In 2012, I wrote 3 parts of the said topic above. The first was on criminal accusation of doctors and the second was on medical negligence. It looks like, the issue that I wrote in my 2nd part is being revisited by the Star today.As I said in my previous article, the current generation of patients are different compared to 20 years ago. They are more demanding, disrespectful and ever ready to sue doctors when something happens. This is something that the budding doctors should realise before doing medicine. The ” I want to help people” rhetoric is not the same as before. You can “help” thousands of patients but a single error will make you to quit medicine all together, not to mention the huge debt that our current generation of students are graduating with. Interestingly, it is the same Generation Y who are becoming doctors and complaining about the working environment/hours. Imagine your own generation will be the ones who will be suing you.

Today’s Star (see below) reported that many private obstetricians are quitting practise due to increasing litigation rate and high indemnity insurance. Well, that is a fact. The number of legal suits is increasing year by year. As our DG mentioned in his reply, the number of O&G suits for MOH last year was 18, an increase by 10 compared to the year before. That is more than 100% increase. As more and more “successful” stories begin to appear in newspaper, more people/lawyers will be going after the doctors. Recently, the court also awarded RM 6million for a spine case in Penang. The name of 3 doctors were clearly mentioned by the news.

With the increasing litigation rate, many O&G specialist are finding it difficult to cope. Their stress level is very high and they can’t afford to make any mistakes. This has resulted in many private O&G consultants pushing away high risk cases to government hospitals. Some have stopped practising Obstetrics and some only does Caesarean sections. I remember when I asked many budding O&G specialist, why they want to do O&G, the answer use to be “ I am dealing with 2 lives and I am happy to deliver a new life to the world“. Well, that was the noble intention. However, this nobel intention is not nobel anymore in this capitalist world. Very few appreciates what we do. In private sector, the word is ” I pay you to deliver my wife. So, no mistakes please!”

The last Cerebral Palsy case was awarded about RM 7 million. I know few more cases pending in high court and one of it is standing at RM 10 million. Due to this increasing amount of awards, almost all indemnity insurance companies had increased their premium since the last 2 years. MMI has increased their premium for Obstetrics by almost 100% with maximum coverage of about RM 5 million. So, if you get sued more than that, you need to pay out of your own pocket. The premium for the RM 5 million coverage is RM 35 000/year. MPS (Medical Protection Society) which is an international organisation and the oldest indemnity insurance scheme, use to cover unlimited amount with occurrence-based coverage. However, starting this year, they have made some adjustment for Obstetrics. They had reduced their premium from about RM 70K+ to about RM 45K. Unfortunately, the maximum coverage in only RM 10 million in aggregate (pending MPS council approval) and it is  “claim-based coverage“. This basically means that you may end up paying out of your own pocket if the council decide to cover only certain percentage of the amount. Furthermore, you must continue paying for years after you stop delivering babies as you must be a member of MPS at the time the legal suit is filed. Legal suits in O&G can appear at your doorsteps 5-10 years after you delivered the baby! Meanwhile, the consultation fees are regulated and limited by the government. So, the consultants can’t charge as they like to support the increasing cost.

This phenomenon will in turn increase the number of patients delivering in government hospitals. At this point, government doctors are indemnified by the government. While I do not know how long this will last, the workload and stress level in government sector will continue to increase. Remember what I said in my previous article? No matter how many doctors we have in government sector, the workload will never reduce as more and more patients are becoming ever more demanding! There is no such thing as easy life, easy money and good future in medicine anymore. Everything that I have been saying in this blog over the last 5 years is slowly appearing in mainstream news. Only those who can handle the tremendous amount of stress and true passion can endeavour. Unfortunately, even then, many will quit.

Unless, the entire healthcare system in this country changes, the situation will not get any better. With the increasing cost and litigation rate in private sector, there will come a time where the private sector will collapse. The government must come up with a Healthcare financing system to address this problem.

Obstetricians are quitting

PETALING JAYA: Senior obstetricians in private practice in the country are opting out of delivering babies as a result of changes in their professional indemnity coverage.

The shortfall of these specialists is expected to create a rise in the workload in government hospitals, increasing the possibility of sub-standards or delays in maternity care.

The Medical Protection Society (MPS), the world’s leading indemnifier of health professionals, changed its policy for obstetricians and gynaecologists this year – from occurrence-based protection to claims-based coverage, under which these doctors have to pay annual premiums for 25 years.

This means if a doctor retires at 60 after delivering a baby, he or she must continue to pay for the coverage until the age of 85.

According to the MPS, the changes were made because of global challenges and risks associated with obstetric claims and litigation.

In Malaysia, the highest protection coverage is taken up by obstetricians, who used to pay more than RM70,000 a year for unlimited indemnity.

Under the claims-based coverage, the amount to be paid annually is lower but the time frame is longer.

More than 500 obstetricians and gynaecologists are covered under MPS, which has over 4,000 members in Malaysia.

MPS has more than 300,000 doctors, dentists and medical students as members worldwide.

Dr Tang Boon Nee of Subang Jaya Medical Centre said many of her colleagues had decided to stop delivering babies as a result of the change in policy.

“As we are liable for up to 25 years after delivering a child, many of us who are older obstetricians will have to pay for coverage well after retirement,” she said.

Dr Tang, who has been an obstetrician for 20 years, said “phenomenally high” damages had been paid out in obstetric claims.

“There was a case last year in which the amount awarded was RM6.9mil. To protect ourselves, we will have to continue paying MPS well into our retirement because of the claims-based system.

“It is not fair as many of us will not be making that much money,” she said.

KPJ Damansara Specialist Hospital’s Dr Gunasegaran Rajan said the occurrence-based indemnity had no ceiling on coverage, but claims-based was capped at RM10mil.

“Recent payouts have already touched RM7mil, and this can only increase. I would have to pay out my of own pocket if the damages awarded are above RM10mil.”

He said that his best option was to stop practicing obstetrics as the future left him vulnerable.

“It is a great shame that the skills and knowledge many obstetricians have acquired over the past 25 years cannot be used to help Malaysian women’s maternal health due to this policy,” he said.

Another obstetrician and gynaecologist, Dr S. Shankar, said doctors could not run the risk of not being covered.

“We don’t have much choice. Our legislation should come up with a better system, like New Zealand which has a no-fault compensation scheme. Personally I will get out of obstetrics as fast as I can.”

In a statement to The Star, MPS defended its policy change, saying that claims-made protection was the more common form of coverage for obstetricians in many countries.

“Claims-made protection requires members to be in continuous membership both at the time an adverse incident takes place and when it is reported to MPS to make a claim.

“It was introduced to price subscriptions for obstetric risks more accurately and fairly as it can be difficult to predict long-term risks.

“This is because obstetric claims can often arise many years or even decades later,” it said.

MPS assured members that even with the new system they would continue to receive high-quality service and support.

Substandard maternity care possible, warns Health D-G
PETALING JAYA: Health Ministry director-general Datuk Dr Noor Hisham Abdullah said there would be an increase in workload in government hospitals and risk of substandard maternity care if the private sector loses its obstetricians.

“With the obstetrics and gynaecology specialists almost equal in numbers in both sectors, there is definitely going to be increased demand. We will not face a shortage of O&G specialists but rather a mismatch in the distribution and the corresponding workload.”

