Feeds:
Posts
Comments

Yesterday, was a sad day for most right thinking Malaysians. I woke up in the morning with a shocking news in my phone. Messages confirming the death of a great fighter and lawyer, Karpal Singh! Since there are so many pranks nowadays , I did not believe it till I saw the official announcement on the online Star. It was a sad day indeed.

For those who are around my age, we grew up with the names like Mahathir, Samy Vellu, Anwar Ibrahim, Karpal Singh and Lim Kit Siang. These were the titans of Malaysian politics. They gave us the colours of Malaysian politics, from humour to court cases and verbal fights in Parliament. One person that stood out was Karpal Singh. An excellent lawyer with unshakable principles of rule of law and rule of constitution. I still remember while I was in the university, how Karpal manage to sneak in the famous DP Vijandran tape into the Parliament. If not because of that daring move, the infamous ” blue tape” would have been classified as “No Further Action” aka NFA.

It was only in January this year, I completed reading the biography of Karpal Singh ” Tiger of Jelutong”. It was an interesting biography of how he took up cases against the government to defend communist as well as many others who were charged in court for which they were looking at death sentence. He was one of the lawyers who believe that everyone should be given a second chance and he was totally against capital punishment/death sentence. He was a fighter who fought against the government over 4 decades.  Despite ISA detention and a motor vehicle accident which rendered him paralysed neck below, he continued to fight for betterment of Malaysians.

He did these without any pay or reward, unlike our ruling government politicians who even got the cheek to make ridiculous and unacceptable statement in “support” of his death! He was a man of principle who stood by it. If it is wrong, he will say it is wrong no matter from which side of the political divide the statement comes from. He was even daring to challenge the royalties based on the constitution and what is allowed legally. A tiger that never slept and continued to shake the country even at an age of 74!

Well, Parliament will never be the same without Karpal Singh. The tiger might be gone but the roar will continue to be heard with many more new Karpals in the making!

Good Bye, Tiger of Jelutong………………. May you R.I.P…………………

About these ads

For close to 3 weeks, I did not update my blog. I decided to keep silent as a mark of respect to the disappearance of Flight MH370 since 8/03/2014. It will remain as the greatest mystery in aviation for many more months/years to come, looking at the way it is unfolding. During these 3 weeks, the SPM and STPM results were announced. As usual, thousands of students are scoring straight As. Since our national exam results are under Official Secret Act ( the only country in the world probably), the only information we get is from the official announcement to the press. From what I gather from the report HERE, there were close to 14 000 students who scored straight As in all subjects with almost 400 students scoring straight A+. What a remarkable figure! It is either our students are getting  smarter or our exam standards are dropping drastically. According to World Bank Senior economist, the poor quality of our education system is more worrying than the amount of household debt !! I still do not understand why the passing mark of our national exams are considered an official secret! For your info, the passing rate of MRCP exams worldwide since it’s inception has remained about 45-50%! In this Bolehland, everything can be adjusted to give the “feel good” factor! The same goes to our tertiary education. Ask any employer who interview job applicants and see what they say.

Now, with this “top scoring” rate of our students and the MMC’s minimum entry requirement , how many students do you think would be eligible to enter medical school ? We should be filled with doctors, walking on the road. As usual, around this month I will receive numerous emails and phone calls from potential medical students/parents asking what they should do. You will see numerous advertisement in newspapers and ASTRO , promoting medical education in countries like Russia, Indonesia, Egypt etc etc. It is a business out there! A good money making business indeed.

Firstly, as I had mentioned many times before, I do not consider SPM as an entry qualification to do medicine. It should be a standardised established Pre-U course. I will never agree using foundation programs to enter medical school. It is just a marketing tool for the universities to get students. Most of the time the medical seat has already been booked.  Students being students and parents being parents, they will definitely choose the easiest and most guaranteed route.

As I have always said, NEVER do medicine for wrong reasons. I still get a lot of questions about future job prospect in medicine. Much has been written in this blog about the possibilities of oversupply of doctors and jobless scenario. If you have genuine passion and interest in doing medicine (after reading this blog on the reality of medicine), why worry about job prospect ? A person who does law, is he worried about whether he will get a job ? Same goes to the rest who does engineering, pilot, business admin, actuary etc etc. Do what you are interested and after knowing what is the demand of each job. Never jump into anything just because your results entitles you to do so. Many of our students nowadays do not understand the reality of the world out there.

Always remember ” A Grade students work for C grade students ” . That’s the reality. Most millionaire’s (if earning money is your intention) are not professionals. In fact, many of them do not even have a degree. They start to learn how to make money when they were late teenagers and become rich by the time they reach 40 years old. Warren Buffet started making money when he was 12 years old! While they are busy making money by investing in stocks, property etc, you are still slogging in the university! So, do medicine only if you have real passion in serving mankind.

Today, 50 top students were given scholarship to go overseas for their courses. The way it is portrayed in the newspaper sounds like, being trained overseas is superior than local graduates. Than why call yourself as an education hub? Frankly, you should only send students overseas if the course is not available in this country. WE can always sponsor students overseas for post-graduate studies rather than undergraduate.

I came across THIS interesting video about life as a Houseman. I must say, it was well done and does show the reality of a junior doctor. However, the scenario  does not tell the actual hectic life of a doctor in a busy general hospital. It dwells more into the emotional aspect of a young graduate. Most of it has been written in this blog since 2010. For those who are interested in doing medicine, please read all the topics under ” For Future Doctors” page

 

26th February 2014 was the day I woke everyone up. When I wrote an article with the title A Wake Up call? , I never ever thought that it will go viral in social media and indeed, waking everyone up! I posted the article on 25/02/2014 at around 11.30pm. The next day I had a staggering 51 113 views in a single day, the highest ever recorded, equivalent to what I usually receive in a month! Almost 4000 came from Russia. It received almost 450 comments to date. 7 000 people shared in Facebook and 96 tweets were made. I spent almost the whole day trying to reply to many of the comments that I received,  replying mainly from my iPad and Blackberry Z10 mobile phone.

