I am not sure what ” Medical Qualifying Board” is our Minister talking about. Is this something new? As far as I know, it all depends on the Head of Department(HOD) and finally the Pengarah of the Hospital. The sad part is that most HOD do not care and to avoid any paper work , they just pass the housemen and release them to another department, hoping the next department will take some action!! That is what that has been happening with so many of them being released with a “license to kill”. Let me tell you a story that just happened recently in JB.
A senior staff nurse was diagnosed to have Ca Cervix stage 2b, 5 years ago and underwent surgery and radiotherapy. Last 3 months she has been having shortness of breath on exertion. She was admitted to a district hospital almost on a monthly basis over the last 3 months. Each time she was seen by a junior MO who just completed her housemanship last year. Mind you, this hospital is just 30 minutes away from the general hospital. Each time she was diagnosed to have Pneumonia and discharged with antibiotics and MC. CXR showed patchy opacities!! Whenever the staff nurse comes back to see the “so-called” doctor, the MC is just continued with sarcastic remark as though the staff is malingering!! No attempt was made to refer this patient to GH. 2 days ago, this staff nurse died after 3 days of admission to a general hospital. CT Thorax showed multiple mets with pericardial effusion!!!
To me, this doctor is not FIT to be called a doctor!! These are the type of doctors that we are seeing nowadays. Remember, this patient is a medical staff herself, imagine what will be the faith of the general public!
Be very worried………………………
Liow: Housemen not up to mark will be booted out
//
KUALA LUMPUR: Housemen have two years to prove their capabilities as doctors or they will be booted out of the healthcare system, said Health Minister Datuk Seri Liow Tiong Lai.“The Medical Qualifying Board will assess the housemen and if they do not show adequate clinical abilities and skills during the two years, their service will be terminated as provided under the Medical Act 1971,” he said.
He said it meant that they could not practice medicine in the country.
Liow said this in response to a Malay news report on Tuesday that questioned the quality of housemen.
The Star had also highlighted complaints about local students who had trained in some foreign universities and were found to lack core knowledge and basic expertise in medicine.
Liow said there are medical graduates studying in 11 public schools and 18 private schools locally as well as students training in Britain, the United States, Australia, Indonesia, the Middle East, Russia and India.
He said that since their education curriculum and clinical experience are diverse, the Government lengthened the houseman training in 2008 from one year to two years for more clinical exposure and guidance.
“If they do not show adequate clinical abilities or capabilities in each department after four months, their training will be extended for another three months,” he said.
Liow said the Joint Technical Accreditation Committee for Medical Education continuously evaluated medical programmes by local and foreign universities.
Choose a good medical school, students told
PETALING JAYA: Students who want to take up medicine should assess their own capabilities and choose universities with good international ranking, said Malaysian Medical Association president Dr David Quek.
“They should choose a school with good international ranking and not because it is cheap and easy to enter and pass,” he said.
Dr Quek said this in response to news reports yesterday that quoted Higher Education Minister Datuk Seri Khaled Nordin as saying that medical courses offered by recognised foreign universities would be checked to eliminate doubts about their standard.
He said it was difficult for the Government to monitor all schools overseas.
He said that while many Malaysian parents wanted their children to study medicine, it was not just for anyone as the job was stressful.
He said seven doctors had mental breakdown each month and the highest number in recent months was 20.
While parents might think their children who scored seven or eight As in Form 5 were intelligent, Dr Quek said Form 5 and matriculation results were not the best indicators.
“They should go through A-Level studies or sit for the STPM and obtain at least 2As in science subjects. This will indicate if they can grasp things fast and are mature enough in their thinking,” he said.
He also said that if top Form 5 Science students decided to do a foundation course, the course duration should be one to one-and-a-half years and that their acceptance should not be automatic but subject to satisfactory standards.
Perhaps to solve this kind of problem, and the general quality of HO is … pathetic, we should change the system
To pass a houseman, the HOD NEED to fill in some paperwork.
That way, every houseman will NOT be pass onto anyone, till he/she proves himself/herself
I think we should lay off talking about medical students and new doctors!!!! everyone will learn and not everyone is the same !!! You may say we are dealing with patients life and this is true but I think we need as seniors to surpervise our junior doctors and stop blaming them for for being a doctor!!
sounds logic..
Why are you blaming the seniors? In the story Dr Pag has just related, the MO was working in a district hospital, which means there would be no seniors around. She should have ‘learnt’ the skills to practice medicine while at med school at honed those skills during her 2-year HO attachment, obviously this didn’t happen.
There is absolutely no way I will accept someone saying “everyone will learn” when it comes to dealing with patients’ lives. They should have ‘learnt’ in medical school. If something like this happened in a Western country, the doctor involved would have hauled up by the medical council and the case would’ve made front-page news.
No one is blaming anyone for being a doctor. I do however blame them (and their parents) for going to substandard medical schools. If they have have learnt SFA in 5 years at medical school, 2 years as a HO are not going to suddenly make them good doctors, especially when there are other substandard doctors around them.
Most of the time, people will get away with bad practice with no major effect on the patient. But on occasion, the patient will suffer with significant morbidity or pay with their life. This is not how doctors are supposed to ‘learn’.
this is wat most of the new drs said when they did some mistakes nowadays. these ar ppl life dat u all try to learn fr. i couldnt deny that even senior dr can do serious mistakes but the most important thng is not to rpt the same 1 in the future and try to improve themselves. this is wat actually very lack in current new drs who hv problematic attitute coz they thnk 1/2 mistakes shud b ok.as wat Nav had said, pt has to pay for that.its the attitute matters.