“It is also important to note that there will be a definite spill-over effect to the neonatal and the anaesthetic services. With this scenario, there will be an increased chance for delayed or substandard care,” he said.

Dr Noor Hisham said the excessive court awards and punitive damages used to penalise doctors would negatively impact doctor-patient relationships.

For the public sector, all negligence claims costs are borne by the Government.

Last year, 18 cases involving obstetric cases were filed against the Ministry of Health, 10 more from the eight recorded in 2013.

A total of 462,626 babies were delivered in both private and public hospitals as well as by private midwives, alternative birthing centres and estate hospitals.

Out of the number, 63,063 were delivered at private hospitals while the most, or 83.9%, were still delivered in public hospitals and clinics.

Meanwhile a medical law lecturer has called for research on the effects of changes to indemnity protection for obstetricians and gynaecologists.

Dr Sharon Kaur of Universiti Malaya said the authorities should look at court decisions, amounts awarded and gauge if the changes in policy could have a knock-on effect.

“If private healthcare services are cut, the burden will fall on public services,” she said.

ON the 8th of July 2015, the medical fraternity was yet again shocked with the death of a medical officer from Sg Buloh Hospital. My deepest condolences to the husband and family members of the deceased. Many doctors went to social media and expressed their sorrow and anger against the life that a doctor goes through in our system. Firstly, I had mentioned several times in this blog that our system is as such that it is difficult to change. No matter how many doctors we have, the job will never get any easier. While the housemen are now doing shift duty, they will end up doing “on-calls” like the old days when they become an MO. However, when each hospital and departments get enough MOs, I hope the same shift system could be implemented to MOs. This could vary from one hospital to another as well as one department to another. Each department have their own problems. Once shift system is implemented, MOs will loose their “on-call” allowances,which means a pay cut. When a pilot project of shift system was started in KKs a year ago, most doctors protested. The main reason was due to the lost of RM80/hour overtime allowance and going back home late. The project was not extended further as KKM, while do have enough MOs, did not have enough support staff to run the KKs till 9-10pm daily. However, I feel it will eventually be implemented in KKs.

Secondly, we should not jump into conclusion whenever we hear such an incident. There are many factors that causes an accident. I am sure each and everyone of us would have had minor accidents or near misses during our life time. People die on the road everyday as we have the highest number of road traffic accidents in this region. It could be due to fatigue, car malfunction (as happened to a doctor over HERE) or may not even be entire your fault. I find many become emotional and blame the “on-call” and the system immediately without further investigations. Our DG has given his response over HERE (see below). People must understand that doctors are not the only profession who work long hours. I have seen engineers, accountants, lawyers , contractors etc who also work long hours and go back home late. It is not unique to only medical profession. In JB, we have thousands of people going to work in Singapore daily. They leave their home at 4-5am and return back at around 9-10pm daily, not to forget the 1-2 hours jam they go through daily in each direction. The only difference is the fact that many other professionals can take back home their job except medicine, where we need to finish our work at work and we are dealing with life and death matters. We are also dealing with humans and not machines/computers or structures where mistakes can be tolerated. But again, it is you who chose the profession and we need to work in the system that we have chosen.

No matter, how the system changes, the workload of a doctor will never come down. Even in developed countries like UK, US, Ireland, Canada etc, doctors still work long hours. Only their total number of hours a week is limited. The profession is such that we cannot leave our work unfinished. Emergency happens all the time. I had written about this many many times since I stated blogging.

ON the other hand, the demand and expectation of patients has gone up by leaps and bounds. This is not limited to private hospitals but also in government hospitals. Thus, it increases the workload of each doctors , no matter how many extra doctors we have in a department. The number of patients visiting government hospitals will also increase year by year as the economic situation worsen. Frankly, how many can afford private healthcare if not being supported by insurance. Even insurance have a limit every year. In my hospital, almost 90-95% of the admissions are insurance supported. Very few are cash paying. Most can’t afford anything more than RM 5-10K. FYI, there is no such thing as below RM 5K in a private centre nowadays. Lately, we have been seeing many grouses in the newspaper regarding high charges in private hospital (HERE and HERE). While the consultation fees by doctors are limited by the government, the hospital fees are not regulated. DG has also spoken about this. Almost every consultant in my hospital will receive at least 1 complain a month! That’s how difficult our lives have become. I hope the younger generations will open their eyes on the real life as a doctor rather than the glorious life that the public wants you to believe.

There’s also a you tube video that has been going viral in the social media. It was about a law graduate talking about the reality she faced after she graduated.

In one of my earlier post “Passion vs Debt” I had written on how the younger generations do not understand that passion is one thing but living a life is another. This lady in the video just proves what I have been saying. High expectation that earning a degree will lead to big salary and good life. This is true in almost all profesional field. She also talks about debt and how she struggles to even own a car. From what she says, I can roughly make out where she graduated from. Her degree is not recognised by Bar council which requires her to sit and pass CLP examination in order to practise as a full fledged lawyer. If not, she can only practise as a legal assistant or advisor which would not give you a high enough salary to survive in Klang Valley or any other big towns. What she says is not much different from what most medical graduates are going to face. If you take huge debt to do medicine, whatever salary that you are going to earn will not be enough to live a life. With car loan, house loan, married life coming your way, it will never be what you had expected. I like what she said at the end : it is beyond race and politics! We are in the same ship and we will sink together if people still get carried away with race and religion issues.

Our education system do not teach our students financial literacy. I suggest students to read ” Rich Dad Poor dad” written by Robert Kiyosaki. Also read many of his books which talks about financial literacy. People who chase degrees and salaried job will never be rich. So, never do medicine for wrong  reasons and never take huge debt to do it either………..

Selamat Hari Raya to All Malaysians……………………

Ucapan Takziah buat Keluarga Allahyarhamah Dr Nur Afifah Mohd Ghazi
Posted on July 10, 2015 by DG of Health




Pada 8 Julai 2015 bersamaan 21 Ramadan 1436 Hijrah, kita telah dikejutkan dengan satu tragedi yang menyayatkan hati dengan kembalinya ke Rahmatullah Dr Nur Afifah Mohd Ghazi, seorang Pegawai Perubatan daripada Hospital Sungai Buloh. Allahyarhamah telah terlibat dalam satu kemalangan jalan raya ketika dalam perjalanan pulang setelah bertugas ‘on-call’ pada hari sebelumnya. Bagi pihak Kementerian Kesihatan, saya ingin menyampaikan salam takziah kepada keluarga Allahyarhamah dan mendoakan agar roh Allahyarhamah ditempatkan dengan para syuhada.

Pada pagi 9 Julai 2015, beberapa orang pegawai kanan dari Ibupejabat Kementerian Kesihatan Malaysia, Putrajaya dan Hospital Sungai Buloh telah berpeluang untuk menziarahi keluarga Allahyarhamah di rumah kediaman keluarganya di Taman Sri Putra, Sungai Buloh. Daripada pertemuan dengan Mohd Hafizuddin Azman, suami kepada Allahyarhamah, memang tidak dinafikan Allahyarhamah bertugas ‘on-call’ bersama 5 orang rakan yang lain daripada Jabatan Anestisiologi. Dimaklumkan Allahyarhamah tidak terus pulang pada keesokan harinya setelah ‘passing over’ jam 8.00 pagi kerana beliau telah pun mempunyai rancangan untuk bertemu seseorang bersama suaminya pada tengah hari tersebut. Allahyarhamah hanya pulang sekitar jam 2.30 petang selepas selesai pertemuan yg dijanjikan. Sementara menunggu temujanji, beliau telah pun berehat di bilik ‘on-call’ yang disediakan.

