In my 2nd part, I wrote about the rot that begins from the top. Well, that is the reality. Lack of supervision and guidance from GOOD consultants are lacking and this has deteriorated the entire civil service. In fact it is reaching a very dangerous level and the patients are suffering on a daily basis. These coupled with attitude problems among the junior doctors is only making the situation worst.
Over the past few weeks, I have been very busy in my hospital. I had blogged about it few days ago with few complicated and rare cases being admitted to my ward. One of the commentator asked why these complicated cases are going to private hospitals rather than government hospitals. First of all, a patient who goes to whichever hospital do not know how complicated their disease is until the doctor diagnoses the condition. I am not talking about collapsed patients who need CPR etc. All ambulance calls are taken to the nearest government hospitals and thus most of these cases are seen in government hospitals. The rest just goes to whichever hospital nearby when they are ill. Unfortunately, our frontline doctors are becoming very complacent, coupled with poor training that they get during housemanship, diseases are being missed!
A 25-year-old patient goes to a GH emergency department after being unwell for 1 week. He was having fever, nausea, vomiting and abdominal pain. He saw a GP for 2-3 times and then the GP referred him to the hospital as he was unable to eat at all and appeared dehydrated. He was observed in the A&E observation ward for 2 hours with a drip and was discharged when the Full Blood Count was normal. The next day he came to see me. From the history and by just looking at him, I knew what was the diagnosis: Hepatitis! He was jaundiced and the liver was palpable 6cm below costal margin, tender as well. His liver was so nicely palpable that even a medical student should be able to feel. It seems that the doctor in the A&E department did not even examine this patient and just told him that it is not Dengue!!
A patient who is a known diabetic, well controlled, presented with 3 weeks history of fever, nausea, vomiting and upper abdominal pain. She was seen 2 weeks prior at a district hospital and admitted for 2 days. She was discharged with no diagnosis while the patient was still having the pain. When she came to see me, she appeared septic with tender, guarded RT hypochondriac region. A diagnosis of cholecystitis was made and confirmed by USG abdomen. In fact, she also had a stone at cystic duct with mild pancreatitis. She was transferred to the GH for further management of empyema of the gallbladder (her gallbladder was clearly palpable). Again, according to the patient, the doctor did not even examine/feel her abdomen during her 2 days stay in the district hospital!
The case of Malaria that I mentioned in my earlier posting was also seen by 2-3 GPs and twice at a government clinic before coming to see me. That’s the reason why the patient refuses to go back to GH despite not having any insurance.
A 31-year-old primigravida at 34 weeks of gestation presented with acute onset of palpitation and chest discomfort. ECG showed sinus tachycardia of about 120/min with S1Q3T3 changes. SpO2 was 94-96% under RA. She was admitted and observed. Since she was unable to afford any further investigations, a d-dimer was sent and came back 3 days later as raised. Her sister is known to have some coagulation disorder and was on heparin during all her pregnancies. She is unsure of the diagnosis of her sister. We transferred her to the nearby GH as a possible case of minor Pulmonary Embolism for further investigations. When she arrived at the GH “bilik saringan” (this was about 5 -6 days after the incident of palpitation), some of the doctors (housemen and even junior MOs) were laughing at her. It seems that she does not look like a patient with Pulmonary Embolism! Since our O&G consultant has already spoken to the registrar on-call, she was admitted to the ward. She was kept for 3 days in the ward and nothing much was done except a repeat D-Dimer and ABG. Since the repeat d-dimer was negative and ABG was normal, she was told that it is unlikely Pulmonary embolism and no further investigations were done! She was also referred to the cardiology MO who just ask 1 question to the patient “is it you who they suspect PE?” When the patient said “Yes”, the MO just took the folder and went to the table and her diagnosis: “ No Pulmonary Embolism”.
This case clearly illustrates the type of doctors we have nowadays. It is the attitude that stinks! All this happened without anyone knowing that the patient is actually a senior staff nurse at a private hospital in KL. She was horrified with the attitude of the doctors especially the cardiology MO who did not even asks her the history of what actually happened. D-dimer can be raised in pregnancy but the very fact that the repeat test 6 days later was normal indicates that the first episode may as well be a minor pulmonary embolism. This coupled with the history of her sister makes the diagnosis of Pulmonary embolism a possibility and a high index of suspicion is important. Unfortunately, even the blood test for thrombophilia screen was not sent. The patient took AOR discharge and came back to our hospital despite not having any money.