I agree with you on many things but not on this one.
First of all, we need to stop this fault finding attitude. Human make mistakes, esp doctors. Often than not, we learn through our mistakes. Hence, my proposal is that we need to change the system. All admissions should be reviewed by seniors ie registrars or consultants. Junior doctors should know that when they are in doubt, they should call their senior for advise.
I would think the patient would be seen by a consultant following admission, no?
Personally, as a junior doctor, I wouldn’t treat as mets on first admission. Common things are common. If the chest infection doesn’t resolve in 4-6 weeks than only I would consider arranging for CT scan.
Thats when follow up come in place. Unfortunately, we dont have establish primary care to oversee this.
Finally, I’m sure you have done mistakes in the past.
I think you don’t get the massage. You said you are a junior doctor but have you worked in a district hospital before? The problem with our health care system is that almost 80% of the district hospital DO NOT have consultants. The most senior doctor will be a MO 3-4 years your senior! That’s the reason you need to be competent enough after your housemanship before going to a district hospital. As you said, junior doctors should discuss with a senior paerson if in doubt BUT this does not happen as many of our young doctors have ego problems!.
I agree with you when you said that you would not treat this patient as mets on the first admission but having a history of Ca Cervix before, mets should always be a differential diagnosis in any patchy opacities on CXR. I am sure you have learned this in med school! Secondly, this patient had only shorthness of breath and not fever. Cough was minimal! Any pneumonia should improve with 5-7 days of antibiotic and when this patient (who is a staff of the same hospital) keep coming back to you with similar shorthness of breath , infact getting worst, a more serious diagnosis should have been considered almost 3 months ago!! Just for your info, she saw the same doctor again and again for almost 2-3 months!!
Everyone make mistakes BUT i do not agree with mistakes like this, very obvious and even a good medical student would have picked up the diagnosis! When patient’s start to sue doctors sooner or later, then you will realise that making mistakes is not a learning process anymore.
haha. dis is wat i said the junior drs owez protest their mistake. if u wan to do a cxr after 4 wks of giving antibiotic, can the pt wait? yes, teoritically but not practically
If HO do not show adequate clinical abilities and skills during the two years, their service will be terminated as provided under the Medical Act 1971—– does this mean that if the HO being extended, they cannot be a doctor, and whatever they have spent for the 7 years (5 years medical school and 2 years training) will be just a waste?
Before 2008, HO training is only 1 year, but now is 2 years.
I seriously got no idea about this issue that just came out in the newspaper yesterday. Well, it does happen in other countries where incompetent doctors are removed and you can never work as a doctor anymore. So, why not in Malaysia? If you are good and hardworking there is nothing to worry about!
Point 1) I am not blaming the seniors but however I think the MO also not completely at fault either. where is the registrar or the consultant ? We are so used to blaming each orther. MO complaining about HO and the registrar about the MO. Never ending. After coming out from medical school and 2 years of HO does not neccesarily make you complete doctor. You should know medicine is learning process. I am sure you ask a physician who has been practising for years, he to would have missed something. It is learning process. 5 year in medical school will not teach you everything if it does then I would call that a super standard school.
Point 2) If something like this happened in a Western country, the doctor who is supervising the MO in this the case registrar and the consultant will also taken the blame…regardless wheater the registar or consultant seen the patient.
Point 3) Here again there is no point blaming the parents or the students for going to what you call as substandard school. There are many reasons for which I am not going dwell into but anyone can be become a good doctor given the right encourgement and guidance. Many of the substandard medical schools do have doctors working all aorund the world and infact doing very well. The questions to ask is why is that??
We go on and on about how bad about the junior doctors and medical schools. I think we should lay off talking about medical students and new doctors and especially their parents please!!
From
A humble doctor from a very substandard school
Dear Arvo20,
All of us know that no one is a complete doctor, at whatever stage in their career. The point I was trying to make is that doctors who have finished medical school should at least know how to identify an abnormal ECG, do a clinical examination, administer oxygen to a patient, etc. According to media reports, some medical schools are producing doctors who do not have those basic skills. MOs, registrars and specialists are not there to teach those basics (they do not have the time), they are there to consolidate your learning and take you to the next level (e.g. identifying WPW on an ECG, advanced airway skills, etc).
A physician who has been practicing for years may very well miss something, but I can bet my bottom dollar he will not miss ST-elevation on an ECG. Properly trained doctors are trained to look out for red flags in all areas of practice. This is very basic practice. A patient with a history of cancer presenting multiple times to the A&E with shortness of breath AND a CXR that shows multiple opacities – come on …. a doctor that misses that should not be practicing.
As for practices in a Western country, the registrar or consultant supervising the junior doctor will only be culpable IF they are informed of the patient and the facts. If the HO/MO has made all the decisions and sent the patient home without informing their superior, they are the ones who will be held responsible.
Reasons for going to a substandard medical school are as follows:
1. Cheap
2. Lower entry requirements
The only group I sympathise with are those that got good marks but could not afford more reputable medical schools and were overlooked by our govt for scholarships. This small group will do well wherever they go because they are motivated and have the intellectual ability. Once they start practicing and see that their medical school didn’t provide them with the skills required, they will go the extra mile and upskill themselves. Unfortunately, they get grouped in with others from that medical school. For every 1 of these exceptional individuals that are ‘working all around the world’, there are 5 in the group below.