Kementerian Kesihatan mengambil maklum isu-isu yang dipertengahkan di mana ianya telah dikaitkan dengan peristiwa malang ini. Sememangnya tugasan seorang Pegawai Perubatan memang berat terutama apabila melaksanakan tugasan ‘on-call’ dan dalam kes ini, pihak pengurusan hospital telah pun berikhtiar memperbaiki keadaan persekitaran kerja dengan menjadualkan sehingga 6 orang Pegawai Perubatan daripada Jabatan Anestisiologi bertugas ‘on-call’ setiap hari. Tidak dinafikan kemalangan jalan raya mungkin terjadi disebabkan oleh keadaan seseorang yang kepenatan setelah melaksanakan tugasan yang berat, tetapi ianya boleh juga disebabkan faktor-faktor lain yang juga harus dipertimbangkan.

Walaubagaimapun, Kementerian Kesihatan mengambil maklum semua cadangan yang telah disarankan dan akan terus mengambil langkah-langkah penambahbaikan dari masa ke semasa. Semua fakta perlulah diteliti terlebih dahulu sebelum sesuatu keputusan itu dilaksanakan.

Innalillahi wa inna ilaihi roji’un


Ketua Pengarah Kesihatan Malaysia

Kementerian Kesihatan Malaysia

10 Julai 2015

I wrote about the Australian Internship Crisis in 2012 over HERE and HERE. While in Malaysia, PMC students are considering going to Ireland for Internship, the Australian government has introduced some measures to reduce the Internship crisis. I must warn PMC students that many doctors are leaving Ireland due to poor pay and poor working condition, including long working hours. That’s the reason why Irish Medical Council has recognised Malaysian housemanship training. They need more doctors to replace those who are leaving to UK, Australia and New Zealand. You can read over HERE and HERE.

IN 2012 , I wrote that Australia is facing internship crisis and it should worsen further. I also wrote several times on local graduates who passed AMC exams but never manage to get internship post. Many had to come back to Malaysia to do housemanship. They skipped housemanship in Malaysia, being confident that they will be guaranteed a job in Australia if they pass AMC exams. I had always said that passing entrance exams do not guarantee you a job anywhere.

One of my blog reader sent me some interesting information on what is happening in Australia. For those who have time, you can read THIS interesting document by Medical Training Review Panel which is almost close to 300 pages long. It has many interesting facts. If you look at page 52 and 53, you will realise that only 10 Monash Malaysia graduates were given internship post for 2014 (look under the table). You will also notice that only 6 graduates of AMC exams were given internship post. Page 11 is also interesting to read. At page 18, you will realise that there are 18 accredited medical schools in Australia. 60% of them(comprising 60% of students) are graduate entry program (interesting info from page 18-31). Page 42 to 49 also has some interesting information regarding the number of international student graduates.

At page 51 , you will realise that they have started a program known as Commonwealth Medical Internship (CMI) initiative. For those international students graduating from Australian onshore medical schools who did not manage to get the usual internship in public service hospitals, you are eligible to apply for CMI. The CMI document is over HERE. In 2014, out of 497 international medical graduates, 277 manage to get internship and another 76 were given under the CMI program. So, either 144 remaining students did not apply or did not get internship program in either pathway. Most students who go to Australia do not come back unless they are sponsored by their government and required to come back.

The CMI initiative places graduates in private hospitals, general practise and rural health care centres coordinated by private hospitals. Definitely, this is not an ideal setting for internship training. At page 16, you will realise that Monash Malaysia and IMU twinning program graduates are NOT eligible for CMI program! This CMI program also comes with a bond. You are required to serve rural area for atleast 48 weeks as a return of service obligation ( see page 19). There is a penalty if you breach the contract.

I thank Nav for giving me the link to this documents. Basically what I am trying to say is that the situation in other countries are also tight when it comes to internship placement. You need to think wisely before investing close to RM 1 million if you intend to send your child to Australia to do medicine and planning to migrate. Never do medicine if you intend to migrate!


Medical school graduates set for training in Ireland
Published: 24 June 2015 11:50 AM
Penang Medical College (PMC) graduates from the class of 2015 may apply for internship in Ireland.

PMC is the only medical school outside the EU whose graduates have this privilege.

This internship is recognised by the Malaysian Medical Council (MMC) and the medical councils of many other countries.

Penang Medical College is wholly owned by the world-renowned Royal College of Surgeons in Ireland (RCSI) and University College Dublin (UCD).

All 97 graduates received their sought medical degrees: MB BCh BAO (Bachelor of Medicine, Bachelor of Surgery and Bachelor of Obstetrics) from the National University of Ireland (NUI), the RCSI or UCD, officially becoming doctors with globally recognised qualifications.

Malaysian graduates are also guaranteed houseman positions in Malaysia, recognised by the Irish Medical Council (IMC).

“Over the years, PMC has been contributing to healthcare worldwide, and in Malaysia in particular, through its globally-recognised doctors graduating from Penang, or the RCSI and UCD campuses in Dublin,” said PMC President, ceo and Dean, Professor Amir Khir.

“As PMC moves forward to position itself to play a larger role as a leading medical degree education provider in the region and beyond, PMC graduates are the future doctors of the world with an international network of healthcare professionals as a resource.”

The graduate doctors also received licentiates from the RCSI and the Royal College Physicians in Ireland (RCPI).

PMC students spend their first two-and-a-half years in either RCSI or UCD medical schools, where they undergo intensive pre-clinical training.

They are also taught by experienced scientists and leading medical doctors in their respective fields.

PMC students then return to Penang for clinical training for two-and-a-half years at PMC. – June 24, 2015.


Nine in 10 medical students may leave Ireland on qualifying
Culture of ‘intention to migrate’ across all six of State’s medical training schools


Nine out of 10 medical students plan to leave or are “contemplating” leaving Ireland when they qualify, a new study involving the State’s six training schools has found.
Career opportunities, working conditions and lifestyle are cited as the top three factors for migration by some 88 per cent of over 2,000 students surveyed.
The study led by NUI Galway (NUIG) and published on Thursday has found pay was not a key issue among the respondents.
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Generation Emigration: Irish Times site for Irish abroad
The Irish Hospital Consultants’ Association had said highly trained doctors are being “driven out”.
The study’s supervisor, NUIG senior lecturer in social and preventive medicine Dr Diarmuid O’Donovan, has called for action to retain medical graduates and attract back those who have already emigrated.
Staff at HSE West’s public health department and at the Royal College of Surgeons in Ireland, University of Limerick, University College Cork, University College Dublin and Trinity College Dublin were involved with NUIG in the study, published in the open access journal Human Resources for Health.
Work and lifestyle
Some 1,519 of the 2,000-plus medical students surveyed were Irish, and some 85 per cent of the total identified career opportunities as a determining factor in going abroad. Some 83 per cent identified working conditions, and 80 per cent identified lifestyle as factors.
Some 34.3 per cent said they were “definitely” planning to migrate, and a further 53.3 per cent said they were contemplating it – a total of almost 88 per cent.
Final-year NUIG medical student Pishoy Gouda, the principal investigator, said previous studies on this theme had focused on graduates, whereas this analysis involved junior, intermediate and senior students in the six medical schools.
“We found the outcome alarming, as it shows that even pre-med and first-year students are thinking about leaving already,” he said. It reflected a “widespread culture of intention to migrate” in the medical schools.
Career stages
While medical graduates traditionally sought experience abroad, the research indicated there were several opportunities during different career stages to leave.
“This outflow of qualified personnel may represent a financial loss to the Irish healthcare system,” he noted.
Almost two-thirds said they did not have a great understanding of the training following graduation, and one-third surveyed also indicated they had a poor understanding of how the Irish healthcare system worked.
Mr Gouda said postgraduate opportunities should also be made more accessible to non-EU students trained in Ireland. European working laws make it difficult for non-EU graduates of Irish medical schools to obtain Irish intern or pre-registration/ foundation-year positions.
Dr O’Donovan said the outflow of human capital meant Ireland was having to make enormous efforts to attract medical staff from other countries, including developing nations.
“ Not only is this a problem for Irish recruitment, but we need to be mindful of World Health Organisation guidelines on international recruitment and taking skilled personnel away from countries that have medical staff shortages,” Dr O’Donovan noted.


