Oleh/By		:	DATO' SERI DR. MAHATHIR BIN MOHAMAD 
Tempat/Venue 	: 	THE MING COURT HOTEL, KUALA LUMPUR 
Tarikh/Date 	: 	12/09/84 
Tajuk/Title  	: 	THE OPENING OF THE 2ND 
			INTERNATIONAL COMBINED SCIENTIFIC 
			MEETING ORGANISED BY THE COLLEGES 
			OF GENERAL PRACTITIONERS, 
			PHYSICIANS AND SURGEONS 
			OF MALAYSIA 



 Yang Berbahagia Dato' Dr. Syed Mahmood, Pengerusi Jawatankuasa
Penganjur; Dif-dif Kehormat; Tuan-tuan dan puan-puan sekalian.

Saya mengucapkan terima kasih kepada Jawatankuasa Penganjur Persidangan
kerana menjemput saya untuk merasmikan Persidangan ini. Saya juga berharap
Persidangan ini bukan sahaja akan memberi manfaat kepada tuan-tuan dan
puan-puan dalam bidang perubatan, tetapi juga akhirnya akan memberi
sumbangan kepada kesejahteraan penduduk negara ini.

Ladies and Gentlemen.

2. I would like to express my appreciation to the Organising Committee for
inviting me to officiate the opening of this 2nd International Combined
Scientific Meeting of the Colleges of General Practitioners, Physicians
and Surgeons of Malaysia. I take this opportunity to welcome our guests
from overseas and I hope you will find your stay in Malaysia both
enjoyable and fruitful.

3. This is a Scientific Meeting of the medical profession and it is a long
time since I was involved in the scientific part of
medicine. Nevertheless, my wife and I feel we are amongst colleagues
today. More than that, I know I am among friends including many very old
ones. In my present job I can keep only a passing interest in the progress
of medicine.

4. Meetings such as this provide an opportunity for the medical profession
in this country to update their knowledge and skills as well as to
exchange experiences with other colleagues from abroad. The advances of
medical technology have been breathtaking. For the new generations, grown
accustomed to beta blockers, psychotropic drugs and steriods, it must seem
inconceivable how medicine was practised before penicillin. Even more
dramatic advances lie ahead of us. But the question that has to be asked
is whether we can afford the cost of modern medical technology? Even in as
rich a country as the United States, soaring health costs have become a
burden. Nearly two thirds of health insurance costs in the United States
are spent in maintaining the last two years of life. That does not seem to
me to be an efficient way to spend health funds.

5. Although only a developing country, Malaysia would still want the best
of modern medicine. But our resources are limited and, whether we like it
or not, we will lag behind in the provision of some of the most
sophisticated facilities. Scientific meetings will have no time for these
mundane matters, but they are facts that must be faced by the government
and the people. As a renegade doctor turned administrator I cannot help
but dwell a little on this unscientific aspect of medicine.

6. Malaysia's medical problem is compounded by the inheritance of an
accident of colonial rule. The British colonial government, faced with the
problem of providing medical care for British expatriate officers, decided
to set up Government hospitals where the officers could be given free
treatment. To encourage locals to switch to western medicine, these
government hospitals also provided, free treatment for anyone willing to
be attended by doctors. The free hospitals became very popular and evolved
into a part of the Government service. If any fee was charged, it was
nominal. In the days when mixtures and powders cost a few cents, the
Government could well afford the dispensing of free treatment. But today
an antibiotic capsule may cost a few dollars each, making medication
extremely expensive. Surgery is even more costly. Of course doctors and
specialists do not come cheap either. Free medical treatment in Malaysia
is now a heavy burden despite the nominal charges. And the trend is for
the burden to become heavier.

7. Some will think that this is a problem for the Government
alone. Actually it is not. It is a problem for the nation as a whole. The
treatment is not really free. The people are paying for it, not directly
of course. The question that they should ask themselves is whether their
money is being spent on the right people, i.e. the deserving poor. Or
could it be possible that some business concerns and even insurance
companies and funds are taking a free ride on possibly the only
non-contributory medical insurance scheme in the world.

8. I am sorry to focus on what seems to be a local issue at an
international conference like this. But while you discuss enthusiastically
on the technological advances in medicine and surgery, you should also
spare a thought for the rapid escalation in cost. When you become
cost-conscious then the technology of cost cutting will receive serious
attention. Indeed to a certain extent it already has, although it may not
be because you are concerned over the cost. When a famous surgeon moves
from theatre to theatre performing only the most sophisticated part of
surgery, while assistants start the operation and close up the patient,
what you are doing is mass surgery where costs are cut. The concern that
will arise from mass surgery is not poor quality of work but a lack of
personal involvement on the part of the surgeon. If carried too far the
surgeon will recognise only a certain part of the anatomy of the patient
and not the patient himself. When that happens hospitals will become
repair shops. So no matter how advanced medical technology becomes, there
must be a certain degree of personal relationship between the patient and
the doctor, if medicine is to remain meaningful. Nevertheless mass or
production line surgery does cut cost. There may be other ways if doctors
learn to appreciate that cutting cost is important. And, of course, it is
important, for high cost of medicine must deprive the poor of adequate
medical attention.

9. It is in the context of these that Malaysia has decided to privatise
some of the Government's social facilities. We are not about to deprive
the poor of free medical treatment. But the present system enables even
those who are able to pay to avoid payment altogether.Indeed, firms which
should have taken medical insurance for their employees are availing
themselves of free treatment. With privatisation, only the needy would be
accorded free treatment.

10. Privatisation of hospitals will initially mean making Government
hospital facilities available to private doctors at a fee. I do not think
we will recover all our costs. There will still be an element of subsidy
by the Government. But, at least, there will be a substantial recovery of
a part of the cost expanded.

11. I am very happy to see this meeting being organised by the three
Colleges together. Malaysia is not a very big country and it will be quite
sometime before we get our 70 million people. Until then a multiplicity of
organisations will only cause confusion. If the Colleges cannot merge, at
the very least they can work together. After all the disciplines are not
only related, but they actually overlap.

Ladies and gentlemen, 

12. I am confident this Meeting will be very fruitful to each and every
member of this noble profession. It is my pleasure now to officially
declare the 2nd International Combined Scientific Meeting of The Colleges
of General Practitioners, Physicians and Surgeons of Malaysia open.

Thank you.