One of my loyal follower sent me this 2 articles below which appeared in The Sun (http://www.thesundaily.my/news/167606, http://www.thesundaily.my/news/175519). I have said this many times that medicine is different. You are dealing with life and it does involve a lot of stress. That’s the reason why I started this blog to educate the people of what medicine is all about! Don’t just jump into doing medicine just for money and glamour.
Being a doctor is not about working office hours and going back on time like many other jobs. You are dealing with life and you have to make sure that you do whatever necessary for the patients before you leave. Of course I don’t agree working long hours like 36 hours continuously but even if you work shift hours, you still need to finish your job!! Life’s are at stake! I am rather amused with the first author below because at one point he is talking about long working hours and on another note, he is talking about excessive work load. Who said that when you become a doctor, you workload is not heavy? Even if you are doing shift system, the number of patients that you are going to take care will still be the same! And finally, he is saying that there will be a paycut!! I mean, I don’t know what this author wants? I guess he wants a comfortable, office hour work for his sister with a lot of money. Then, don’t become a doctor, that is my answer.
I think the reply by the specialist below sums up what is actually happening in our hospitals currently. I have said it along the way in my blog. If you think being a housemen is stressful, wait till you become a specialist especially in private hospitals. You are the housemen, medical officer and the consultant for the patients. You work 24 hours a day, 7 days a week. You can be called at anytime of the day.And you will sued for any mistake that you make. No one cares whether you are tired or not! So, don’t think only as a housemen, you are overworked!!!
The day you choose medicine as your career, that’s the day you have committed to life long learning, hard work, stressful life and poor social life. So, if you are NOT into it, then find another job!
Overworked housemen
Posted on 5 October 2011 – 10:09pm
Last updated on 6 October 2011 – 09:57pm
THE term houseman refers to an advanced student or graduate in medicine gaining supervised practical experience. In Malaysia, it is compulsory for doctors to undergo housemanship for two years after completing a medical degree.
During housemanship, they are rotated between six departments – emergency, medical, paediatric, general surgery, orthopaedic, and obstetrics and gynaecology – spending four months in each.
My sister is a houseman in a government hospital in Selangor. For the past eight months, I have been surprised to notice her working hours. There is no maximum number of hours a houseman can work.
This has led to a situation where my sister is often overworked and has hardly seen daylight since she embarked on this respected career. She had always wanted to become a doctor, but eight months into her housemanship, she seems to have snapped. Such conditions may result in wrong decision-making and management, and poor performance.
The work load is too heavy and the hours too long. When she is on call, she sometimes has to work for up to 36 hours straight. Unfortunately, housemanship is taking its toll on many young doctors. After completing a gruelling course, they get to face endless working hours.
Previous Health Ministry director-general Tan Sri Dr Ismail Merican had revealed that many medical graduates were unable to cope with housemanship.
My sister informs me that a shift hours concept has now been introduced in housemanship as a measure to address the problem of too many new doctors and of overwork. I’m not sure that this system will work, but I really hope it does.
The only drawback of this system is that you are not entitled to “on call” allowance.
Currently, with housemen required to do 10 “on-calls” a month, this adds another RM1,000-RM1,200 to their monthly salary. So indirectly, shift hours means a pay cut.
Furthermore, there is also sometimes an element of bullying and high-handedness in the way some senior medical officers and consultants treat their junior house officers. They become Little Napoleons and are dictatorial. They say they went through the same regimen which made them good doctors.
So it is decided that the current crop of newbies needs to go through the same process.
Housemen are often screamed at by specialists. This is bad work ethics and I find it to be uncivilised as research has shown that the result of such an attitude would result in less effective staff.
Finally, I hope the ministry is aware of this matter. May the relevant authority ensure that these public service doctors are happy and capable of providing the best service to the nation.
F.A.
Alam Impian
Young doctors mollycoddled
Last updated on 12 October 2011 – 10:00pm
I REFER to “Overworked housemen” (Letters, Oct 5) and other grouses that increasingly make their way into our media by Generation Y housemen. As a specialist in a government hospital in Selangor, I feel that instead of silence that may be misconstrued as guilt, there is a need to reply.
We are now at a crossroads in our health system. The high standards that were maintained through the years have fallen by the wayside. This is especially evident from the constant complaints of the younger generation, although the system and the government are bending over backwards to accommodate them. The reasons:
— An overload of new housemen/doctors – 500 a year in 1998 and 7,500 in 2011, with the number estimated to rise to 10,000 in coming years.
— Too many medical schools in the country – 42 at the last count, with some having very low standards. Indonesia with a population of about 300 million has half the number. How did these colleges come to be recognised?
— Too many medical schools recognised overseas, with the standards, especially of Russian ones, being extremely low.
— So we are now inundated with housemen to train, wherein 60% are of very low standard – meaning not even fit to pass the finals in a medical school exam, let alone to treat patients.
— We, the specialists, are forced to retrain and even reteach these incompetents.
— There are only so many times you can give advice to a person who doesn’t listen – sometimes when a patient’s life is at stake, voices have to be raised! Don’t you agree?
— Increasingly, our politicians get involved when some VIP’s son or daughter who can’t cope, just wants to float through. Many specialists have been given letters of warning, when all they were doing was enforcing appropriate disciplinary action in respect of housemen who had gone AWOL.
— The number of litigation cases against the Health Ministry due to housemen is at an all-time high.
— The shift system was opposed by all senior faculty in the ministry, vis a vis all senior specialists, but it was forced on us. Who is going to monitor all these housemen under the shift system – the specialists?
— When these housemen become medical officers and specialists, are they also going to go on shift?
— We have better things to do than mollycoddle a tsunami of sub-standard doctors. If we are not careful, there will be a great exodus of specialists from the public health system in the next few years.
All you see in government hospital nowadays are the poor and the illegals – everyone else has an insurance card! So to the powers that be, wake up and smell the coffee.
