I was really laughing my head off after reading this article in today’s Star. Coming from our Deputy Prime Minister makes me wonder the type of politicians that are running this country. I am sure many knows the answer to that?

Firstly, this is a publicity stunt my the medical college mentioned. Secondly, all speech by politicians are written by the inviting body. Basically it means that the speech was written by the college mentioned and then sent to the respective VIP’s political secretary for vetting purposes. I myself have written a speech for the Minister of Health who suppose to come to officiate a SCHOMOS gathering way back in 2006. That’s how our politicians work. I was made to understand that only Dr Maharthir writes his own speech when he was the PM!

Obviously, our DPM do not know what he was talking about during the launch of the so-called “medical education fund”. WE have almost 34 medical schools with some producing 2 batches of graduates ( 1 local and 1 twinning). The said college is one of the college which has 2 parallel programmes running , 1 twinning with Indonesia and another giving UKM degree.

Just look at the number of medical schools below:

1)    University Malaya (UM)

2)    UNiversiti Kebangsaa n Malaysia (UKM)

3)    Universiti Sains Malaysia (USM)

4)    Universiti Putra Malaysia (UPM)

5)    UiTM

6)    University Sains Islam Malaysia (USIM)

7)    Universiti Darul Iman

8)    UNiversiti Sarawak Malaysia (UNIMAS)

9)    Universiti Sabah

10) Universiti Malaysia Kelantan

11) Melaka-Manipal Medical College: 2 programmes

12) Monash University Malaysia

13) International Medical University (IMU)

14) SEGI University College

15) Allianze College of Medical Sciences (ACMS): 2 programmes

16) Penang Medical College (PMC)

17) Mahsa University College

18) Masterskills University College of Health Sciences

19) Royal College of Medicine Perak (UNIKL) : 2 programmes

20) Universiti Islam Antarabangsa (UIA)

21) Newcastle University Malaysia

22) Perdana University : Graduate Medical School

23) Perdana University : RCSI

24) Inssaniah University College

25) Quest International University Perak ( starting soon)

26) RCSI Trengganu ( starting soon)

27) KPJ University College (starting soon)

28) Cyberjaya School of Medical Sciences

29) AIMST

30) Taylor’s University College

31) Management and Science University (MSU)

32) University Tunku Abdul Rahman (UTAR)

33) University College Sedaya International (UCSI)

34) Lincoln University College( started 2011)

35) University Pertahanan Nasional Malaysia ( started 2009)

I was informed that the number of new housemen this year is reaching almost 4000. That is when half of the medical schools above are yet to produce their graduates. The report in Star today confirms one thing: the ratio is already 1: 900 ( 2011). So, how long do you think it will take for us to achieve 1: 600? I presume before 2015, much faster than 2020 that was predicted before.

After that you will be privileged to get a job . You will be told to shut your mouth and take a pay cut. I just saw some poor souls who have been recruited by a new medical school. Surprisingly, some of them are from our neighbouring country who was told that their degree will be recognised by their home country since the university is a branch campus offering the same degree! They were also told that their degree is recognised by GMC. Unfortunately, I have to break the bad news to them. Up to today, Singapore Medical Council is yet to recognise Monash University Malaysia, so what makes them to believe that they will recognise this university? These students also thought that Malaysia will offer them housemanship, it seems they were told by the university?

I really pity these students who will be caught in a limbo in 5 years time.

Med students need sponsors

Read Full Post »

One of my loyal follower sent me this 2 articles below which appeared in The Sun (http://www.thesundaily.my/news/167606, http://www.thesundaily.my/news/175519). I have said this many times that medicine is different. You are dealing with life and it does involve a lot of stress. That’s the reason why I started this blog to educate the people of what medicine is all about! Don’t just jump into doing medicine just for money and glamour.

Being a doctor is not about working office hours and going back on time like many other jobs. You are dealing with life and you have to make sure that you do whatever necessary for the patients before you leave. Of course I don’t agree working long hours like 36 hours continuously but even if you work shift hours, you still need to finish your job!! Life’s are at stake! I am rather amused with the first author below because at one point he is talking about long working hours and on another note, he is talking about excessive work load. Who said that when you become a doctor, you workload is not heavy? Even if you are doing shift system, the number of patients that you are going to take care will still be the same! And finally, he is saying that there will be a paycut!! I mean, I don’t know what this author wants? I guess he wants a comfortable, office hour work for his sister with a lot of money. Then, don’t become a doctor, that is my answer.

I think the reply by the specialist below sums up what is actually happening in our hospitals currently. I have said it along the way in my blog. If you think being a housemen is stressful, wait till you become a specialist especially in private hospitals. You are the housemen, medical officer and the consultant for the patients. You work 24 hours a day, 7 days a week. You can be called at anytime of the day.And you will sued for any mistake that you make. No one cares whether you are tired or not! So, don’t think only as a housemen, you are overworked!!!

The day you choose medicine as your career, that’s the day you have committed to life long learning, hard work, stressful life and poor social life. So, if you are NOT into it, then find another job!

