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The government recently had slashed the 2015 budget by at least RM 5.5b, mainly operational budget. I am not sure whether it will affect civil servant promotions for this year as promotions involves a lot of money. Generally, during any economic recession, promotions will be postponed. If the oil prices do not increase or the ringgit falls further, we may be in for a roller coaster ride this year. FYI, Petronas contributes at least a third of our government’s revenue! The government has also started to charge maximum full rate for any foreigners seeking treatment in government hospitals/clinics. This is also to generate more income for the government as they become desperate for money.

In my previous blog post, I mentioned that the waiting period for Housemanship stands at about 6 months as of end of last year. The waiting time is expected to get longer this year as more and more medical schools starts to produce their graduates. However, from March 2015(hopefully), MOH will be introducing what is known as e-Houseman! NO, IT IS NOT Housemen working from HOME for heaven’s sake but a way to shorten the waiting period (see below).

MOH will be introducing an on-line housemanship placement portal for newly graduated doctors. Fresh graduates will first need to apply for Temporary Registration with MMC after which they need to apply to SPA/JPA. Once you  are accepted into civil service, you will be given a password and user ID to log into ” e-Housemen”. This portal will list all the available post in various hospitals and the vacancies. The waiting period will also be mentioned. It will be available online twice a month.

Thus, it is entirely up to you on where you want to do your housemanship. You decide based on vacancies and waiting period. If you decide to choose the popular hospitals aka Klang Valley, the waiting period will be even longer. It will subsequently affect your seniority in civil service. I hope this system will work flawlessly but as usual, I am a bit skeptical about it. How the system works will depend on how fast the system is updated by the respective hospitals/MOH. Human and system errors can occur.

ON another note, this will eventually overcome the maldistribution issues between rural and urban hospitals as well as East and West Malaysia. If you want a job early, go where the vacancy is. Similar situation will occur when the MO post becomes full. As I said many years ago,  as the situation becomes tight, maldistribution will be solved.

Happy Thaipusam and Chinese New Year ………………….

Massage from Dr Krishna Kumar MMA President

Massage from Dr Krishna Kumar MMA President

 

e-houseman bantu graduan pilih penempatan dengan cepat (http://bm.therakyatpost.com/berita/2014/12/19/e-houseman-bantu-graduan-pilih-penempatan-dengan-cepat)

KUALA LUMPUR, 19 Disember:
Kementerian Kesihatan Malaysia (KKM) hari ini melancarkan sistem penempatan graduan perubatan yang dikenali sebagai e-houseman, bagi memperbaiki sistem sedia ada.
Menterinya, Datuk Seri Dr S. Subramaniam berkata, sistem itu yang akan mula beroperasi pada 15 Mac 2015, memberi peluang kepada graduan perubatan untuk memilih hospital pilihan mereka.
“Kami mengenal pasti kelemahan dalam sistem penempatan graduan perubatan sebelum ini dan melihat sistem baru yang diperkenalkan ini lebih telus dan mudah.
“Ini sekaligus mengikis persepsi orang ramai terhadap kementerian yang kononnya memilih kakitangan dalam proses penempatan,” katanya selepas merasmikan Persidangan Pengurusan KKM di Hotel Royal Chulan, hari ini.
Beliau berkata, graduan perubatan yang berdaftar dengan Suruhanjaya Perkhidmatan Awam (SPA) dan mendapat sijil pendaftaran sementara daripada Majlis Perubatan Malaysia (MMC), layak menggunakan sistem ini dan proses seterusnya dilaksanakan serta diluluskan KKM.

Tambahnya, proses ini hanya memakan masa 10 minit, jika graduan sudah memilih penempatan mereka dan bersetuju dengan syarat ditetapkan.
Katanya lagi, sebelum ini proses penempatan memakan masa lama dan kerjasama dengan SPA serta MMC dapat mempermudahkan semua urusan.
“Sebelum ini, KKM akan memilih penempatan untuk graduan dan kini mereka boleh memilih sendiri, sekiranya ada kekosongan. Permohonan itu akan dibuka dua kali sebulan dan prosesnya adalah mudah,” katanya.
Dalam perkembangan lain, Subramaniam berkata, persidangan bertemakan ‘Towards a seamless organisations’ bertepatan usaha mentransformasikan sektor kesihatan, bagi memberi perkhidmatan lebih cekap dan berkesan.
Seramai 229 peserta menyertai persidangan itu, bagi menambah pengetahuan dalam aspek pengurusan menyeluruh, untuk mendokong visi dan misi KKM, selaras peranannya sebagai peneraju perkhidmatan kesihatan negara.
Read more: http://bm.therakyatpost.com/berita/2014/12/19/e-houseman-bantu-graduan-pilih-penempatan-dengan-cepat/#ixzz3PpH9dGQp