A 45-year-old lady presented to a GH emergency department with acute onset of inability to talk. She was crying while she entered their emergency department. She was observed in the observation room and some blood test was done. After about an hour, she was discharged with a diagnosis of ? depression. She was brought to see me the same day and she was crying whenever I ask her any question but she is able to understand what I am trying to say. She can reply by writing or with some slurred speech. This is a clear case of Expressive Dysphasia, likely secondary to a stroke. She is crying because she could not talk/respond to anyone! An MRI showed infarct at Broca’s area. She was also noted to have Hypertension and Diabetes. I just saw her almost 2 months after the incident and she is now able to talk and explained what actually happened at the GH’s emergency department. The attitude of the doctors in the emergency department that she mentioned really makes me feel sad.
To be continued…………….
The cases illustrated are all quite clear cut. As a government doctor, really feel ashamed to read it….
Ditto what has been said by the previous commentator, the cases are quite straight forward, especially the PE. Then again, I’ve seen a pregnant patient w PE during my O&G rotation that made me remember the details till now. I’m still a medical student, soon to enter year 4. And your writings scare the hell out of me. I don’t want to be an incompetent doctor as mentioned above. I’m worried that I won’t have adequate knowledge and proper training by graduation to treat the innocent and helpless patients.
The current reality of healthcare service providers is really scary… Thank you for making me scared enough to work harder. I don’t want to be like them!
Dear Asha,
I am glad that you have a right attitude. Learn as much as possible from your good lecturers during Uni life. When I was undergrad, I used to approach those good lecturers to give extra clinical teaching. From them, I learned a lot and make me a competent doctor. Just remember that there is no end of learning in medical field.
I do agree that some of the doctor in the government are not up to the ‘safety’ standard. But bear in mind that the government hospital is the ‘place’ that make what you are now. I really have no doubt about Dr Prega as a good doctor indeed as he cares about the medical system in Malaysia, if without this blog, some of us may or may not know what is happening on ‘the other’ side, instead of just criticizing.
I was taught by a senior physician who is a senior university lecturer as well as Professor of medicine. He told me that : Why most of the medical cases were successfully ‘treated’ or ‘detected’ by the specialist instead of the MO/GP? This is because of the the disease has a spectrum of symptoms. In early stage, the symptoms are vague and by the time they ‘reached’ specialist, it already become ‘full blown’ and what we said is ‘easier’ to diagnose.
Other than that, the specialist has more access to the facilities available to the hospital compare to the MO/GP. So they can reach the diagnosis faster. They (specialist) have right to use original/more expensive drugs (which the effect is better).
I guess that some of reasons that all these ‘mistakes’ made are due to that the respective discipline doctors are not posted enough time in a department, that is why he/she not having enough time to be exposed to all sort or spectrum of diseases seen. Go and ask a psychiatric MO or Dermatology MO or Eye MO to do ER or outpatient, I think the same mistake do happen because they are not exposed to such situation before.
I have a few uneasy experience with private specialists for example. A simple low back pain after investigated by the private orthopedic surgeon, diagnosis was disc protrusion and he was prescribed 12 types of medication everyday. Such patient unable to tolerate so many medicine and came back to me. I manage to reduce it to 6. Total cost 4.6K because company paid for it.
2nd uneasy experience was a 73 year old lady was referred to a senior surgeon for colonoscopy for prolonged diarrhoea and bad stool. She was scolded badly by the senior surgeon when she asked more and didn’t explain the findings with the old lady. The old lady came back to me complaining ‘I have paid him more than RM2000 and he scolded me like a dog’. I have no choice but to refer her to my friend (further away hospital) for a repeat procedure immediately. So she has to undergo twice colonoscopy in 3 days times by 2 different surgeons.
Some clear cut cases like acute cholocystitis with positive Murphy’s sign, recent blood test, ultrasound and other investigation. When they went to private, the private would repeat everything done. I guessed the private not ‘trusted’ the investigation done outside.
My friend went to private (expensive one) for medical check up and tested HbsAg reactive. He was utmost worried and went outside repeat 4 times in 4 different lab like BP/pathlab/Gnosis/Clinipath and all shown negative. Went back to the private doctor – insisted that he is a carrier and refused to repeat. Reason given – unable to question the integrity of the hospital lab.