Overworked housemen

Read Full Post »

Malaysian Medical Association in collaboration with Columbia Asia Hospital Nusajaya and Hospital Sultan Ismail will be organising the Johor Rheumatology Update course at Grand Paragon Hotel, Johor Bahru on 23/10/2011. I am the organising chairman for the above course which is being held for the first time in JB, open to all doctors free of charge. Below, is the programme outline:

08.40 a.m.     Opening speech by MMA Chairman:                   

                        Dr. Kamarudin Ahmad

08.45 a.m.     Introduction by Organizing Chairman

                        Dr. Pagalavan Letchumanan

09.00 a.m.     Making a Diagnosis in Rheumatology : Simplified

                        Dr. Pagalavan Letchumanan

09.45 a.m.     Systemic Lupus Erythematosus : Diagnosis and Treatment

                        Dr. Loh Yet Lin

10.30 a.m.     Tea Break

11.00 a.m.     Rheumatoid Arthritis: The era of Biologics?

                       Dr. Pagalavan Letchumanan

11.45 a.m.     Seronegative Spondyloarthropathy:  The Masala

                        Dr. Loh Yet Lin

12.30 p.m.    Lunch

01.15 p.m.    A Global Epidemic: The Double “O”

                        Dr. Yoga Raj

02.00 p.m.    Treating an Ancient Disease: Gout

                        Dr. Pagalavan Letchumanan

02.45 p.m.    SLE and Pregnancy: What to look out for?

                        Dr. Rajesh Mahendran

03.30 p.m.    Tea Break & The End

Read Full Post »

World Arthritis Day is on 12/10/2011 and the Arthritis Foundation of Malaysia(AFM) usually organises public forums to educate the public in creating awareness of various musculoskeletal diseases in Malaysia. For the first time in Johor, on behalf of AFM, I will be organising a public forum this coming Sunday 16/10/2011 in my hospital , Columbia Asia Hospital Nusajaya.

We chose 2 very common arthritic problems that the general public faces: Gout and Osteoarthritis. See below for more info on this forum. Admission is free and all those who are staying in JB are welcomed.

Read Full Post »

Didn’t I say , it is coming. It is official that the compulsory service for Pharmacist will be reduced from 4 years to 2 years ( including housemanship). This was announced today by MOH. If I am not mistaken, the compulsory service for pharmacist was introduced in 2004 due to shortage of pharmacist in the government sector. In just 6 years, they have reduced it back. It was reported in Bernama that 90% of the post in government sector has been filled!! I know pharmacist are now functioning as dispensers in many government hospitals and some klinik kesihatans have 2 pharmacist!

So, the government is now allowing them to resign earlier to enter private market. Another knee jerk reaction for poor planning! Unfortunately the private market is not that great either. Most private hospitals only need 1-2 pharmacist to run the show. Same goes to the retail outlets. So where are these pharmacist going to go? Is this the prelude to stopping dispensing rights to GPs? Once there are a lot of jobless pharmacist out there, the government may just stop allowing doctors to dispense medications and insist on GP clinics to hire pharmacist. Well, doctors are next in line……….. I am already hearing rumours of compulsory service being scraped for doctors.

 http://www.bernama.com.my/bernama/v5/newsindex.php?id=618149

Pharmacists’ three-year stint with Govt reduced to one

Read Full Post »

I am a UK graduate and I’ve been working in Malaysia for almost a year. On my first day, I called my MO by her first name (respectfully) to ask her a question, and she did not answer, so I asked again, and she said to me ‘I would like to be addressed as Dr xxx’. For someone who has been calling all doctors, even my consultants in medical school by their first name, how lame that is, I thought. But I’m used to that now. Just because I am addressing them by their title doesn’t mean that I respect them all of them, especially ones who are obviously empty tins. If I disagree with something, I will say it out.

In Malaysia there is this thing that HO should round early in the morning first, then the MO will round again (which we are suppose to follow and write), then again with the reg and the specialist. I have never encountered anything like this where I studied. There is just so much repetition here. What is the problem with everyone just arriving at the same time and then we do ONE single round together? Are consultants too mighty high to be asking questions or examining patients? Yes, the juniors should know and present the cases, but so should the specialists and the consultants. Here, we come at 6:00-6:30am in the morning to see all the patients, then there will be another 2 or 3 rounds with people more senior than us so we can ‘update’ them patient condition so that they are able to add on their own management plan. Most of the specialist/consultant would just stand at the bedside listen to the juniors present, bombard lots of question, dictate some plans then move on, without even saying a word or looking at the patient. Then when the intimidating boss-like figure is finished, the patient would rush to ask me what had he just muttered before I had to rush off to tail ward round. In the UK, junior doctors come half an hour earlier than the consultant to get the investigations results ready and find out if anything happened overnight/over the weekend, then wait for the consultant to turn up to start the round. If it is a non-consultant round, everyone would get on with the round as a team. There is no such thing as HO to see the patients before the reg. There, the registrars, SHO and HO help each other out so they finish their work as quickly as possible. Isn’t that a much more efficient use of everybody’s time? Once, my nice MO was helping me with a particularly difficult IV line, and another MO asked him ‘why are you doing HO’s work?’ You see the attitude? Don’t get me started on the TDS round. Yes, they do rounds three times a day here (in most specialties), sometimes x 3 due to the hierarchical arrangement as I have mentioned above.