 

Just 10 mins for emplacement of interns under e-Houseman system
Posted on December 20, 2014, Saturday

KUALA LUMPUR: The Health Ministry yesterday launched the cutting edge ‘e-Housemen’ system for emplacement of medical graduates during their housemanship.
Its minister Datuk Seri Dr S. Subramaniam saw the new system would expedite processing of housemanship applications from one month currently to just 10 minutes.
“Before this system, medical graduates had to register with the Malaysian Medical Council (MMC), Public Services Commission (PSC) and the Health Ministry.
Now they just have to register with MMC only.
“After registration with MMC, they will be given a temporary registration certificate following which they can use the ‘e-Housemen’ system that will be operational from March 15,” he told a press conference after opening Health Ministry’s Administrative Conference and Innovation Night 2014 here yesterday.
Elaborating on the system, Dr Subramaniam said medical graduates could choose which hospital they wanted to do their internship and if there were no vacancies, they could defer it until that particular hospital had an opening.
He added that system would also put an end to perceptions that the housemanship system was bogged with bureacracy and favouritism.
The three-day conference themed ‘Towards a Seamless Organisation’ which began yesterdaY is being attended by 229 senior officers of the ministry and hospitals. — Bernama
Read more: http://www.theborneopost.com/2014/12/20/just-10-mins-for-emplacement-of-interns-under-e-houseman-system/#ixzz3PpHQMw8e

It’s been a while since I updated my blog. It has been a hectic year-end for me with so many stuffs to settle including registration for GST etc. Interestingly, along the way I received a lot of information regarding issues surrounding the field of medicine. After my last post, I received a lot of comments in this blog, some questioning the bullying and long working hours etc. As I have said many times before, doctors cannot run away from working long hours. The recent floods in many of the states in Peninsular tells you how doctors had to work when situation demands. Hospitals in Kelantan were flooded and many critically ill patients had to be transferred to other hospitals including to Klang Valley hospitals. Doctors in these hospitals who worked tirelessly trying to save lives never even considered how many hours they had worked! When the situation demands, as it always does, doctors work. That’s the reality. So, for junior doctors who thought that doctor’s life is just sitting in a cozy room and seeing patients as they walk into your clinic, please change your perception. If you can’t handle it, it is better to change your profession or do something that is not clinically related. As for bullying, I had said enough. Unless the system changes, nothing will change.

Since almost 8 years ago, I have been constantly writing about possible future unemployment of doctors. Despite producing all the facts in this blog over the last 5 years, many refuse to believe and accused me of trying to take care of my rice bowl. Some even said that there is no such thing as unemployed doctors! The reality is now right in front of our eyes. In fact, it is happening 2 years earlier than I predicted (2016). Please remember that 50% of the medical schools in Malaysia just started to produce their graduates since 2014 onwards and these medical schools have not reached their maximum production capacity yet.

MMA had a meeting with the Minister of Health last month and the Minister finally admits (he refuted the allegation last year during a dinner meeting with MMA) that we are facing shortage of post for doctors. I attach the snapshot of the interview below. He said that the waiting period stands at 6 months now and will get longer. He also said that they might raise the min requirement to 5As in SPM. However, he declined any possible pre-employment exams, likely due to political pressure. As I had said many times before, I disagree that SPM being used as sole criteria. A better method would be to limit the type of Pre-U courses that can be accepted for medical schools. Foundation studies, which are NOT standardized, should NOT be used. Established standardized Pre-U courses like STPM, A-Level, IB, AUSMAT etc should be the sole entry qualifications. I also support a common entry exam as practiced in many other countries but of course it is a politically unwise move as many MARA, Majlis Agama and JPA scholars may have a problem if they do not pass the exam.

There are still many out there who do not understand the field of medicine. Just last week I was talking to a Marketing executive regarding the 6 months waiting period for housemen and possible limitation of employment for doctors. His immediate respond was: why not do Masters while waiting for employment!! Their perception is that Masters in medicine is equivalent to any other Masters program as for other fields. In any other field, you can directly go for Masters after graduating without any employment. BUT in medicine, post-graduate training is a FULL TIME WORKING AND PART TIME STUDYING. You can’t get into a Master’s program without completing your housemanship ( aka full MMC registration) and at least a year of MOship. It is the same anywhere in this world.