IN 2012, I wrote THIS. The article was about the reduction of compulsory service for Dentist from 3 years to 2 years. Since 2001 , it was 3 years compulsory service. It was mentioned that there were 400% increase in the number of dental graduates since 2002 (when the compulsory service was increased from 2 years to 3 years). While the actual numbers are still small, it was good enough to fill up the total number of post in civil service. However, I still feel that the private sector still needs a lot of dentist. The fact remains that many Malaysians are not bothered about dental hygiene.

Now, barely 3 years later, it is now being reduced to 1 year !. It was announced by the Minister of Health on 14/06/2015. The reason: tremendous increase in the number of graduates !. Sounds familiar ? The only reason why the same is not being done for doctors is because the MMC is reluctant to do it. If it does happen, we will be seeing countless number of incompetent doctors having ” license to kill” out there. I feel the time will come for MMC to reduce the compulsory service. BUT I would prefer if they can introduce an entry or exit exam to filter out the incompetent ones rather that reducing the compulsory service.

Definitely, we do not want to end up like what is happening in India, as published by Reuters over HERE (see below). Again, much of what is written in that article may sound very familiar! Medical Education should never be commercialised!

So, when will be our doctor’s turn to have ” license to kill”?

Selamat Menyambut Bulan Ramadhan

Only one-year mandatory service

KUALA LUMPUR: The compulsory service for all dentistry graduates will be reduced from two years to one year effective July, said Health Minister Datuk Seri Dr S. Subramaniam.

He said graduates who had registered with the Malaysian Dental Council would be placed under the ministry to undergo possible training.

The move, he said, was due to the tremendous increase in the number of graduates of up to 30%, as well as to ensure that new graduates would continue to serve under the mi­­nis­try.

“In the one-year compulsory service, we will give them adequate training so that they have the knowledge and skills to be competent dentists.

“For those who served their compulsory one year, they may join the private sector or if they wish to continue training elsewhere or do postgraduate studies, they may do so,” he told a press conference after launching the Malaysian International Dental Exhibition and Conference (Midec) here yesterday.

Also present were the ministry’s Oral Health Division principal director Datuk Dr Khairiyah Abdul Muttalib and Midec organising chairman Dr Shalini Kanagasingam.

Why India’s medical schools are plagued with fraud

The Reuters probe also found that recruiting companies routinely provide medical colleges with doctors to pose as full-time faculty members to pass government inspections.
MUZAFFARNAGAR (India), June 16, 2015:
Last December, Dilshad Chaudhry travelled with about 100 of his fellow villagers by bus to a local Indian medical-school hospital. They’d been told that foreign doctors were coming to tour the facility, and check-ups would be free.
There was nothing wrong with Chaudhry; he was accompanying his brother, who had a back problem. But “every person was told to lie in a bed even if they’re not sick,” he said.
The 20-year-old electrician said he never saw any foreign physicians that day, but the hospital’s Indian doctors kept checking that the phony patients were in bed. “They wanted to make sure no one escaped,” he said.

That was the same month government inspectors visited the hospital, which is at Muzaffarnagar Medical College, 80 miles northeast of New Delhi. The inspectors checked, among other things, whether there were enough patients to provide students with adequate clinical experience. They determined there were.
But a year earlier, inspectors had found that most of the college hospital’s outpatients “were fake and dummy and seems to be hired from nearby slum area”, according to the official report.
“In paediatric ward all children were admitted … without any medical problem and were hired from nearby area!!!!!”
“I am not very keen to reply,” said Dr Anil Agarwal, the school’s principal, when asked about the episode with Chaudhry.
India’s system for training doctors is broken. It is plagued by rampant fraud and unprofessional teaching practices, exacerbating the public health challenge facing this fast-growing but still poor nation of about 1.25 billion people.
The ramifications spread beyond the country’s borders: India is the world’s largest exporter of doctors, with about 47,000 currently practicing in the United States and about 25,000 in the United Kingdom.

Schools and scandals
In a four-month investigation, Reuters has documented the full extent of the fraud in India’s medical-education system. It found, among other things, that more than one out of every six of the country’s 398 medical schools has been accused of cheating, according to Indian government records and court filings.
The Reuters probe also found that recruiting companies routinely provide medical colleges with doctors to pose as full-time faculty members to pass government inspections.
To demonstrate that teaching hospitals have enough patients to provide students with clinical experience, colleges round up healthy people to pretend they are sick.
Government records show that since 2010, at least 69 Indian medical colleges and teaching hospitals have been accused of such transgressions or other significant failings, including rigging entrance exams or accepting bribes to admit students.
Two dozen of the schools have been recommended for outright closure by the regulator.
Paying bribes — often in the guise of “donations” — to gain admission to Indian medical schools is widespread, according to India’s health ministry, doctors and college officials.
“The next generation of doctors is being taught to cheat and deceive before they even enter the classroom,” said Dr. Anand Rai.
He exposed a massive cheating ring involving medical school entrance exams in the central Indian state of Madhya Pradesh in 2013. Rai was given police protection after he received death threats following the bust.
The poor state of India’s medical education reflects a health system in crisis. The country has the highest rates of mortality from diarrhea, pneumonia and tuberculosis, creating pressure to train more physicians.
Patients are regularly denied treatment at public hospitals that are so overcrowded, often the only way to see a doctor is to pay a bribe.
The causes of the crisis are manifold: Too few doctors. A government-backed surge in private medical schools which, to boost revenue, frequently charge under-the-table fees for admission.
Outdated government regulations that, for example, require college libraries to keep paper copies of medical journals and penalize those that subscribe instead to online editions.
Charged with maintaining “excellence in medical education” is the Medical Council of India(MCI). But this government body is itself mired in controversy. Its prior president currently faces bribery allegations.
The council is the subject of a mountain of lawsuits, many of them pitting it against medical schools challenging its findings. The cases often drag on for years.
“The best medical schools in India are absolutely world class,” said David Gordon, president of the World Federation for Medical Education.
But, he added, the Indian government’s process of accrediting a “huge” number of recently opened, private medical schools “has at times been highly dubious”.
India has been rocked by a series of recent medical scandals, including doctors accused of serious crimes.
In November, a group of junior doctors at a medical college in the eastern city of Kolkata allegedly tied a suspected mobile phone thief to a pillar, slashed him with a razor and beat him to death with bamboo sticks, according to local police.
Nine of the accused men remain in jail; they deny murder charges, say lawyers involved in the case. Three suspects remain at large.