I had a lot of nasty comments but many of it were from people who did not really understand what I actually wrote. Many were accusing me of degrading Russian graduates etc. This is a problem which I commonly see among many of the younger generations. They pick a single sentence and accuse people of something. I saw many “would be” doctor’s attitude which is rather shocking and just proved some of my comments on quality! When you read an article, the interpretation should be based on the entire article and not a single sentence. The fact remains that there are many unqualified students who are doing medicine overseas, including Russia, Indonesia, China and Middle East. Some of the comments that I received proved that as a fact. This is one of the reason why the quality of products of these universities are poor. No matter what people think, you need certain level of intelligence coupled with true passion and interest to become a good doctor. This is what the entire article is all about. Of course, I did mention that there are good, hardworking graduates from Russia/Indonesia etc but majority of these graduates are those with good entry qualifications who had no choice but to go to these countries due to financial constraints or government sponsorship. This fact was again supported by many of the comments in this blog. Many comments also supported the fact that graduating from these universities are not difficult. Trust me, the same scenario is happening within our own country.Of course there are also students with good results but turn up as a “bad” doctor but the probability of these happening is very much lower than the other. This usually happens as they were not interested in medicine anyway.

Then, there was another issue on using SPM results as an entry qualification. Despite me mentioning very clearly that I would prefer a good established, standardised Pre-U course as an entry requirement into medical course, there were many who accused me otherwise. The SPM minimum requirement is from MMC and not by me! I believe that it was the SPM result that I posted in the article that attracted visitors from all over the world. Many were shocked to see a person with such a result becoming a doctor. You can argue till the cow come home but it is a fact that you need a good entry qualification (established Pre-U course), at least top 10% of the cohort, to enter a medical school in many developed countries. For those who say otherwise, why not you try to do that  in countries like US, UK, Australia/N Zealand and many of the European countries? They will ask you to fly kite! These countries also have a good quality monitoring system in place, after graduating.

It is also a known fact that the quality of doctors are deteriorating. This is due to reasons such as the one mentioned above, mushrooming of medical schools with inadequate academics and inadequate housemanship training (due to oversupply). These poorly trained doctors are then released to the community with a “license to kill”! Frankly, a doctor can kill a patient with a stroke of a pen. Many of these doctors do not even know what they don’t know (lack of insight)! Imagine a patient with Chronic Renal Failure being given high dose NSAIDS leading to a fatal Acute Renal Failure! Yes, it has happened! Imagine a postmenopausal bleed being told to be normal and discharged ! A 74-year-old lady with 1st episode of seizure being discharged after a pint of drip (Na 115)! These are just the tip of the iceberg. I can give you dozens of examples which is happening on a daily basis. These doctors who are completing the housemanship are the ones who are forming the backbone of the entire healthcare system in this country. Klinik Kesihatans, District Hospitals and even in general hospitals, MOs are the most important front liners. The deteriorating quality of doctors will bring down the entire healthcare quality of these country! Numbers does not matter, quality matters! Thus, when I said that many of these poor quality doctors will end up as GPs or chronic MOs, many GPs were unhappy with me. Again, they quoted a single sentence in my comment and said that I am degrading GPs. My sentence was from a series of comments that I was replying. I was saying that, many of these “poor quality and poorly trained” doctors will end up as GPs, and who monitors them? Once they open their clinic, they answer to nobody. Again, don’t misquote me. I know many good doctors who have become GPs. Many of them are my good friends and they know what I am talking about. I am talking about the future. We can’t compare the training that we got from what the current generation of doctors are receiving. Same goes to some of the junior specialist who leave to private sector too early without adequate experience. We need a proper monitoring/upgrading system in place.

2 days after I wrote the infamous article, I had a chance to meet up with the MMA President and Secretary in JB. They came down on 27/02/2014 to discuss our preparation for the upcoming National MMA AGM in May 2014.  Our President just attended a meeting in Putrajaya with MOH officials, WHO representative etc. He revealed a shocking information. According to WHO representative, they had never issued any statement regarding doctor: population ratio of 1: 400 for a developed country ! WTH! All these while, it was these ratio that was quoted by our government in producing more doctors and the mushrooming of medical colleges. The news appeared in the Star on 9/03/2014 (see below). The reason why WHO never made such statement is because they are well aware that quality will be compromised to achieve the ratio. That is exactly what is happening in this Bolehland………………..

AS we mourn the lost of MH370 and being in the spotlight of the world with flying bomohs, I hope we will not see a future where our people go to neighbouring and other countries to seek medical treatment!

mh370

MMA: WHO denies setting doctor to patient ratio

BY NEVILLE SPYKERMAN

PETALING JAYA: Malaysia does not need one doctor to 400 patients to be considered a developed country, said the Malaysian Medical Association (MMA).

MMA president Datuk Dr N.K.S. Tharmaseelan said the World Health Organisation (WHO) had denied setting the ratio which is often used to justify the mushrooming of local medical colleges.

“The purported WHO statistic is often quoted to deny the fact the country had too many doctors, though it is obviously so,” he said.

Dr Tharmaseelan said WHO representative Dr Gulin Gedik, during a meeting at the Ministry of Health on Feb 27, was surprised when the issue was raised by MMA.

He said the ratio had led many countries, including Malaysia, to produce more doctors without having the infrastructure or facilities in place to train them.

“Dr Gulin assured MMA no such figure existed or would be imposed by the WHO, as there were many issues to delivering healthcare,” said Dr Tharmaseelan.