Recently I received an email from a doctor in Bahrain. He allowed me to share his predicament in my blog, as below:

“I discovered your blog website some time back, and I have to say your words and experiences are a strong confirmation about what I have been feeling about Medicine even before I graduated as a doctor in 2004.                            My parents are old school folks from Karachi, settled in Bahrain since 1979. I was educated in Bahrain, and was sent to Pakistan to study Medicine.                           

During my time as a medical student in Pakistan, I had to suffer a dysfunctional and rotten state education system, and students willing to do anything unethical to cut corners to jump ahead. Following the crowd and herd thinking has always been something I hated.                           

I always had a strong suspicion in medical school that conditions were going to be worse, and the western nations would close their doors and opportunities for everyone taking the USMLE/PLAB path. I really wanted to get myself away from all those problems and study healthcare management in the UK.                           

Business and politics has interested me more than clinical practice. I don’t necessarily hate Medicine, I just hate the lack of opportunities and deep problems that await you even before graduation from Medicine.                           

I told my parents before my graduation that I would change my career after gaining the MBBS degree, but was forced to continue after my housemanship.                           

I passed MRCS part 1, PLAB 1 and PLAB 2 after a lot of investment of time while not working in Bahrain. I really wanted to train as a surgeon in the UK, because I seemed to have been mentally competing against my professor of surgery. But during my time in the UK after gaining full GMC registration, I realised that the market and training job/post for which I had struggled for was non existent.                             

After making no headway in the UK, I returned to Bahrain, cleared the licensing examination and subsequently joined a private medical centre as a General Practitioner. I am grateful to Almighty God for allowing me to earn and save money while living with my father. My saved income has made me feel confident, and allowed me to think about what to do in the following 5 and 10 years ahead.                             

My advice to everyone around me is to avoid medical school at all costs and try achieving more at less financial and mental investment. That is in line with Sun Tzu’s principles in the Art of War. A senior UK registrar from the UK agreed with me when I said studying Medicine does not make any business sense in this day and age.                           

Hope to meet you one day soon to talk about the abysmal state of affairs of doctors worldwide.  

Regards & Best Wishes “  

He also said the following, which I had already mentioned long time ago:

Most, if not all of the children wishing to become doctors have had no real exposure to hard economic facts of life and the job market. It’s very easy to say one wishes to serve mankind, but once you graduate and your family can no longer support you, and you have utility bills, rent etc to pay every month, then feelings of charity gradually fades away. The world and society have no patience with anyone who can’t pay their way or find a job, why should medical graduates be treated or regarded any different from everyone else?”

As mentioned by him, when you ask anyone who wants to do medicine, the standard answer will always be “ I want to help people”. Of course at that young age, many do not know anything about medicine or just get carried away with what is shown on TV. Furthermore, they are living with their parent’s money with no commitments. I have had many medical students who wanted to help people in war-torn countries and work with WHO etc but ended up going nowhere. I know some students who said that they want to set up charity clinics and even start a foundation to help the poor etc. Do you see any doctors doing as such? Life starts after you graduate, when you start collecting debts (if not already), get married, have children and your parent’s financial help gets cut off (unless your parents are millionaires). This is where you will realize that no matter what your earlier intention was, reality bites. You will realize that being a doctor is just another job to earn a living. All the noble intention will disappear into thin air. Very few will endeavor.

Here I attach another email from a lawyer who reads my blog, which is self-explanatory:

I think one of the main reasons for the deteriorating quality of HOs is because they don’t understand the profession before leaping into it. This is a  “fast-food generation” where people seek instant gratification and get all disappointed when things do not immediately live up to their expectations. A lot of parents are still under the delusion that doctors immediately earn a lot of money and live a comfortable life with guaranteed jobs, so they keep encouraging their children to do Medicine for all those wrong reasons. It makes me very sad – more people should read your blog in order to quell these misconceptions.”

Doing medicine is not a good idea if you intend to migrate. However, I use to say that if you intend to migrate, please do medicine in the country where you intend to migrate. Unfortunately, even that may change soon. Just last month, there was a suggestion in UK that all foreign students graduating from UK must leave the country before applying for a job. This will have a great impact to medical graduates as they are usually given internship post under student visa. Graduates from outside UK are almost impossible to get an internship post in UK despite passing PLAB due to their immigration laws. The situation in Australia is also the same as I had written over HERE as well as what was written HERE. The reason why I keep saying this is because due to the current political climate of this country, almost 80% of non-bumis that I talk to are planning to migrate, atleast for their children.

