All this while, I have been talking about the healthcare system in this country, the issue of oversupply of doctors within the next 4 years, unethical practises in private sector, poor quality control and lack of proper training of junior doctors and clear-cut mistakes committed by junior doctors and front-liners. One issue that I never touched was the issues concerning patients!! As a country develops, medico-legal issues will increase as well. In some countries like US, there are more doctors resigning then being produced. That is one of the reason why you don’t see many being interested in becoming a doctor in developed countries and they depend on foreign doctors.
The comment below was posted to me in my blog few days ago. I did reply him but then I thought there is a need to explain this issue in more detail as a blog entry. If your intention is to help people, then are more than many ways to do it. I know many successful business man who spend money to set charity foundations, gives scholarship to the needy students etc etc. You may not necessarily need to become a doctor to help people. Many believe that by being a doctor, they can save many lives. This is the general misperception among the public. Yes, you may be right as we can treat many infections with antibiotics, do a cardiac bypass surgeries to save the heart etc etc. BUT, how many patients that you can actually cure from an illness? This is a question that needs to be asked. Many at times, we are just prolonging the survival by controlling a disease. Can you cure Diabetes? Can you cure Hypertension? How many tumours that is operable by the time it is detected? Almost 50% of heart attack patients die even before reaching the hospital. Even for those who reach the hospital, how many still survives despite being in the best cardiac centre? All the glorious lifesaving stunts only occur in TV programmes but not in reality. How many cancers that can be cured despite all the advance surgical techniques and chemotherapy? We see many well-known celebrities with a lot of money still succumb to cancers. When I was a student in UM, our motto was “ to cure sometimes, to relive often but to comfort always”.
I had a 3rd year medical student who went into depression when she found out that a 14 year old boy in the ward who had leukaemia died. She refused to go to the ward for quite some time and needed counselling. So, being a doctor does not mean you can save lives all the time. Be prepared to see deaths and suffering where you can’t do much.
Now, coming to the next question: do I enjoy my work? I replied that sometimes yes and sometimes NO. I did almost quit medicine at one point in time. When I was sitting for my MRCP exams, I had a credit card debt of RM10K with a pathetic salary of RM 2100 permonth. A car loan of RM 600 permonth is deducted leaving with an income of RM 1500 with 2 kids to support. I was staying in a rented house with no furniture but thank GOD, JKR was willing to loan some furniture. That was the time that I felt that I should have done some other course as I saw my friends who did engineering, accountancy, IT etc were already driving big cars and having a well-paid job and need not pay more for postgraduate studies like what I was doing.
Let’s talk about patients. Seriously, how many patients really thank you for the job that you do? When I was in government service, many patients just feel that the government is paying you to work and serve them. Many don’t appreciate what you do as they hardly pay anything. You are considered as a cheap doctor! Of course, many of the patient’s relatives are never in close contacts with the specialist in the ward. On the other hand, you can also scold the patients if they do not want to listen to you as they are not paying for your service. Then when the patients make a complaint to the pengarah, rules can be bent to entertain the patient. Many superiors just do not want the complaint to be blown up. Suddenly the patient do not need to wait for appointment and can be seen fast etc etc. VIPs get treated instantly when the general public need to wait in a “Q”. One good thing of being in a government hospital is the fact that patients rarely complains about a particular consultant.
In private sector, the situation is entirely different. Patients pay for your service and they expect no errors. Being human, there is no way a doctor can have no errors. Patients are becoming more demanding and dictate what they want. This is a scenario that you will see in any developed country. “ We pay and you do” is becoming the motto. Being in a private hospital over the last 2 years showed me how the younger generations got no respect to doctors etc. Do you really think that the younger generations are like the older generation who respects and accepts whatever you say? The older generations often forgive and forget but the younger generations don’t. I have been scolded by patients for treating a acute cardiac failure just because I am not a cardiologist. Complains have been made against me for refusing to admit a patient to the ward just because there is no one to take care of the patient at home!! Admission for family indications and not medical indications!! There are also patients or relatives of patients who just want to find fault at anything possible so that they can blackmail the hospital and specialist. All in the name of not wanting to pay the bill. Almost every month, my hospital gets at least 4-5 complains and dissatisfaction from patients. They even complain of you answering a phone call while examining a patient and refuse to pay the bill by claiming that the doctor is not paying full attention to their son!!
The world is changing. The generation Y that keep complaining in the papers of housemanship etc is the same generation who will face this kind of patients in the real world. The “forgive and forget” generation are gone. The same generation Y will complain against you. The litigation rate is going up on daily basis and almost every doctor will be sued in their lifetime. Complains to MMC is also increasing daily and they have 6 Preliminary Investigation Committee to look into all the complaints. For all the life’s that you might have saved, a single complain or legal action will leave you in depression. You will begin to wonder why this is happening to me when I have saved many life’s before! So, if you think working as a doctor is exhausting, wait till you have a patient who scold you, complains about you and even shouts at you.
This is the reason why you find many doctors order all sorts of investigations to satisfy the patient and relatives. It is also known as CBM: cover backside medicine. In most developed countries, this is what that happens. CT Scans, MRIs, battery of blood tests are being done just to save their backside. I saw this happening when I was in Singapore. The real medicine is gone and will eventually disappear. We will be taken over by machines and robots which will interpret the test and tell the patient what he/she is suffering from. Even treatment will be decided by computers. BUT the human touch will be missing………………..
Hi doctor, thanks for the eye-opening article.
I am a final year student studying Biomedical Sciences in UK, and I have an interest to pursue medicine since young. However, my parents do enot have sufficient money to fund my medical studies overseas, and my current option is : either PUGSOM / Monash, and I am intending to apply for Singapore’s medicine programme as well. Given that the future of medicine in Malaysia is rather bleak, I am having doubts about medicine at the moment, regarding the future prospects as a doctor. I don’t mind working long hours, it’s just that the inability to get the deserved career development (with so many restrictions imposed by the government) after putting in so much effort will make me miserable.
I did consider to switch into private corporate sectors, as I am partially attracted by the lucrative salary offered for oversea students (since I am from a considerably good university most of my friends managed to secure jobs with minimum 3.5k salary); but however I insisted on staying because I believed that no matter how much I am earning, it would not make my life happy because I genuinely enjoyed bringing happiness in people’s life.
But as I am approaching graduation, I am getting more uncertain about this decision. What I would enjoy as a career is one that gives me the flexibility to go from one area to another (i.e. corporate), with full potential for development (i.e. corporate), but on the other hand I would really wish to make a significant impact on other people’s life as well, and that is the reason why I am applying for medical schools.
I am sure that you will try your best to make sure that I stay away from medicine, as this has always been the mainstay of your comments to anyone who expressed any doubts in medicine, but I consider my case rather different, as what I am looking for is job satisfaction. My question to doctor : do you enjoy your job ? I am hoping to seek answers from you to enlighten me and give me an insight of what is going to happen to me in the next 10 years time. It is not an easy decision to make considering both sides are equally attractive, but I am sticking with the decision to become a doctor thus far. I am sincerely hoping that your views would guide me in my decision-making. thanks.