He said Malaysia’s current one doctor to 600 patients ratio should not be used to build more medical colleges as these could affect standards.

“We should instead amalgamate the existing colleges into a sustainable level,” he said.

He said more emphasis should be put on raising the standards and quality of training provided to doctors and allied health professionals rather than aiming at an Utopian goal.

Dr Tharmaseelan also pointed out that the problem plaguing the Malaysian healthcare system was the reluctance of doctors to serve in rural areas including Sabah and Sarawak. He said there were wards in urban government hospitals which had up to 100 doctors when they just needed 20 or 30.

“The authorities should compel new doctors especially those who obtained government scholarships to serve in rural hospitals,” he said.

He also called on the Education Ministry to strictly enforce the five-year moratorium on medical colleges and gradually reduce the number of admissions to medical colleges.

My last blog entry on 17/02/2014 received the highest number of views in a single day since it started, 4 years ago. It achieved 11 195 views in a single day!! This goes to show that there are many who are worried about the situation. I also received few emails and blog comments from students who are doing medicine elsewhere without the minimum requirement introduced by MMC in 2011. It is very sad that our society is still a very ignorant society. Some of them are not even aware of the guideline! Are we leaving in caves?  With the information technology, there is no excuse! I would blame it on our education system!

When I read some of the comments and emails, I realize that there are many who are doing medicine with pathetic SPM results. Majority do not understand what medicine is all about.  With many dubious and mediocre medical schools out there, getting an MBBS degree is as easy as any other course. What you need is just money!! Money talks! How many students who go to Russia ever failed their 5 years medical course?  We have heard and seen many mediocre students doing medicine in Russia as well as in some other universities in Indonesia, China and Eastern European countries. I know one who got 9Fs in SPM but was doing medicine in Ukraine! Some of the comments that I received in my last blog entry just proved the scenario. The poor entry qualification is one of the main reasons why you see graduates with poor quality from Russian universities ( the talk of the town). On another note, there are good students who go to Russia, as they could not afford any of the local medical colleges. These students generally do much better when they start working. I have heard horror stories of what actually goes on in some of the medical schools!! The fact that they do not even know how to take history and examine the patient, tells you a lot. The very basic reason why you go to a medical school !

Many were tricked by agents who promised guaranteed job, similar to what happened to thousands of nurses. They were told that as long as they have a MMC recognized degree, they would get a job when they return. Well, it is true at the moment but not anymore. With limited number of post within the next 2 years, having a MMC recognized degree does not mean anything. Having a degree, which is registrable by MMC, does not mean you will get a job. It is the same in any other country. In Malaysia, job is given by SPA and Ministry of Health. MMC only provides Temporary MMC registration for you to undergo Housemanship.

With so many dubious Foundation programs organized by many universities as a “short-cut” to attract students into their medical school, MMC had no choice but to introduce the minimum requirement based on SPM results in addition to pre-university results (only A level, STPM and few other courses can supersede)!! We are probably one of the very few countries in the world, which do not use a standardised pre-university qualifications as a sole requirement. I would rather prefer if MMC makes a few well-known Pre-U courses as the minimum requirement, such as STPM, A-Level, IB, Australian Matriculation etc etc. As far as I am concerned, Foundation studies SHOULD NOT be used as an entry qualifications into medical course. Not only it is NOT standardized but prepared and marked by the university itself!! Whatever said, you need certain level of intelligence to do medicine. You may not need to be a A-star student but at least the top 5-10% of the cohort.  Medicine is not for any tom, dick and harry. That having been said, you also need genuine interest and passion to function as a good doctor.

Since the minimum requirement was introduced in 2011, all students accepted into local private medical schools have to submit their results to MMC for verification. The universities will do this. However, despite this I have heard and seen many students being accepted into medical schools locally without the minimum requirement.  The students are accepted and subsequently asked to appeal to MMC. When Crimea Medical University was derecognized in 2005, the NOC was introduced. The government noticed that there are students who have very poor SPM/STPMresults, from Arts stream and even those who fail SPM, were doing medicine in Crimea.  Unfortunately, there are still many students out there who are doing medicine WITHOUT NOC. This is simply because, they were told that as long as they have a recognized degree, it is not a problem.

Sad to say, the situation will change soon. Last year’s MMC’s guideline clearly says that those who do medicine in an unrecognized university without minimum requirement, will NOT be permitted to sit for the MQE exams. This basically means that you can forget about practicing medicine all together in this country. You can try to get a job in another country where your degree might be recognized.

When the job market gets saturated, the government will become choosy as any other profession in civil service. Preference will be given to government-sponsored students and local public university graduates. This will be followed, by the rest. With limited number of post available, what criteria will SPA use to offer employment? This is where your NOC will come into force. Very likely that those who do not have NOC or the Minimum entry criteria will be the last choice to be offered a job. You may end up jobless as there will be almost 6-7,000 graduates/per-year by 2017.

Obviously, there is no law to do this but getting a post in civil service is a privilege and not a must. The only problem in medicine is the fact that if you do not do housemanship, you will not be able to practise as a doctor in this country. Thus, MOH is working on a few formulas to decide on who will get a job in MOH in the future. With the civil service being controlled by almost 90% from a single race, the people as well as the politicians will make transparency and biasness as an issue. So, we need to come up with fair and transparent criteria.

Over the last few months, many suggestions are being discussed at MOH level. The first suggestion is to give housemanship post on contract basis, after which you need to sit for an exit exam. The exit exam as well as your superior’s assessment will be used to decide who will get a MO post. Basically, you need to reapply into government service after Housemanship. What happens to those who fail? Obviously, you may not be able to work as a doctor or may need to redo housemanship.