S.A.
via email
Pagalavan's Avatar 
dear overworked houseman,
yes, it is true that housemen cannot claim for on call allowance anymore, but they are entitled to rm600 monthly allowance according to latest Budget/Bajet.
but for A&E m.o, god knows how long they have been on this shift system and they cannot claim oncall too, plus they have to do extra works (i.e.KSWP) in order to get extra cash, not a rm600 monthly free gift, duh! 😦
dear doctors!
i’m wondering why money is an issue despite millions of life are depending on doctors (life saver),
i really appreciate and feel very glad that the consultant has much concern about the innocent public peoples medical care.
if money is everything then one should not decide to study medicine and business field always welcomes them. why dont study commerce! u still can earn money! medicine is not money! pls understand that!
regarding the incompetent doctors and hitler-like consultant;
consultant be strict not coz they wanna be superior to u but they want the houseman to know what they doing with the people life!
try to think why the consultants are pressuring the houseman!
as dr pagalavan said before, everything is because of the student and their poor basic knowledge!
Not attending lectures, getting low marks in exams, cutting classes, having fun during the medicine course in oversea…Yes ofcourse they paying money , and money making university will always pass them! that’s not a matter for them !
the student itself must have self awareness of what they doing…remember studying medicine is not fun! it is really need 100% hardwork! u need to sacrifice everything and only read ur books, go to clinics learn alot as the practical is concern!
reading and memorizing, taking exams..is not medicine! it is life. love the life! pls….
we are in 3rd world country..a doctor should able to make a diagnose with physical examination which 80% and 20% is laboratory result which is only serve as confirmatory component for what u have diagnosed!
when u fails to do so! then u r the victim of ur superior people!
im really appreciating Dr pagalavan blog! thank you dr.
im learning alot from this blog.
money isn’t everything; but nowadays, almost everything needs money
(pun intended, hehe)
students now are so poorly behaved..!!!
seriously.. “the student”.. i really hope you improve your communication standards.. i understand this is a blog and we do sometimes “talk like it’s raining in the lake”… but u either choose internet lingo and deliberately go crazy… or write proper simple basic sentences
Hi chillax, thx for ur advise!
Ok boss!
Not related to the above post.
But, I thought you might be interested.
http://www.aduanrakyat.com.my/pelajar-mbbs-di-mmmc-ditindas
something is very wrong…
p.s – also read the comment
thanks.
Thanks for that link snake eye. Private colleges have been trying to make money off their students since day 1 – though I think the hostel fees mentioned by this guy are reasonable but having excessively large intakes obviously isn’t.
Dr P, even you get a mention in the comments section. I thought this bit was funny: “ko quote pagalawan but ape…die suma koolej terok selain um”. Had me in stitches 🙂
Haha, yes I read it. Now you know the type of doctors we are producing! Imagine a doctor who talks like a pasar malam guy! It just confirms the standards of our medical schools.
Hafizah is my junior. I am working as a MO in the same hospital as her.
Whatever being told by her about the substandard doctors churning out from the college mentioned is true.
We are in grave concern of the quality of graduates from our alma mater. In fact, I’m dissapointed with so many of my juniors are too naive to accept the facts (looking at the comments posted in the site and fb).
Besides, many consultants would have the same idea that manipal students generally lack enthusiasm in learning. There’s quite some number of them with attitude problems.
I also came to know that the passing rate of the most recent batch in final MBBS exam is about 98%. It’s obviously fishy, isn’t it?
Almost all medical schools in Malaysia has almost 100% passing rate. Even the students who failed will pass after resit!!
By just reading the comment in the said website tells you a lot about the type of students that are becoming doctors!
should send a copy to our Pak Najib to see.. Let him know how the government is wasting our tax payer money to sponsor these monkeys to become a half-cookeds doctor in future..!!
Absolutely agree with “Imagine a doctor who talks like a pasar malam guy” …. Seen lots of them!
However, there are lots of passionate medical students around too. For those medical students, it is the medical programme that let them down rather than themselves. It is also unfair to blame them about choosing the wrong place to study medicine.
Firstly, they do not have money to enter good universities overseas, and they need luck to enter local public uni. even with good STPM results.
Secondly, most medical students are clueless about medical co-curriculum. They cannot tell which programme will provide a good training as a lot of private universities will only advertise about their “strength”
I am not surprised though. During my summer holiday ~4 years ago, I did my hospital attachment as a 2nd year medical student in one of the Manipal Uni. teaching hospital in Malaysia. When I was attached to the labor room, there were about 6 of 7 of medical students from Manipal Uni doing their O&G clinical teaching in the same hospital. Surprisingly, they just walk in and sit at the reception for a few minutes before leaving the ward. This happens daily when I was there. In the end, I am the only medical student in the ward learning from the HO/MO and assist with deliveries.
Snake eye, agree with u that some ( in fact many) of student in MMMC have attitude problems. But the person in that article doesnt know how lucky he/she is. Being sponsored by JPA still complaining? I got 4A* in A-level, my friend got 5A in STPM, non of us get any places in Local uni(not to mention JPA), reason? we’r not from matrix. My family is not rich enough to send me to better school, so i have to join this money minded school, One thing (i think) is good here is that i get to do research and get my journal publish(if possible). Every school will produce good and bad students, in general, whole educational system in this country is corrupted. (now i heard 8A spm student will automatically gain JPA scholar=.=)
read through some of the post.. maturity of our students are highly questionable… how the hell are this fellas gone grow up to independently manage acute emergencies… these are the type of fellas who will laugh at a male with paraphimosis or a female with axillary hyperhydrosis..
Passing exams gives you the MBBS, but attitude makes you the doctor.
yes axillary hyperhydrosis is a relative emergency… they come to clinics with sever anxiety attacks at 2 in the morning
Helo chillax, pls have ur self checked with a psychiatry!
“The Student”…if you really are a medical student, I’d categorise you in one those HIGHLY QUESTIONABLE MATURITY and ATTITUDE group. And yes, as is stated previously, please improve your communication skills. Reading you comments are like poking red hot needles into my eyes.
Oh and by the way…its PSYCHIATRIST, not psychiatry…=)
Just came back from my induction.
Met lots of Russia and Ukraine graduates there…..
First, surprise and sad to know that they did not have any clinical skills training (i.e. taking blood, Cannulation, CPR, setting up drip, ABG etc.)over there . They din even have the facilities such as artificial arm to practice venupuncture and cannulation! They are only given a clinical skills log book during elective to achieve those clinical skills in Malaysia (i.e. government hospital).
