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Just to update for those who wanted to buy my books when it comes to the bookstores, my books are available at the following bookstores for the moment:

  1. Kinokuniya (Suria KLCC)
  2. MPH (Subang Parade)
  3. MPH (Mid Valley)
  4. MPH (One Utama Megastore)
  5. MPH (NU SENTRAL MALL) (NS)
  6. MPH (Vivacity Megamall) – Kuching
  7. Smart Book Shop (Kuching)

As informed earlier, my Ebooks are available at Google Play Store and soon Amazon Kindle. For those who don’t wish to buy directly from me as stated HERE, you can also buy it online at Kinokuniya Online and MPH Online.

Thank you for all the support so far and you are welcomed to write reviews at any of their sites.

 

I have had many queries regarding e-book version for my books. I am proud to announce that the E-Books are now available at Google Play Store.

Please visit Google Play Store or HERE.

The price is determined by Google and Publisher. I got no control over it. If you want to purchase Hard Cover books, please visit over HERE.

 

ON this auspicious 59th Merdeka day celebration, I would like to announce that my books “Hard Truths of Being a Doctor Part 1 & 2″ are both available at Kinokuniya Bookstore in Kuala Lumpur.

If you would like to buy it online from them, please visit the following website .

You can still visit my blog post HERE if you would like to purchase directly from me.

 

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In my first post with the above topic , I mentioned about the government’s intention to introduce contract HO post. Sometimes I do not know whether to laugh or cry. Few years ago when I predicted that the time will come for graduates to wait in a “Q” and jobs will not be guaranteed for doctors, I was scolded, laughed at, humiliated and given numerous sarcastic remarks. Few years down the line, when what I predicted happened, the situation has changed. Now, these very people claim that I am boasting and self-glorifying. I don’t know what these people really want. When you tell them something , they don’t listen and when it happens, they throw back their tantrum to the very same people who predicted it will happen. What precaution did you take ?

There was a meeting between MOH officials with HODs of a big hospital in Malaysia recently. In this meeting, the current situation of doctor’s post was discussed. Please be informed that MO post is currently 16% oversubscribed! Interestingly, some of the HO post are being converted to MO post to cater for this oversupply. This happens because , all those who are appointed into civil service are on a permanent post currently. Thus, the government is now in the process of trying to get contract HO post to fill up the gap and to shorten the waiting period . However, this new situation will only reduce the waiting period from about 8 months to about 6 months. With the increasing number of graduates from this year onwards (all 32 medical schools will be producing graduates from 2016 with increasing numbers), the waiting time will only shorten for a short period of time before climbing back to about 1 year or even longer.

It is expected that the contract HO post will start from this October if approved by cabinet. The question is “what happens after HO?”. It seems that the government is not obliged to provide jobs to everyone, which is a fact. Thus, if you do not get a permanent post after HOship, your contract may be renewed for another 2 years to complete your compulsory service. After the 4 years compulsory service, you can do what you want! The GP market is going to be severely affected by this as those who can’t get a job in MOH will open their clinics in every corner of the town. The struggling GP market will continue to struggle.

As I said in my previous post, this will affect post-graduate education. At the moment post-graduate education can only be done in public hospitals. I also heard rumours that those with MRCP, MRCS Part 1 etc will have a better chance to get into a permanent post. Another good news is the fact that some of the public universities are building their own teaching hospitals which can probably employ some of these MOs. UPM, UiTM, University Sarawak and Sabah etc are all in the process of building their own teaching hospitals. However, these will take another 3-5 years to materialise.

It is also informed that no more contract extension will be given to those who had retired from civil service. This “post retirement contract” is something which I had always felt is not appropriate. Those who had retired should not be reemployed to the same post under contract unless it is a very much-needed service with no replacement found. In many instances, HODs who had retired continued to become HOD under contract. That is not right as far as I am concerned.

I still get questions from foreigners who are interested to do internship/HO/MO in Malaysia. Let me tell you once and for all, Malaysia DO NOT provide housemanship to foreigners. Foreign Spouses of Malaysians were given internship post till 2014 under contract but stopped since then. In February 2016, MOH came up with the following circular to confirm the fact that foreigners will not be given housemanship post till further notice. It also mentioned on those who has quit housemansip or terminated.

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With the introduction of HO contract post, it will become very much easier for MOH to terminate any HOs who go missing or have poor performance.