Some may argue that we are still short of doctors as you can see hospitals being overcrowded with doctors running around. While I agree that we are short of specialist, I disagree that we are short of general doctors. What we are facing is actually MALDISTRIBUTION of doctors, between urban and rural, between public and private, between hospitals, between departments and between East and West Malaysia. Klang Valley has a doctor: population ratio of 1: 400 but why are we seeing the public hospitals overcrowded with patients? That’s because, public hospitals and clinics are catering for 80% of the population. If you add up all the beds in Klang Valley (private and public), we have enough number of beds to cater for the population. Same goes for the number of doctors but many of these doctors are either running their own clinics (GP clinics), in private hospitals or doing administrative work. The only way this “presumed” shortage of doctors would be solved is when we integrate the private and public health sector into a single entity paid by a National Health Financing Scheme. The supposedly 1CARE scheme is still in limbo for time being. The private healthcare is almost 80-90% supported by insurance. If insurance companies collapses, the private healthcare will collapse! Specialist can also become jobless.

The government on the other hand would not be able to sustain the ballooning healthcare cost by building more hospitals or creating more post. We are one of the very few countries in the world, which is still surviving with a system created by the British almost 50 years ago. It is not sustainable. Thus, as long as housemanship is under civil service, there will come a time where the government will not be able to give employment to everyone as what is happening to the nurses. The filtering has begun with the re-introduction of compulsory SPM BM paper for all, including foreign spouses and non-availability of post for PRs as mentioned in my earlier post.

We also know that government is financially hard pressed now. The fall of the oil and commodity prices, the rise of US dollars etc is putting a lot of burden to our financial coffers. Our ruling regime has wasted enough money. The 47% who voted for them were deceived by the false promises from the ruling government. When the opposition said that we are heading for bankruptcy before the election, many supporters of the ruling government refuse to believe. We have a bloated civil service (one of the highest per capita population in the world), which is also not sustainable in long run. Almost 50% of our budget is allocated as operational budget, meaning paying civil servants (25% of the budget) and to maintain and run the civil service. As much as I don’t like Dr M for his social engineering and the reason for racial polarization in this country, I must agree to some of his long-term policies such as Dasar Pensyarikatan and Dasar Penswastaan. The whole idea is to reduce the number of civil servants to about 500K to reduce the financial burden of the country. Unfortunately, the number has bloated to almost 1.5million in just less than 10 years after he left! No job is going to be guaranteed in the future.

My advice for students is to do what you are interested in after doing some research and not based on which field can make more money and which field has more prospect etc. If money is your intention, than there are many ways you can make money. Most millionaires do not even have a degree! If migrating is your intention, never do medicine. Jobs that are most needed nowadays are not professional jobs but technical jobs like interior designing, any form of designing, architecture, software engineers, accountancy, technicians etc. Professional jobs limits you in many ways. Do it only if you have real passion for it.

Happy New Year  to everyone……………… May 2015 be a better year for Malaysians……….

IMG_20150104_181151IMG_20150104_181427

2014 in review

The WordPress.com stats helper monkeys prepared a 2014 annual report for this blog.

Here’s an excerpt:

The Louvre Museum has 8.5 million visitors per year. This blog was viewed about 670,000 times in 2014. If it were an exhibit at the Louvre Museum, it would take about 29 days for that many people to see it.

Click here to see the complete report.

I attach a request by a medical student to publish the following survey in my blog. Please support her. The closing date will be 15/01/2015.

A dead body can create miracles. Do you believe that it can rise from death and save lives? We want to know how much you know about this mighty act of organ donation. So, please help us to complete this online survey by just a few clicks. 4 minutes of your time means a lot for us, thank you!

English version: http://goo.gl/forms/C0UJSwVPzQ
Malay version: http://goo.gl/forms/84sSK6Y69y

Yours sincerely, UniKL-RCMP Year 4 medical students.

Well, I just returned from my holidays down under. During my holiday, I read a lot of news regarding housemanship situation back home. In fact, before I left to Australia, I did receive few emails and phone calls regarding latest development in housemanship postings. However, I did not have the time to write anything till today.