Unfortunately, due to the hectic environment in the Malaysia hospitals, most of they were not given the opportunity to learn and achieve those clinical skills learning outcomes. Worst, to fill up the log books, the students have ordered from the local shop a fake stamp with doctors’ name and sign up those outcomes themselves. It is unlikely that their supervisor in Russia/Ukraine will notice as they cant read Bahasa Melayu. Lol……
Secondly, majority of them did not attend a ward-round, grand-round, MDT meeting etc. before. From the sounds of it, the first day of their housemanship will be their first day of clinical exposure including history taking and examination on a real patient.
Thirdly, interestingly, all their international students (99%) are from Malaysia. I wonder why no other countries/parents from other countries send their young generation to study medicine there.
Well, generally, most of them have a heart to become a doctor. I feel that it is the medical program-me that let them down rather then their own ability to pursue medicine. I wonder how many students/parents will go/send their children to these universities when they know what they are getting are a few lecturers who cant speak fluent english teaching in the lecturer theatre for the whole 5/6 years or training. These is accompanied with little/without any patient contact and clinical exposure.
[Posting from Melbourne]
“They din even have the facilities such as artificial arm to practice venupuncture and cannulation! They are only given a clinical skills log book during elective to achieve those clinical skills in Malaysia (i.e. government hospital).”
That is absolutely shocking.
Over here we get a log book in third year that includes one cannula (i failed miserably at that one btw :p). Im in my final year at the moment, and on a typical ED shift, I’d probably do 3-4 cannulas and a couple of bloods.
The point is, even as a student, we are expected to function at intern levels. We do the history, examine, do bloods and write up plans. Of course, we are not doctors and everything needs to be signed off and doublechecked – we are all supervised by senior consultants (Registrars are never allocated students) who then does a brief hx and ex before correcting our plans and signing off all the drug charts, pathology and imaging requests that we have made. This process is a bit time consuming, and realistically we only see around 4 patients per 10 hr shift (consultants also ensure we dont see Cat I’s or complicated Cat 2/3 patients)… But the little practical pearls you pick up is priceless. We then handover the patients to the registrar of the relevant specialty who does the admissions for the wards….or write up the discharge for patients sent elsewhere.
The trend in medical education currently is to start clinical exposure as early as possible and make everything as clinically relevant as possible – less theory, more practice. I do have my quips with this though (lack of basic teaching is an issue and learning on the wards is bloody time consuming and inefficient sometimes). Even the archaic, stiff-upper-lipped grey haired professorial old school system in England has been steadily introducing clinical placements as part of their medical courses.
Medicine is really about how to approach presenting complaints, and to manage patients. Knowing Tally and O’Connor by heart means nothing. It’s really an art… that said, there are things that must be done for every presenting complaint which makes up the current standard of care (ie. not being negligent) – and such things are picked up in a clinical environment.
Then you have the practical skills. How fast can you pop a cathether in with proper sterile technique? How confident are you at popping in lines? That kind of stuff… How sensitive are you to listening to HS abnormalities and all the different resp sounds (other than crackles!)?
If what GCG says is true, then it’s no surprise that the Ukranian/Russian graduates have a tough time in first year.
Ultimately,it is all up to attitude that will determine whether a person will become a good or bad doctor.
Hectic as Malaysian hospitals can be,but there is always a time and place to do/learn/observe all these procedures.It’s all up to the student.
It’s sad that medical students have no way of knowing how good a school’s medical curriculum is before attending.
well shame on u,GCG.blaming the universities and the medical system for the outcome of medical abilities.i myself is a ukrainian graduate.and i could have never been more proud of where i come from until i actually become a medical officer.seriously, how well the doctor is performing is not from where he/she has graduated from.it’s how they see what a doctor’s job is and how sincere are they in becoming one.
on friday, in the operation theatre, a 1st poster from a local uni was depressed for all the scoldings he had during assisting one of the M.Os. so i went and approached him to console and eventually he broke down and told that he is very depressed working in obgyn. with only 1 houseman per ward,the clerkings of new admissions, the reviews and having to go to o.t at the same time. saying that the workload was just too massive.
i replied to him saying that during my time, there was only 4 houseman in obgyn. where sometimes we only had only 2 in wards to spare the other 2 for clinics.where in my days, i had to cover the labour room, the alternative birthing centre and at the same time, helping the gynae ward with admissions and discharges. and we didn’t have shift at that time and we were doing eods until i didn’t realised that i was actually due for surgical posting already!and we worked practically from 5 am to 11.30 pm like every single day.i even have colleagues who just can’t be bothered to go home and just stayed in the hospital without going back for i don’t know how long.
so the thing is, everything always go back to our intention of becoming a doctor.if u had known, ur university would not able to provide u the practical skills, u need to find it for urself and not being spoonfed to.so to all those future doctors,just suck it up already. u are already having lots of sparetime to work on ur skills that u r lacking off whilst, we had to be at work at 4.30 am to steal the very little time we have to just be good as we are required to. i’m not even joking about the time really.just ask the senior medical officers in tawau.
life as a doctor in malaysia is hell but we did chose this.so why the complain?
to FMK.. GCG has his/her own point of view.. poor medical school does affect the outcome of graduates.. no one can denies the fact.. but i think u should be careful with ur words.. “well shame on u”.. this should’t come out from the mouth of a so-called MO if u r not agreed with anyone’s comment.. but sadly, i hav seen a lot of Ukrainian graduates saying it.. most probably they have been scolded a lot and now they like to blame the others with the “shame on u” statement..
Dear FMK,
Thank you for your reply. Sorry for your misunderstanding regarding what I have posted.
Firstly, I did not blame the medical system or the universities for inability to provide clinical skills training. My intention is to point out that a proper medical school should have provided the opportunity for clinical training and exposure especially if they demand a hell-lot of money from its students. I personally feel it is unfair for the students to pay the money and yet do not receive good teaching.
Secondly, I do not complain about the life as doctor in a hectic hospital environment in Malaysia in my posts above, I believe. In fact, I believe the environment is much more better compare to 10 years ago. I just mentioned that due to the hectic nature of hospitals in Malaysia (huge medical students from local uni., HO etc.waiting to learn), it is harder for elective students to achieve all their clinical skills in such a short period. Obviously, if you are keen you can definitely find a way to learn it. However, it is unfair to send students out to other countries to learn/practice clinical skills without providing such training themselves despite they are the one who receive the tuition fees.