The scalpel thrower
The system’s problems are felt abroad, too. Tens of thousands of India’s medical graduates practice overseas, particularly in the United States, Britain, Australia and Canada.
All of these countries require additional training before graduates of Indian medical schools can practice, and the vast majority of the doctors have unblemished records.
But regulatory documents show that in both Britain and Australia, more graduates of Indian medical schools lost their right to practice medicine in the past five years than did doctors from any other foreign country.
In the United Kingdom, between 2008 and 2014, Indian-trained doctors were four times more likely to lose their right to practice than British-trained doctors, according to records of Britain’s General Medical Council. (The U.S. and Canada lack publicly available centralized databases of disciplined doctors.)
The British cases include that of Dr Tajeshwar Singh Aulakh, who received his medical degree in 1999 from Punjabi University in Patiala, India, according to Indian government records.
He was assisting during a hip operation in 2008 in Shropshire, England, when he allegedly grabbed a scalpel, slashed the patient’s stitches and threw it toward a nurse, according to British government records. The United Kingdom later struck him off its list of approved physicians. He could not be reached for comment.
The Australian cases include that of Dr Suhail Durani, who graduated from an Indian government medical college in the northern city of Jammu in 2003. He was imprisoned in Perth for more than 18 months after being convicted in 2011 of sexually assaulting a female diabetic patient who had shown up in the emergency room with symptoms of a potentially serious illness.
In an interview, Durani maintained his innocence and described his medical training in Indiaas excellent. He currently is not practicing medicine.
Dr Ramesh Mehta, vice president of the Global Association of Physicians of Indian Origin, said there are “major problems” with some private Indian medical schools. But he added that a doctor’s success depends as much on “personality and attitude” as on his or her college training.

Fake degrees
About 45% of the people in India who practice medicine have no formal training, according to the Indian Medical Association. These 700,000 unqualified doctors have been found practicing at some of India’s biggest hospitals, giving diagnoses, prescribing medicines and even conducting surgery.
Balwant Rai Arora, a Delhi resident in his 90s, said in an interview that he issued more than 50,000 fake medical degrees from his home until his forgery ring was broken up by the police in 2011. Each buyer paid about US$100 (RM375) for a degree from fictitious colleges. Arora was twice convicted and jailed for forgery.
“There is a shortage of doctors in India. I am just helping people with some medical experience get jobs,” said Arora. “I haven’t done anything wrong.”
India currently has about 840,000 doctors — or about seven physicians for every 10,000 people. That compares with about 25 in the United States and 32 in Europe, according to the World Health Organization.
The shortfall has persisted despite India having the most medical schools of any nation. That’s because the size of graduating classes is small — typically 100 to 150 students.
Indeed, gaining admission to India’s top medical schools is akin to winning the lottery. The All India Institute of Medical Sciences in New Delhi has been rated the best medical school in India Today magazine’s past five annual surveys.
According to the registrar’s office, it takes in only 72 students for its undergraduate course each year out of about 80,000 to 90,000 who apply — an acceptance rate of less than one-tenth of 1%. As in theUnited Kingdom, most medical school students attend an undergraduate programme.
Similarly, Christian Medical College, a top-ranked school in the southern city of Vellore, received 39,974 applications this year for 100 places, according to a school official — an acceptance rate of 0.25%. By contrast, the acceptance rate at Harvard Medical School for its entering class in 2014 was 3.5%.
Health ministry officials and doctors say India’s medical-education system began to falter following a surge in new, private medical colleges that opened across the country during the past few decades, often in remote areas.
In 1980, there were 100 government-run medical schools and 11 private medical colleges. Thirty-five years later, the number of government medical colleges has nearly doubled.
The number of private medical schools, meanwhile, has risen nearly twenty-fold, according to the Medical Council of India. There are now 183 government medical colleges and 215 private ones.

‘Little better than quacks’
Many of the private colleges have been set up by businessmen and politicians who have no experience operating medical or educational institutions, said MCI officials.
Sujatha Rao, who served as India’s health secretary from 2009 to 2010, said the boom in private colleges was driven by a change in the law in the early 1990s to make it easier to open new schools because the government was struggling to find the money to build public medical schools.
“The market has been flooded with doctors so poorly trained they are little better than quacks,” Rao told Reuters.
Not that a legitimate degree necessarily makes a difference.
A study in India published in 2012 compared doctors holding medical degrees with untrained practitioners. It found “no differences in the likelihood of providers’ giving a diagnosis or providing the correct treatment”.
The study, funded by the Bill & Melinda Gates Foundation, concluded that in India, “training in and of itself is not a guarantor of high quality”.
Last year, an individual described as a “concerned” student at a rural government medical college in Ambajogai, in western India, posted a letter online with a litany of allegations about the school, Swami Ramanand Teerth Rural Medical College.
There were professors who existed only on paper, he alleged, and “no clinics and no lectures” for students in the medicine and surgery departments. Conditions were unsanitary at the hospital, and pigs and donkeys roamed the campus, he wrote. The writer also alleged that students had to pay bribes to pass exams.
“We are not taught in this medical college,” the letter stated. Students have graduated “without even attending a single day”. The writer said the letter had been sent to various government agencies and health officials.
Records from the Medical Council of India, the body charged with maintaining the country’s medical education standards, show that an inspection of the college this January found numerous deficiencies, including a shortage of faculty, residents and lecture theaters.
Dr Nareshkumar S. Dhaniwala, who served as the principal of the college between 2011 and 2013, said “there is some truth in the letter”.
Animals, such as pigs and cows, do roam the campus, teachers and students don’t turn up for lessons, and there is a scarcity of running water in the dormitories, he said. And before he joined, he said, he heard students had to pay to pass final exams.
“I found the students were not very interested in studying, they don’t come to classes, they don’t come to clinics,” Dhaniwala said.
“Medical education has gone downhill all over the country because the teachers are not as devoted as they used to be.”
Sudhir Deshmukh, the college’s current principal, did not respond to requests for comment.
The Medical Council of India, which was established by the government in 1934 and oversees medical education, has itself been swirling in controversy.
Dr Ketan Desai, the council’s former president, faces criminal charges related to his arrest in 2010 for allegedly conspiring to receive a bribe to recommend authorizing a private medical college to accept more students. The case is still pending; Desai has denied the charges.