And for those who think that being a doctor guarantees you a job anywhere in this world, don’t live in a delusional world. Doing medicine for migration is the worst thing to do. It is the most controlled profession in the world and most difficult to migrate. Just recently, there were suggestion that Australia should stop recruiting foreign trained doctors.  Please check how much easier it is for people of other profession to apply for “Skilled Migration” Visa to Australia compared to medicine. With the new PM in UK who supports anti-migration policy, the situation may not be any better. Singapore has also stopped conducting qualification exams for foreigners with unrecognised basic degree. Unless you want to migrate to an African or 3rd world country, doing medicine is the last thing you should do.

The world of medicine is not the same anymore. Majority of those who I talk to are intending to retire early. For those who intend to do medicine, PLEASE read my books. You can buy it online as mentioned HERE. It should be available in Kinokuniya bookstores very soon. Popular will be next………..

Almost 3-4 years ago I predicted that there will come a time where HO post will be given under contract. In August last year, I again predicted and heard rumours that HO post may be give under contract, after which you need to apply for a permanent MO post. There were even a suggestion than that en exit exam is being considered after housemanship. Well, looks like once again my prediction may become a reality soon.

TheStar reported today that MOH is waiting for green light from the cabinet for creation of temporary HO post. This basically means the HO post will be given under contract. What happens after housemanship? It basically means that you will need to reapply for a permanent post as a MO. There are pros and cons in this system. Firstly, how do SPA or MOH decide on who will receive permanent post and who will receive contract post? I presume JPA scholars/government scholars might be given preference for permanent post as the contract guarantees a bond with the government. Secondly, how do you assess who will get permanent MO post after the contract expires? This is where the said exit exam may come into force. BTW, 300 contract post were created this year for dental graduates as reported by DG and written by me in March 2016.

On the other hand, it will keep all HOs on their toes. If you don’t complete your housemanship in 2 years (usual duration of any contract post), you may not be able to continue the contract. It is also easier to terminate HOs who are missing in action. If you perform badly during housemanship, you are likely to have a lesser chance of getting a permanent MO post. Be also aware that if you do not get a MO post in government, you have almost zero chance of pursuing post-graduate education.

As i had always said, there is no such thing as job security in medicine anymore. It is considered as just like another job but medicine is far more complicated than any other jobs out there. Without housemanship, no full registration. Without full registration, you can’t practise as a doctor etc etc.

What’s next ? A reduction in compulsory service from 4 years to 2 years ? Open clinic after housemanship? Another of my prediction which may come into reality. Then we may have a lot of doctors with apparent ” license to kill”……………

Temporary posts can reduce waiting time for medical grads

KUALA LUMPUR: There is good news for medical students who will be graduating soon as they may not have to wait too long before being offered a job.

The Health Ministry is in the final stages of implementing a plan to introduce temporary posts for medical graduates who face a long wait to do housemanship.

Its deputy director-general (medical) Datuk Dr Jeyaindran Sinnadurai said the rigidity of the current system did not allow the ministry to offer permanent positions to more people as they serve their housemanship.

The plan for temporary posts, he said, needed the Cabinet approval before it could be introduced as “we have to ensure that it is fair to all and no one is marginalised”.

On whether the ministry can justify the number, he said “yes” as it had developed many new services.

“The workload has increased, so we need those numbers to deliver care to the public.

“Presently, we take in about 4,500 house officers annually on permanent posts and upon completing their housemanship, they become permanent medical officers,” he told The Star after chairing a lecture at Hospital Kuala Lumpur on Thursday.

It’s been 7 years now since I started to blog. Over the last 7 years, I had at countless number of times explained in detail about degree recognition, license to practise, job opportunities, quality, apparent “license to kill” and changing landscape of medical practise. Unfortunately, our society especially students and parents are still living in an ignorant world.

Today, there was an interesting letter to theStar(attached below). As usual, it has to come from a parent , similar to what I wrote in my blog post dated 10/06/2016. We have too many naive parents out there who refuse to listen to advise but will complain when it happens. The letter that was written clearly shows that he is not aware how the field of dentistry works, similar to medicine. You must understand that Dentistry had 3 years compulsory service since 2001 till 2012, after which it was reduced to 2 years. In June 2015, the compulsory service was reduced to 1 year which means that ONLY internship is done in government service for the purpose of full registration. I wrote about this in March 2016. The reason for this reduction is due to shortage of post in civil service.

