MMA & Our Health Care System: Let Us All Show A Greater Commitment

By Dr David KL Quek

dquek@pc.jaring.my

Of late, there have been increasingly loud rumblings that the MMA is not doing enough. Criticisms are being leveled at the Association and at its leadership, that we have badly misrepresented the medical profession. Worse still, some have even accused the MMA outright that it has sold-out on doctors on the many issues which seemed to have inundated our profession, recently.

FOMEMA, Managed Care and the Private Healthcare and Services Act were the most contentious issues, which have generated the most heat. Unfortunately, the MMA has been placed at the dock of this intense recrimination. It is certainly most unjust and unfair of doctors to arraign the MMA, without first coming forward to try and fully understand the actual issues themselves and their many intricacies. It does nobody any good to simply be an armchair critic.

" Neither let us be slandered from our duty by false accusations against us, nor frightened from it by menaces of destruction to the government, nor of dungeons to ourselves. Let us have faith that right makes might, and in that faith let us to the end dare to do our duty as we understand it." Abraham Lincoln

No one can pretend to understand all the relevant goings-on within the MMA and its activities, unless we take the trouble to learn about them, by becoming interested participants. Countless debates, long dreary but necessary meetings, voluntary research and compilation of reports/studies, and difficult representations made by our MMA leaders with officials from the Ministry of Health or concerned governmental agencies, such as the Economic Planning Unit, are all the order of the day. Besides that, our leaders have to temper the medical profession's interest as well as to engage in diplomatic compromise, so as to gain whatever little concessions, on many an issue.

The trouble is, most of the tremendous legwork and actual drudgery of point-by-point representation undertaken by MMA, is not always apparent for the casual and uninterested doctor out there. It is only when issues begin to impinge upon their practice or livelihood, and their so-called perceived "rights" as doctors, that, they react, often as cry-babies, as if their toys have suddenly been taken away!

But, doctors must get off their cribs and get involved! They must come out of their neat, comfortable and provincial shells, to let their opinions be heard. They must come forward in numbers which will be seen to be the strength of our true medical profession. Doctors should rally behind the MMA wholeheartedly, and through that sheer force of unity and purpose, we can surely be heard, loudly and noticeably. We must be seen to be heard. Otherwise, we will be ignored.

We cannot just murmur along, muttering dissatisfaction, and indulge in negative but silent head shaking, without becoming part of the blame as to why we doctors have been sidelined and discounted in the state plans concerning Healthcare policies. Why have we led ourselves into this marginalized position, where we have only a puny say or representation? Why couldn't we have a better lobby to make things work better for us doctors? Why doesn't the government and authorities that be, listen to our legitimate grouses and well-meaning ideas? Why have health plans and decisions strongly opposed by the MMA been pushed down our throats?

The sad but painful truth is because we as a medical profession, don't count for much as a political force. We appear to be lame ducks which can be led to the water, no matter what. And we appear to be fractious and divided - unable to present a strong or plausible front of unity of purpose and ideals, notwithstanding that we represent more than three-fourths of our doctors!

In many ways we have been lucky, that the MMA has many dialogue friends within the Ministry of Health. The Minister of Health and the Director-General of Health, have been most attentive to our concerns, and have made special efforts to accommodate our points of view and our misgivings. But because others too have their say, our voices have often been muted, in the rush to privatize and mercantilize our healthcare system. However, think how much more strength of purpose we would have if we were all more united, and more ready to support the MMA all the way?

We should participate more directly so that we can see for ourselves the workings of the MMA, our Association. Come join in the innumerable committees, attend the Annual General Meeting, and other seminars and workshops which are being organized ever so often. Then we can see that our MMA leadership has for the past several years, been very actively involved in making our voices heard on many, if not, all of these issues. But, we need the strength of numbers to show that we mean business, and that we are prepared to back our elected leadership so that our legitimate interests will not become bamboozled, and sidetracked.

We need commitment from everyone so that when we are negotiating any issue, we would not be overtaken by events which clearly portray our fractured and divided fraternity - that we have been betrayed by a sizable number who have chosen an easier path, who have acted for their own self-seeking financial interests. The MCOs and FOMEMA issues were clearly the ones where an impatient but sizable minority voted with their purse-strings in mind. In so doing, they have greatly undermined the strong hand that the MMA had, in trying to work out more equitable and ethical solutions with the powers that be.

"The voice of intelligence ... is drowned out by the roar of fear. It is ignored by the voice of desire. It is contradicted by the voice of shame. It is hissed away by hate and extinguished by anger. Most of all it is silenced by ignorance." Karl Menninger

The MMA has been rigorous in championing our medical profession's viewpoints, so much so that we have been accused of being too parochial and self-interested, of being anti-progress or even anti-governmental policies. We have also been regarded as being too self-serving in protecting our turf, which is of course, what we should be doing!

Thus far, our MMA has been quite steadfast in our ethical concerns and mission objective that we do need a more consistent and transparent Health Care Policy for the future. This is necessary to carry us Malaysians through into the next millennium. We have initiated seminars which had previously seen the revelation of the Ministry of Health's and EPU's vision of where our health care concerns are heading (Berita MMA, Nov 1996).

We have volunteered several detailed reports on our vision of a National Healthcare Plan and its Financing options, and presented them to the government. However, while some of our proposals have been accepted and incorporated in part into some of the new bills, many have not.

But, we continue to strive uncompromisingly to let our voices be heard. Resignation and withdrawal into one's cocooned practice cannot be the choice to help make a difference. Neither does berating or denigrating the MMA without being a constructive participant. Worse still, when one is not even a member!

There is still much more work to be done, and still greater challenges ahead which will mightily test our resolve and will. As concerned medical practitioners, we must all try to contribute more so that we can present a more concerted ONE voice. By participating and involving ourselves more, by being willing to sacrifice a little each, we stand to gain that much more in the future. Doctors must commit more to the MMA, and only then can the MMA truly become our profession's representative bulwark beacon for all.

"If we are to be a really great people, we must strive in good faith to play a great part in the world. We cannot avoid meeting great issues. All that we can determine for ourselves is whether we shall meet them well or ill." Theodore Roosevelt

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