Lately, I am hearing and coming across many issues that really make me feel that our healthcare system is going down the drain. Yesterday I publish the first Part of this topic, taken from an MO’s blog. The attitudes of current doctors is simply so glaring for anyone to miss. In fact almost every day I am hearing news from my ex-hospital regarding the house-officer’s situation and how many patients have succumbed due to poor basic knowledge of the frontline doctors. The entire system seems to be collapsing day by day.
I have talked enough about the mushrooming of medical schools over the last few years. In fact, I first wrote about these and the quality of doctors produced way back in 2006 when I wrote an article in MMA magazine. Many said that I was over exaggerating. The same people who told me that, agrees with me now. Many of these medical schools were only interested in making money and not bothered about the quality. They just dump the quality issue to Ministry of Health. Unfortunately, MOH can’t do much. Once you are a HO, you have already been accepted as a civil servant and any action need to follow proper procedure under the General Order (GO). It will take years before any action is taken to any civil servant unless it is a criminal charge. I remember one of my ex-Pengarah of a hospital told me that he wrote tonnes of report about a missing Attendant, but after 4 years, his name is still on the employee list, of course his pay was stopped. I also had a Cardiologist who left almost 6 years ago but his name is still in the list because he has not officially resigned. Thus, if you follow the procedure, they have to take disciplinary action before terminating him!! WTH! The entire system is just too much of bureaucracy and procedures.
When I was active in SCHOMOS from 2002 till 2006, we use to bring up the issue of retaining senior specialist in Ministry of Health. One of the main reasons is to train junior doctors in service. Without experienced senior consultants and specialist, what guidance do the junior doctors get? Unfortunately, MOH and JPA were not interested. As for JPA, doctors are just another bunch of government servants who do not need any special attention. Thus, slowly all the senior specialists just left the system not only because of poor pay/promotion but also due to frustration with the system. Many felt that they could not do the best for the patients due to various limitations and poor support from the government in developing certain field. Political influence and bureaucracy is another factor.
This left the system with poor guidance from “good” senior consultants. It is sad to see that most of the remaining senior consultants and heads of departments are also known as “world travellers”. Most of the time they are either not around or going for conferences all over the world sponsored by pharma companies. I know one HOD who stays at home most of the time and only comes for ward-rounds about 1-2 times/month and receive JUSA C salary. I heard she got JUSA B recently! The best part, she is also the head of a subspeciality training committee! In MOH, once you become the head of a department, you will remain so forever and no one can touch you. In fact, even after you retire, you can be reappointed as HOD under contract basis. About 3 years ago, I did suggest that HOD post should be rotated every 3 years like in Singapore in my MMA article after returning from Singapore General Hospital. I heard that our ex-DG did issue a circular for HOD rotation but unfortunately there were tremendous amount of objections from the current HODs, for obvious reasons I presume!
In 2006, after much discussion and countless number of paperwork’s by SCHOMOS with JPA and MOH, finally locum was legalised. We should thank our ex-Minister of Health Dato Seri Dr. Chua Soi Lek and our ex-DG for making this a reality. Unfortunately, it is clearly being abused and misused currently. The locum should be after office hours and weekends when you are not on-call. However, we have consultants and HODs doing locum in private hospitals during office hours and leave the wards to the junior doctors. I know of one HOD from East Malaysia doing locum almost on a weekly basis in 2 different hospitals in West Malaysia!! Not sure whether he even does anything in his so-called resident hospital. There are even some consultants who does locum outside during office hours and send their patients to the government hospital for certain procedures and even to collect medications. So, the patient sees this particular consultant in a private hospital and gets all the procedures and medications from the government hospital. The consultant gets the fee!
These HODs and senior consultants in government hospitals are misusing the system to the maximum. Of course, not all of them. I know some who are really dedicated and work hard but they are becoming a minority species now. Those who misuse the system know that the hospital will still run and there are junior specialist, medical officers and houseofficres to take care of the patients. This is why there seem to be a lot of mismanagement/misdiagnosis happening in these hospitals nowadays. No proper guidance from senior consultants! And what can you do about it? Nothing! Everyone covers everyone. The Pengarahs of the hospitals are not bothered as they don’t want paperwork. The juniors will not complaint as their SKT marks depends on the HOD. The good junior specialist will also get frustrated with the department and eventually leave the service! And so it goes into a vicious cycle of mediocrity…………………….