In my earlier post over HERE and HERE, I wrote about the waiting period for housemanship and the worsening disciplinary problems among housemen. I would not elaborate further on these 2 matters. Before I left for my holidays I received at least 3 emails/blog comments regarding new developments in housemanship employment. We all know that Malaysia do not provide housemanship for foreigners. I had received many queries from foreigners in India, Pakistan etc enquiring about this. However, foreigners who are married to Malaysian can be given housemanship post under contract if your degree is recognised in Malaysia. Unfortunately, the situation seem to be changing rapidly.

About 2 months ago, I received information that a Malaysian PR was told that she will not be given a job by KKM. She is a Singaporean who grew up in Malaysia right from kindergarten days. She graduated from one of the private college here. Following that, I received 2 emails from foreigners ( one from India and another from Indonesia) who are married to locals. Both had degrees which were not recognised by MMC. Thus, they spend almost RM25K going for attachment and sitting for MQE exams. They passed. Unfortunately, when they applied for housemanship, KKM told them that a new rule will be implemented . They will need to sit and pass/get credit for SPM BM paper!! It is very clear that KKM do not have enough post to provide housemanship for foreigners or PR holders. Thus, they are creating “so-called” new rules as an excuse. As I have said many times before, passing MQE do not guarantee you a job. This applies to any country in this world. Every country will give priority to their citizens followed by PR. BTW, even Malaysians who do not have BM credits may not get a job soon!!

Many at times, when graduating students ask me whether they should start their housemanship while planning to sit for USMLE or AMC exams, I had always advised them to do so. This is because, passing AMC or USMLE or PLAB DO NOT mean you will get a job in those countries. Unfortunately, there are students who felt otherwise. They felt that if they start housemanship, they will not have enough time to prepare for these foreign exams. Well, they may be right but life in medicine only gets tougher and never gets easier. As I had mentioned since 2012, Australia is also facing internship crisis. The situation will only get worst from next year, as mentioned over HERE. So, if even their own medical school graduates may not be able to get internship post, what more foreigners, who are sitting for AMC exams. So far, I heard only 5 Monash Malaysia graduates manage to get internship post in Australia for 2015.

I received an email from a local university graduate who wanted to migrate to Australia. She declined housemanship posting in Malaysia mid of this year and decided to sit for AMC exams. She had passed her Part 1 and planning to sit for her Part 2 soon. Then came the bad news. Her senior of 1 year who had already passed her AMC exams is returning to Malaysia to apply for housemanship as she could not get an internship post in Australia. It is the same for USMLE as well. I know many who never manage to get residency of their choice. Thus, I will say this again : NEVER do medicine if your intention is to migrate!!

Over the last few weeks there have been multiple letters to newspapers regarding the working condition of house officers. While I had written many times about these issues before, what interested me most was the letter written to Prime Minister’s office. I received a copy of this letter which I would not publish over here, presumably written by a group of housemen from Klang Valley. The letter states 2 main  issues: one on bullying and another on long working hours(supposedly 17-18 hours). Few days after I received the letter, I also saw the letter from PM’s office instructing the state health department to investigate the truth of the matter. It also appeared in the Star. Let me elaborate on both.

2 days before I left to Australia, I received a phone call from a mother whose daughter is doing housemanship for the last 3 months. She informed me that her daughter is very depressed and wants to quit housemanship. She claim that she is being bullied and she is unable to handle it any further. Surprisingly, according to her, the biggest bullies are NOT specialist or even MOs. It is the senior house officers!! Firstly, we need to define what is bullying and what is scolding. Medicine deals with patient’s life and thus certain mistakes have serious repercussions. You go to medical school to learn the basics of medicine and housemanship is to apply those basics in real world clinical medicine. The problem now is the fact that the quality of house officers has deteriorated tremendously to the extend that the senior doctors just throw their tantrum all over the place. Who will not get angry when you do not know how many chambers does a heart has? They should not have graduated in the first place! While I agree that scolding your juniors in front of patients and public should not happen but sometimes, the hectic work life of specialist or MOs just shoots them off the roof.

Bullying on the other hand has nothing to do with scolding for making mistakes.Bullying includes actions such as making threats, spreading rumors, attacking someone physically or verbally, and excluding someone from a group on purpose. Unfortunately, this seem to be an Asian culture. I had said it many times in this blog that the very same person who is complaining about bullying, will become a bully when he becomes a senior. I had personally seen this right in front of my eyes. AND that is exactly what is happening in the case above. The biggest bullies for her daughter were Senior HOs!! As long as these happens, bullying will not end. While KKM do have protocols to make complains on bullying, the line that demarcate bullying and scolding is blurry. The deteriorating quality and the surge in the number of housemen will only make bullying worst.

