10KM Rule May Disrupt Care, Harm Patients: Doctors

Malaysia lacks a central electronic medical records system, while patients may also be hesitant to temporarily switch health care providers.

KUALA LUMPUR, April 3 — The government’s 10km travel limit on seeking medical treatment may endanger patients who see their regular doctors further away, especially those with chronic conditions, medical professionals said.

They also said certain treatments, depending on the individual case, can’t be postponed for two weeks, after Health Minister Dr Adham Baba gazetted a regulation to prohibit people from getting treated or buying medicines at facilities located more than 10km from their homes until April 14, amid the Covid-19 epidemic in Malaysia.

“Has anyone thought about the patient? It appears not,” said Dr Milton Lum, former president of the Federation of Private Medical Practitioners’ Associations, Malaysia (FPMPAM).

He told CodeBlue that patients usually have to travel some distance to seek health care, whether in the hospital or clinic. A patient treated at Hospital Canselor Tuanku Muhriz UKM (HCTM) in Cheras, for example, may be staying in Petaling Jaya or in Klang located more than 10km away. Employees’ panel hospitals and clinics, too, may be over 10km from their homes.

“Patients with chronic conditions like diabetes, cholesterol, heart problems — they have to be managed by a particular clinic or particular hospital. Are you asking them to shift care to someone who’s nearer their home? There’ll be a lot of disruption,” Dr Lum said.

Even if a particular treatment is available in a facility that is closer to a patient than the hospital or clinic they patronise further away, Dr Lum pointed out that trust in one’s regular health care provider and the doctor-patient relationship superseded convenience. A person, for example, may want to continue seeing the general practitioner (GP) she has been seeing for years, instead of temporarily switching to a new one closer to home.

Dr Lum urged the government to make an exemption for both health care providers and patients from the 10km movement restriction, which also applies to purchasing food and daily necessities.

Dr Nirmala Bhoo Pathy, associate professor of clinical epidemiology and public health at Universiti Malaya, speaks at the Second Federation of Private Medical Practitioners’ Associations, Malaysia (FPMPAM) Malaysian Health Care Conference in Kuala Lumpur on August 31, 2019. Picture by Boo Su-Lyn.

Dr Nirmala Bhoo-Pathy, a public health medicine specialist from Universiti Malaya’s Faculty of Medicine, said it was difficult for patients to temporarily get care close to their home because Malaysia lacked a central electronic records system like in the United Kingdom.

“So, this is going to cause a lot of problems in identifying the kind of drugs, and their doses,” she told CodeBlue.

She also said diabetes medications, for example, are only available in certain facilities, citing a patient who stays in Manjung, Perak, but gets diabetic drugs from a highly specialised team in Putrajaya as these treatments are not available in government facilities in his residence.

A person with diabetes can’t stop taking insulin for two weeks, which would affect patients if they run out of prescriptions during the MCO.

“Disruptions in continuity of care may have long-term medical and non-medical impacts on patients and their families.”

Dr Nirmala Bhoo-Pathy, public health medicine specialist, Faculty of Medicine, Universiti Malaya

Dr Nirmala stressed that continuity of care was the cornerstone of managing chronic disease.

Association of Private Hospitals of Malaysia (APHM) president Dr Kuljit Singh said the majority of private hospitals with multi-disciplinary subspecialties are located in the Klang Valley, while others are based in Penang Island, Penang, and Johor Baru, Johor.

Many private patients, he said, have long-term follow-ups, with their medical records in hospitals that are likely more than 10km from their homes.

“So it’s impractical for a patient, for example, from Damansara not to come to Gleneagles or Prince Court, which is definitely more than 10km. You don’t expect him to see a new specialist and restart the whole thing because there are no medical records,” Dr Kuljit told CodeBlue.

States like Sabah and Sarawak don’t have many private hospitals, while even most public hospitals are further than 10km from patients’ residence in these geographically large states. Other states in peninsular Malaysia, like Terengganu, Kelantan, Perlis, and Kedah also mainly have just one private hospital, located in their capitals.

“Some exceptions need to be made for medical patients. They should at least show medical cards, appointment cards, email, or WhatsApp or SMS to show that they have a thing. So, flexibility must prevail because some of these patients need to continue medication, and medications may only be available in those hospitals,” said Dr Kuljit, noting that patients can’t get drugs from a local pharmacy without a doctor’s prescription.

Dr Kuljit Singh, President of Association of Private Hospitals Malaysia. Picture courtesy of Dr Kuljit Singh.

When asked if it was fine to postpone some treatments, he said it depended on clinical judgment, noting that perhaps treatment for early or mild cataract could be delayed.

“Some conditions are okay now, but they might become bad in two weeks’ time or one month’s time, you wouldn’t know,” he said. “A blanket ruling is actually dangerous.”

Some patients, for example, may have other health problems, so the best time to do surgery is now because their diabetes and blood pressure are under control, instead of waiting for two weeks when the patients’ condition may worsen and complicate an operation.

“The question is, two weeks maybe can, one month can, but what if it goes beyond that?” Dr Kuljit said.

“So, we need to make a decision at some point. These patients already waited for a month, these electives may turn into an emergency one day.”

The MCO was imposed on March 18 and has been extended to April 14. Health director-general Dr Noor Hisham Abdullah said yesterday that the government would decide on April 10 if it would continue the MCO beyond April 14, saying that it was still too early now to conclude if the coronavirus epidemic could be contained. Over 3,100 people in Malaysia have been infected with Covid-19, while 50 have died.

Former Deputy Health Minister Dr Lee Boon Chye said he didn’t understand the need for the 10km-radius restriction on seeking medical services, pointing out that there is already an existing interstate travel ban under the nationwide Movement Control Order (MCO).

“Furthermore for rural areas — 10km is a small distance. Even for urban — your regular doctor may be more than 10km away. Or are there hospital facilities within 10km radius of any location!” Dr Lee, who is also Gopeng MP from Perak, told CodeBlue.

“If you are stranded at Pangkor Island — you have to violate MCO to get to Sri Manjung Hospital. If you are at Malim Nawar Perak, the nearest hospital is more than 10km. We have not talked about other government facilities yet!”

Klang MP Charles Santiago from DAP. Picture from fb.com/charlessantiago.

Klang MP Charles Santiago said heart patients in his constituency were referred to Selayang and Serdang hospitals, while the cancer centre for children was in Kuala Lumpur.

“People have to travel more than 10km from Klang,” the DAP lawmaker told CodeBlue.

The National Cancer Society of Malaysia (NCSM) said it has received reports of four cancer patients getting turned around at police roadblocks in the Klang Valley, Melaka, and the East Coast after the 10km travel limit was imposed on March 31.

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