion as to whether he is required to be a witness or a defendant. The practice of medicine on the other hand requires the patient to have full confidence and open out his secrets to the doctor. If you hold back vital information, the diagnosis may be entirely different to the disease that you have. Lawyers who enter hospitals may also do so with some trepidation, maybe even more so than doctors who enter courts, as their lives are at stake. There is a perception that medico-legal matters are on the rise. We may put forward a few reasons for this: 1. A better educated and increasingly assertive public with greater awareness of the medical and legal systems; 2. Rising expectations of medical results; 3. Commercialization of medical care with erosion of the doctor-patient trust relationship. This paper will discuss the reasons for and the ways to address medical errors as well as explore the reasons for defensive medicine. The argument is put forward that public education programs on the risks inherent in some of the new advances in treatment modalities and surgery and professional education programs on the need for obtaining the patient's informed consent to such treatment is needed. Public advocacy programs to demonstrate the problems in medicine and the delivery of health care resulting from strict cost containment limitations should be carried out. There is also the need to enhance the level and quality of medical education for all physicians, including improved clinical training experiences. Doctors' must manage their clinical affairs in a professional manner without being dictated to by the legal system. However, it would be wise to take note of the views expressed by learned counsel and judges in their courts. The middle road is always the best and we must never be extreme in our viewpoints. We must always remember the patient is why we are here and the patient must never suffer in the process while we formulate our responses to the medico-legal challenges that lie ahead.
A systematic approach to death registration and reporting is essential for studies and comparison within or between countries. One of the accepted methods in the system is to have medically certified death. The objective of this study was to improve the proportion of medically certified death (MCD) in the state of Malacca. Structured questionnaires were used by Medical Assistants (MAs) in the investigation of the cause of death for non-medically certified deaths. Data on certification of death by MAs in Malacca was analysed and compared with the total deaths obtained from the Department of Statistics. Possible determinants of deaths were investigated. Total deaths in the state of Malacca during the study period from 2000 - 2001 were 5941. About 35% (883/2493) of the total deaths in year 2000 and 45% (1550/3448) in 2001 certified by MAs were examined. By districts, 50.6% were certified in the district of Malacca Tengah, 13.4% Jasin and 36.0% Alor Gajah in 2000; 65.9% occurred in Malacca Tengah, 11.0% Jasin and 23.2% Alor Gajah in 2001. This project helped to increase the percentage of the medically certified deaths in Malacca from 49.8% in year 1998, 49% in 1999 to 73% in 2000 and 85% in 2001. The proportion of MCD in Malacca in 2000 (73%) may be increased to 93% if all MCDs done by MAs were accepted by the Department of Statistics. There is still a high proportion (23.6%) of ill-defined conditions such as old age and sudden death being diagnosed by MAs. The study shows that the quality of mortality data particularly in the percentage of medically certified deaths can be improved.
A hospital-based case-control study of viral encephalitis was carried out at Port Dickson Hospital, in the state of Negeri Sembilan, Malaysia. Between March and May 1999, 69 clinically diagnosed viral encephalitis cases and 31 controls were interviewed. Job histories on pig farming activities were assessed by a group of epidemiologists and veterinary surgeons. Results show that among clinical cases of viral encephalitis, 52 (75.4%) cases were diagnosed to have Nipah virus infection based on positive serology for antibodies to the cross-reacting Hendra virus antigen. The Nipah virus encephalitis was significantly associated with a history of working in pig farms (p < 0.001, OR = 196.0, 95% CI = 20.4-4741.6), history of contact with animals (p < 0.001, OR = 38.3, 95% CI = 8.2-209.0) and with history of direct contact with pigs (p = 0.002, OR = 34.4, 95% CI = 2.6-1,024.4). The Nipah virus infection was also significantly associated with history of feeding/cleaning pigs (p < 0.001, OR = 102, 95% CI = 11.9-2,271.5). These results provide evidence that involvement in pig farming activities is significantly associated with the risk of getting Nipah virus infection. They are potential risk factors for Nipah virus transmission in the major pig-producing area of Bukit Pelandok, Port Dickson Negeri Sembilan.