The latest suggestion, which is seriously being considered, is the common entry/licensing exam or MMLE. Many countries as well as many other professions do this. Even our nursing board has exams similar to this.  The lawyers have CLP but they can still work as legal adviser without CLP. For me, this will be the best option. MMLE should include all graduates including the local public and private universities. It should be standardized and centralized by MMC unlike the current MQE exams. Only those who pass will be able to get a job. This will definitely remove the mediocre ones as long as it is fair and transparent.  Unfortunately, this was suggested by our ex ex DG (Tan Sri Dato Dr Ismail Merican) but was shot down by cabinet due to political reasons!! In Malaysia, education is always politicized!

So, for those students who do not have the minimum criteria, please do some other course. This is my advise to you. Firstly, unless you do well in a well established, standardized Pre-U course, you do not qualify to do medicine. Secondly, with the soon to be surplus of doctors, your chances to get a job in Malaysia will be slim. Finally, do not waste your parent’s money. Put that money to good use. I would also like to advise parents that they should not force their child to do medicine and please do not ask your child with mediocre results to do medicine. You are committing  a crime to the society. I have seen enough mistakes being done by the current generation of doctors, life threatening mistakes that I have hardly seen before. It clearly shows the deteriorating quality of doctors in our community. We do not want to see students with SPM results like below to do medicine. In “real and genuine” medical schools, they will not even survive the first year. I am not saying that all good grade students will become good doctors but you need certain level of intelligence to do medicine coupled with passion and genuine interest.

FYI, the SPM result below is a Russian graduate who applied for Master’s program. A friend of mine who were interviewing them sent it to me!! She got a shock of her life when she saw the result!! Obviously, this student would not have got a NOC based on the current criteria. Obviously, she may not get a Master’s seat, as the competition is getting tougher.

Our ignorant society needs a wake up call……………………

IMG-20131227-WA006

Over the last few days, I received and read few information regarding the situation of employment of doctors in Malaysia. As I predicted almost 8 years ago, every single prediction of mine is becoming a reality sooner than I had expected. I read the latest Berita MMA (Feb 2014) yesterday where both the editor and the President was talking about the oversupply of doctors and the fact that JPA is asking MMC to remove the compulsory service. It is interesting because when I first wrote about this possibility in 2005 and 2006, the then MMA president said that I am over exaggerating ! While MMA is adamant that the compulsory service of 4 years (including 2 years horsemanship) should remain, how long can the government remain silent that there will be unemployed doctors in near future? As I have written over here, by 2016/17,  housemanship will likely be given on contract basis, after which there is no guarantee that you will get a  job. In order for them to do this, compulsory service of 4 years must be removed.

2 days ago, our Health Minister has confirmed that MOH and MOE are strongly looking into introducing a common entry exam (MMLE) for ALL medical graduates. At the moment, they will only enforce the minimum entry qualifications as per MMC guideline. It is very likely that those who DO NOT have the minimum entry qualifications after 2011 will not be able to get a job upon their return to the country. Thus, I would like to remind all those who are doing medicine elsewhere without NOC and without the minimum entry requirement, to be prepared to get unemployed. Even though I had not received the official statistics for the year 2013, it is mentioned in the same article that Malaysia has achieved a doctor:population ratio of 1: 600 (1: 790 in 2012) which suppose to be only achieved in 2016!! We are 2 years ahead! Remember that 50% of the 40+ local medical programs have not produced any graduates. I am very sure we can achieve the target of 1:400 by 2017 instead of 2020.

On another note, I was informed that the MO’s post for Peninsular Malaysia is almost FULL.  Almost a year ago, I published this circular from MOH which stated that the MO’s post in certain states are deemed full. One year forward, I am pretty sure almost all states are facing the same problem except East Malaysia. Thus, most of those who will be finishing housemanship this year will be posted to Sabah and Sarawak. “You Tak Suka You Boleh Keluar! ” will become  MOH’s motto. Be grateful that at least you have a job in MOH. Soon would be graduating doctors may not even get a MO job! It is also confirmed that those who finish Housemanship in Klang Valley and Seremban will be transferred out of the state for MOship.

In my last article about Dengue, I wrote about the extension of Klinik Kesihatan working hours to 10pm in Dengue hotspot areas. I did say that it will remain so even after the Dengue epidemic is over simply because it is the most politically correct thing to do. However, the government will not be able to pay RM 80/hour for all the doctors as overtime allowance for the staffs due to the current financial situation. I mentioned that there will come a time (very soon) that the shift system will be introduced to KKs. In fact, a pilot project was initiated in KK PD last year but did not receive good response from the doctors. I was told that they have started another pilot project at Putrajaya KK recently. With close to 15 MOs in most major KKs now ( use to be less than 5), it is inevitable. Some KKs do not even have enough rooms for the number of doctors.

Today, it was mentioned in the Malaysian Medical Resources website (see below) that the shift system for KKs is almost confirmed coming, very soon. The word came from DG’s mouth itself. Of course, it will start with the KKs in major towns followed by semi-rural and rural areas. The only issue I worry about is the safety of doctors and staffs. As a government servant, you just have to follow what the Ministry says. You can’t overrule MOH. Discussion will be held but whatever decision made by MOH need to be followed. Otherwise ” You Tak Suka, You Boleh Keluar!”

For those who went to KK hoping to have an office hour job and better family life, the time has come to do night calls. Since you decided to become a doctor to help mankind, duty calls……………..

 

Licensing exam for docs?

| February 14, 2014

Subra says his ministry is considering several ideas aimed at improving health and medical care.

 PETALING JAYA: The Health Ministry is proposing that the government require doctors to pass a licensing examination before allowing them to practise in the country.