The second issue was ” working hours”. I had also written about this before over HERE in 2011. While I don’t agree working 32 hours continuously  as what we did when we were housemen, being a doctor means we have to work long hours! That is a fact that most students should know before doing medicine. We cannot just let go of our responsibility to the patient before going home. WE must make sure we have done what we need to do. There is NO such thing as office hour job for doctors. In the court of law, patient safety is the most important consideration. These housemen think that they are the only one working 17-18 hours a day. Most doctors do and even people in other profession work long hours. The only difference is in other profession, you can bring your work back home where as in medicine, your work is done in the hospital. Even after 18 years of service, I am still working 24hours a day, 7 days a week. I can be called anytime of the day, even on weekends. Life in medicine will never get any easier. You must learn to work long hours. If you can’t, then leave.

Our DG has given a good reply to those who complain about working hours over HERE(see below). Another reply from a Paediatrician is also worth reading for those who complain about working hours (see below). Interestingly, a recent study in US showed that work hour limit for trainee doctors do not improve patient safety!! I know many who complains about working hours but will be sitting in a clinic doing locum when they are free!.

You chose this path and you need to adapt to what medicine wants you to be. Life’s are at stake and medicine is a life long learning. Even now, I am still learning. The most important teachers are your patients! The more time you spend with your patients, the more you will learn. I may be harsh but my advise to those who complain of long working hours is : please leave if you can’t handle it.

Response to the article Trauma faced by some housemen in hospitals’ by ‘Disgusted Malaysian, Kuala Lumpur’ dated 8th December 2014.
Posted on December 10, 2014 by DG of Health
I refer to the article published in The Star entitled ‘Trauma faced by some housemen in hospitals’ by ‘Disgusted Malaysian, Kuala Lumpur’ dated 8th December 2014.

The Ministry of Health (MOH) appreciates all feedbacks which have been provided on the housemanship training. Housemanship programme emphasises on training rather than merely employment, whereas the medical officers’ main role is to provide medical service, hence their roles are different. The 2-year housemanship has started since 2008. It encompasses training in 6 disciplines namely General Medicine, Paediatrics, Surgery, Orthopedics, Obstetics and Gynaecology, and alternative postings (either Emergency medicine, Psychiatry, Anaesthesia or Primary Care) for a period of 4 months each.

The housemen flexy working system has been implemented since September 2011 and was improved further from January 2014.The introduction of the flexy system is among the continuing efforts by the government to maximise the houseman’s learning process which aims to further improve their working conditions. It provides a chance for them to gain experience and take advantage of the learning opportunities to be competent and safe doctors.The flexy system requires the housemen to work an average of 65-75 hours per week. Housemen are entitled to a one day off per week but it is not necessary for it to fall on weekends. Housemen are doctors under training and they must fully utilise the opportunity given to them to improve their competency. MOH is monitoring closely the housemanship training in government hospitals to ensure the flexy system is successfully implemented.
Feedback pertaining to Housemanship Training need to be chanelled to the Housemanship Training Committee at the hospital and State Health Department. It is worth mentioning here that the doctors’ utmost responsibility and inherent value is providing safe and quality care to the patients. The nature of doctors’ working hours is different than other civil servants because patient care requires continuous services of 24 hours a day or 7 days a week.
In appreciating our doctors’ commitment, the Government has given various incentives such as the critical allowance of RM 750 per month and a special allowance for housemen of RM 600 per month. It is hoped that with all the efforts made by the Government, the aspiration to produce quality and competent doctors for the nation will be achieved.

DATUK DR NOOR HISHAM BIN ABDULLAH
Director-General of Health Malaysia.

HOs must stop griping and learn the job
I REFER to the letter “Trauma faced by some housemen in hospitals” (The Star, Dec 8) on the trauma faced by House Officers (HO) at the hands of seemingly sadistic Medical Officers (MO).

I would like to offer a different view of the matter lest the public gets the wrong impression of how medical supervision is practised here and worldwide.

No MO will willingly traumatise a HO unless the former is extremely overworked or the HO is so hopelessly trained that the MO is so exasperated by the inadequacy of medical knowledge and lack of responsibility.