Next: The rot from the top to the bottom……………………
Pagalavan's Avatar 
Who wants to be the HOD nowadays? More headache than anything. Expecting HOD/senior doctors to do what medical schools should have done, in addition to administration and providing service to the public is a heavy task. The obligation of passing your skill and experience to the junior doctors are long gone since many HOs now think they know better. If your HO screw up, it is your at fault for not supervising. You will have to attend the meetings and do the paperwork. With 100 HOs, how would one supervise every little thing the HOs do? If you are given monkeys as your workforce, how to expect monkeys to run the factory?
If it were me, I’ll bail out as an HOD, and fast. I’m not surprised many public hospitals do not have experience doctors anymore. Something must be done at the pre-U and entry to medical schools and the medical schools themselves.
Cmon la.. all this complaining and criticising.. dont forget, poor patients of today NEED treatment. Whether you department, ho, mo, etc etc are competent or not, that patient needs care.
It’s not just about being a doctor, im talking about being a human being!
Stop thinking about how much money the crony is making, etc etc. all the time. At the brink of death, do you think your cash in stash will matter? No. What will matter, though, is all the patients you had potential to treat, despite having inadequate services/manpower/money/etc. You know why? Your guilt of not helping the poor will get the better of you when you are emotionally vulnerable.
This is what I call health care myopia. The fallacy that patient will get better if you complain more.
You know, if its a political problem you dont have a choice, just vote for the opposition and hope we have a credible check-and-balance based government. If political situation does not change, what can be done? This is not a computer game where you can customize your reality and save game everytime you lose. This is reality. You’re a doctor? Then serve the people. You feel that the country is not good enough for you? Then improve it by taking action and leading an exemplary life. You want to do medicine but afraid that the future is not strong enough? Throw away the idea that there is such as a thing as a good job with good pay in ANY field. Work smart, enjoy life, and be productive.
I am not complaining or criticising. I am talking about the reality on the ground and hoping someone will listen and change the system(BTW, I tried my best before but failed!)! No matter how noble your intention is, at the end of the day, it is still a job to earn a living. Once you have a family of your own, noble intentions will dissapear!
For those who have bought a no return medical ticket, may the medical luck be with you all.
Problem with some doctors is they all want to be rich.. there is a sad but real desire for doctors to lust money.. And who doesn’t? We all look at the group of GPs who own ten clinics, or that cardiologist or orthopedic surgeon who earns 100k in private and subconsciously go “Thats what I want to be!”
The select few who are chosen to be true Doctors, are those who treat a patient, no matter how small the problem, and get a sense of appreciation (even if its not there), even if its for charity. But alas, our world’s inflation rate is not static. Thus idealism gets a serious boot.
That’s why, if i was the PM, I would make one single change for doctors. All government doctors are allowed to purchase one car, tax free, every ten years. That will satisfy the ego-lust… 🙂
So the real question is, is capitalism and medicine at odds? Perhaps. How’s the medical story in socialist China?
I hear this nonsense all the time about how doctors should serve entirely for the love of helping people and financial renumeration should mean nothing. The fact is, most doctors do not lust money. Whether you choose to believe this or not is up to you.
The reality is that medicine/surgery does not pay particularly well when one takes into account the huge time, effort and financial expense it takes to become a specialist physician/surgeon. No intelligent person would put themselves through
all that for what is relatively modest renumeration in comparison to other professions. So at the end of the day, you will find that the best doctors out there still do it primarily out of love of their profession.
Your statement that “there is a sad but real desire for doctors to lust money” is not technically correct. It should be corrected to “there is a sad but real desire for Malaysians to lust money”. So even if a medically inclined person was an idealist, living in materialistic Malaysia would wash all sense of idealism out of them before long.
I’m going to leave things here because we’re starting to get off topic. I’ve read Dr Paga’s blog for a long time now. He raises many good issues which are at the core of why healthcare in Malaysia is rotting. Please don’t bring your smack talk about financial renumeration, idealism and “healthcare myopia” into it.
I agree with what paga is trying to highlight. People will always bringing up the nonsense about “stop complaining and remember about the patient”. I cannot understand that.