Those that go to these medical schools because they didn’t get the marks, sorry, but I do not think they should have done medicine in the first place. Practicing medicine requires a certain level of intellectual functioning. You cannot take any Ahmad, Ah Wong or Arumugam off the street, put him into med school, and expect him to be a competent doctor (part of the reason is that these ‘cheap’ med schools try their best not to fail you, so they can get more money). If these guys went to a med school in the UK, Aus, NZ or North America (or even some of the better ones in Malaysia), they wouldn’t make it past 1st year.
My angst about the whole situation is due to the fact that the good blameless Malaysians are dying in our public hospitals because of incompetent doctors. An incompetent lawyer will make you lose your case, An incompetent computer technician will bugger up your laptop. An incompetent financial advisor will make you lose your money. An incompetent can make you lose your life. That’s the difference. Patients are not our playthings on which we ‘practice and learn’.
With all due respect Sir, I think you are the one who s missing the point.
My point is BLAME THE SYSTEM, NOT INDIVIDUALS.
By all means, tell the doctor off. He made a mistake therefore he should learn from his mistake.
But do we have to keep telling MO s off and keep striking them off?
You of all people should know that it is well unsafe to let doctors of 2 years of experience to run district hospitals.
We need at least a registrar to review all patients before being discharged.
Therefore, until we gain more specialists and consultants, MOs and HOs will be reprimanded and looked down but mistakes will be inevitable.
Having trained in the UK, I witnessed first hand how the seniors are being supportive and accommodative despite being a foreigner.
One skill that I find admirable is that they always clarify history from patients although I have presented the same information to them.
Yes, the mets should have picked up earlier. the question is, would that change the outcome. If her prognosis is 3 months without treatment, I wonder if we could extend it to 10 years with chemotherapy??? NO!!!and would she get the chemotherapy in 3 months??would the outcome really change?? May she rest in peace.
A doctor who missed ST elevation should definitely get striked off. But not in this case. It is the system who is at fault, not the individual.
I wouldnt buy the Malaysian judiciary system but take this doctor to a court in England, I’m sure he wouldnt be penalised!
I’m not being sarcastic here but lets face it! This fault finding attitude is so ingrained in our culture.
Yes, you are right. As I said, the health system in our country is such that you are thrown to a district hospital after housemanship. That’s the fact that we have to except and thus the doctors should be competent enough to deal with it. That’s the reason the housemanship training was extended to 2 years in the first place. It will probab;y take another 50 years before we can equip all our district hospitals with consultants!! thats if the brain drain can stop anytime soon! So we just have to live with it and that’s the reason why our doctors need to be really competent!!
Secondly, would you say this if the patient was your mother/father or close relatives! I am sure you will do whatever possible to extend her life even if it is another 3-6 months, right? No doubt , she would have died anyway but a good palliative treatment with palliative chemo and radio might have extended her life another 6 months. Remember she has children and the youngest is 12 years old! Thirdly, I did not mention what are the words that this doctor have told the patient when she came repeatedly to see her for dyspnoea. Words like ” heee, ini nak MC lak ni, tak nak kerja !!” . The doctor even threw her medical record when she came to continue her MC. Is this the type of doctor that you are defending!
As I said, one of the main problem with the current quality of doctors is that , not only they have poor knowledge and skills but a very poor attitude. They refuse to learn and even ask for opinion from their seniors. I can give you multiple examples. Lastly, would you send your relatives to see a doctor like this?
Hai, Siti. I agreed with you that in our health system need overhaul, we need some ambitoius souls like you as if not the system will be forever ‘rotten’ like this.
Last time, I was ambitous. some of the reasons I quitted the system because of political reason, the ego of the senior MO doctors & specialist and others.
My worst experience was after I resuscitated a badly injured youngster after a serious accident for 6 hours. Neurosurgical gave up, surgical gave up, orthopedic about to gave up but I never gave up. After I pushed few times the ortho MO for femur fracture stabalisation, they finally did that. On the coming morning, the youngster still survived. I was scolded by the anes specialist as well as the neuro specialist because of the ‘mass’ I gave them (when I called up OT to follow up the case). All department tried to push away the case as afraid of their departmental mortality statistic would increase. I complained to my boss, but nothing could be done.
After one week, the boy still survived and after 2 weeks, he was opted for organ donation after that despite he never woke up. After confirmed organ donation by the family, all the department involved started to grab him. And finally the medical team and anest them got all the credits from the newspaper. These was one of the bad experience I got in the hospital.
I wish to say that the system need soul like you and you can make the different. Time will tell.
i was quite shocked when i read thru ur post. can i ask u 1 question. if a pt who is relative or urs suspected having a endstage ca but the dr told u dat no ned to do any further Ix as it wouldnt change the outcome, ar u going to get frustrated? treat a pt as human plz, human has feeling
Well, I wasn t defending the individual. I’m criticizing the system.
I have 1 and a half year of experience and MRCP part 1. I am able to do procedural skills. Does that make me competent? no!
I believe I have a lot more to offer to the country in the next few years.
Our definition of competent doctor varies. They are some doctors who really have good bedside manner with patients but they speak to juniors in condescending manner.
Im lucky I get to work in the UK. My only hope is my fellow friends and collegues to practice in the same manner in the future. Of course I am not expecting this to occur overnight. It may take years but we need to cultivate teaching culture and avoid fault-finding attitude.
I am aware of the situation in Malaysia and also realized that is very little we could do to salvage the system.
I think they should have 2 MOs of the same level to run the district hospital. There should be at least 2 senior doctors seeing a patient before discharge.