With the current standard of medical graduates coming back, some of whom with dubious medical training in institutions that have been approved through political means, it is not surprising that the MOs are stressed by these incoming HOs.

The extension of a HO after the stipulated period is the decision of the supervising specialist, and he or she has to justify appropriate reasons for extension.

If the performance is still below par after the extension, the HO’s name will be forwarded to the Health Ministry’s director-general to send him to another specialist for supervision.

Nobody likes to extend a HO because of the paperwork that is involved but due to the maintenance of a respectable standard and the future safety of patients whom the HO will be entrusted with, these MOs and specialists have to maintain these standards of care.

The writer has to understand that getting a paper with MBBS or MD is just the beginning of a lifelong journey of training and retraining.

The initial degree should have taught a basic foundation in medical knowledge, ethics and basic practice to allow the HO to function with further supervision for another one to two years and be trained to be a specialist of his or her choice after that.

Without any further training, the MO can become a general practitioner in this country.

If the HO’s performance and knowledge is below par compared to his peers, it will not be fair to let him “loose” to the general public.

This training of HOs occurs all over the world and it is one way of ensuring that the public will be given safe young doctors to treat them in the future.

Ask any supervising specialist in the profession and one hears of the deteriorating standard and responsibility of new incoming HOs.

There are good ones who perform and never write in the newspapers and there are bad ones who complain about working 32 hours at a stretch. They just have to get used to it!

That’s what they signed up when they chose medicine where the patient is paramount to our sleep, food or toilet habits.

I think the writer exaggerated about the predicament of HOs. There is not a trained specialist who has not slept in the operating theatre, patient’s bed, at the table or in the toilet in his lifetime.

A smart HO should get used to sleeping a few hours in between patients and admissions, wherever.

These complaints are nothing new and the HOs just have to get used to working unlike other workers in the workforce as they will have the lives of their ill patients literally in their hands.

The less they complain and the more they learn from these patients and their superiors, the better doctors they would become.

PAEDIATRICIAN Z

Kuala Lumpur

My last blog post received almost 27, 000 views in a single day on 5/11/2014. Numerous comments were made. My comment was very simple, a once well-respected and trusted profession to whom the community looked up upon, has gone to a stage where the authorities have to ask sisters/nurses of the ward to monitor their discipline. Some commented that there are only a few bad apples in our profession BUT let me tell you, for those who are not in the system will not know that it is NO MORE a few bad apples. The fact that the Minister has to instruct and give extra job to the sisters to monitor the discipline of house officers is enough to explain the gravity of the situation. BTW, the topic discussed had nothing to do with insulting the nursing profession. It was all about the deteriorating attitude of OUR profession! We brought it to ourselves.

The same situation seems to be happening in smaller district hospitals and Klinik Kesihatans. I am beginning to hear stories that taking MCs, EL and coming late to work is becoming very common nowadays, despite having more MOs. Sometimes I wonder whether it is better to keep less number of doctors than having more as it is easier to monitor. I always believed in quality than quantity. Recently I heard that 4 MOs did not turn up to work in a KK on the first day of the week! 2 decided to take MC, 1 took EL and another claim stuck in traffic jam! Some MOs were found to be taking frequent MCs (must be immunocompromised I guess!), given to each other by themselves! What will MOH do about this ? I am sure sooner or later, another similar circular will be issued to KK sisters to monitor the situation. Few years ago, there was already a circular stating that MOs can only be given MC by a specialist but no one seem to be following this anymore. What impression does the other staffs of the clinic will have on us? An unreliable bunch of ………..?

Every now and then, I hear that HOs and MOs do not turn up to work because they are busy doing locum in 24hr clinics. Some has been caught before. Let me remind those HOs that doing locum before full registration(aka completing housemanship) is ILLEGAL! MOs are allowed to do locum with permission from the Hospital Pengarah. However, the place where you are doing locum must be written in your APC. As a doctor, you can only practise at the places mentioned in your APC. Practise at any other place can be deemed illegal.