Health Minister Dr S Subramaniam has said that he would propose that Malaysia follow a system similar to the one used in the United States, where there is a qualifying exam for those who wish to practise medicine.

“If this idea is accepted, we have to ensure that those graduating from local and foreign universities have to go through a common exam,” he told FMT in recent interview.

However, he added, his ministry would need the cooperation of the Education Ministry and the Public Services Commission in order to push the proposal.

He also confirmed that the government would raise the minimum educational qualifications for students intending to pursue a medical degree.

At present, a student needs 4Bs in the core science subjects at SPM level and a CGPA score of 3.0 at the STPM/Matriculation level as the minimum requirement for acceptance into the medical programmes of local universities.

Dr Subramaniam said this needed to be reviewed to ensure that standards were not compromised.

However, he acknowledged that this would be difficult to enforce in cases of students going overseas for their degrees because Malaysia could not legally bind foreign institutions to impose minimum requirements.

He said the government would have to work out some legal mechanism to ensure that students going overseas would be subjected to the same requirements imposed upon those entering local universities.

Logistics

Dr Subramaniam also spoke of the country’s need for more specialist doctors, saying the government was providing “various avenues” for general physicians to get specialist training.

He said the total number of places for specialist training in local institutions had been increased from 300 to 1,000.

“We also want to provide more opportunities for the younger doctors to specialise in certain fields so that there will be a range of specialists to cater to future needs,” he added.

He also spoke of the current shortage of doctors, saying his ministry was particularly concerned about increasing their numbers in rural areas.

Malaysia has a doctor-population ratio of 1 to 600, whereas the World Health Organisation (WHO) recommends a ratio of 1 to 400.

But Dr Subramaniam said he was confident that Malaysia would reach the WHO ideal before 2020.

The future of Klinik Kesihatan

Posted on February 17, 2014 by palmdoc

Klinik Kesihatan

Dr. Masliha Harun posted in the DG Datuk Noor Hisham’s FB page

Now because of the workload (at ED) they will sent all the non emergency cases to us (urticaria-3yrs,MC seekers,chronic disease-defaulters and etc) during the extended hours up to 11pm everyday and including public holiday or Sunday whole day. Which actually,as stated earlier,we suppose to “utamakan” dengue and fever as our priority cases,but if this going on- (since we can’t never reject patient) so our workload is getting heavier and heavier,is like we see OPD cases for non stop untill 11pm everyday.
Just because of that,our beloved government would like to make a shift system for all the staff. But only one question i would ask??why we need to please them (people who abuse the system rm1) when we make all our staff suffer…
If u agreed to shift system,we can never had extra allowance to claim,we can never get same cuti (weekend) like other people and we can never enjoy our working area and we getting more stress everyday as a doctor.

to which the DG replied

The future of KK will be in the form of shift duty and the working hours will not be more than what is expected from each and everyone. Extended hours was given because each doctors are doing more than the requirement allocated time. First we need to get more doctors and staff to be posted to KK. Once we have enough staff of all categories the extended hours call allowance will be reviewed. Being a doctors we must adopt to on call system and even shift duty so that’s the future and I agree the implementation will be in stages

As a result of the current surge in Dengue, the MOH has admirably responded with more KKs with extended hours from 8am to 11pm

Working in the Kelinik Kesihatan is no longer that 9 to 5 job which was seen easier than the hospitalists going on night call. However with more and more KKs opening up till 11pm it means doctors serving in KK have to work up to 11 pm. It’s the outpatient equivalent of going on night call and it’s tough on the doctor’s personal life.

When you take up medicine, know that it is not an easy job. It was never meant to be a 9 to 5 “regular office hours” type of job for the clinicians. If you want that, then do something else other than clinical medicine.

When there are more and more MOs in service – inevitable given the current glut in junior doctors and only pending the number of posts allocated for MOs if there is enough money to pay for them (the “staffing issue”) – things will change. As the DG alluded to, it will eventually change to a shift system. No more extended hours call allowance but the working hours won’t be so long.

The issue of abuse of the KK extended hours system needs to be addressed by the administrators in MOH. Get tough on MC seekers, and for chronic disease defaulters, they should be given a short follow-up to regular hours clinic times.
Perhaps the KKs should be strict on the number of patients seen per day. The practice of taking all walk-ins no matter what has to stop. If you want to improve the standard of outpatient care, enough time has to be allocated for the consultation. Patients too should follow an appointment system and walk-ins discouraged.

For a physician in Malaysia, Dengue is considered as a bread and butter disease. Since Dengue was first discovered in Malaysia in early 1900, it had claimed many lives. Unfortunately, to date, there is NO cure for this disease.

The current Dengue epidemic/outbreak, which started almost 11 months ago, somewhere in April 2013, is one of the longest and most disastrous episodes I have ever seen during my 17 years of service. I have never seen such a long epidemic before and it looks like there is no end coming.  Unfortunately, our public who screams when they hear about 3-4 H1N1 cases or Hand Foot Mouth syndrome seems not to be bothered about Dengue. They take it very lightly as though it is a non-fatal disease. For the year 2013, Dengue had claimed almost 94 lives. The number has reached 17 deaths in just 37 days of this year! Remember, majority of these patients are young and healthy individuals. JB hospital is having 1 death every week since November 2013!!

Where are we going wrong? It is a preventable disease and a holistic approach is needed. Our public health officers seem to be overloaded with this epidemic, so much so, they do not even come and interview any dengue cases in the wards anymore. Personally, I feel it is of no value. As long as they are aware the number of patients and where they are from, actions should be taken. Unfortunately, I feel that we are losing the battle. We are still deploying the same strategy since the last 50 years or so, which clearly has failed to control the disease this time around! The actions taken also seem to be rather slow due to shortage of manpower and lack of budget. What is the point of notifying within 24hrs when no action is taken within 48 hours?

