GPs are enforcers in primary healthcare

I REFER to the letter “Malaysia’s general practitioners need help” (The Star, May 20) pertaining to the recent Cabinet decision to turn down the request of general practitioners (GP) in clinics to harmonise their fees with medical officers in private hospitals, and also the Health Ministry’s plan to set a ceiling price for medicines.

I feel sad that the plight of our healthcare professionals was not given due consideration by our policy makers.

I would like bring their attention to my practice in cancer care, a multi-professional field in which oncologists, other site-specific specialists and GPs all play a role, especially in a resource-limited country like ours.

Cancer management is a huge undertaking and a continuous public health challenge in Malaysia. While a shortage of oncologists looms, the demand for oncology services in our country is increasing. With a population of 34 million, the current ratio stands at 3.4 oncologists per one million people.

Optimum cancer health services can only be delivered via good policies and governance, integrated infrastructure and systems for awareness, prevention and early detection as well as efficient and timely diagnosis, treatment and supportive care.

Malaysian cancer patients frequently present late, leading to poor outcomes. Lack of nationwide effective prevention, poor access to specialised investigation and treatment as well as use of unproven alternative medications in cancer have been commonly highlighted.

However, non-adequately tapped primary healthcare systems deserve a mention too if we are serious about improving cancer care in the country.

We need to prioritise the implementation of an integrated and multidisciplinary approach to cancer care, and this is where the GPs come in.

Sadly, however, understanding of the involvement of primary care physicians in cancer care is lacking. The GPs’ tasks within the broad cancer care spectrum may range from prevention, cancer screening and diagnosis to treatment of side effects during definitive cancer therapy, shared follow-up and survivor care, bereavement and end-of-life care. The value of the work of these professionals should not be overlooked.

Let’s look at the simplest example. One key aspect of the national strategic plan for cancer control is to promote a healthy lifestyle, prevention and early detection.

The levels of cancer prevention efforts, broadly classified into primary, secondary and tertiary prevention, lie within the realm of public health.

Various health education programmes, health awareness campaigns and vaccination are the basics in primary prevention.

This is followed by secondary prevention through health screening and early detection of cancer with prompt initiation of treatment as the goal.

In an established cancer diagnosis, tertiary prevention focuses on reducing the impact of the disease with rehabilitation and improvement of the patient’s quality of life.

GPs play a huge role in implementing secondary prevention and can be instrumental in shaping the patients’ initial decisions to go on the clinical pathway rather than the unproven treatment methods.

Their clinical skills and rapport with patients, which may have been built over many years, would help patients to navigate the healthcare system, especially when they progress from one treatment phase to the other.

If the GPs are not remunerated according to their roles, lack of continuity in cancer care may result, reducing the quality of the care process.

The “first-contact, continuous, comprehensive and coordinating care” by GPs is indeed challenging and therefore definitely worth investing in. Furthermore, cancer care in future may make it necessary to involve GPs in the management of patients after completion of their treatment and to provide support for families and carers, including during bereavement.

Recognising the value of GPs and fostering a long-term plan for them to deliver efficient cancer care will ensure that patients’ needs are met throughout the cancer trajectory.

DR MASTURA MD YUSOF Consultant oncologist Shah Alam