The ignorance of the writer is clearly visible on this letter. Firstly, you don’t become a “dental surgeon” after graduating. The term itself is wrongly used. The one year compulsory service is ACTUALLY Internship. Without internship, you will not be able to be fully registered. Without full registration, you WILL NOT be able to practise as a dentist. I am not sure what “world-wide standards” is he talking about BUT there is NO such thing as practising without completing internship. Without internship, which is a supervised training period , you are NOT eligible to practise medicine/Dentistry. Graduating as a doctor/dentist DOES NOT give you a license to practise. License to practise is totally a different issue than having a degree. Unfortunately, at the moment, internship can only be done at government sector. Anyone caught practising dentistry or medicine with temporary registration or without any registration can be regarded as bogus doctors! Parents should also understand that spending huge amount of money does not guarantee you a job. I had always said that taking huge amount of loans to do medicine/dentistry does not make any economic sense. NO private or public colleges can guarantee you a job.

On another note, our Minister had said that medical graduates can do some other jobs while waiting for housemanship posting. The waiting period currently stands at 8 months. As I said in my blog post last month, i know a graduate who is working as a pharmaceutical rep while waiting for housemanship. The situation will only get worst from this year onwards. AND I still get emails from students who are intending to do medicine in an unrecognised university! Sometimes, I feel I should just give up trying to educate the public! MMC has introduced a new fee structure for MQE examination. I did write last year that MMC had increased the registration fee to RM 1000 with maximum of 4 attempts. This year they had introduced a common theory paper for a fee of RM 3000.  Yes, this will be the way forward. MMC should conduct the MQE exams themselves rather than allocating to various universities where the exam standards vary. I hope eventually, the clinical component will also be standardised. Will this lead to a Common entry exam for all foreign graduates? I understand that MMC is gradually reducing the number of recognised universities overseas.

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A blog reader sent me a message in my Facebook today asking me to update my blog more regularly. Yes, I have been busy for the last 3 months with all these tax issues against doctors and would continue to be busy for another 2 months till all the issues are settled. Till then, I may be slow in updating my blog post unless something “hot” appears. Anyway , all information needed by students are available in this blog OR they could just buy my book and read.

The world of medicine is changing. Doctors are getting sued almost daily basis. Complains to MMC is increasing by leaps and bounds. It is shocking to see the latest disciplinary actions taken by MMC which is available at their website. The numbers keep increasing. A lot of black sheep are appearing in our noble profession as I mentioned in my last blog post. A new medical indemnity scheme has been introduced this year. Interestingly, since the new scheme started, in just 7 months, they have 4 cases filed in court for medical negligence! That shows how the society is changing. I have almost daily complains in my hospital for various issues. At the end, everything boils down to money!

Think before you decide on the life that you want………………

 

 

Abolish compulsory government service

MY son graduated as a dental surgeon from a local private university on December 2015 after five years of intensive study and spending a few hundred thousand dollars. Sadly, he is still waiting to be called for an interview for the one-year compulsory government service and is not gainfully employed.

I understand from reading the newspapers that there are not enough vacancies for dental surgeons in government hospitals. In this situation, I certainly do not understand why the one-year compulsory government service is still not abolished. Can the Health Ministry or Malaysia Dental Council (MDC) offer some sensible and more logical explanation? I am sure others who are in the same boat as my son, and their parents too, will appreciate being enlightened on this.

This waiting period is a trying and demoralising time for my son who is eager to serve the people in this beautiful country.

And while he is waiting, he is wasting his life away and suffering financial loss too.

Why can’t the MDC issue a temporary annual practising certificate to newly-graduated dental surgeons to allow them to work in a private clinic until the Government is ready to take them? After all, they are fully qualified to practise in accordance with worldwide standards.

My son borrowed RM100,000 from PTPTN to finance his course. If he is gainfully employed now, he can start to repay the loan.

I look forward to an immediate solution from the intelligent and efficient officials at the Health Ministry and MDC.

FRUSTRATED PARENTS

Subang Jaya

3 years ago, i wrote an article about a pharmacy which was treating patients like a doctor‘s clinic. In fact that was the 2nd time I wrote about the same pharmacy. For the first, I sent an official complain to Jabatan Kesihatan/KKM and for the 2nd I sent the letter to JKN. However, I never received any further feedback from any one of them. Typical of any government agencies which never provide any feedback. Wonder whether it is under Official Secret Act!

While over the last few years, I do see patients being prescribed medications by pharmacist which they should not be prescribing in the first place, I just kept quiet as I felt it is worthless complaining. I have seen Prednisolone being given by pharmacist without prescription and even NSAIDS being given continuously without even knowing the patient’s renal status. Worst still, I have even patients buying Methotrexate from pharmacy without even my prescription.

Last week, yet again I saw the VERY SAME pharmacy/pharmacist prescribing the following 2 medications to a patient with poly arthritis of 1 year duration!