Doctors are complaining because they care about the patient! How can you treat patients properly if you have no competent staff! And you are not the one responsible for hiring and firing. You are GIVEN a bunch of questionable HOs in a even more questionable environment/system and expected to churn out super excellent healthcare exceeding even developed nations. Yeah, you can treat 5% of all the patients yourself which I believe majority if the consultants are doing. But what happens to the other 95% ? This is the core issue. If I don’t bloody care about the patients I wouldn’t be interested to complain at all.
And I would ask, who would like to live in poverty? Anyone? Expecting altruism to save the day is naive. If you are constantly worried about how to pay your next bill, how can you comfort your patients? I say leave this mumbo jumbo “healthcare myopia” out of the picture.
I wish to highlight that doctor is not always wrong as well as patient (customer) is not always right.
Sometime doctor / health care system can be the ‘victim’ from the patient.
When I attended my induction course about 10 years back, our group did raise a question to the KKM/JKN pengarah – Are we doctors ‘protected’ from the patients abuse like foul word scolding, threatening from patient, rich manager who only pay RM5 and took medicine >RM1k/month and others. The answer was ‘NO’, there is not such law to protect doctor from patient abuse.
So doctor in 1st line like KK/OPD doctor & Emergency doctor are having all these issues everyday.
In Singapore, the doctor are well protected from all these abuses where the hospital authority can sue the patient from abusing doctors and the facility.
The worst case I encountered last time was a patient from 30km away from hospital called for ambulance to pick him up and send to the hospital just to change CBD only. If these thing happened in Singapore, the patient will be fined Sing dollar 150/= for first offense and increase the fine subsequent attempt. These abuses are always happening in Malaysia hospitals.
In Malaysia, you are government “servant”. The government pays you to serve the people. And of course too much politics! if you complain about the patient, you will see a politician sitting at your clinic asking you to explain! Politicisation is what that is screwing up the system, be it health or education!
So gone la. Since everyone is going to (or planning to) leave MOH at the earliest time possible, so what chance do poor people have?
Forget about everything. Forget idealism, forget myopia and whatever else.
Let’s focus on one thing.
The children and women who get killed in brutal wars.. what hope is there for them? none.
The children and women who fall prey to an incompetent health care system.. what hope is there for them?
So I’m a disillusioned young doctor. I dont know what to do. One one hand, I want to serve the people. On another hand, I need to feed my family.
Tell me wise seniors, what should I do?
Doctors need a visionary leader. We need to band together. We’re so fragmented. Where’s MMA??
KKM doctors, MOE doctors, private consultants, GPs, academia, chronic m.o’s.. all segregated..
Because of this, we are ruled and conquered by the powers that be.
What is going to happen in 2015 when Asean Community comes into full effect? Are we going to be diluted by highly qualified specialists from our neighboring countries because the true Masters of the medical community (politicians who dictate KKM policy, who also seem to own our private hospitals)
want to maximise profit by cutting costs?
Who cares about the quality of doctors when 1Care is about the re-structure the entire system?
Foreign MNC pharma firms have locked up their revenues through intellectual property rights. Local private hospitals will churn out profits by charging high fees (we’re still waiting for the updated fee schedule). And the medical fraternity is diluted by 30 medical schools photostating doctors.
Just. damn. frustrated.
Doctors themselves are not united, so how are we going to fight? Only less than 50% of the doctors are even members of MMA. The entire health system need to be intergrated and that needs political will. I don’t see it coming anytime soon. Even the 1Care system may not be implemented unless BN wins big in the next election. Even then, I am sure some middle man will be making big money to run this 1Care system and soon after it will go bankrup as well.
Those agents mushrooming of medical schools exactly following Goverment’s foot step. Let’s see, JPA, MARA, Yayasan send bunch of SPM holder students for “6 months” course at Intec, Malaysia before they do their 1st degree of Medicine. Wheres their “atleast 1 year” of foundation studies??
“No matter how noble your intention is, at the end of the day, it is still a job to earn a living. Once you have a family of your own, noble intentions will dissapear!”
Dr P, I salute you for your honesty. You are a real example of CAT like the Penang State…..Not many private Dr dare to say the above statement…
You are the Man…Dr P!!
I can relate to you….I have been trying to change….
I cant do much….but I dont know how long I can last in the battle….