Can I just re-ireterate that Im not saying the seniors are wrong the juniors are right. I think medicine fascinating and its even more interesting if you get to work in a friendly atmosphere with appropriate, fair and safe system in place.
Dear Siti,
You are very idealistic, infact too idealistic. When I was in gov service, i too felt the same as you, that we should teach the younger generation, guide them and help the country, develop the department etc etc. In fact, I started journal clubs and teaching rounds in my hospital. I took MRCP students for short cases etc etc. Housemen refuse to leave my ward as they enjoyed being in my ward and I never scold anyone, even though I am strict on certain things. BUT unfortunately the system does not allow you to do so. At the end, you will get frustrated, tired and will be forced to leave the service. Same like how underqualified students are being allowed to do medicine in our local private medical schools. What can we do about it? nothing! because everything is politicised in this country.
where have ur ethics gone dear doctor? pointing fingers at others who work in the same field as urs?…or maybe ur elite med school didnt gave u med ethics classes?
Dear hoho,
It would be unethical to NOT voice out concern if there is an incompetent practitioner. There is absoutely nothing in medical ethics that says one should ‘keep quiet’ if there is an incompetent practitioner in the midst – one should do the exact opposite in fact. Any medical school worth a salt would have incorporated this into their teaching of medical ethics (having said that, medical ethics has really only been taught in medical schools in the past 10-15 years).
What I do agree with though is that if anyone has any personal concerns about a practitioner, it be brought through the proper channels. Even though I lack faith in our medical council, it is still where one should go to lodge a formal complaint against an incompetent practioner.
I think you are the one who should read medical ethics! I did not mention any names or the place that this incident happen. If something like this were to happen in another developed country, it will appear in the newspaper and the medical council will reprimand you.
Even a good final year med student should be able to make a diagnosis like this and the attitude of this doctor really sucks(pls read my comment to siti).
So, are you saying that doctors can go on making serious, obvious mistakes like this but no one should question or bring up this matter. Just sweep it under the carpet, no matter how many lives that you kill? That’s ridiculous!!
Wait till the time when patients start to sue each and every mistakes you make in the name of “learning process”. Then you will hate yourself for being a doctor. FYI, doctors are being sued nowadays even for not taking proper consent for surgery!!
So, like NAV has said, it is unethical for you not to bring up this issue. It is NOT ethical at all for you TO KEEP QUIET! Pls read medical ethics. There is no where in the medical ethics which says that you must protect your colleagues for making an obvious mistake or negligence! In fact I can even be called as an expert witness in court for a medical negligence case which I have to speak the truth and not cover up!! I only breach medical ethics if I mention the place and the names of the doctor or patient!
I am fed up with you dr paga, you only find fault, you do not give suggestions, and as i read through your blog, when u were attached to KKM, u did not dare to bring all this issues out, only when u went to practise in the private sector, u r expressing your unhappiness…
Dr, You have no balls to speak up when u were in KKM, so you better keep it that way.. You are putting your fellow junior doctors down and behave as though you are the only good dr there is in Malaysia..
I think you should read my MMA articles which I wrote many years ago while I was still in KKM. Unfortunately there was no such thing as a freely accessible blog during those days when I was in KKM. BUT I have written enough about KKM in my MMA articles WHILE I WAS STILL in KKM till 2006!! Please check for yourself under My MMA articles session.
FYI, I am not putting down anyone. I did not mention any names or place where these things happen.I do not tolerate any form of incompetence especially when it involves cases where even a final year good medical student should be able to pick up. AND the attitude is another matter!!
Wait till you have a doctor like this treating your mother or father, then you will remember what I have said! I will see whether at that time, you will say “it’s OK, they are all still learning !”
trulyagree wv u on dis. wait till they hv a dr like dis treating ur relatives then they will understand more.
BTW, please, again go and read all my postings and my MMA articles. I have given enough suggestion and ideas for improvement, even way back in 2004!! Please read carefully before making any comments! So, stop saying that I have not criticised KKM before while I was in KKM.
I have even brought a Pengarah of an hospital to task for not paying on call allowance and have removed a clerk in an hospital for not doing his job in submitting documents for full registration!! I can tell you stories of what I have done when I was in KKM. Please do not make any asumption when you do not know me !
true indeed…one would be unethical if another incompetent doc is practicing and yet let him/her be…it would be more ethical like u said if we lodge a formal report to the medical council instead of talking about it in a personal blog is it?
and oh, dr paga..u keep on saying,” wait till u have a doc like this treating ur mother or father”…i know what u mean, i truly understand it but PLEASE, dun act like u NEVER did any mistakes before and dun talk like ur the best doc ever here in Malaysia…THAT IS SIMPLY UNETHICAL
and yeah, dun tell me im backing up this doctor even though of what she did..no…i dun back her up..i just dun like the fact that u talk about this in ur personal blog, claim dat it is even unethical if u keep it quiet rather than lodging a formal report..
Did I ever say that doctors do not make mistakes! Everyone make mistakes but NOT so obvious one like this. Please read through the case before jumping to conclusion. It is a straight forward case that need no further elaboration!!
Anyone can discuss any case in their blog as long as the names are not mentioned. You can see this type of cases being mentioned even in journals and magazines which is open to public!
FYI, a formal report has been made to the state health department. BUT as usual , no action will be taken except probably a transfer!
I must say, that from the case above, its pretty obvious the doctor screwed up. I mean, cmon, its a textbook case! Mistakes are mistakes, but this is a blunder of the highest order. It’s like a bus driver consumed alcohol, and crashed a bus of 30 school children, and the newspapers is trying to defend him by saying ‘yea it’s a mistake’.