Opening “Klinik Kesihatans” up to 10pm is not going to solve any problems either. Our Health Minister announced before the Chinese New Year that KKs would be opened till 10pm in Dengue Hotspot areas to reduce the congestion at Government Hospital emergency departments (ER). I think the more important issue is to educate the public that emergency department is for emergencies and not for cold cases. In 2003, MOH introduced outpatient clinics in Emergency Department with a rate of RM 40/hour. It was open to all doctors in the hospital. It failed. Subsequently, with the same reason of reducing ER patient load, most major KKs were asked to open till 9.30pm with a locum rate of RM 80/hour since 2008. Again, did this reduce the ER department patient load? The answer is NO. What we need is “public-private” integration, which will make our GPs as part of the primary health care system supported by a National Health Financing Scheme. This is what 1Care “suppose” to do but due to the current political situation, it has been postponed once again.

Now, with the excuse of Dengue, all KKs in hotspot areas are being asked to open till 10pm. Likely, even after this epidemic settles (hopefully), the opening hours of these clinics will remain, with the excuse of “ receiving good response from the public” as the 1Malaysia clinics supposedly did. The GPs nearby these clinics will definitely be affected. Eventually, MOs in KKs will be asked to work shift duties in order for KKM not to pay the “overtime allowance” of RM 80/hour. A pilot project of shift duty was conducted in KK PD last year. With close to 15 MOs in major KKs, it is not impossible to introduce shift duty. It will come, whether you like it or not. The only problem will be safety issues especially for female doctors and lack of support staffs despite having enough doctors.

What are we lacking in the preventive measures for Dengue?  Firstly, we are still going after the Aedes mosquito after the incidence has already occurred (chasing from the back). Fogging and house inspection are only done almost 2-3 weeks after a case is reported in a particular area. By this time, the mosquito would have bitten hundreds more and would have laid hundreds of eggs all over the place. Should we think about detecting Aedes mosquito breeding area before it even starts to infect people with the Dengue Virus? During the 2003 outbreak, the then Johor state Pengarah Dr Prethapa Senan came up with a good idea.  He decided to place a half cut mineral water bottle(small), on a wooden stick, pricked to the ground every few kilometers in a hotspot area. The health inspector will periodically check these bottles and immediate fogging and cleaning of the affected area with residence help is done, if an Aedes mosquito larva is detected. I found it rather interesting and  although it involves a lot of work, it did bring down the number of dengue cases and the epidemic was over in just 6 months. Another issue that I always wonder is to what happened to discussions between MOH and researchers and academics from our universities?? I am sure many academics are involved in Dengue research and their expertise may be useful in controlling the disease.

As far as I am concerned, this Dengue outbreak should be considered as a National Disaster and a proper disaster plan should be developed for an all out war against Dengue. BUT I don’t see it happening from our political masters who are more interested in making “jokes” everyday in public. I don’t see any massive adverts to “scare” the people in the mainstream news, papers as well as alternative medias. This disaster should send chills through the spines of every resident so that the people will get frightened and do the needful to help the authorities. The Ministry should work hand in hand with the residence rather than working on their own. There is no point having mortality meeting after a death has occurred and only after that, inspections are done at the deceased house and surroundings to “prevent” another death!! Whatever said, Dengue is a public health issue and not a clinical issue.

There is NO cure for Dengue. IT is your own body’s immune system that kills you. That’s why the complications occur after the fever settles as your immune system starts to produce antibodies. It is also the reason why a secondary infection is more fatal than the primary infection. Many patients have the idea that early admission to hospital can cure their Dengue but frankly, the body cures itself. The only thing that doctors do is to keep you well hydrated and treat the complications, hoping that your body will over come it’s own immune system’s assault. Thus, there are also many Dengue cases that can be managed on an outpatient basis. The most important thing is that the patients need to be monitored by an experienced doctor. From my experience, when complications occur, many will die no matter what we as doctors do! You survive purely by luck!

Whether anyone realize it or not, this outbreak is a huge public health burden and draining huge amount of money. The insurance companies are bleeding billions of ringgits due to huge amount of admission to private hospitals. Many of these admissions may not be necessary but the fact remains that a patient can only use his medical card if he/she gets admitted. Thus, there are many unnecessary admission to private hospitals simply because the insurance companies do not cover outpatient treatment. I would suggest that insurance companies should make some adjustment during this outbreak to cover outpatient treatments of Dengue. This will definitely save a lot of cost for them.

It is rather sad to see young patients dying from a tiny virus and a mosquito. Many at times, we just watch this patient’s die right in front of our eyes as we stand helpless! May this epidemic come to an end soon………………

National dengue alert

Posted on 6 February 2014 – 10:15pm
Last updated on 6 February 2014 – 10:34pm

Annie Freeda Cruez
newsdesk@thesundaily.com

KUALA LUMPUR (Feb 6, 2014): The dengue fever and dengue hemorrhagic fever situation is worsening nationwide, with the number of cases hitting 9,453 and 17 deaths, all within the first 37 days of this year.

For the same period last year, the figures were only 2,559 cases and five deaths.

Expressing concern, Deputy Director-General of Health (Public Health) Datuk Dr Lokman Hakim Sulaiman said today: “Dengue is not only a big issue in Malaysia but also globally, as countries worldwide are experiencing an increase in deaths and cases and this is very worrying.”

According to the World Health Organisation (WHO), dengue cases has grown dramatically around the world in recent decades. Over 2.5 billion people – more than 40% of the world’s population – are now at risk from dengue and WHO currently estimates that there may be 50 million to 100 million dengue infections worldwide every year.

Lokman said the ministry has intensified its efforts to contain the outbreak but added that the public also needs to play an important role by keeping their houses and surroundings clean and free of mosquito breeding grounds.