‘Junk body’
In interviews, medical school officials complained that the MCI had onerous inspection requirements that were outdated and arbitrary.
“The Medical Council of India is a junk body,” said Dr A. K. Asthana, principal and dean of Subharti Medical College in the northern city of Meerut, which has been accused of demanding illegal fees for admission. Asthana denies the allegations.
The council has tried — unsuccessfully so far — to close the school. “I’m totally frustrated with the MCI. Totally frustrated,” he said.
Dr Vedprakash Mishra, the head of MCI’s academic committee, told Reuters that the agency has created “discipline and accountability” among medical colleges by imposing fines and, in several cases, prohibiting schools from admitting students for up to two years.
“We don’t compromise and mitigate on the requirements,” he said.
Asked about allegations of corruption within MCI itself, Mishra abruptly ended the interview. “This is not what I want to be discussing,” he said.
Under the government’s current regulations, private medical colleges generally must have campuses on at least 20 acres of land. Because urban real estate in India is expensive, many schools open in rural areas where recruiting qualified, full-time doctors to teach is difficult because pay scales are low and living conditions are tough.
Interviews and MCI records show that some private colleges solve the problem by cheating — they recruit doctors to pose as full-time faculty members during government inspections. The physicians work there for just a few days or weeks.
Two MCI officials estimated that there are several hundred Indian companies involved in recruiting them.
In October, a doctor in New Delhi received an email from a local company called Hi Impact Consultants with the subject line: “Urgent requirement of doctors for MCI Inspection in Ghaziabad”
The email offered up to 20,000 rupees a day (about RM1,163)) if the doctor appeared for an inspection at Saraswathi Institute of Medical Sciences in Hapur, east of New Delhi. The doctor, who requested anonymity, has no connection with the college.
“If interested please revert back ASAP,” the email concluded. The sender described itself as “a Medical Executive Search firm”.
In an interview, Sanjeev Priyadershi, Hi Impact’s executive director, confirmed that the firm had tried to recruit doctors to appear during government inspections at medical colleges where they don’t normally work.
“My client wanted to hire full-time faculty members for inspection purposes,” he said.
Dr Shailendra K. Vajpeyee, the principal of Saraswathi, said the college is constantly struggling to recruit qualified professors. Vajpeyee said he knew of Hi Impact Consultants, but denied he had employed them during his 18-month tenure.
“I don’t know why that email was sent” by the company, he said. He declined to comment further about the matter.

‘Biased inspectors’
At Muzaffarnagar Medical College, where electrician Dilshad Chaudhry was taken in December, students can read medical journals and books in a sprawling, circular library and take classes in clean and modern lecture halls.
But finding enough patients to provide students with clinical experience at rural, private teaching hospitals like Muzaffarnagar is a challenge. Many people in rural India simply can’t afford the cost of treatment.
School principal Agarwal denied the allegations by MCI inspectors that the college’s hospital had inflated its number of patients during a 2013 inspection.
“Sometimes the inspectors are biased, that is for sure,” he said. He also denied the hospital had ever recruited local villagers to pose as patients.
But Dr Vaibhav Jain, a former student at the college, told Reuters that the hospital would conduct “free check-up camps”, to lure rural villagers to the facility on inspection days.
He said the hospital sometimes would promise free ultrasounds, but only a small number of people would be tested. Villagers often later complained about it to students at a clinic in Bilaspur where he worked, he said.
“We used to say we can’t do anything, the machine was not working,” he said.
Medical education is in trouble across India, said Jain. “The truth is that many medical students aren’t prepared to be doctors when they finish” college.
“And the result is the patient suffers.”

Well, the world is changing! I had written several times in this blog that patients nowadays are not the same as it used to be. This is something that the current budding doctors are totally unaware when they claim that they want to “help” people by being a doctor. Only those in practise will understand what is happening out there.

Today, Malay Mail published several articles regarding ” Dr Belittle“(see below). It was about a Facebook posting which supposedly breached patient confidentiality and made various unwarranted remarks against the proponents of home/natural birth. Actually, I have been watching this ongoing debate among these group of doctors and the supporters of home birth for quite some time now. While both have their own believes , I do agree that certain unwarranted remarks or unacceptable language should not come from professionals like us. We should debate it in a civilised manner with facts rather than emotion. Saying that, I do see a lot of emotional rants in this blog by the younger generations when they don’t agree with my statements. But, do you see me doing the same?

We should understand that patients have every right to accept or deny our treatment. One of the ethics of medicine is “patient’s autonomy”. It is not mandatory for any patients to follow your treatment plan despite all the explanation given. You can scare and scold a patient but they have every right to deny any treatment offered to them. I use to get irritated by these group of patients when I was a junior doctor but after some time I began to accept the fact that our job is just to advise. You advise a patient for mastectomy for Ca Breast but she goes for traditional treatment. 6 months down the line , she comes back to you with metastasis all over the place! Do you scold her? It is her body and her life, you can’t do anything about it! Unfortunately, over the past 18 years, I have one thing which seem to be getting louder by the day. It is the refusal to seek doctor’s advise or treatment. The patient rather trust a traditional medicine practitioner than a doctor, simply because they feel that these practitioners are prescribing and using “natural” treatment rather than chemicals. They refuse to believe that these “natural” treatment are usually adulterated  with modern medicine chemicals such as steroids, NSAIDS and antibiotics. But you can advise till the cow come home and they will not listen to you. They will only listen when complications occur and they come back to you for treatment. I had seen enough Addisonian crisis, Liver toxicity and peptic ulcer disease from patients taking TCM. I had even sent some for analysis and showed them the proof.

What do I do when I see such a patient, nowadays? Basically, I don’t give a damn anymore. I tell them right to their face that since they do not want to take any treatment plan from me, please do not come to see me again for any problems. I rather treat and “help” patients who are willing to follow my treatment plan than wasting my time on patients who are never compliant. And for those who do come back to me, I will give them a piece of my mind before treating them.

Unfortunately, that is the reality out there. That’s why whenever a budding doctor tells me that he wants to help people, I tell them that not many patients nowadays really appreciate your help anymore. The real appreciation nowadays are in rural areas and interiors. Unfortunately, not many doctors would want to work in these areas. Just yesterday, I heard another Gynaecologist being sued in court. Together with him, another 2 doctors will have to be involved as they co-managed the complications that this patient had.

Coming back to the articles in Malay Mail today, I find the articles rather depressing. Firstly to the fact that many “unprofessional’ remarks were made by doctors which is not the right thing to do. NO matter what you discuss openly in any public forum/social media, patient’s details and particular should never be released. I see a lot of such pictures and details being written in Facebook  which is unethical. Anything that you publish that can directly or indirectly point to any patient’s particulars, where it took place etc can be sued by the patient. Also, please remember that a written consent must be taken from the patient for any pictures or videos taken. On the other hand, the article seem to be supporting home/natural birth proponents, blindly. While home birth is nothing new, it should be done by people who are trained medically. Even in some developed countries like N.Zealand, UK etc, midwives do deliver babies at home. However, these are done to low risk cases only. If they pick up anything unusual or feel that the patient might be high risk, the patients are referred to hospital for delivery. Unfortunately, the proponents of such method in Malaysia are mainly non-medically trained people. Majority do not take any responsibility when complications occur. Furthermore, they provide information that are not true and never disclose the complications that had occurred to their clients. No action can be taken against them as well. Remember, even some of the supporters of such methods had died during delivery.

Unfortunately, as a doctor, our job is to treat any emergency no matter who they are. They can be drug addicts, prisoners, murderers, robbers, snatch thief’s, HIV patients or even patients who refused to listen to you before. Your job is to treat them for whatever emergency they come with. If it is non-emergency, in a private sector, you can refuse to see the patient on a basis that you are emotionally not ready to treat such a patient. BUT, in government sector, you can’t, as you are an employee of the government, paid by the government to do the job.