Look, system-blaming aside, put your emotions away and look at this case for what it is. A doctor screwed up a very typical case. Any decent history taking and logic can link a history of Ca with recurrent pneumonia as a red flag.
The Malaysian Health System is full of the above stories, and has been happening for the past 20 years. It has been covered and naive patients have not received the care they deserve. Are we surprised? Nope. I am surprised that some of YOU are surprised.
Stop the idealism crap. Embrace realism. Widespread hypocrisy has given rise to a disillusioned group of amazing doctors who are leaving the gov service. Its happening now, and will continue to happen until someone empowered, somewhere out there, makes a concerted effort to reform our system. Admit it, the only reason most of you dont leave the gov service is because your are tied town by some scholarship bond, OR you are in desperation to become a MMed specialist for some ego-fulfilling reason, OR you are just too ‘chillax’ in your hometown KK. Bah humbug.
And I was shocked by a certain comment by ‘Concerned’. No seriously, ‘you only find fault’?? Is that the most intellectual thing you can say?
Im not in full agreement with dr paga all the time but damn you ‘Concerned’, he is probably the only person right now in this country who is giving some fodder against our pathetic health system. Go, go, go and post a link or cite an article over the past 20-30 years that has credibly argued against some of our policies. Go home you ignorant kid.
Let me tell you something, I have seen how our fantastic KKM specialists work. Don’t have this great illusion that those who ‘stay’ in the government are selfless in service to the Rakyat. Yes there are always exceptions, but so many of these H.O.D/specialists are running private clinics, locuming during their ‘calls’, going back home way before 5pm, outsourcing their specialist procedures to M.O’s, etc etc. In the meantime, those private specialists do everything on their own, right from taking blood, clerking right up to attending court cases for mistakes. Yes, you make a mistake, you pay. But that’s not applied to gov servants, eh?
Siti Nizar
“Yes, the mets should have picked up earlier. the question is, would that change the outcome. If her prognosis is 3 months without treatment, I wonder if we could extend it to 10 years with chemotherapy??? NO!!!and would she get the chemotherapy in 3 months??would the outcome really change?? May she rest in peace.”
You say you trained in the UK? Oh, right. Looks like the British have changed their perspective on patient’s rights and palliation.
http://www.who.int/cancer/palliative/definition/en/
Whats the point of sending people to the UK when all you bring back is arrogance and false pride?
I dont think Siti Nizar is back yet to Malaysia, I think she’s having a really good time working in the UK.
dr.paga please post some cases like this and point out where the mistakes and the proper management..it will be good guidance for upcoming doctors..
Unfortunately even though I have a collection of cases but I am afraid that it will lead to litigation by patients. If any patient finds out that the case is theirs and there is mismanagement involved, the doctor may get sued. You may even get sued for putting up the case withour the patient;s consent! Anyway, I am thinking of putting up some images and short case histories later.
y there should be mismanagement?..as i noe u r d best rheumatologist in jb n malaysia..do put ur successful management..many doctors not aware how to diagnose rheumo diseases..how to detect murmurs..how to analyse a/b test..ur guidance is extemely needed..an apple a day keeps a doctor away..a case a day keeps houseman problem away..please do consider this doctor paga..rather than discussing neverending problems we must put our energy and soul towards the nation healthcare development..FYI many are aware bout your blog and many docs and med students will get benefit of case studies..
When You talk about any cases, these patients would have seen by many doctors before reaching the hospital. Thus you can’t avoid the fact that patients may think that the doctors have misdiagnosed or mismanaged them. That may become a issue if the patient read the case. It has happened before in other countries. Consent is another issue.
However, I am still thinking about it, infact I have been thinking about it since I started this blog. Copyright issue need to be considered as well
Shouldn’t you be relying on a textbook to “diagnose rheumo diseases..how to detect murmurs..how to analyse a/b test” ? A random blog isn’t usually the best resource (no offense Dr Pag).
Please post up more of such examples to enlighten those that still live in their own idealistic and delusional world. I’m sure we all will benefit from it
To Dr Paga,
What about posting lastest reports and treatments on rheumatology?
Each year there are some changes to the diagnostic criteria.
I really pity you Dr, what you did here was badly bombarded by some group of people. Anyway dont give up, I believed what you did is for the better of future doctors. Future doctors should know their plight and suffering they are into and take notice of it. I have come across many consultant’s medical blogs, many never dare to voice out against our medical system.
I practise freedom of speech ad everyone have their own opnions. I approve all comments whether it is for or against my opinion! BUT please refrain from using vulgarities
then if a formal report has been sent, and no appropriate action is taken, then u should try and do something else..talking about it in a blog wont change a thing yeah? u sound like an expert in this kind of things…why don’t use those expertise of yours and do something rather than talking about it here…action speaks louder no? and chillax, i think siti is not being arrogant here…she’s just giving out her point…does talking in an open discussion makes one snobbish? it doesnt matter if what she thinks is too idealistic and all of u is living the reality…at least she has a useful comment about how the health system should be done…rather than we talk and point fingers here, why don’t use what we have at hand to solve the problem
You know how many formal complaints are there everyday in every hospitals in this country!! Please go and check for yourself! Any complaints made by the patient or other doctors to the hospital or state health department will finally end up as NFA (No further action) or the doctor will be transfered to another hospital/non clinical site. This has been happening all along unless it appears in the newspaper.