Some of my GP friend are enthusiastic in follow up the patient. But most of the referral (>70%) were like throwing a stone inside a pond – no feedback. The patient just gone ‘disappeared’.
I didn’t complain about the private specialist. I just want to point out that you should choose a doctor with good service because you have paid with your hard earned money and you deserve it.
I suspect this is one of the reason why the medical cost is increasing every year. Medical card holder is paying ?30% higher than cash patient.
http://thestar.com.my/news/story.asp?file=/2010/12/2/focus/7529272&sec=focus – some medication are 300X more expensive than pharmacy outside
http://www.thestar.com.my/news/story.asp?file=/2010/12/28/nation/20101228170839&sec=nation
Thanks for the comment. Yes, there are bad sheeps in both sector. Some private specialist are just there to make money and nothing else. They are not bothered about what happens to the patient with many unethical practises inlcuding unnecessary surgeries etc etc. I will write more about this under my “Malaysian Healtcare system for the dummies Part 3” coming soon.
As for the cases that I have mentioned above, I am not really interested whether the doctor got the diagnosis or not but MORE concerned about the attitude of these doctors. Of course, most of the patients that I have mentioned should be able to be diagnosed by even a medical student but was missed.
The attitude of current frontliners are pathetic. There is no emphathy at all. They just don’t care for the patient or even take an initiative to refer to people who can asisst in making the diagnosis. That is what that is worrying me. I have many more examples but these examples are just good enough. I will write about how 2 ectopic pregnancies were missed and a ruptured ovarian cyst in severe pain were just discharged home , later in my Part 4. As I said, lack of supervision is the major problem in our healthcare system.
And YES of course, government hospital is still the best to train anyone but the doctors themselves should be interested in the first place.
This is the worst example I ever seen
http://www.straitstimes.com/BreakingNews/Singapore/Story/STIStory_639428.html.
She shouldn’t be a doctor at the first place
Beside private hospital. I would like to request Dr Praga to discuss about the
1. Medical check up in the medical center (currently is mushrooming) which provide medical screening package, 5 year program, 10 year program and etc. The package comes from minimum 1k up to 15-20k for sign up package. The marketing team will brainwashing their client and giving free hotel stay for tourism. Don’t get excited when you received a call saying that you are selected for free screening. Your nightmare is just started at the same time. They are ‘no less mercy’ compare to the unethtical private specialists as mentioned.
2. Unethical insurance agent who used to disclosed the patient diagnosis and trying to convince the patient that buying medical insurance beside covering for medical expenses, they give the ‘patient’ perception that they can ‘make money’ as well from the insurance claim.
These are the ‘HIDDEN’ areas where patients from local as well as foreigner are ‘slaughtered’ up to the maximum as well.
Remember Chinese saying ‘Goat’s fur eventually come from the Goat itself’. What are you claiming is from other insurance customers. This is a viscious cycle. Our next generation is going to pay for the price.
I’m against LTL to promote what ‘medical tourism’ : it is more of profit driven and also feeding the ‘greed’ of the private specialist / hospital management + owner as well. All these will push up further the medical cost and causing the local people the complication.
Yes, of course. I know of one private hospital in JB who is offering whole body MRI as health screening!!! WTH. Almost all private hospitals in Malaysia are owned by GLC!! it is a way for the government to make money. That is the reason for the medical tourism. Economy is another factor.
Not necessary. In KL at least 3 which are not GLC nor hospital related. One in PJ, One in Ampang and one in Sungai Besi. They are hiring a team of marketing peoples. Some successful marketer can earn more than anyone of us. About 100k per month. Now not only medical screening, chilopractic and orthopedic also start having concept of screening. The insider people told me that the spinal screening when tested on same people can get normal and abnormal result. So, no matter how well you are, they result can still be abnormal. The test also applied to the ankle bone density test as well. The result all can be manipulated eventhough we know the golden test for bone density is DEXA scan.
Is is true that KL alone has the highest density of CT scan machines
in the world?
