A Day in Putrajaya

I spent the best part of the days today in Putrajaya being immersed into the new Dengue treatment guideline. Certainly there is a fight shift in the treatment algorhitm compared to the last guideline from 2009.

It creator looked neat on paper, easy to follow but my main worry was the input mainly came from the Government Doctors and I worry that they may not under stand limitation of these guideline in the private setting. The practice guideline which they talked about was more on the clinical part, and as a hospital maybe SJMC may need to modify some of the nursing pathways to accommodate. Patient placement in the ward is one of the issues, as the paying customers were more keen on the size of their rooms rather than the monitoring level which the nurses could provide.

The fluid resuscitation regime appeared more systematic, with emphasis on oral fluid intake. Criteria of admission may not apply to Subang as most of time patients were admitted on their request. I was about to ask about whether the Private hospital can be more selective on their admission but that was going to be thorny issue.

I was not able to attebd tomorrow's chapter I was afraid since I would be having clinic. The topic tomorrow appeared more ICU and inpatient orientated, which was more relevant to my practice. Clearly plenty to catch although my current practice did not differ much from the gist of the discussion. At least the need for platelet transfusion was laid out as I still think that there is too much pressure to transfuse either from lack of knowledge, fear if impending deterioration as well as pressure from patients and their relatives. I felt that we a plus have a poster at the Casualty spelling out that platelet transfusion does not cure dengue. The recent drama about papaya leaf also did not help matters.

On the whole, a fruitful day.

Back to UMMC

In the middle of my busy schedule, I received an invitation to give a talk at UMMC, something which I would not say no to. Sure enough, the day came and the topic given was somewhat tricky and not something I had touched before, although well within my realm.

I cancelled my Saturday morning clinic for this - my talk was about 11.30 - and was there in ample time to have a look around and listen to the other speakers which happened to be my former colleagues.

The irrepressible Mrs DhillonAfter delivering my talk, I had to make a quick exit as I had a referral to attend to at Park City, followed by meeting up with Anita after her reunion. We then had dinner after that for my Mother-in-law's birthday. Not much time to linger around after the talk.

None the less I felt honoured and it was certainly great to meet familiar faces and say hi to some old friends.

GST Fever

Although the deadline for GST registration was looming, there was no end to the confusion on the actual program. Almost every week, there were new amendment, and the uncertainly was really eating away on us Doctors. The rumours that GST would not be charged onto patients was going to be a myth, but the Customs were not doing a good job informing the public of this fact.

It looked like everybody would be in for a shock come April Fools Day. I could just imagine how my patients would act when they see their bill.

So, yesterday, I had another briefing given by a Tax agent on how to handle the incoming uncertainty. I left the room with more apprehension than I started. It would be a nightmare once the system is implemented, as the amount of paperwork and submission I had to do every quarter would be a headache. And apparently you must use the services of a certified tax agent for the auditing. This would cost extra money and frankly unnecessary. And the agent who gave us the briefing unashamedly asked us to use his service and buy his software to help us deal with the invoicing. And that was the point when I left the room ....

So, I'm bracing myself for a stuttering start when GST would be implemented. Not really saying that I was looking forward to it ...

GST

The topic on everybody's mind at the hospital lately had been GST. Or Goods and Services Tax. Akin to the VAT in the UK. Will we as Doctors be affected by this new ruling?

The management got the Consultants from Ernest and Young in to brief is on the impact it would have on us. It appeared that we would be exempted. It may sound good initially but that carried some major draw back. It seemed that we would not be able to charge our customers GST for services but we were subjected to GST for rentals and equipment. Not exactly fair wasn't it.

The ruling had yet to be tested, and there would be uncertainty at the beginning. Some teething problems. Praying that in the end things would work out for the better.

Talk Done

So far I had only been in the room, apart from breakfast this morning. Been busy finishing off the slides and also catching up on some sleep.

Now that my session was done, I plan to have a visit into town right after lunch. Check out would be at 2 pm for me. Flight home 5.45 pm.

Anita had alerted me on what to get but I doubt if I could make it. Let's see ...