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According to the patient, she was not even examined by the pharmacist. He just listened to her complains and gave her the medications above. One is a steroid(Betamethasone) and another is Sulphasalazine! Patient developed allergic reaction to Sulphasalazine and THANKFULLY, she stopped the medications. Sulphasalazine contains sulphur and allergic advise should always be given as it can cause Steven Johnson Syndrome and Toxic Epidermal Necrolysis. I will always advise patients about allergic reaction whenever I prescribe Sulphasalazine. Furthermore, this is a generic Sulphasalazine! Finally, one fine GP referred this patient to me.

So, what action has the JKN taken to this pharmacy? How in the world they can continue to prescribe these type of medications to the general public? I forwarded yet again this picture to a colleague of mine in JKN for further action. While I don’t expect anything much but at least I have done my job to protect the public.

ON another note, why did this patient even landed up with a pharmacist? Sometimes, we are to be blamed for all these issues. Patient had seeked multiple consultations from various GPs and Klinik Kesihatans but was only given NSAIDS. Patient has clear-cut Rheumatoid Arthritis. Her RT wrist is almost fused now.

Then we have TCM practitioners who are happily treating patients with “so-called” herbal medications which obviously contains steroids. The moment the patient walks into my clinic, I will give them a spot diagnosis and most of them will be shocked! An obvious Cushing’s syndrome. Serum Cortisol levels will be < 16 in almost all these cases. I do this just to prove to the patient that they have been taking exogenous steroids. Interestingly, recently I came across a patient who was given intravenous infusion by a TCM practitioner over the last 2 months. It was given periodically with tapering dose durations. The patient has Rheumatoid Arthritis. The patient definitely looked Cushingoid. Was he giving steroid infusions? “ Hari ini masuk ubat, besok boleh lari lor“, exactly what the patient told me! Obviously it is steroids! I wonder whether the person giving it knows that these are all steroids and nothing miracle! Or are they giving western medicine in the name of herbal medicine?

I call a spade, a spade all the time. Many do not like me because of this but I have my principles. Patient safety comes first in all instances. Sometimes, we doctors are to be blamed for all these distrust going on out there. While I have said that patients are becoming more and more naturalistic, claiming we are giving chemical to destroy their kidneys etc, doctors are also venturing into unethical medicines. Unethical practices are NOT uncommon nowadays. I have seen enough steroids being given by doctors themselves. Just saw a 76 year old man with OA knees given betamethasone daily for the last 3-4 years. The daughter is asking me why is his skin becoming thin with easy bruising! How am I suppose to answer that when I know exactly what’s the answer.  I saw a patient with generalised body-ache being given Prednisolone 5mg tds! Am I outdated or something? Many doctors out there still do NOT label their medications despite the law mandating it. Eventually business and profit takes over you, either consciously or unconsciously!

It’s called “Prostitution of Medicine“, a word described by the late Prof TJ Danaraj, the founding Dean of University Malaya medical faculty. Commercialisation of medical education and medical practise will eventually lead to this. Medicine is used to make money. It’s not a noble profession anymore.

The world on the other hand is going mad, especially in Malaysia where race and religion is used for business. WE have doctors promoting anti-vaccination (circulating in Facebook) and home birth. In fact, my wife just saw a HO who refuse to vaccinate her child! She is still doing her Housemanship. Interestingly, her husband who is not a doctor is not against it !We have doctors promoting supplementary products claiming can cure every illness in the body. We have an apex University promoting miracle water, suppose to cure 150 illness. We have syariah compliant dental clinics , whatever it means! What’s next ? Halal and Non-Halal clinics/hospitals? Trust me, we will be seeing more and more of these type of issues creeping into this country.

The practise of medicine is never the same anymore. I enjoyed practising medicine during the first 10 years of my service when patients listens to you and unethical practices were almost unheard of. Now, it saddens me when I see patients refusing medical treatment, refusing vaccines, unethical doctors, lost of clinical medicine and the rise of investigative medicine(make money for corporate guys). The rise of vaccine preventable infections like Diphteria and Measles are part of the consequences of our society’s ignorance. Wondered why our medical forefathers created medical councils run by medical practitioners to control the ethical practise of doctors? They had predicted few centuries ago that medical practise can be misused for profit and the world of medicine will eventually undergo slow death.

Many youngsters will realise all this when they start their practise. With more and more doctors being produced with huge debts behind them, medical business will only get worst! While my books will hit the stores within the next 2-3 months, I am now preparing for my 3rd book which hopefully will be released next year.

Selamat Hari Raya 2016 to everyone……………