KUALA LUMPUR, Oct 2 — Dr Noor Hisham Abdullah has criticised MediExpress (Malaysia) Sdn Bhd’s instruction to panel hospitals to prioritise local anaesthesia (LA) over general anaesthesia (GA) for operations.
Dr Noor Hisham, a former Health director-general from the Ministry of Health (MOH) and current chairman of UCSI Healthcare Group, told the third-party administrator (TPA) not to interfere with clinical decision-making.
“MediExpress should not cross the line of the medical profession. We cannot afford to compromise on quality and safety of clinical care,” said Dr Noor Hisham in a Facebook comment on a CodeBlue article about MediExpress’ directive.
When asked for further comment, the senior consultant breast and endocrine surgeon told CodeBlue that clinical matters should be left to professionals.
“It’s not one size fits all. Professional clinical judgement is the key to safety,” said Dr Noor Hisham.
“As I said, we need to have a stringent professional assessment on a case to case basis. At the end of the day, safety comes first.”
UCSI Hospital in Port Dickson, Negeri Sembilan – where Dr Noor Hisham currently practises as a resident consultant breast and endocrine surgeon – is among the over 200 private and university or semi-government hospitals nationwide on MediExpress’ panel, besides government hospitals under the MOH.
CodeBlue reported earlier today a directive by MediExpress (Malaysia) Sdn Bhd in a memo yesterday to panel hospitals to prioritise LA as the first-line anaesthesia modality over GA for procedures and surgeries, requiring providers to provide a “detailed” justification of the need for general anaesthesia.
Multiple doctors across specialties slammed MediExpress, with a consultant urologist saying that it looked like TPAs and health insurers are neglecting standards of care (SOC). Many SOCs, he said, are understood and practised, including types of anaesthesia chosen for certain procedures of which GA is a given in general.
“However, with advancement, certain procedures may be done under LA or sedation. But, looking at guidelines, it usually is clearly stated in terms of options available,” wrote the urologist on Facebook.
“At the end of the day, it goes back to shared decision making and patient autonomy. Questioning that part of it makes it look like the clinicians are doing something out of the norm.”
A paediatrician pointed out that things sometimes change on the operating table, saying: “Sometimes, we initially plan under spinal, for Caesarian as an example, but for some reason we need to convert to GA on table. So we need to delay until insurance approve? Or the total cover can be declined later?”
A consultant anaesthesiologist, commenting on Facebook, told doctors working for TPAs to leave clinical decision-making to clinicians and to engage them if they were unsure about the rationale for clinicians doing certain things.
In response, another anaesthesiologist said sarcastically in a post for the top management of TPAs to make LA their first choice. “If cannot tolerate the pain, ask their in-house TPA doctors to treat then; seems so clever.”
An internal medicine physician, commenting on CodeBlue’s report headlined, “TPA Instructs Panel Hospitals To Prioritise Local Over General Anaesthesia”, wrote on Facebook that he thought he was reading The Onion, a satirical site.
“The headline seemed to be a joke. Then I read the article and I felt sick. Ridiculous.”
A paediatric surgeon sarcastically posted on Facebook that MediExpress’ top management should be invited for free surgery under local anaesthesia, “perhaps any laparotomy, cholecystectomy, prostate surgery or any kinds of it.”
TPAs and health insurers are currently unregulated in Malaysia, in terms of the conditions of coverage, premium rates, etc. The only insurance aspect being regulated by Bank Negara Malaysia is fraud.
Correction note: An earlier version of this article erroneously described Dr Noor Hisham as a visiting surgeon at UCSI Hospital. He is a resident surgeon at UCSI Hospital. The article has been corrected.