Thirdly, I did not blame the quality of medical graduates from Ukraine or Russia. I am just pointing out that they have less opportunity to learn clinical skills in their medical school as the training is not provided in their universities. Obviously, I do not know the whole situation in these medical schools and I have not been there. These comments are based on what I have told by my fellows friends from Russia and Ukraine universities. I am sure there are excellent doctors from Russia and Ukraine Uni. too. And I absolutely agree with what you say about “how well the doctor is performing is not from where he/she has graduated from.”
Finally, I am just saying that if you are paying for something, you definitely expect something that has good quality and worth for the penny you spend for. In the end, who does not want a good medical training in their universities?
I do apologize for the phrasing of this post above:
” Unfortunately, due to the hectic environment in the Malaysia hospitals, most of they were not given the opportunity to learn and achieve those clinical skills learning outcomes. Worst, to fill up the log books, the students have ordered from the local shop a fake stamp with doctors’ name and sign up those outcomes themselves. It is unlikely that their supervisor in Russia/Ukraine will notice as they cant read Bahasa Melayu. Lol……”
However, this is what happening…..
I hope there will be monitoring of the implementation of the shift system to ensure adequate training and exposure for the Hos
Hopefully but I don’t think it is going to happen. Who is going to monitor? Specialist? They are just too busy or some would not be bothered.
all you guys should go **** off.
i graduate from ukraine and we are as good as
if not better than the fancy pansy graduate of US,UK,Canada, etc.
See yourself.
Is name and country of medical qualification so important to you?
I tell you the patient dont care where you graduate.
whatever fancy crap title FRCP/S etc.
My pateints love me, I have good communication skills.
in the end, is how you talk to pateint and hold their hand, must be
good doctor.
You know everything so what?Make you a better doctor??
maybe i know less, but you should not think you are better doctor.
I have no idea how did Eastern European med school manage to produce grandiose and over-confident doctors.
Those fancy FRCP/S are not crap, those are hard-earned titles that require a lot of training and hardwork, and they enable you to be a specialist, or to enter a subspecialty training, so yes, those “fancy crap title” are important, as least for your career progression.
Would you want your love ones to be treated by you? or someone else? =D
K W MD(Ukraine), your attitude in this public forum is regrettable. Civil discourse is encouraged but I believe such rants reflect badly on the medical profession as a whole.
The bottom line is that the opinion of seasoned consultants should be taken into consideration, or at least respected.
The general consensus so far amongst those who are responsible for supervising the Ukranian grads have not been favorable – but note that it does not mean that everyone is bad.
As I have mentioned in the past, a diamond shines eventually no matter where it comes from or where it ends up (ok, it’s translated from a malay proverb but you get the idea).
Again, being liked by your patients and genuinely delivering an appropriate level of care are two different things. Asian patients, especially the more elderly ones in general have a greater respect for doctors (cultural? i dont know) and will give you that impression… but is your management of their presenting complaint up to scratch? There is no way you would know unless someone scrutinizes your plan and approach to a patient.
That is the role of the senior treating team – and if they find themselves telling a junior the same basic things over and over it can get very frustrating for them. Perhaps some of them really are obnoxious to juniors/HO’s. But the problem, as it is contended by many on this blog, lies not with them alone.
Your delusions of grandiose and ego is somthing that a doctor should not have. Yes, no doubt that you need good communication skills to be a good doctor but it does not by itself make you a good doctor!! You need knowledge and good clinical skills. Our population is still naive and majority think that a good talking doctor is knowledgable. Try doing the same in a developed country and you will know what I am talking about! To be a good doctor, knowledge is still the most important factor. NO point talking but missing a pneumonia, unstable angina etc. The patient will still die! You will only know what you miss when someone tells you. That someone is a person who has FRCP etc, someone senior and experienced. BTW I don’t know where you are practising, but in major towns, patients do see where you graduate from and what degree that you have.
Your attitude is an embarassment to the medical profession.
K W MD….
Just a note…probable someone already mentioned it.
Knowing more will not make you a better doctor, just a safe doctor. On the other end, KNOWING LESS WILL DEFINITELY MAKE YOU A BAD/DANGEROUS DOCTOR (remember the first commandment of medical practice?Go search if your med school did not teach you). Name is not important but qualification of a medical school almost always equal to quality of it. There are medical schools in India and Middle East that are recognized almost globally.
In the end, what is the difference of you comparing to medical assistant that treat and reassure patient without knowing what is really going on.
And get a FRCP first before you say its fancy crap lol.
K W MD(Ukraine)
—- baseless egotistical rant snipped —
I wager your fancy Ukrainian alma mater must be so proud of you right now.
Dear K W MD(Ukraine):
True, you patients may not care or sometimes don’t even bother where you graduated from as long as you solve their problems. Also, congrats to you coz your patient love you very much. HOWEVER, not all patients will appreciate your treatments and sometimes, they will blame you for some reasons. Are you going to ask them to **** off, as you said previously, will you? It is all up to attitude, enthusiasm and the skills that will determine whether a person will become a good or bad doctor. For your information, some of the commentors in this blog are subspecialists, who have much more experience than us, so please show some respect, as how you respect your SHO and MO. And finally, the correct spelling should be “PATIENTS”.Thank you.
YSQ
MB ChB (Edin)
” in the end, is how you talk to pateint and hold their hand ”
My goodness, KW MD, get a chaperone first.
Seriously, this is the disease which has affected us so deeply, it’s shocking. When an entire generation of general practitioners treat their patients with “lovely chatter and hand holding” to ease that ‘oh-so-typical-abdominal-colic’, thats precisely how we miss abdominal aortic aneurysms.
But KW MD from Ukraine, it’s no problem to you, isn’t it? If you want to use the word ‘fuck’, please do. Don’t censor your good self. What would people in this blog know? Fancy FRCP/S which can be obtained through passing ‘simple’ exams overnight and buying medical degrees in foreign countries. Heck half of us must be quacks to you!
“My pateints love me, I have good communication skills”
“I tell you the patient dont care where you graduate.”
I’m gona barf.
Dear all,
I have no intention to upset Russia/Ukraine Medical Graduates. If you read my posts properly, I did not say graduates from this universities are bad. I am just pointing out that the medical programme offered by the universities does not provide enough clinical experiences. This is to help those future medical students to understand and be aware about these uni.’s co-curriculum before enrolled with the programme. That’s all I am going to say. Sorry to cause such an up-roar.
T.T
Totally agree with what you’ve said.