All these years, even after locum was legalised in 2006, MOs/Specialists locum incomes are never properly declared to LHDN(IRB). While the clinic may declare the locum fees paid as an expense, I am not sure how many doctors who do locum ever declare their income generated from locum. Remember, every income that you receive are taxable. We all know that the government is running out of money! The last Budget 2015 and the impending GST are clear indications. The drop in oil and oil palm prices in international market will further reduce our country’s income. So, the government has to fall back upon the people to get the money back! Thanks to the 47% who voted in the last election. The toll prices are going up next year, electricity tariffs may go up in June 2015 and petrol/diesel subsidies are being removed effective 1/12/2014. While doctors who are running clinics cannot charge GST to patients (GST exempt), they have to pay and absorb all the GST charged by their vendors on supplying equipment, drugs and clinic rentals. Thus, the overhead cost will definitely increase which in turn reduces your net income further. ON the other hand, an increase in your consultation fee is limited by the government and the patient’s ability to pay! Patient’s cost of living will also increase after GST implementation.

While GST comes under Customs department and follows a completely different set of protocols, income tax comes under LHDN. Doctors in private hospitals who are generally self-employed are still confused about GST. Negotiation and discussions are still going on, between MMA, APHM, Hospital Managements and Customs.

LHDN on the other hand is going around blocking all the loopholes they have, to generate more income for the government. Coming back to the locum incomes mentioned above, LHDN is sending circulars to clinics making it compulsory to declare who their locums are!! The circular (see below) clearly says that, it is needed for LHDN to collect more MONEY! So, for those who thought can do locum and escape without paying tax, please beware. LHDN may come knocking at your doors one of these days. The penalty can be an additional 20% of the tax not paid! Furthermore, you can be barred from leaving the country!

As I wrote in my Part 1 and 1b of the above topic, life is not going to get any easier for doctors. So many rules and regulations are changing nowadays. If the separation of dispensing rights happens in April 2015, income of doctors will further decline. The medico-legal cases and seeking compensation from doctors are also increasing day by day!

Well, it’s time to take another holiday to clear my mind and release my stress. I will be away and may not be able to answer the comments in this blog from 26/11/2014 till 7/12/2014. It’s time for me to go for another round of thrill rides down under!

Good Day mate!

 

LHDN 2

 

For years I have been writing about deteriorating quality of medical graduates. For years I talked about the poor knowledge of housemen and their inability to handle stress. I had also written in this blog the “tidak-apa” attitude of the junior doctors nowadays. We can still tolerate some lack of knowledge as it can be learned but the feedbacks that I get from my friends is the attitudes of the current generation of doctors. Many go missing in action (MIA), SMS their colleagues and even MOs that they are not turning up for work, giving stupid excuses such as car breaking down (can happen even 3 times/month!) etc etc. With the load of housemen in some hospitals and the introduction of shift system, the MOs and Specialist has given up monitoring the housemen. NO one bothers about them anymore. Only the good, hard working ones catches the eyes of the specialist and MOs. The same generations are becoming MOs and the cycle is repeating itself! Unfortunately, the system can’t do anything to kick them out!

Our profession use to be a well-respected profession. People use to look up to us and the staffs in the hospital respected us for whatever we did and said. Most doctor,s up to 10 years ago, use to be the cream of the country. They were the top students and to become a doctor , you need to have a brilliant mind with a lot of hard work. You need not be a ALL A star student but still need certain level of intelligence. We worked tirelessly with only the patient’s safety and life in our minds. Unfortunately, the situation is changing rapidly. Now, anyone can become a doctor as long as you have the money. Everyone who enters a medical school seem to be able to pass after 5 years. No one seem to care for the patient. Many are only interested in the status and salary. Everyone is only thinking on how they can earn money as fast as they can. Everyone is being calculative on the amount of time they are working. Many are becoming “bodoh-sombong”, don’t know anything but don’t bother to find out and give stupid advises to patients! I can go on ranting about it here but the situation will only get worst. Until the entire healthcare structure changes to kick out the “non-functioning” doctors, we are heading for self-destruction.

Doctors had always monitored doctors (apprenticeship). No one interferes. Unfortunately the system seem to be falling apart as specialist are unable to monitor the situation anymore. Thus, MOH has developed a NEW monitoring system for Housemen! Below, I attach a letter from Lembaga Jururawat Malaysia (mind you, NOT MMC!) informing that the Minister has instructed all Sisters of the ward and Matrons to monitor ALL the housemen in the hospital. A “tracking mechanism” is being developed. It will be on trial till December 2015 for feedback.

Well, we brought this upon ourselves. We have come to a stage where nurses aka sisters aka nursing body are being asked to monitor the attitudes and disciplines of housemen aka doctors!. We had lost all the respect that we once had. Soon, they may ask MAs and KK sisters to monitor MOs!!

It is a sad day for medicine………………..

Never do medicine for wrong reasons!

 

 

KKM NUrse 1

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