I agree that there is often a full spectrum of disease, some of them are only picked up by specialists once the presentations are clearer. I myself had to adopt the ‘wait and see’ approach in some of my patients when I was a house officer. However, there is a big difference between unable to do anything when presentations are vague and incompetency when presentations are clear supported by investigations. Please tell me how do you justify the actions of an A+E MO who discharge a patient with tramadol when the patient had ongoing chest pain and ECG showed ST elevation consistent with an inferior STEMI despite concerns raised by nursing staff ? This person should not have been allowed to pass med school, let alone pass HOship. I accept that we are all human and mistakes do happen, sometimes due to lack of experience, but when mistakes are ignored despite concerns raised is not human error anymore, it is called dangerous practice. It doesn’t take a specialist to diagnose STEMI and it is situations like this that makes healthcare unsafe.
Regarding private specialists who provide poor service, let me share my own experience. 10 years ago, my grandfather was admitted to the ICU of a certain private hospital after a 3rd stroke event. There was a team of 3 specialists, 2 physicians and an anaesthetist. Initially, interaction with the healthcare team was mainly between the family and the physicians, but most of the time, when we asked about my grandfather’s condition, the physicians failed to provide adequate information and only said ‘we are doing our best’ or ‘we are giving him the best medications’ or ‘he is in safe hands’. At no point were they ever been honest about the real situation. After 2 weeks in ICU, the anaesthetist finally came to us and told us that the stroke was so severe that he has no recovery potential and will die the moment life support was removed. He was just being kept alive artificially while the physicians are having a merry go round experimenting on new expensive medications that has absolutely no basis. The specialists, as we call them, can’t even let a 96 year old man die peacefully. On top of that, they also did not consider the cost of their experiments to the family members. Back then it cost rm1000 per night in the ICU. This is how unscrupulous some specialists can be and that was 10 years ago when in general, the attitude and competency of junior doctors have not reached the state that it is today. Imagine what will become of the system when the current bunch of junior doctors become specialists.
My family is somewhat fortunate because there is somebody around to provide checks and balance in regards to healthcare matters. While I am not a specialist, the very least, I can tell if what doctors are doing makes sense. That, however, is not the case with most of the general population. In the private sector when it is so profit driven, I can only imagine to what extent doctors are willing to go in order to maximise profit. It is also hard for the general public to know if the doctor whom they are paying provides good quality services. Having MMed / MRCP / FRCS etc on his / her title doesn’t mean that the doctor is good. These days, it really depends on the toss of a coin.
Yes, not all private doctors are sincere. Many are there just to make money with unethical practises. I will write more about these issues in my next posting on ” malaysian healthcare system for the dummies”. A good theoretical doctor is not necessarily a good clinical doctor. I know of people who can regurgitate Harisson’s but can’t diagnose and manage a simple disease.Managing a patient is more than what is written in a book.
I feel sorry that you had to go thru that. Good medical practice should not involve admitting a 96-year-old patient to ICU after a stroke.
My favourite story about private doctors is as follows: My mother is a GP. One of her patients was experiencing exertional angina so she referred him to a cardiologist. Angiography showed some stenosed vessels. Cardiologist pushed strongly for angioplasty and discouraged bypass surgery. The patient (simple blue-collar worker) wasn’t sure so he went back to my mum. My mum saw the angio results and recommended bypass surgery over angioplasty, so this is what the patient booked himself in for. The Cardiologist eventually found out about this, called the patient up in his house at night the day before the surgery, and hassled him over the phone and eventually persuaded him to have angioplasty instead, which he did. He never thought for one minute that the cardiologist didn’t have his best interests at heart … until he saw the bill. Over $20k, only 2-3k less than bypass surgery (this was 8 years ago, don’t ask me how much people get charged now).
Are some private practitioners in Malaysia that hard up for money – to the point where medical ethics goes flying out the window? I know lots more stories, but it would take hours to type them all out.
Sometimes I don’t know which is worse: An unconsciously incompetent govt doctor who causes harm to a patient or a competent private practitioner who knowingly exposes the patient to harm for financial reasons.
Worst of all is an unconciously incompetent doctor who knowingly exposes the patient to harm for financial reasons.
Current price of CABG price is about RM38k. For stenting, 1 stent is about RM22k, 2 stents about RM 30k and 3 stents about 38k. 3 stents price about the same with CABG. Stent use is drug eluting stent.
We should that stenting $$$ is earned by cardiologist where CABG $$$ is earned by cardiothoracic surgeon. That was why the cardiologist was so desperate.