People shouldn’t be offended with your statement.
For those who are already in the system, nothing can be done other than improving yourself.
Our main concern is the potential students and parents.
Obviously the public is not well-informed regarding uni.’s co-curriculum.
But then, like what Dr. Paga said before,
“Medical education should never be commercialized at the 1st place…”
http://www.kyivpost.com/news/business/bus_general/detail/108417/
Quote : Due to the low qualification level of
graduates from Ukraine’s medical higher
education establishments, including the
prestigious Bohomolets National
Medical University, as well as high level
of corruption there, Iran has refused to recognize diplomas issued by Ukrainian
medical universities.
Quote: “We know that the European countries, and the
United States and Canada came to this
conclusion much earlier. Ukrainian doctors that
want to get a job in these countries have to
pass a humiliating procedure of re-attestation
and additional training. Only a few of them receive the right to practice medicine at once,
while the others start their career as a nurse or
working at laboratories, and only after some
time they can hope to receive the right to treat
people,” the deputy said.
Dear all:
When I first started following the blog, I remember Dr. Paga did point out some comments regarding the quality of AIMST University, MMMC as well as the Russian medical schools, and immdiately, some students from those Unis stood up and “defend” themselves. Well, I’m sure Dr.Paga and other commentors are not trying to condemn or to judge those medical students, instead, they are actually doing their best to help those students, so that they may improve their clinical skills. Being open-minded is essential in the the process of learning, especially in the medical field! If anyone is not be able to accept any criticism, he/she should think medicine last!
Here is something for perspective: True story.
I spoke to a foreigner (European) who settled in Malaysia recently. Mind you, he was a former top exec who’s kids are in Singapore and Australia. Why he chose this country? Stable politics and economy, and value for money. The trick is to find the right things at the right place.
Can you believe that?
I told him that Malaysians want to get out of the country. He laughed.
He said it’s unfortunate that our own people cannot appreciate what we have and that most Asians think Europe is a lavish country where melons and cheese are available for free. He invited me to go for a holiday to the PIGS (portugal, italy, greece and spain) and see for myself, how people with degrees and masters qualifications are essentially jobless. He asked me why has this happened if European countries are the true ‘masters’ of the world?
I said i don’t know.
His answer: The businessmen and politicians DONT sleep in the same bed.
Go figure.
* btw he gave me permission to post this story on this site. Informed consent taken *
You used the word “value for money”. Now, that is exactly what this person is doing. He has the money and filty rich and thus he decides to come and spend his retirement in Malaysia. So, he does not care who runs the country and what racial politics that the government is playing with. What he wants is a comfortable life with no tax! Why are his kids in Singapore and Austrlaia? Would he send his kids to a school in Malaysia? These people are investors and they come here to make money. I see alot of them in JB where they leave in big luxury bungalows worth 2 million but work in Singapore! They are given a lot of incentives by the government under Malaysia my 2nd home programme.
No country is perfect. Most people leave Malaysia not because they don’t like the country. They are pissed with the politics and racial discrimination. Since they get a better job and prospect in another country, they leave. In Malaysia, if you have the money, you can lead a happy life.
The trick is to find the right things at the right place.
I guess that’s why his kids are studying in Singapore and Oz. Evidently couldn’t find the right thing (good education) in the right place (Bolehland).
It is a sad irony that expats who enter under “Bolehland my second home” have far more privileges accorded them than citizens who are constitutionally second class just for the ‘fault’ of being born the wrong race.
There is no type in the above story. Read it again.
sir, i wanna ask, why Unlike the Royal Colleges in the United Kingdom, Australia and Canada, or the Academy of Medicine, Singapore, the Academy of Medicine in Malaysia has no legal right to have postgraduate courses, conduct examinations and award degrees or diplomas? and certainly postgraduate training here in Msia is not recognized elsewhere.
you have to ask the government. The government wants only the universities to offer postgraduate degrees. Academy of Medicine did suggest a centralised exam format for postgraduate but still not accepted by the government. Hopefully in the future things will change.
Hi rein,
Postgrad training in Malaysia is administered by select universites (UM, USM, UKM and soon UPM). The govt has strong control over university appointments and policies, and therefore controls postgraduate training. Make your own conclusions about why that is the case.
I know for a fact that with Anaesthesiology, the College of Anaesthesiologists (CoA) – Academy of Medicine Malaysia had set up a programme in the 1970’s (largely modelled on the ANZCA training programme) to train anaesthesiologists in Malaysia. While waiting for final approval, legislation was rushed through parliament to allow only the universities to administer postgraduate training. The CoA only has nominal say in how training is done now through a Joint Committee with the universities.
The situation in Singapore is actually the same as Malaysia. Postgrad training is administered by NUS, with a Joint Committee comprising of the relevant college (part of Academy of Medicine Singapore) and NUS. The difference is that in Singapore the college/academy has almost an equal say on training with NUS, unlike Malaysia where you get the impression that the college/academy involvement is there for show and that they have no real power to change things.
to KW MD (Ukraine):
1. if FRCP/S are crap title.. then no doubt, MD (Ukraine) is the “super duper crap”.. just because of your ego and poor attitude, you have spoilt the good name of all the Ukraine graduates.. you need to apologize to all your friends from Ukraine..
2. if i were in the admission committee, i will never select you as a medical students no matter how good your academic achievement.. because your personality and character are horrible.. it seems like your medical school just simply take students without interviewing and screening the candidates..!!
3. if only one or two peoples talking about the quality of Ukraine graduates, you may take it as bias.. but if a lot of peoples from other countries as well are talking about the same matter, then you should accept it as a fact and improve yourself.. it seems like you have poor insight and living in your own world..
4. as good as graduate of US, UK, Canada..?? the funniest joke of 2011.. you can cheat yourself.. but you can’t cheat us..
5. patients love you..?? how? they kiss you? they hug you..? i think you should become a politician, and not a doctor..
6. if you can’t take criticism, you will not improve..
7. if you are really proud of yourself, why don’t you put up your full name? so your parents and your orang-orang kampung will proud together with you as well..??
8. you are actually telling and proving to the public, the current younger generation of doctors are poorly behaved.. or in the layman term – kurang ajar.. because of the black sheep like you, the good name of the young doctors spoilt..
