Clinic Schedule

Schedules for our nephrology clinics will be published here. First published schedule is posted on 19 October 2008. We hope the blog will help in coordinating our nephrology clinics in Sabah.

Most of the consultation clinics are in Kota Kinabalu. The nephrologists also travel regularly to various districts in Sabah to run visiting clinics (See the calendar).

Each regular follow-up case (old case) is allocated a 15-minute slot of consultation time while 2 slots (30 minutes) are usually spent for a new case. Typically a full session of clinic will run for 3 hours (e.g. 9am to 12pm) or 12 slots. Therefore one doctor in one clinic session is expected to attend to 12 old cases, or, 10 old cases plus one new case etc.

The meaning of one clinic slot is well defined: 15 minutes, one doctor. Ideally, the definition should include one nurse, one consultation room. Unfortunately, like many other MOH hospitals in Malaysia, this is still far from ideal due to shortage of staff and rooms. Yes, we are still running clinic where two doctors and two patients (sometimes plus family members) squeeze in one consultation room, and at the same time, one nurse attending to all tasks.

We emphasize this time allocation because this will ensure all patients receive equal attention. From experience, we realize that rushing through a congested clinic will compromise the care of the patients.

Almost all regular follow-up patients will have their blood taken for renal function tests and sometimes urine tests prior to the appointment. More sophisticated investigations maybe needed depends on the condition. We are following scheduled appointment system and patients are advised to register half an hour prior to their scheduled time. We aim to attend to all patient no later than 30 minutes of their scheduled appointment time. We hope that all our patients spend less than two hours for their clinic visit. However, other factors may prolong the clinic visit such as need of repeat blood tests, waiting for radiology investigations and queuing for prescription.

Doctors are reminded to fully responsible for the 12 clinic slots of the day. If the doctor in-charge is planning for leave or meeting, two-weeks notice is needed in advance in order to re-schedule all the 12 clinic slots. For unexpected emergency reason, he or she should try to get a replacement, or, as a last resort, postpone the clinic session to another day.

We hope that we can have a well organized nephrology clinic system. Our aim, of course is to make sure a pleasant clinic for both the patients and health care workers because we believe this is the best way to ensure effective clinic consultation, communication and treatment.

Introduction

This blog is about the nephrology service in Sabah. We are here to provide information about our units.

Sabah Nephro is the Sabah Renal Resource Center. The center provides renal patients with information and educational material to assist them in managing the effects of renal disease on their lifestyle.

The main health care provider for renal patients in Sabah is the Ministry of Health (MOH) of Malaysia. We are doctors and nurses working in hospitals funded by MOH. These are public hospitals. We take care of most of the renal patients (>90%) in Sabah.

Nephrology services available in Sabah include hemodialysis, peritoneal dialysis, consultation and treatment for renal patients, including follow-up for renal transplant patients. Hemodialysis remains the main option of renal replacement therapy (RRT) in Sabah. The number of hemodialysis patients increases rapidly over the past three years as MOH has invested heavily in installing dialysis centers all over the districts in Sabah. In general, dialysis in MOH funded hospital is very affordable but ironically this life saving treatment is neither widely nor easily available due to various socioeconomic reasons.

Currently, renal transplants are mainly performed for those with potential living-related kidney donors. Opportunity of cadaveric renal transplant is scarce, just like all other places in Malaysia. We send the patients and their donors to Kuala Lumpur Hospital or Selayang Hospital for the transplant surgery. Renal transplants done in Malaysia are still the minority. Most of our other transplant patients pay for their organs in those countries where commercial transplants are available.

Efforts have been made to improve the care of renal patients. Beside striving to increase the financial budget each year, a very important but yet difficult task is to have enough number of staff. Not only nephrologists and medical officers, staff nurses and medical assistants are also in high demand.


Today, we have three nephrologists (one paediatric nephrologist and two adult nephrologists) working in MOH funded hospitals in Sabah. Some of the dialysis centers are potentially expandable to accept more patients but unfortunately shortage of staff has prevented us to proceed further.

Despite all these limitations, our staff are still working diligently to develop the nephrology services in Sabah. Preventive measures, delaying deterioration of chronic kidney disease and providing quality RRT for ESRD (end stage renal disease) or AKI (acute kidney injury) are the directions of our daily works.

By starting this blog, we hope to provide another channel of communication; among us, the health care workers and also enable our patients to access us more easily. Ultimately, we aim to deliver our service with quality.