“then if a formal report has been sent, and no appropriate action is taken, then u should try and do something else..talking about it in a blog wont change a thing yeah? ” What else should be done ? can you enlighten me? Should I ask the patient to go to a reporter? Or should I ask a lawyer to take up the case to court? I have worked enough years in civil service and being the SCHOMOS Chairman of a state, I have done enough to change the system, but it will not change! you are probably too young to understand what I am talking about. You will realise what I am talking about in another few years time when your frustration grows! I have many juniors talking like you before but came back to me years later and admitted that the system will not change!
I think you should go back again and read what I have written. This is not about pointing fingers. It is about patient’s life. You know how many lifes are dying in our healthcare system due to mismanagement? You said that I keep asking this question ” what if it is your mother/father?” I ask this questions to every of my junior doctors when they neglect a patient and you know what, I get the same answer ” silence”……………. Why is there double standards when it comes to your own relatives/friends? I always teach my juniors that we should treat every patient as our own relatives and friends.
WE have doctor now who do not know how to read ECGs, interprate CXR, infact do not know what is hypoglycaemia. These are things that you should have known before graduating from medical schools. And the case above illustrates the same, something that a med student should have been able to diagnose! And I will continue to write about these issues as a citizen of this country and hoping that it will change the system for a better.
So “hoho”, you are giving your point, Siti has given her point and I’m giving my point. This is the internet and dr paga is giving his point. What is your point?
This discussion we are having here IS part of the ‘problem solution’ process. It’s called brain storming, discussion, voicing out, etc etc.
“why don’t use what we have at hand to solve the problem”
So really, what’s the problem? Has it even been defined yet? That what is happening here. We are trying to outline the problem. Try to contribute.
Queen,
yes, Im having a great time, I work hard to be where I am now. You should too! 😛
Chillax,
I think you should calm down and relax!
Say what you want, it doesn’t bother me in the slightest.
We all have a common interest, that is to improvise our crap health system.
There are rumours that apparently house officers need to undergo an assessment to make sure they are fit to practice. I agree some may have attitude problem but the assessment should be for all doctors including seniors and it needs to be continuous. There should be a council to monitor all doctors, not just houseman!
What if the attitude problem only starts after 30??
There are some consultants who also have attitude problems, never fail to shout, humiliate and treat juniors with contempt.
Private,
I’m not surprised. Dont get dishearten by it. What goes around comes around.
In an ideal world, they have an arrest team. Mind you, in those circumstances DNAR (Do not Resuscitate) form needs to be in place.
Dont think the elderly with multiple co-morbidities would appreciate strenuous CPR that will most certainly break her ribs not to mention, risk of tension pneumothorax.
Folks, forget about the above example, lets concentrate on why he might have done the mistake and how we can practice safe medicine.
Could he be tired? Its probably not a bad idea to abolish this appalling working hours when we have adequate doctors. I am more than happy to email HR my oncall rotas. 🙂
That way, more doctors will stay in gov hospital. Yeah, money is important but at the end of the day, you want to make minimal mistake, no damage. You chance of making mistake is higher when ur tired. I don’t think houseman will learn much by doing CPR and full resuscitation on his own in the middle of the night. We need a team at night not just houseman.
Siti Nizar,
There is a council to monitor all doctors. It’s called the Malaysian Medical Council (MMC). You might have something similar in the UK as well, I believe it’s called the GMC 🙂 The problem with the MMC is that it’s run by a bunch of nincompoops who protect their friends. Only 11 of the 33 members are elected. The President has a conflict of interest by virtue of also be the Director-General of Health. 18 of the 33 members are appointees of 6 public universities in Malaysia, which means they have a disproportionate amount of influence when it comes to accrediting local medical schools, and a conflict of interest when it comes to their own medical schools. If you look through their website, they summarise 11 cases brought against doctors in 2008, where disciplinary action was taken. The link for the 1st half of 2009 is dead and they haven’t bothered to update things since.
Consultants who shout at and humiliate junior doctors should be taken to task, I totally agree. But what is the currnet process? Complain to the HOD or Pengarah? Won’t get you anywhere. Only if some form of assault occurs will anyone take notice (like that surgeon who slapped the anaesthetic MO with his blood-stained glove a few years ago, even then it became all hush hush later). A directive like this needs to come from the top – zero tolerance. But there is no inertia for change from the pwers-that-be. Mind you, junior doctors should also learn to be more respectful to patients – they frequently shout at old uneducated aunties and uncles just because they don’t understand something.
As far as working hours go, there are many senior doctors who believe that the current system where you sometimes work for >30 hours at a stretch is the best. That of course is nonsense. Studies have shown that staying awake for 24 hours puts your concentration and reaction levels equal to that of a driver just over the alcohol limit. No one would let someone over the limit for drink-driving operate on their mum would they? I’ve heard of surgeons having micro-sleeps while operating because of this! Having said that, the UK has taken it too far with the 48-hour rule imposed by the EU. You cannot expect the same breadth of experience. 60 hours per week is a very reasonable limit. Emailing your rota will do no good. Pengarahs and HODs in the hospital are too inflexible to change, partly because they don’t want to do the extra work involved. It’s a cruisy life for most of them and they wouldn’t want to spend extra time taking care of the welfare of junior doctors. Only if MOH or MMC make it a blanket rule, will things change.