Malai Poh, MD (Canada)
It is upsetting to see how a perfectly well-constructed platform of discussion started by Dr Pagavalan being degraded into some foullish, bad-mouthing heated argument. Instead of looking at the problem as a matured professional which we all doctors should, some decided to start throwing attack and criticism, most which are baseless to begin with.
We are looking at how to improve houseman training, or to put it in a more frank manner, how to prevent the whole housemanship training from turning into a circus so that our future generation will still have a chance of getting decent healthcare without forking out our whole lifesavings over to the private hospitals. I have worked with housemen from local universities, colleges with twinning programmes, overseas graduates, Russian/Ukraine. It is true that not everyone starts off with the same foundation of skills or knowledge, but with the right attitude and mentality, they can all be on par with one another in due course of time.
Of course the ratio of houseman: senior (MO/Specialist) has to ‘healthy’ in order for both parties to enjoy and excel in what they are supposed to do- be trained and trained. Therefore, it boils back down to the number of graduates we are churning out.
If anyone has a better idea on what to make the government realizes that it is time to start closing some of the dubious colleges, capping the number of applicants, and enforcing stricter entry criteria into housemanship, now is the time to speak up. It will be fruitless to belittle others qualifications and elevate one’s own status, when in reality, we are all hoping for the same thing, aren’t we?
What I mean is that ppl care too much on where graduate from and title- FRCP/S.
Ppl look down on me when houseman time bcos Ukraine graduate lousy they say. All I have to do everyday take blood , trace results. get scan, rounds, do branula like stupid clerk. everyday!Nobody care I dint eat the lunch or dint sleep.
They say I dont know how to read ECG- but did not teach me-so how?
Everyday asking me things and saying I dont know.
Then they say I dont know using the ophthalmoscope-hello? in Ukraine only the eye doctors use ophthalmoscope at ward bedsides.
I notice even the UK,Canada graduate never care about patient- they talk fancy style at case presenting. Patient not care where graduate from or title- you must have good communication skills.Make patient comfort,talk to them, hold their hand when they suffer, alot doctor not listen.Is this good doctor?
The good doctor not just talk bad about people,show off and just treat patient like robot.
That is why my patients love me.its important the communication skills.
I say hello,ask patient about his life and family, other things.sometimes i help them buy roti canai.That is why they happy.
now i just finish houseman, I want to do specilist course,so that next time i will tell my HO,MO to have good communication skill,talk to patient and be the caring good doctor.Not just the doctor treat like robot.
ECG interpretation is seriously basic stuff. Ok you are probably not expected to identify complex conduction abnormalities, but the things you just need to know how to spot almost instantly: like ischaemia and how to localize it, basic BBBs, QT changes (and its causes), potassium high/low, atrial flutter and fibrillation…and the two shockable rhythms.
The opthalmascope is another basic tool. It’s not rocket science. You should be able to spot basic changes (signs of raised ICP, glaucoma etc), and screen for things like macular degeneration and diabetic retinopathy (the common stuff!).
I say hello,ask patient about his life and family, other things.sometimes i help them buy roti canai.That is why they happy.
ಠ_ಠ
you have got to be kidding.
Be careful who you treat, because eventually a litigious patient is going to haul your arse to court… for something glaringly obvious that was missed that resulted in harm – and no, your roti canai’s wont save you.
K W MD (Ukraine), if what you say is true then serious commitment needs to be in place for training during internship in order to establish a basic level of safety for patients. Things like opthalmascope lessons and ECG seminars for a start.
With the large number of interns (6000+) next year it wont be easy…
To KW MD (Ukraine):
1. we are not here to tease you or blame you, but we just want you to wake up and come back to the real world. we also want to make you aware of what you are talking about. we never said that we are excellent, but at least we respect our senior colleagues.
2. hello – all the houseman in malaysia also everyday take blood, trace results, get scan, rounds, do branula like stupid clerk, not only you! we also didn’t each lunch and didn’t sleep. so what are you complaining of? if you want easy life, you shouldn’t choose medicine in the first place!
3. you should learn how to read ECG in your medical school! what is your professor in Ukraine doing? you paid them money but they didn’t teach you?? you cannot expect the MO/specialist to teach you the basic things! just take a look in your MO/specialist payment slip, there is NO “Elaun mengajar houseman”! also, did you really open your mouth and ask your MO/specialist? if yes, i’m sure they are willing to teach you! if you don’t ask, then don’t expect us to spoon feed you!
4. using ophtalmoscope is one of the basic things you need to learn during your medical school time. now only i know Ukraine graduates don’t know how to use ophtalmoscope! i thought you said Ukraine graduates are as good as UK, US and Canada graduates? in most universities, using ophtalmoscope is one of the famous osce questions for undergraduate. you may fail in your exam if you cannot use it correctly!!
5. “make patient comfort,talk to them, hold their hand when they suffer”.. if you only can talk but cannot treat, then why don’t you just go for counselling course? save money save time! and no need take blood everyday!
6. again, i want to remind you, none of us here is looking down on you.. it is your own attitude that get you into trouble. please bear in mind, most of the commenters here are senior practitioners and involve in teaching as well. they are the one who will guide you through your postgraduate training later. with your ego and poor attitude, no one will keen to teach you. be careful with what is coming out from your mouth! seeking knowledge must be humble! if you want to do “specialist course” and behave immaturely, you will likely end up to hold patients hands everyday in the district hospital as chronic MO. remember, postgraduate training is DIFFERENT from undergraduate training!
7. you read through what i said and digest yourself. if you really cannot get what i meant, and still cannot find your own weakness, then it is up to you and the fate to determine your future. i am not going to say anything more than this. we are happy to share our experience with the young doctors who are keen to learn and well behaved only.
U r typical USSR graduates!!! I am graduated from Ukraine as well and currently 3rd year in service. No doubt comparatively we r not as good as local grads at the beginning but it is all depend on you yourself.
U said –
They say I dont know how to read ECG- but did not teach me-so how?
Everyday asking me things and saying I dont know.
Then they say I dont know using the ophthalmoscope-hello? in Ukraine only the eye doctors use ophthalmoscope at ward bedsides.
What a childish and unprofessional thinking? I am totally agree with what mint, chillax and pgy1 commented.
Dr Kw , wake up please!! please keep ur hand off from the keyboard, ur comment embarrass me as we r from the same Uni. Hopefully u wont be a sub standard MO and i dont think u will become a specialist with the thinking u have now.
