I visited my gynaecologist yesterday for what I thought was a regular urinary tract infection (UTI).
My gynae’s clinic in Kuala Lumpur is small and serene. Two watercolour paintings of the Eiffel Tower and an English mansion hang on one side of the wall, while the other wall is filled with black-and-white stock photographs of couples with babies.
I suppose those photographs will be replaced with a boring whiteboard of medicine prices come Thursday – assuming that the drug price display is enforced on May 1 as planned. The government has yet to announce the gazettement of the order under the Price Control and Anti-Profiteering Act 2011 (Act 723).
At the specialist clinic, I dutifully informed my gynae the date of my last period (last Tuesday) and when I had sexual intercourse with my long-term partner (last Saturday) – I document everything on my Apple Health app – before my symptoms appeared yesterday (Monday). (Yes, I’m a model patient.)
With a female assistant in the examination room, he proceeded to examine me and applied a liquid medicine inside my vaginal canal, saying he found a small ulcer or minor inflammation of my cervix.
Does the Ministry of Health (MOH) or the Ministry of Domestic Trade and Cost of Living (KPDN) expect the clinic to list the price of this particular quantity of medicine? It is as if the government expects me, the patient, to interrupt my gynae while he’s probing my vagina with a speculum and ask him for the name and price of the drug before I tell him to proceed.
I didn’t, but simply braced for the agonising sensation of the treatment that my doctor claimed would merely be “uncomfortable” or “a little painful”.
He then explained that my minor cervical inflammation was likely due to low immunity during my period and that sexual intercourse wasn’t the cause, but had just made the symptoms appear. (My long-term partner felt bad about it before I visited my gynae.)
While I’m undergoing my vaginal exam, will KPDN officers lurk in the waiting room of the small clinic? Irrespective of their gender (my gynae is a man), I would not feel comfortable at the thought of non-medical enforcement officers just waiting outside while I spread my legs for my doctor. To me, the mere presence of KPDN officers would violate the sanctity of the doctor’s room.
After my exam, will KPDN officers question – using vulgar terms instead of medical jargon since they’re not medically trained – what medicine the doctor applied inside my vagina and whether the price for that particular quantity is listed? If they do that, I myself will tell the authorities in no uncertain terms to leave immediately.
KPDN’s meme-filled video of its price display enforcement at a car service workshop illustrates the ministry’s crass approach that is completely inappropriate in health care. When I’m in pain, I don’t want to be used – by the State, no less – to create “funny” TikTok content for hundreds of thousands of views. Simply blurring the patient’s face in such videos won’t be acceptable either.
(In case KPDN doesn’t know, taking photographs or videos is prohibited at public health care facilities. Private health care facilities have similar rules to protect patients, which I expect the government itself to comply with.)
If KPDN wants to enter the world of medicine – which is completely different from supermarkets or car service workshops – then they had better know what they’re getting into. They have to be comfortable with doctors talking about vaginas and all the “gross” parts of medical conditions like the depiction of symptoms of cervical cancer in a textbook.
But if even reading this article makes them queasy, then perhaps it isn’t appropriate for KPDN to enforce drug price display.
At the end of my visit, due to the drug price display issue, I asked my gynae for an itemised bill – something which I had never asked for during my previous visits or other infrequent visits to my general practitioner (GP). (Private hospitals always give itemised billing.)
The RM450 bill on a slip of paper, with the name of the prescribed antibiotic scribbled in barely legible handwriting, was as follows:
- Consultation fee: RM100
- Procedure (actually the exam): RM150
- Oral medications (Zithromax and a vaginal wash): RM200
It is somewhat contradictory for the MOH to, on the one hand, promote bundling with the diagnosis-related groups (DRG) payment system but, on the other, demand itemisation of health care charges with drug price display.
Under the price transparency policy, the clinic would have to further itemise the charges for my gynaecological exam by delineating the cost of the medication used, separately from the procedure itself, as well as the use of a speculum, gloves, gauze pads, and whatever other instrument my doctor used to deliver the medicine.
(I wasn’t watching what my gynae was doing underneath the sheet, but simply stared at the flowered wallpaper under harsh examination lights as I slowly inhaled and exhaled, just wanting it all to end.)
Itemised billing for health care (actually transparency) is exactly what the MOH is supposedly trying to move private hospitals away from.
In my case, the doctor used just a small amount of medication during my gynaecological exam. He didn’t give me the remaining tube or bottle to take home after my visit. So how is price display supposed to work?
Is the clinic meant to display the price for the SKU (stock keeping unit) and charge me that price, even though only a small amount was used? Or is my doctor supposed to charge me a fraction of the price of the SKU, which might confuse both patients and enforcers due to differing prices between the display and bill?
While I understand that the MOH wants to provide patients the ability to fill their prescription elsewhere if the displayed prices of their prescribed medicine at a GP or specialist clinic are perceived to be too expensive, it’s not that simple in reality.
I found my gynae three years ago through some positive internet reviews. I returned to him because I was comfortable with him and he would already have my history based on repeat visits.
When I received my first-ever itemised bill at the clinic yesterday, which included RM200 for antibiotics and vaginal wash, I deliberated on whether I should request for a prescription and fill it at an AA pharmacy just a few doors down.
It could not be any more convenient for me to take my prescription to a pharmacy that would definitely charge me a lot less for antibiotics. But I didn’t.
The Hokkien term “pai seh” – loosely translated as feeling embarrassed or sheepish – perfectly captured my feelings. Asking my regular gynae for a prescription to fill elsewhere, just so I could save some money by not buying medicines from him, felt wrong somehow. Malaysia does not have a culture of dispensing separation, unlike the UK.
Domestic Trade and Cost of Living Minister Armizan Mohd Ali recently compared medicine to gold, asking: “What’s so special about medicine that price displays need to be exempt?”
While KPDN may not understand doctor-patient relationships, I certainly expect the MOH to appreciate the complex interactions between a doctor and patient that cannot simply be reduced to monetary transactions over drugs like a retail good.
If the ultimate objective of drug price display is to benefit patients, the government should first ensure that enforcement of the policy does not cause any discomfort to patients or violate patient confidentiality. (Some patients may not want outsiders like enforcement officers knowing that they’re at a gynae clinic in the first place.)
I am personally still on the fence about drug price display. While I support the MOH’s intentions for price transparency, the government seems to lack understanding of the complexities of health care.
This story about my gynae visit is meant to give KPDN a small glimpse into the raw and elemental world of medicine that is simultaneously a terrible beauty to behold and a mishmash of horror and gore—far removed from pretty gold products glittering in velvet cases behind glass counters.
As for MOH, think about what you really want to achieve with price transparency.
Boo Su-Lyn is the editor-in-chief of CodeBlue.