I am a Malaysian cardiologist in North America, of course, without know more about this case I could not comment more especially the practise in malaysia which could be commercially driven (happens everywhere). In general, there are sets of guidelines we follow in AHA/ACC for angioplasty vs CABG, and of course CABG has been recognized as mortality benefits in some cases especially diabetes, however, there are many cases in real life that fall into the grey area, not the clear black or white. The stents technology of course is not as old as the history of CABG, in MOST cases, the mortality benefits are the same. Personally, If i have to choose between CABG and angioplasty, I would go for angioplasty if possible.
Hi SC,
You missed the point of what I was writing. I wasn’t trying to have a debate between angioplasty and CABG. Rather, I was trying to illustrate the fact that this particular private practitioner did not have the patient’s interest at heart when recommending a course of treatment. I cannot remember the exact details, but I was told that a CABG would’ve been better for this particular patient.
dear dr. pagalavan,
all the cases you mentioned above are… quite understandable when you present it that way. i mean it’s more or less like the classic cases we see from books. i’m a fresh graduate now and my take on this is, could it be that you are more experienced and you know what is more important to pay attention to, and summarized them in the cases above hence pointing us towards the right direction? it’s a fact that new HO like me will be doing all sorts of investigations, most unnecessary in order to find a diagnosis. sometimes it can be quite confusing. but doing more is better than doing less, and in some cases, not caring at all? just asking your opinion because i’m obviously still trying to find my feet, and there’s obviously difference between solving cases which are presented nicely on paper than handling a real patient from A to Z all by myself.example with the patient who just cry and won’t talk, sometimes HO may just be panic. what is your opinions dr ?
When I was teaching in Monash, I always tell my students this: a good doctor is a person who listens to the patient, takes a detail history, exaine the patient and come to a few differential diagnosis. The investigations comes later. I use to drill my students with history taking and sometimes I spend almost 1 hour of bedside teaching just to discuss the history alone. The students will be shocked to the level of detail that I go to and how I can come to a diagnosis by just listening to the history. The cases I mentioned above came exactly as how I have presented. NO grandfather stories! So, I am sure if the doctor has taken proper history and examine the patient properly, a diagnosis could have made. THese are the type of cases that we use to get as long cases during our final year exams those days.
Dear Dr Pagalavan,
Just a few questions here.Since you have worked in Monash, what do you think of Monash graduates? And Do you have any advice for preclinical students?
The first 2 batches were good as there were only 40-50 students per batch and with 12 fulltimers and few part timers, we could monitor them closely and provide quality teaching. BUT I heard the situation has deteriorated as the number of full timers is still the same but the students have increased to 100-120/year!! Pre clinical years is the time to learn the basics of medicine. Pathology, anatomy and physiology is the most important as far as I am concerned
” An unconsciously incompetent govt doctor who causes harm to a patient or a competent private practitioner who knowingly exposes the patient to harm for financial reasons ”
brilliant.
And both categories of doctors are fast rising in this country… the socialized health care delivery will kill the second group though.. but boltster the first..
I wanted to share this story.
When I was away with my studies in outstation, that’s when my mother called and told that my grandmother had a stroke, and was admitted to some government hospital in KL. After 18 days of admission, the doctors decided to discharge her. She was then sent to a nursing home.
I’m not able to visit her since I’m engaged with my exams and stuffs.
Then, recently I got to know that she had an episode of Pulmonary embolism, diagnosed via CTPA in a private hospital.
On further questioning – it seems that she had a unilateral leg swelling 2 weeks prior to admission to the government hospital for her stroke.
Even a layman can tell there’s a leg swelling.
And this means that throughout the 18 days – no one, including the HOs, MOs, Specialists had picked it up?
Or they just don’t care?
Luckily she’s fine now. Just need to continue with her neuro-rehabilitation.
just my little cents 🙂 just to share,,nothing to do with the topics
4-5 years ago during my a-level, while playing football i got a severe pain on my knee after colliding with other player. a very loud sound,,its not sound of bone cracking,,but its painful like u just break ur leg..my knee is like slipping when im going down or up of the stairs/ladder
i went to 2-3 clinics for the next 1 month,,
one saying tht theres nothing to worry,,its just a knock.. <–indian muslim doctor
2nd said,,its accumulation of fat in ur leg,,, <—- wtf it was! <—malay doc
3rd one was a bit annoying for me,,he said im overweight,,checking my bmi,,then realise tht my bmi is 24..damn 24! check my BP etc2.. then,,just prescribed me painkillers…wth! <—chinese doc
i never used their prescription,,bcause i know thts a wrong diagnosis
so i decided to give a visit at hosp perdana,kb..seeing orthopaedics specialist.