I cant help but to reiterate once more – how could Eastern European medical schools churn out such grandiose doctors to begin with? As far as I know, almost all my friends graduated with a feeling of inadequacy – that they are afraid of killing patients, clinical skills not up to par, unable to function when they are alone, etc – even when some of them are top scorers.
For communication, I think the US Canada and other OECD countries + Malaysia would have taught the medical students the same if not better – with simulated patients and communication skills workshop. In my school you cant get through the year without passing your communication module.
I wish you all the best in your specialist training course, and may you pass your post-graduate exams.
I think you are digging your own grave. You have just proven to the world how bad a graduate from Russia/Ukraine is. ECG is something that should have been thought in a medical school. No medical school should be graduating a person without being able to read ECG and make common diagnosis like infarct, ischaemia and arrythmias!! It is not for the MOs or specialist to teach you how to read ECG after you graduate!! Housemanship is to learn about management of patients. Same goes for opthalmoscope, it is a basic teaching of any medical school in the world. Gosh, you have just proved what people have been saying all this while about russian graduates.
Definition of a good doctor by GMC: “Patients need good doctors. Good doctors make the care of their patients their first concern: they are competent, keep their knowledge and skills up to date, establish and maintain good relationships with patients and colleagues*, are honest and trustworthy, and act with integrity.
* Those a doctor works with, whether or not they are also doctors.
Now, do you fall into this category? I don’t think so. Just having good communication skills alone is NOT going to make you a good doctor. The statement above says that being competent and keeping up to date knowledge and skills are still the main factor in becoming a good doctor. I seriously think you need a psychiatrist help as you are going in a wrong direction. Please be very careful of what you say.
Do you know anything about “doctor-patient relationship”? Being too close to a patients and talking about their personel life and buying food for them is NOT encouraged. You must at all times maintain a good profesional relationship with the patient. You will never know which patient is going to make use of you for their gain or even sue you in the future. Be very careful about this. You will know what I am talking about in due course. Trust me! Don’t assume all patients are angels!
Being a doctor is hard work. If you are only interested in talking to the patient but not interested in taking blood , tracing results. get scan appts, do rounds, do branula everyday, then why did you become a doctor? Talking to patients the whole day is not going to make them better or save their lifes. What you are doing above is what that is going to save their lifes.
Finally, you should also improve your English. I think the best specialist course for you will be Psychiatry.
O O O
one more thing…I know it will sound bad but…
If you have time to buy roti canai for patient, then why not spend just 5 minutes of those time at least learn something about ECG. probably after one month of time from holding patients’ hand and buying roti canai you will be able to read basic ECG.
Then spend next month reading something else
I cannot emphasize more about life long learning as a doctor. Things taught in medical school will be close to obsolete 3 years after you graduate.
I really hope no one flames KW MD after this. Poor chap had to buy roti canai all.
Regardless of the point u tried to make, it was you who initiated the disrespect by telling the respected readers here to f8ck off. I don’t think that was fair of you.
Nobody cares whether you eat,sleep or drink water? WAKE UP AND SMELL THE ROSES. This is the real world we are talking about. Stop watching Royal Pains, House and all the american tv shows. We may have a system as polished as the Brits or the Aussies, but real patients are dying due to medical ignorance on a daily basis.
You know what, I don’t blame any of you. Your unis made a quick buck out of a majority of you. Simple as that. And now, the public health system will have to suffer.
* we may not have a system as polished *
Ali
Do you have any good suggestion on how to “make the government realizes that it is time to start closing some of the dubious colleges, capping the number of applicants, and enforcing stricter entry criteria into housemanship”. In my opinion as long as $$$ is involved there is no way government will do something like that. :Like few of us said before – they will milk this cash cow until it dies.
To K W MD (Ukraine)
I am not saying its not important to have communication skills. But without knowledge, what good is it to be a doctor.
If you don’t know something, read yourself. Isn’t that what is all medicine all about? Medical graduates SHOULD know how to read and pick up basic emergencies on EKG. There is no such thing as ONLY ophthalmologist using ophthalmoscope at bedside.
The fact that if someone is asking you things and you don’t know pretty much sums up why others say you don’t know stuff. Don’t expect others to teach when you can’t even read up on your own.
And if i did not say in my previous post, I know a lot of excellent doctors from all around the world, including ukraine. they all come from different places but one thing in common is that none of these doctors ever expect others to teach them stuff. every single of them reads up on their own without being questioned, and I have never heard any of them complaining “why you expect me to know if you dont teach me”.
how is it possible to graduate but not knowing ECG? this really creep me out. i thought we’ll learn at least lead 2 ECG reading in basic science like physiology??? its a major part of every physiology books (pathology also). unless a student had never touch any text book ???
dear Mr Pagalavan,
I am writing in disagreement of your post respectively. You choose to isolate a Doctors work to other jobs. It is true that a doctor carries more responsibility than many other work. Yes it is a question of life and death. But unfortunately the system we are living our life demands all of us, including Doctors to sell our labour in exchange of wage. Doctors job has been reduced to earning money like any other job. Without an economic security, nobody will be able to lead a fulfilling life. We all work for our own economic advancement and my humble opinion is that a Doctors working hours and his wage does not tally in the simplest form.
The writer of the SunDaily has correctly pointed out the ridiculous working hours and burden that an Housemen had to carry and the accumulation of stress on their shoulders. I also strongly believe that they are being severely underpaid taking in account of the current purchasing power, inflation rate, market rate for jobs and so on. Many youth that were ambitious and passionate of being doctors have been hit with the reality of the situation where they are unable to keep themselves motivated. I have heard countless doctors complaining everyday of their inability to lead a good social life due to their job. Doctors save life, and it is for this exact point that they should be rested more and be given more time to relax their mind. Their job is too important and their focus should be 100% during the job, not thinking about what time they get off work and how they are going to settle their debts.
I quote you “I mean, I don’t know what this author wants? I guess he wants a comfortable, office hour work for his sister with a lot of money. Then, don’t become a doctor, that is my answer.” I think it is an unfair statement. Not only unfair to the author and his sister, it is also unfair for other workers. It does not say anywhere in a job description that a doctor must be overworked and underpaid. Doctors need to sacrifice, put more passion in their job, be more compassionate and so on, but should not be overworked. All the above mentioned qualities and much more should be expected from workers from every sectors and their exchange of labour time must be adequately matched by their wage plus a serious consideration should be emphasized on the amount of stress that goes into the work. It is not a good advice to ask any individual to not become a doctor or a lawyer or any other profession because of the unfairness of the system.