Ah … but one last thing about this …. you will find that many junior doctors don’t want the rules to change. Why? Because their income will suffer. Currently, a big chunk of their income is from calls after hours. If this is decreased, their overall pay goes down. The situation has become like this because everytime the govt increases doctors’ pay (like has happened over the last 6 years), they are actually increasing the call rates and allowances. This is easier to do for them (and easier to take away also in the future). If they increase the basic pay, they have to go through a long process … which can be done if they want to but they avoid doing so because it also means paying more pension in the future (pension is only calculated based on your basic pay).
the problem is the health care system…if u havent noticed..or still pointing fingers at other junior doctors..and god, lose that attitude
hoho,
If anyone has an attitude, it’s you.
The problem is indeed the healthcare system. Incompetent junior doctors (not all, just a few) are part of that system, so are specialists who humilate their juniors for no real reason, so are private specialists who operate on patients for no reason just to make money, so are nurses who have gone through 18 months of nursing college and come out with no useful skills, so are private hospitals who offer unethical ‘health screening packages’ to make more money, so are some local Masters programmes whose standards have dropped badly over the last 10 years because the good teachers have left. These are all components of the health system.
You cannot change the system without changing the people that are part of the system … and that is done by putting steps in place (guidelines/laws/directives) that result in change being effected.
Part of that process is to highlight what is going on. That is why I think this blog is great. If enough people know about the nonsense that happens in our health system, there may be enough momentum for change. Unfortunately in this country it is all the more difficult because the power for real change is concentrated in a few people at the top.
Nav,
I’ve heard about this GMC equivalent. But not too sure about their role.
FY1, there are weeks where we work 60 ++ hours per week. Apparently they calculate all the hours we do in 4 months and divide it by 16 (weeks)
I swear I work more than 48 hours a week considering I work in district hosp. We work on every other weekends, either long day or night shift.
The registrars work in UK work more than 48 hours a week. You can opt out from the EU working time directive.
The good thing is we always get a day to recover- / 2 days day off after 4 nights shift. Bliss.
Medicine is a lifelong learning process. There are only so much you can learn during university life. There are certain things that you wouldn’t learn from text book. Bedside manner, how you treat your colleague, patients etc and how you should handle with stress. A supportive team be it, consultant or reg or MO will make a whole lot of difference.
We may need to consolidate our/their learning by arranging monthly teaching etc.
Call me an idealist, I, for one, would definitely go mental if I haven’t slept for 36 hours. I hope I wont shout at aunties and uncles in the future 😛
I think I need to stop. I have suggested too much you guys may throw bottles at me.
Dear Siti,
First of all I think you should come home and get yourself into the system. Commenting about our health system from overseas is of no use. You should come and work here and see for yourself how screwed up the system is and then talk about changing it. For your information, eventhough district hospitals do not have consultants or registras, their on call is only 1-2 times a week because there are usually about 5-7 MOs in district hospitals, especially those that are nearer to GH. So there is no excuse of being overworked! Furthermore, they do not run any outpatient clinics in district hospitals , only emergency department. FYI also, most of these doctors go home in the afternoon! There are a lot of nonsence that is going on in our health care system which probably you would not be aware when you have not worked here!
Our MMC is toothless, period. All complaints within MOH is investigated within the hospital or state health department and usually end up as NFA! or the doctor will be transfered. Nothing reaches the MMC unless the public complaints directly to MMC. Even then, MMC will not do anything. Even if MMC wants to suspend the doctor, as a civil servant, another long procedure awaits you. It is a 2 parellel system which do not work together! The process of suspending a civil servant is anotehr major process involving JPA and SPA!! It is a lot of bereaucracy in our civil service that you will never be able to change unless it comes from the top! Unfortunately our politicians are only interested to take care of their seat!
I know our DG, Ismalil Merican personally. When he took over the office in 2005, he had a lot of plans to change a lot of things in our system. For the first 3 years, he did his best and worked hard to change the system. But finally, he himself gave up. You notice that over the last 3 years, he remains very quiet. Before I left civil service, he told us 1 thing: no matter how hard you work to change the system, there is a lot of bereaucracy and you will be vetoed from the above!! So, if the DG himself cannot change the system, who else can? I can bet the bottom of my dollar that our DG will never agree with the 1Malaysia clinic(run by MAs) but still have to say yes and smile to the reporters!
Most of the remaining consultants and HOD is our system do not do any work!! Most of the time they are not even at work! they will either be flying around the world (world travellers) or sitting at home. I know of an HOD who stays at home and takes care of her children but getting a JUSA C salary! What action can be taken? none! You can complain all you want to the Pengarah or MOH, NOTHING will be done. It is simply because the procedure to take action is soooo long that no one bothers! You are right that there should be continuous assessment of all doctors but it will not happen! Most HOds don’t even run their own clinic or do ward rounds! FYI there is something known as SKT which is a form of asessment of a particular gov servant but again it is of no use!
The only way for the system to improve is to have a complete change of our healthcare system and good regulatory unit and proper action to be taken on errant/incompetent doctors. ONLY then, it will improve. As a citizen of this country, it is my right to point the mistakes that are being commited and the lifes that are being lost due to negligence and I will continue to write cases like this. Remember, I am not talking about some HIFI diagnosis. I am only talking about diagnosis that even a med school sudent should be able to diagnose. However, looking at the entry standards and quality of doctors that are being produced in mass over the last few years in this country, our health care will only get worst from now onwards!
Interesting to see many comments placed from the last comment i posted. Well said Siti Nizar and Nav, Paga we agree to diagree….
Siti, nice of you to take my criticism elegantly 🙂 respect.