So, if any of these patients who decided to deliver at home come to you with a complication, it is your job as a doctor to treat them. You can complain all you want, but that is your job. You decided to become a doctor to help people. So, just keep quiet and do it no matter how much anger you have in your heart. You have to accept the fact that it will never be the first or the last such case that you will see. That’s when you will ask yourself why I became a doctor when patients don’t listen to me anyway? And when the mother dies, a full report need to be sent to MOH as maternal mortality is a national index. Subsequently, you will be called for the Maternal Mortality meeting to find out why the mortality happened. I feel in such case, MOH should take action against the proponents of home births. BUT do they have the authority/law to do that?

As for the patients, it is their right. If they want to harm themselves, it is up to them. It is their life not ours. I realised this after few years of working as a doctor. BUT they should realise that they should NOT cause any problems to others as well. Don’t run to the hospital when complications occur. Take the people who advised you to do home delivery to task. Sue them or ask them to pay for the complications. Unfortunately, our society are more than ready to sue a doctor but not a traditional medicine practitioner or anyone else who has been advising them all this while. Do you see anyone suing these people? You don’t! That’s the sad life as a doctor. Not only you get sued for everything nowadays but also get called up by MMC for emotional rants, as you had breached professional ethics!

Doctor’s life is never the same anymore………………… so, It’s time for me to take another holiday on the seas….. ……


Doctors reminded of professional etiquette
By Vanessa Ee-Lyn Gomes
Published: June 3, 2015

PETALING JAYA, June 3 — A government doctor may have possibly breached patient confidentiality by discussing a young mother’s home delivery case over social media, says deputy health director-general (medical) Datuk Dr S. Jeyaindran.

He said the Health Ministry had regularly reminded doctors about Facebook use besides professional etiquette regarding medical discussions over the Internet.

Dr Jeyaindran said a patient’s information was always confidential.

“There is a very fine line because doctors sometimes use social media to discuss a patient’s condition or conduct consultations, but the patient’s name should never be revealed.”

He said there were implications and repercussions from public postings on social media which doctors may be unaware of.

“Unfortunately, a lot of doctors still do not realise that postings on social media may lead to breach of patient confidentiality and ethics,” he said when commenting on a young doctor’s Facebook post which ridiculed a patient suffering a third degree tear following a home birth.

Other medical professionals left mocking comments on the post.

Dr Jeyaindran, who is also a member of the Malaysian Medical Council, said it was inappropriate for medical professionals to post such comments.

“The use of social media to openly discuss patient issues is not appropriate and is definitely not advocated,” he said.

He said the council could investigate the matter if there were complaints from the patient, her family or the public.

“The doctor has to be present before the disciplinary committee to see what form of patient confidentiality has been breached,” he said.

“It does not matter who lodges the complaint because the doctor’s professional conduct will be examined.

“We will also study what information was shared in the post.”

On home birthing, Dr Jeyaindran said the ministry did not advocate it because of the risks that could lead to complications.

It is understood an investigation will be carried out on the direction of the director-general of health to ascertain if there was a breach of professional conduct and patient confidentiality.

– See more at: http://m.themalaymailonline.com/malaysia/article/doctors-reminded-of-professional-etiquette#sthash.y47COpoB.dpuf

MMA: Patient info not for open discussion
By Ida Nadirah
Published: June 3, 2015 07:32 AM GMT+8

PETALING JAYA, June 3 — Social media has given rise to issues regarding patient confidentiality, said Malaysian Medical Association (MMA) president Dr Ashok Zachariah Philip.

With widespread use of social media platforms such as Facebook, medical practitioners are not excluded from using them to channel their experiences, joys and frustrations.

However, Dr Ashok said doctors were discouraged from using social media as a forum to discuss patient information.

He said doctors in general do not reveal patient details, but would sometimes share information with other doctors for discussion or consultation.

“The problem with Facebook and such, even if something is discussed in a closed group, people can still share the information,” he warned.
He said patient information and histories should not be shared in open forums, and should only be done in traditional channels, such as bulletin boards.

Dr Ashok said the sharing of a patient’s photographs could only be done with the patient’s consent. Failure to have consent would be unethical, even if the patient was unidentifiable.

“If found guilty of breach of confidentiality, the doctor may face action by the association as well as the Health Ministry,” he said.

In reference to the recent criticism on a Facebook post where a mother suffered third degree tears during a home birth, Dr Ashok said it was not right for the doctors to use such crude language.

“We, as doctors, are human as well, and we may be angry over the result of a patient ignoring the doctor’s advice.

“However, we still have to treat the patient in the best way possible, and in no way suggest causing more harm,” he said.

He said it was improper for the doctors to comment publicly about the mother, whose medical history was unknown to them.

He said it was not uncommon for mothers to deliver at home.

– See more at: http://m.themalaymailonline.com/malaysia/article/mma-patient-info-not-for-open-discussion#sthash.X9KmQppk.dpuf

Use lidi and yam roots to stitch tear, doctor advises

Wednesday June 3, 2015

PETALING JAYA, June 3 — A young woman who sought treatment for a third degree tear after home birth has become the butt of crude and distasteful jokes from doctors who latched on to sarcastic comments posted on Facebook by the doctor who was treating her before delivery.

In the general tirade againt home birth by 26 others including young doctors, one even went as far as saying that the patient should use yam roots and a lidi (coconut leaf skewer) to stitch the wound.

If that was not rude enough, he went on to suggest in a similarly unprofessional vein that the first-time mother use glue and aloe vera to heal herself.

A Kuala Krai medical officer who agreed to the doctor’s post, mockingly said: “Yes, please repair naturally. No analgesia (painkiller) please.

Another doctor belittled the woman and patients who supported natural birth, saying “I guess positive vibes, giving birth while standing, lots of hugs, etc can’t prevent third degree tear? Hmmm, maybe because it was not natural enough.”

A third degree tear involves a tear through the perineal muscles and the muscle layer around the anal canal following a natural birth.

The person who started the sordid affair, a house officer at the Hospital Sultanah Nur Zahirah in Kuala Terengganu, had posted this on her Facebook page on Saturday night: “Homebirth. refused everything. Came to hospital for 3rd degree tear. Yes doctor, please repair my tear. Keep calm and continue oncall

To add insult to injury, the doctor also included part of the patient’s pregnancy record book in which the woman had said she would not require any medical attention during delivery at home.

The shocking use of unacceptable language and breach of patient-doctor confidentiality has come in for reprimand from the Malaysian Medical Association and the Malaysian Medical Council which took the doctor who belittled the mother and her fellow medical practitioners to task for bringing the profession into disrepute.

A group of mothers who advocate home birth have also expressed outrage over the manner in which the doctors had treated the woman who went for a procedure that had gained acceptance worldwide.

The photograph of the woman has been circulated widely and found its way into other public Facebook postings despite an attempt to erase the patient’s signature.

The first Facebook posting has been taken down but the author and other doctors continue to discuss the matter openly on Facebook.

– See more at: http://www.themalaymailonline.com/malaysia/article/use-lidi-and-yam-roots-to-stitch-tear-doctor-advises#sthash.67D0nPC8.dpuf

Home birthing is here to stay, doctors told

Wednesday June 3, 2015

PETALING JAYA, June 3 — Doctors have been told to wake up to the fact that home birthing is here to stay.

Hypno-birthing educator Nadine Ghows said the phenomena of doctors criticising mothers who advocate home birth had been going on for some time on social media.

