Lim Baeley, Student
Musa Mohd Nordin, Paediatrician

Baeley: My name is Lim Baeley, I am a year 10 student and currently studying for my IGCSEs at Asia Pacific International School. As part of my Future Pathways Careers programme, I am seeking to complete a one-week placement to gain experience in the workplace. Although this programme is supposed to be a week-long, but I understand that you are a very busy doctor, so therefore I would be very appreciative to even be able to work shadow you for 2-3 days.

I am not sure if you remember, but exactly 15 years ago you were there to witness my entrance into this world and you were my paediatrician. You were also the one who discovered that I didn’t have abnormal bone growth, solving the mystery when another doctor ran the wrong test on me. As I would like to pursue a medical degree in the future, I am hoping to work shadow the doctor who was there at the very start of my life and helped cure me of my many terrible rounds of cough.

Musa: Hi! Yes you can shadow me. My nurse will do the necessary official bits. Tell me when exactly you want to start. So it does not clash with my holidays or conferences etc. And so began the elective period from 2-6 December 2024. We began ward rounds at 7 am in the mornings, and she was punctual at 7 on the dot.

We transitioned from the babies in the maternity ward, labour room, Neonatal Intensive Care Unit, to examine the general paediatric cases clustered in the paeds-ortopaedic ward, Premier, Mesra and the main paediatric ward in Qaseh. We saw cases in the Emergency Department (ED), and she assisted with the minor procedures of venipuncture, venous cannulation, heel pricks, and administration of nebulization, among others.

She joined in the clinics, played with the children, measured their weights, heights and head circumferences. And listened to the conversations (history taking) with the parents and the child, from birth history, immunsations, diet, milestones, admissions to hospitals, family background and medicines taken.

And watched the examination of the baby or child or toddlers or adolescents, and the preparation and administration of vaccines. Most of my elective students and I enjoyed breakfast at the Kreate or Gossip outlets after our morning rounds but Baeley somehow missed out on this most important and critical makan and chat sessions!

Musa: It was such a delightful report to read. You have a very interesting style of writing which made it a very enjoyable read. Not the usual boring type of reports. I too love writing and you may read them online. My latest op-ed was on the highly controversial topic of “Value Based Diagnosis-Related Group (DRG): Boon or Bane? I know it sounds German to you” (1)

She was not to be intimidated! She fired back!

Baeley: Hi! Good evening Dr. Musa. I’ve finished reading the article you wrote about the DRG system. I would like to share with you my thoughts on it. J From the eyes of a naïve 15 year old girl, who still has so much more to learn and discover in this world and knows nuts. I think implementing DRG system in Malaysia would likely face some challenges! Reasons to why I say so, enjoy reading.

• Categorising patients with different illnesses into standardized groups is a challenge itself as individual conditions and their severity vary. This creates difficulties in ensuring accurate classifications, which could result in poor healthcare outcomes, bringing us further from the resolution.
• The public’s acceptance of such a system is uncertain. Not all patients would agree to be referred to government hospitals, especially if they perceive the care to be subpar and limited due to the overpopulation of patients.
• From my experience, I happen to know a few rather affluent ladies who much prefer to visit a private hospital to seek medical attention compared to needing to go to a public one. If the DRG system is in place, these ladies will not be happy at all.
• Private hospitals might end up having a decrease in business as the majority of the major (complex and complicated) cases will be handed to the public hospitals if this system is implemented.
• Therefore, private hospitals might also not be so keen to this as their revenue will decrease.
• Looking at the status quo in countries that have adopted DRG systems, such as the United States or Germany, there are obvious struggles as evidence.
• For instance, DRGs often lead to hospitals focusing on less complex cases to optimize efficiency, leaving more complicated and resource-intensive cases to public hospitals.
• This could increase the pressure on Malaysia’s public healthcare system, especially towards the already low medical staff rate.

Musa: This is good. J Let’s see if the healthcare portals might consider publishing. Can you check with your parents if this is OK?

By  
Dr Musa Mohd Nordin, Paediatrician

This article is the personal views of the author and does not necessarily represent the views or official stance of RTM.