“We can only contain the outbreak with public cooperation, especially from people living in urban areas,” he said, adding that three states have shown high incidences of the disease – Negri Sembilan, Federal Territories of Kuala Lumpur and Putrajaya and Sarawak.

He said that in view of the situation, even Health Minister Datuk Seri Dr S. Subramaniam was going to the ground once every two weeks to check on the situation.

The ministry has identified 594 dengue hotspots in the country, with 115 in Selangor, Negri Sembilan, Kuala Lumpur and Putrajaya, Lokman said.

He urged members of the public suffering from high fever (40°C/ 104°F) accompanied by two of the following symptoms: severe headache, pain behind the eyes, muscle and joint pains, nausea, vomiting, swollen glands or rashes, to seek immediate medical help.

“Do not wait till the situation worsens as severe dengue is a potentially deadly complication,” he said, adding that all hospitals and clinics were on the alert for dengue cases.

Extension of govt health clinics hours soon

PUTRAJAYA: Plans are afoot to extend the operating hours of government health clinics to accommodate the rising number of dengue patients, said Health Minister Datuk Seri Dr S. Subramaniam.

The move followed a 251% increase in dengue cases recorded in the first four weeks of this month, when 7,370 cases were reported against 2,098 in the same period last year.

A total of 2,229 cases were recorded throughout last week alone, marking a new weekly record high for dengue cases in the country’s history, he added.

“The number of patients in hospitals has increased significantly, especially at the emergency departments, where there is a need to reduce the load.

“There are already some health clinics that are open until 10pm, but we will study the possibility of extending their operating hours, especially at high-density areas in Selangor and Kuala Lumpur, where the load is heavy at the hospitals.

“Not all dengue cases require patients to be warded as some can be monitored without being warded depending on the doctor’s instructions,” he said at the ministry here yesterday.

He said a recent study conducted by the ministry found that the reproduction rate of the Aedes mosquitoes remained high in Penang (3.8%), followed by Sarawak (3.7%), Perlis (2.6%), Malacca (2.2%), Negri Sembilan (2.1%), Selangor (1.7%), Sabah (1.6%), and Kuala Lumpur and Putrajaya (1.5%).

Dr Subramaniam called on owners of premises that ensure that their places are free of Aedes mosquitos.

 

On dengue, what is the Health Ministry’s action plan? – Malaysian Doctor

FEBRUARY 07, 2014

Since early this year we have been hearing a lot of statistical data on the rise of dengue cases especially in Kuala Lumpur and Selangor.

The number of deaths is rising and number of aedes index statistics is also rising.

Dengue is a disease spread by a known vector the aedes mosquito. Control of the vector is an integral approach in managing the disease.

The Ministry of Health (MoH) has been very reactive in their approach of the problem so far by having many mortality review meetings and now extending clinic hours of its Klinik Kesihatan.

In other words more work for their clinical arm i.e. doctors that are seeing patients. The same doctors that are already overworked with increased number of patients are now expected to work longer hours to see more patients.

What we have yet to hear from MoH is what is their Public Health approach in preventing the continuing rise of the disease? The whole Public Health campaign against dengue has clearly failed with the rise in cases.

We wonder how much has been spent on the dengue awareness campaign last year by the District Health Officers in Selangor and Kuala Lumpur. We also wonder why when there are deaths in dengue only clinicians are questioned on their duties and not the District Health Offices.

When crime rates are high we question what is the police doing about it? Similarly when preventable disease rate is high we should be questioning what is the public health officers doing about it?

So is there someone in MoH that can provide holistic solution rather than spewing out statistical data only? – February 7, 2014.

* Malaysian Doctor reads The Malaysian Insider.

* This is the personal opinion of the writer or publication and does not necessarily represent the views of The Malaysian Insider.

 

 

 

As of this month, my blog is 4 years old. As of today, this blog has hit 1.5million views since it started. Over the years, I wrote about many issues surrounding the field of medicine to wake people up from their “guaranteed job, money and good life” dreams. I was ridiculed many times and even given rude comments for telling the truth but no one can argue with the facts provided in this blog. After 4 years, finally the government admits that we are going to have surplus of doctors within the next few years. When I wrote this 4 years ago, in fact 6 years ago, I was laughed at!

Our Health Minister recently spoke on this issue and have recommended that the entry qualifications into medical school to be reviewed. He admits that we are reaching the doctor: population ratio of 1: 600. Thus, all application of new medical schools and application for increase of intake will be frozen. But yet again, we did hear this 2 years ago (May 2011) but nothing happened. Politics and money takes priority, I guess.

Frankly, getting 5Bs in SPM is nothing nowadays. The latest PMR results shows that close to 8% of students got straight As. So, how many students would have got at least 5Cs and above. Interestingly, these results are not for public viewing. I tried looking for the statistics in Ministry of Education/LPM website but I could not find. Is it a national secret? What I could get is only the media statement regarding the general performance of the students. IN 2011, almost 70% of PMR students got at least  all Ds and above. If you ask anyone who had interviewed graduates etc, they will definitely tell you that the standards of our exams and universities have gone down the drain. The quality of graduates are atrocious. Even from some of the comments in this blog, you can guess the intelligence of the students. Personally, I don’t blame them as the education system do not encourage students to think or learn.They don’t read anything other than what is thought in school. According to World Bank report, the standards of our teachers are also going down the drain. Almost 93% of our teachers do not even have 3 distinctions or more in SPM but yet the intake of teachers have increased by 30% over the last 5 years. We are more worried about quantity than quality, similar to the situation of medical graduates now. We should never compromise quality for quantity!!