The worst part is having to play the servant for MO/reg/specialist/consultants. In my hospital, HOs have to regularly to go the record department to trace files for the reg’s case presentation/ write up. Last week, my friend had to go to my specialist’s car to fetch a stack of photo frames to her office. In departmental census, the HOs does all the data collection (trawling through the case records) not knowing the end results whilst the boss gets to present and publish. We call patient up to inform op date, cancelled op, rearrange op so often I thought we sounded like a professional telephone operator. You can’t blame me for cursing under my breath whilst performing these stupid errants.

In Malaysia, HOs are unappreciated slaves. Everyone, senior and junior figures in the medical profession, should rethink the way we are doing things here. You may say the practice has stood the test of time but is it really worth wasting so many hours for sometimes so unproductive as three morning ward rounds in a day just because of hierarchy? Is it fair to treat HO as your servant doing your secretarial job? Are MO/Reg/Specialist incapable of occasionally helping your new HO make some referrals or write a prescription or ask for a CT scan, or God forbids, take blood? Are we not in the same boat to make patient better? I foresee that it will take another 10-20 years for us to change the culture, if it ever will. The seniors always have their ‘back in those days’ or ‘you have to learn’ excuses

The above comment was posted in my blog by a houseman. I must say that he was right on certain issues that are ingrained into our system. It is a culture here that you must address a senior by the title and not by his/her name. I know that in western countries, you can call a consultant by his/her name but in Malaysia, you will be considered as disrespectful. It is part of the Asian culture and you just to accept it. It will take many more years to come before it chances. It is the same for all Dato’s and Tan Sri’s. When I refuse to address them as Dato so and so when they come to see me as a patient, they will look at me differently but I do not give a damn. It is not a God-given title for me to address them by the title. At least if you are a Professor or something, I will address them as such. Same goes to the community who are so enthusiastic to make their children a doctor by hook or crook just to get the title “Dr” infront of their names.

Let’s come to the ward round system in Malaysian MOH hospitals. The system that the HO is talking about has been around for many years, even when I was a houseman. In fact, even I use to ask the same questions when I was a houseman. It is really a time-wasting situation. That’s the reason when I became a specialist; I made sure that I am in the ward by 8am every morning unless I am stuck in a meeting or jam. I usually walk into the ward around 8am and wait for the houseman to finish taking blood by 8.15am. By 8.15am I will start my rounds and the houseman must join the rounds by then. It is mandatory for them to finish taking blood by then. My idea is always to finish the rounds by 10-11am so that the houseman and medical officers will have all the time to do what that has been ordered.

Then, when I went to a hospital in Klang Valley to do my subspeciality training, I entered the ward at 7.50am and noticed that I was the only one around!! I asked the nurse where the housemen and MOs are; and they smiled at me. It seems the HO comes at 8am, MO comes at 8.30am and the specialist only comes at 9.30am!! WTH!! Sometimes the specialist comes only after the MO/HO has completed the rounds and starts all over again. Of course, the specialist who does a consultant round has all the right to start the round again BUT I always felt that it is counterproductive. By the time they finish the round will be around 12-1pm and you are just left with another 4 hours to settle everything else! Sorry to say but most of the current specialists in government hospitals are in this category. Majority of the good ones have left the service not due to money but due to frustration with the system. No matter what you do, the system will always frustrate you. As someone said: either you join them or leave!

Now, housemen doing office boy’s job? Well, no matter what you become or what job that you do, you always have to start from the bottom, unless you are self-employed. It is common for all profession. Even fresh law graduates have to work as an office boy when they do chambering. There is no such thing as easy way to learn. You have to go through tough times and even be a slave to become a better person in the future. That’s why you are known as government “servants” ! But of course, I think it is atrocious for the specialist to ask the housemen to do the data collection and tracing of notes for something that the consultant is going to publish. If they do so, then the houseman’s name should be included as one of the author. When I was a houseman, the Head of O&G department challenged me to do a study on maternal weight gain during pregnancy for the 3 different races in the hospital.  I took up the challenge and completed the study just before I completed my O&G posting, which was my last posting as a houseman. On my last day, I submitted the report to him and he was shocked. He never expected me to do it. The data supposed to be presented at the state scientific meeting but I was transferred before that.

I know that not everyone will be interested in academic life but the houseman should take the opportunity to get involved in the study and learn something. I am sure most specialist or consultants will be happy to welcome you into the group. Having said that, I must admit that most of the good specialists and consultants are not in MOH hospitals anymore. That is the sad part! And also, please remember that no one appreciates you in government service. You will always remain unappreciated. Your job is to serve the community, paid by the government/tax payers. Before 1994, there was no such thing as “oncall” allowance and then we were offered RM20 for every call! pathetic.

Read Full Post »