She said the language used by the doctors tended to be patronising and condescending, oreflecting a lack of training on basic etiquette.

“Some doctors still see patients as someone to control … this is partly due to the ‘white coat’ syndrome,” she said.

She said the attitude of some doctors towards patients was unhealthy and they lacked an understanding of their role in the patient-doctor relationship.

She was commenting on the case of a house officer who had posted confidential information on a patient on Facebook which in turn elicited rude and crude remarks from a host of others including doctors.

Nadine, in decrying the actions of the doctors, said basic training on etiquette had to be offered to young doctors especially on the strict rule that they could not share any information on a patient with the public.

She said a medical lecturer from Universiti Kebangsaan Malaysia (UKM) had started a basic etiquette course for young doctors last year.

“Maybe we will not see the results soon now. I hope this course will play a role in ensuring that humanity and respect are brought back to medical care,” she said.

Researcher and engineer Nur Firdaus A. Rahim, 31, said every patient had the right to their opinion on matters involving medical procedures and their requests had to be respected by doctors.

“They should not belittle or insult parents who holds their own opinions on such matters,” she added.

“I am affected by their actions. I had initially planned to give birth at a government hospital but will now chose a private hospital that is more natural-birth friendly.”

Flight attendant Zamzilah Fairuz Kamarul Zaman, 30, said she did not mind doctors sharing their experience “but sharing patients’ records goes beyond the limit.’’

– See more at: http://www.themalaymailonline.com/malaysia/article/home-birthing-is-here-to-stay-doctors-told#sthash.v69ph7lE.dpuf

Last week, our PM revealed the 11th Malaysia Plan (RMK 11). As usual, a lot of sugar-coating and wonderful plans were mentioned. With the current reputation that our PM is enjoying, it has to be taken with a pinch of salt. The market did not respond well this time around. On Monday, our Bursa crashed. That simply shows that no one believed what was mentioned in RMK 11.

I will not talk about the entire plan as many of it are repetitive issues. I will concentrate on the medical field as attached below. Let’s look at the 1: 400 ratio. This is nothing new. Right from the beginning, the government’s intention is to achieve the ratio by 2020. That’s the reason why numerous medical schools were given license to start. As usual, our government is only interested in quantity rather than quality. We want to achieve everything on paper but in reality, half of it ” tak boleh pakai !!”. First they said that it is WHO recommended ratio, but last year, WHO has made it very clear that they never came up with such a ratio. Interestingly, just last month, MOH said that we are short of post and there are too many graduates coming into the market, but suddenly everything changes. I believe our PM do not know what he is talking about, as usual. Secondly, with the number of graduates being produced now, we will achieve the ratio 1: 400 by 2017. Don’t need to wait till 2020. All our 36 medical schools will be producing graduates by 2017. We have already reached a ratio of 1: 600 in 2013. The statistics for 2014 is yet to be announced.

Whatever said, these ratio does not mean anything as it includes both government and private doctors as well as doctors in administrative jobs. No matter how many beds that you have in the government sector, it will always be overcrowded as 80% of patients are dependent on government hospitals. This brings me to another question of bed ratio; 2.3: 1000 patients that was mentioned in RMK11. This ratio includes both private and government, but only 20% of patients will use the private sector. Unless the government comes up with a National Health Financing Scheme (which was not mentioned in RMK 11), the bed ratio do not mean anything. Everything will look glorified on paper but meaningless in reality.

Now, let’s look at the “so-called” new hospitals that are going to be built. Are they really new hospitals?

1) Hospital Bentong : There is already a 152 bedded hospital in Bentong. So, is this new hospital replacing the existent one?

2) Hospital Baling : Again, a 160 bedded hospital is available in Baling. So, nothing new either.

3) Hospital Kamaman: A 116 bedded hospital is available

4) Hospital Maran : A 60 bedded Hospital Jengka is in Maran, about 40km from Maran town. A 500 bedded Hospital Temerloh is also about 40km. I am not sure where exactly these new hospital is going to be but likely it will be quite nearby to the existing hospitals.

5) Hospital Pendang :This will be a new hospital

6) Hospital Pasir Gudang : Hospital Sultan Ismail, a 500 bedded hospital is just 15km from Pasir Gudang. There are also 3 private hospitals in Pasir Gudang District: KPJ Pasir Gudang, Regency Specialist Hospital and Penawar Hospital. So, do we really need another hospital there? Will it ever materialise. It is an industrial area where most workers are foreigners.

Building an upgraded hospital is good. However, looking at our track record, likely these hospitals will never see the light of the day. Remember, Hospital Shah Alam is yet to complete since RMK 9. Remember, Hospital Sultan Ismail was delayed for almost 3 years? Furthermore, most of these hospitals are only going to replace the existing hospitals with better facilities. It is not going to increase the number of new post very much. There will still be too few of a new posts for increasing number of new graduates.

What about cluster hospitals ? In early 1990s, a concept known as Nucleus Hospital (under RMK6) was introduced. Hospital Manjung, Hospital Sg Siput, Hospital Kulai, Hospital Segamat, Hospital Batu Pahat etc are few of the hospitals that are Nucleus hospitals. A total of 12 was introduced based on a system in Britain. It suppose to be community based hospital which acts as a nucleus for further expansion and upgrading. Unfortunately, many remained as district hospitals with some basic speciality. I got no idea what this cluster hospital is all about. I presume it is sharing of manpower and facilities among hospitals within a district/area. If that is the case, specialist may be running between few hospitals. I remember our Health Minister did mention about this few months ago. It may end up chasing away more specialist from the government sector.

Upgrading of health clinics is a necessity. Unfortunately, many of the current clinics are already facing shortage of funds and expired equipments. I hope the current ones could be upgraded first before selecting a “few” for upgrading work.

Finally, another 165 “1Malaysia clinics” will be introduced. This is a disaster for GPs. Some of this 1Malaysia clinics in N.Sembilan and Selangor is currently being filled by MOs. While it is a good publicity stunt, it will affect many GP’s income.

While everything looks good on paper, many may not happen. With the current economic situation, where will the government get the money? That is the question many economist are asking. Some of these projects will be shelved as usual, or postponed to 12th Malaysia Plan. Many may fail, as happened again and again, countless number of times……… History repeats itself!





I recently received few emails from medical students involved in the above organisation. It is an organisation of Malaysian medical students both locally and overseas. It is interesting that they have come to realise the issues that need to be addressed for their future. Thus, they are actively organising various events in Malaysia which will be participated by Malaysian students from around the world. Some of them had contacted me to advertise their program in this blog. Their next upcoming event will be in Sg Buloh Hospital next month as attached below. The Event is called MMI MAID – Making an informed choice.

A little introduction on MMI – it is an organisation that has been very actively organizing major events that involve many medical schools in Malaysia.We are a Malaysian-registered medical student organization representing Malaysian medical students both locally and overseas. Our committee comprises of both local (UM,UPM,PMC,MMMC,IMU,MONASH,AIMST etc) and overseas Malaysian medical students

Please feel free to visit page in fb : https://www.facebook.com/mmimaid and website for this event : https://malaysianmedicsinternational.wordpress.com/about-2/what-we-do/ They also have another big event coming up in August 2015 known as Malaysian Medical Student Summit as seen over HERE.


details on event


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