The mushrooming of private universities/colleges since 1990s is partly the reason for this deterioration. The fact remains that these private entities are a profit driven venture. What they need is money but who cares of the quality of products. It is not them who are going to employ these graduates. The same goes to medial schools as well. We have had nurses with GCPA of near 4.0 but you will be shocked when you interview them. They can’t even answer simple questions which should have been thought in the nursing college. When you check their SPM results, you are in for another shock!

The fact remains that we have too many universities/colleges in this Bolehland with too few academics and many “kangkung” professors! We simply do not have enough human resource to support such a number, as I have written BEFORE. The politicians just wanted to make money and decided to make Malaysia into an “education hub” of Asia. God save this country!

GONG XI FA CAI TO EVERYONE………………………..

 

Entry requirements for medical school may be tightened, says Subramaniam

JANUARY 17, 2014

KUALA LUMPUR, Jan 17 — The government may tighten the minimum entry requirement for students who want to pursue higher education in medicine, in future.

Health Minister Datuk Seri Dr S. Subramaniam(picture) said a study and discussion with the Education Ministry had been carried out on this matter.

He said the proposal was to ensure that only truly qualified students would take up medicine and in the long-run, would control the number of new medical graduates entering the job market.

“Now it’s (minimum entry requirement) 4Bs. We may raise it because a lot of students are getting A’s now. We will also make this mandatory for students who are taking up medicine overseas,” he told reporters after the Thaipusam celebration at Batu Caves, near here, today.

There are currently 33 medical schools in the country which produce about 5,000 new medical graduates each year and causing an influx of new doctors in the job market.

“Our ratio has almost reached one doctor per 600 population and as far as training is concerned, the Health Ministry ensures that everybody will get adequate amount of training. We won’t compromise on the level of training and exposure,” he said.

Dr Subramaniam said the government had also frozen the registration of new medical schools in the country and applications to increase the student intake into their medical programmes.

Earlier, Dr Subramaniam who is also MIC deputy president, said Thaipusam at Batu Caves this year had attracted some one million visitors over the past 10 days.

He said a medical team from the ministry, assisted by members of the Red Crescent Society and St. John Ambulance as well as the Fire and Rescue Department, had been on duty at the site to provide medical help to those in need.

Up to today, the medical camp had registered 85 cases of visitors seeking medical help, he added. — Bernama

- See more at: http://www.themalaymailonline.com/malaysia/article/entry-requirements-for-medical-school-may-be-tightened-says-subramaniam#sthash.C9dDrhQ6.dpuf

World Bank: Worsening education obstacle to Malaysia’s high-income hopes

DECEMBER 11, 2013

Children attend their first day of elementary school in Standard One (Primary One) at a local school on the start of the new school year in Kuala Lumpur 06 January 2003. — AFP picKUALA LUMPUR, Dec 11 — Education standards that were deteriorating despite Putrajaya spending twice as much as neighbouring countries on schools could stand in the way of Malaysia’s plans to join the ranks of developed nations, according to a recent World Bank report.

In a report titled “Malaysia Economic Monitor: High Performing Education” that echoes criticism over the recent performance of Malaysian schools, the World Bank highlighted the critical role quality education plays in a country’s aims to gain a high-income status.

In 2011, Malaysia spent the equivalent of 3.8 per cent of its gross domestic product on education, or more than twice the average 1.8 per cent within Asean nations.

“A nation’s human capital, which is largely built by its education system, is a fundamental driver of economic growth,” it said in the report.

“The quality of cognitive skills of Malaysian students, as measured by standardized international tests, is not on par with the country’s aspirations to become a high-income economy.”

In its report, the World Bank noted that while Malaysia has extensive coverage with its schools and achieved near-universal access that has nine in 10 Malaysian adults undergoing at least lower secondary education, a commensurate increase in quality was not observed.

“In addition to ensuring the system has the broadest possible coverage (quantity), the quality of education is perhaps even more critical.”

Pointing to the Programme for International Student Assessment (PISA) survey results released last week, the World Bank was blunt with its assessment of Malaysia’s underperformance.

It said Malaysia did not only trail high-performing education systems in East Asia, but also poorer nations such as Vietnam, which outperformed the country by a significant margin.

In the latest edition of PISA, Malaysian students lagged far behind their peers in Singapore, who placed second behind top-scorers in Shanghai, China, as well as 15-year-olds in Thailand.

While Malaysian students registered marginal improvement for mathematics, they lost ground in both science and reading ability.

The combined results meant Malaysia was 52nd overall out of the 65 countries, and firmly entrenched in the bottom third of the survey.

Aside from the stagnant PISA performance, the World Bank also highlighted Malaysia’s continued decline in the Trends in International Mathematics and Science Study (TIMSS) benchmark in which the country once performed well.

“Learning outcomes in the TIMSS were above the international average between 1999 and 2003, but declined sharply in 2007 and further in 2011,” it said.

To arrest the decline, the World Bank said Malaysia needed to prioritise teacher quality over quantity, noting that the sharpest fall in education standards coincided with an aggressively expanded recruitment programme for educators.

It noted that the teacher population shot up by 30 per cent between 2004 and 2013, an issue that it said may have since worsened; the number of trainees enrolled in teacher training institutes have ballooned from 37,439 in 2011 to 46,491 this year.

Another problem was the low standards of those seeking to become teachers. It noted that 93 per cent of those applying for the Bachelor of Education programme did not have the necessary academic qualifications (3 distinctions or more at SPM level), while 70 per cent offered a place in the programme also fell into the category.

Only 3 per cent of offers went to applicants considered high-performers.

- See more at: http://www.themalaymailonline.com/malaysia/article/world-bank-worsening-education-obstacle-to-malaysias-high-income-hopes#sthash.861eV0lE.dpuf

Follow

Get every new post delivered to your Inbox.

Join 927 other followers