he felt my knee,,drag it forward,,n i could see significant movement..he told me to hav mri scan,,as its could be ant. cruciate lig torn.
now,,im in clinical phase of my med school age in india,,
in ortho posting, i learned about various test on common knee injuries,,ant/post drawer test,,mcMurray test,,mcl test.
now i wonder,,why the first three docs never done such a simple test on me?
this should be a good lesson for me to be a good doctor
Goodness me… Accumulation of fat in the leg?? WTH!!!
i hav some chats with them though
the 2nd one said how to be a good doctor,,hows the attitude blablabla,,but seem like he not practice wht he said,,bcause he prescribed meds without evn touch my knee..-ve point for physical exams.
the 3rd one,,when i asked, can i do cyclings bcause im gaining my weight since i couldnt do physical exercises? n he said,,’no,,u should jogging..’
im like,,wht is happened with this doctor? i cant evn walk properly,,how can i do running..?!
i told this story to that ortho consultant..he damn angry about it haha he said “itulah,,bila doktor tak habis blaja,,dont be like that blablabla :D’
in acute phase of ligamental knee injury, usually it is hard/impossible to do proper physical examination because the pain is still there and the soft tissue is still swollen. Usually I will ask the patient to come back at least in 6 weeks time after injury to fully assess his knee condition; but a good doctor should at least suspect a ligamental injury even before touching you knee, just by listening to your history (i.e. popping sound and slipping knee when going up/down the stair) and by looking at your swollen knee.
“The eye doesn’t see what the mind doesn’t know”
A doctor who cannot take a good history and a patient who cannot give one are in danger of giving and receiving bad treatment. ~Author Unknown
even history is textbook ACL injury. cmon…
Dear Dr P, have been hearing stories regarding the introduction of shift system in gov hospitals for HOs, namely s.petani and klang. Do you know when other hospitals will start with this system and when it will be fully introduced to all M’sian gov hospitals?
Latest I heard that all hospitals will implement by 1st September if everything goes well.
Thanks.
interestingly, during ortho posting, i got a case to clerk,,a similar complaint like mine. because of so excited, im not completing other tests,,and only stressing on the drawer test whcih surely going to be positive..
n guess wht..i got a ‘nice’ words well-drilled into my brain by the doctor.. 😀 so nice that it felt like u’re just killing a person,,or felt like, u’re the dumbest guy in the world.
as harsh as they sound, i always believed, their words are just from the tip of the tongue, not from their heart,,they just want their students to be better than them..to be a good doctor.
but i think many have taken it personal nowadays,,took it into the heart instead of brain..see more into how much it hurt u than how much it bulked u up.
i rather hav ones told me my mistakes,,as praises may lead to complacency..and complacency kills ur learning process
as our little moment/mistake,,may be the patients’ lifetime..
praises may lead to complacency???
very wrong my friend.
an opinion can never be wrong
and i said it ‘may’,,not ‘will’
hi
i am a dental officer who is doing oncall at one of the main hospital in klang valley..just finished with my on call roster last weekend…n i did see the so called attitude of the medical officers in the ED…an elderly lady was crying for help and in pain, but nobody seems to care..they in fact asked the aunty to slow down her voice…they told her that medication already given , so the aunty just need to relax…but to me clearly the patient was restless and very much in pain…i was very sad seeing that…only if i could help…:(
As I said, the main problem is the attitude of the current generation of doctors.
I think you should go and ask what was happening rather than making own assumption. It could be psy patient or having family problem. What was the old Auntie main complaint? Some pt may exaggerate to get attention. I did not say her complaint was not important. I would think you should at least ask the ed doctor first rather than immediately accusing that it was their fault.
Last time, I also got Auntie bad toothache and dental officer reluctant to come at night. Only asked to give ponstan and come back tomorrow to dental clinic.
Like dr pagavalan said, in the end it all comes down to attitude of the doctor. We have people that doesn’t want to work in every single field. Just look at different government department lol
When I was away with my studies in outstation, that’s when my mother called and told that my grandmother had a stroke, and was admitted to some government hospital in KL. After 18 days of admission, the doctors decided to discharge her. She was then sent to a nursing home.