And yes, this is why I like dr pagas page.. its giving us a platform to voice out our opinions for problems in our country’s health system without being overseen by a glass ceiling (something which MMA has failed to do in recent years)
In fact, I have already suggested to him to have a malaysiakini-style blog… once the authorities and public take notice, you have a brilliant environment to change the quality of our health system, but he has already said its beyond the scope of this site. Fair enough.
But for now, this is doing just well.
Back to the problem, I have to fully agree, there is a massive conflict of interest when your DG is also the MMC president. Imagine if the Bar Council’s president (R Kesavan) was also the attorney general of Malaysia? And lets not forget, the current MMA president, a very smart individual, but is not making hard statements in public media to protect Msian doctors, young and old. Surely there is some sort of institutionalism we have to offer to our junior doctors, and then internally whip them to shape, right? That is not happening.
Hi guys,
I’ not a doctor, but I am fully aware of the current situation with our healthcare system (my wife is a doctor, and I’ve got lots of doctor friends). Been following your blog since only a few weeks ago Dr Paga and I find it quite interesting. I do agree with you on some things but I do not fully agree with your approach of fault finding, complaints and negative approach to things – saying this could not be done, that is impossible etc.
One suggestion on the change that we need to make to our healthcare system and how we could do it. Probably we need to do an Egypt. They got the change that they wanted, but we could probably do it in a more civilized manner. A facebook group page would probably be a good start. Someone need to lead. 🙂 Time for the ‘people’ to make the change.
Just my two cents. 😛
Interesting. If we do not find faults, make complaints , how do we improve the system? In order for us to change the system, we need to find the problem first, right? That’s what I am doing.
Yes, we need to change. Creating a facebook group will not do anything! This blog is also an attempt to change people and hoping that the system will change. An Egypt style may be needed when the time comes!
Heh heh … sorry Dr Pag, Egypt style will not work with the health system here. The govt has too much control over the unions and our lives. Ring-leaders have any organised activity that the govt is not happy with will be transferred (which again is a misuse of power). As someone who has participated in doctor strikes myself overseas and having to front up to the media (as the union rep for that region), it is not a pleasant experience. Also, public sentiment will not be on our side partly because there is no culture to strike in Malaysia.
Also agree that a facebook page is pointless. This blog is much more useful. The more people read it the better. So, if you’re reading this, and think more people should know about the stuff in here, forward the link to your friends.
Siti Nizar,
I will too, and all the best for your CT1.
And Dr Paga is right, if you are so optimistic about the healthcare system in Malaysia, why not return to Malaysia after your FY2?
Also I hope you are one of the privately funded student too!
Queen,
I’m coming home after Fy2, hence the comment.
You got the wrong end of the stick. we are suppose to be on the same side to come up on how we could contribute.you have mistaken my intention and attack me personally.
Dr Paga,
Its been a pleasure. I rest my case.
hi dr paga
I am a silent reader. Have been reading your blog quite regularly. But for the first time – I would like to say something.
Before I begin – I like to state that I am still working in the system, already did my trial by fire in districts for a few years and now doing my post graduate.I worked in a tertiary center in Klang Valley and previously in a secondary referral – state hospital which for the sake of confidentiality would not be named. Like you I also cringed over the fact that some of the young newly finished HO sent to the districts were in fact not ready for it – some of them – their basic medical emergency knowledge is lacking.
What can we do? we have already prolonged their training? give them thick logbooks that they should fill. Should we send senior MOs and specialist to districts then — ooops we forgot – Malaysia still lack of senior experienced MOs and specialist because a lot of them still stuck in district as chronic MO *for them to go do their postgraduate/specialist training — mereka hanya akan dilepaskan oleh KKM dengan bersyarat ada pengganti * ooo the doctors yang patut datang ganti tak datang2… takperlah doktor – doktor lebih diperlukan di sini.. well too bad…
Siti nizar – the district hosp in malaysia is different in a sense there are no consultant/specialist/registrar to hover over you to make sure you do correct things. You are the consultant/specialist/registrar for the hospital and as a doctor – you should know when to refer a case when you realise the case is beyond the scope of your training or that patient is not getting better with your management.
In this case – the doctor who saw the nurse should realise earlier on that this case should have been referred to a hospital with specialist care for a second opinion as she is not getting better despite antibiotics.
the medical qualifying exams — for it to be fair – it should be independent of the medical schools influences but KKM as a clinical body lack the people who can construct this examination so at the end they will recruit local medical schools to be on the exam board. This will produce bias towards the local graduates (having a better advantage) and against foreign grads.
dr pagal – I am too frustrated with our system *thoug am in different system now due to postgraduate training but I still feel deeply for the current health system. Our health system is falling apart due to improper distribution of staff (nurses and doctors alike), inadequate health budget which ‘menguntungkan’ only certain quarters – with good medications is often out of reach of the public. I see a lot of people trying to change the system – like you but became frustrated. We need more people like you to expose the inadequacies of our health system. Perhaps with the ensuing public attention – the higher ups would begin to listen for our call for change.
I do hope we don’t need to resort Egypt-like protests to achieve it 😀
There is no perfect health system – even UK’s NHS and US’s medicare have faults – that is why we have to build our own to cater to our local needs.
Keep it up dr Pagal.. there are ppl who support you.. albeit a bit silently but no less vocal than you are
BTW – I too wondered how DG could be part of the 1M clinic thing – it is so unlike him to agree with that kind of atrocity knowing the clinician he is.. but then you were right when you said that health in Malaysia is over-politicised – sad isn;t it
i strongly duwan ny egypt situation in our beloved country..