The government is incapable to facilitate the amount of doctors that it planned to produce and they could not facilitate the amount of money needs to be allocated for our health system. This exploitation of every workforce in a whole is a direct result of the failure of the government to plan their economy and to distribute wealth proportionately. Our PM rent, water, electricity for this 4 years is totaling up to RM 50 million. How much does it cost for the countless aristocrats that we have and to support the corruption of both the ruling party and the opposition politician. Channeling the least of those economy towards the health sector does not only solve the workers problem but benefits society as a whole.
My humble opinion is that the problems are not caused by the inadequacies, or the ignorance of the housemen but the problems are caused by the weakness of our system. The system for profit is increasingly selling medical degrees in every college (qualified or not) creating a situation of incapable young doctors. The training that they undergo after college also does not help them to blossom as an aspiring doctor, instead it demotivates and mold these youngsters into becoming restless, uncaring, frustrated zombies that grow up to do the absolute minimum in order to salvage some time for themselves. The underlying system is at fault and those who use the state mechanism to impose such system is largely at fault. Unless we stop blaming these young doctors and start seeing them as victims of this vicious system, we are not going to grasp the root of the problem. Unless we grasp the root of the problem, there is no way of finding the solution.
I agree to disagree. Everyone knows the root of the problem but nothing can be done about it unless each and everyone in the system try to change it. The system includes everyone of us! WE form the system. I will say this again that being a doctor is different from any other profession. There is no such thing as office hour work in medicine and also there is NO money in medicine either. Yes, the doctors are underpaid but soon, there may be even jobless doctors like any other profession. AS I have been saying all this while , if you are doing medicine for a comfortable life and money, then forget about medicine, period
Medicine is stressfull with a lot of workload, that is the reality. I give you 2 scenarios:
1) you are admitted to a gov hospital. At 5pm, you get a severe chest pain. The doctor incharge tells you that his job finishes at 5pm and you need to wait for the next shift doctor? What would you do?
2) you are in a private hospital under Consultant A. At 9pm you get another chest pain. The Consultant says that he is at home and ask the medical officer to see and manage your case? will you be happy?
AS I have said above, I do not agree working 36 hours continuosly but no matter what system that you are in, being a doctor carries a lot of responsibility. Even when the shift duties are carried out, you workload is still the same and your responsibility is to make sure that each and every patient under your care is stable before you pass it to the next person. YOu can’t just leave the ward ar 5pm and leave every patient unstable! A lawyer can say that my office closes at 6pm and I will see you tomorrow. A engineer can say that today is a public holiday and I will review your plan tomorrow. BUT can a doctor say that your chest pain can wait, my job finishes at 5pm? I will repeat this ” there is no such thing as “working hours ” for doctors. You can have a limit of working hours but that does not change your responsibility and work load. It just gives you more rest.
I start my rounds in my hospital at 7.45 am everymorning. After finishing my round at 9.30am, I go down to start my clinic. While I am running my clinic, I also attend to emergency in ER and in the ward. I finish my clinic at 5pm and then start my evening rounds whch finishes at 7pm. I go home, take my bath and return back to the hospital to see the unwell patients till about 10pm. At 2am if any of my patients suddenly develop any problem, I have to go back to the hoapital to see him/her. The next day, I do the same routine(7 days a week). Your patient belongs to you and you are responsible for what happens to them. If not, a lawyer’s letter will be waiting for you in a couple of days! That is a doctor’s life, whether you like it or not. That is the reason I started this blog to educate the budding doctors about the real life of a doctor. NO system change is going to change the life of a doctor. In US, more doctors are resigning daily then being produced due to high litigation rate.
The only time you can have your own “office hour” work is when you start your own clinic but again you need to work from 9am to 10pm daily , 7 days a week ! I have a GP friend who has been doing this for the last 14 years! So, if you are looking for a comfortable life, good social life , good money and less workload then find another job. That is the reality which you need to accept as a doctor. Wait till the litigation rate to go up. It is already happening in Klang Valley as written by the specialist in the letter above. I get calls now and then from lawyers asking for my opnion about certain cases which they are planning to sue!
The last paragraph about doctor’s life is real. I guess if any serious wrong doing, your boss might not able to cover you in future. For example a baby upper limb become ischemic because a houseman injected medicine into her artery instead of vein, that time MOH still covered the HO.
Latest incident like wrong blood transfusion by a doctor in Penang GH got suspended. The police officer that shot water inside the Tung Shin Hospital also going to get ‘punishment’.
Conclusion : Learn well while during your housemanship. Current system is HO still dun have medicolegal resposibility. But once you are MO/specialist and if anything happen, lawyer letter will follows.
I wish to emphasize that event or work documentation is very much important. It is going to protect you when you need it. Last time, I documented eveything included the time calling the private hospital, what the MO said, what ordered they gave and every small detail. It saved me and my hospital a big lawsuit. e.g. In your hospital, when you page the respective MO, even they dun reply, pls document it otherwise anything happen to the pt, you are going to be responsible for it.
“Unless we stop blaming these young doctors and start seeing them as victims of this vicious system, we are not going to grasp the root of the problem”
Good point.
Doesn’t matter. The health disruptions are already happening in other countries. When the iPhone hit us, nobody had a clue what was an app and how it will redefine the technological world. Yet, apps are nothing but widgets and gadgets and whatnots which have been in the technological market for years.
Similarly, disruption in healthcare is already occurring in global innovation hot beds like US, Taiwan, South Korea and Japan. Anyone follows http://www.kevinmd.com? Unfortunately, UK, Australia and New Zealand are not the most competitive when it comes to innovations.
Look at the tech industry. What happened over the past 20 years? Thats whats gona happen to the health industry over the next 20 years.
So maybe we don’t need that many quality doctors after all, we just need someone to press buttons on a machine a decade from now.
Haha, that will never happen. You still need the human touch and brains to be a doctor. You still need surgeons to operate and physicians to decide on management. Yes, technology will make a doctors life easier in getting information but does not change anything else. At the same time, technology will also increase the litigation rate as patients are getting alot of info from the technology, preparing to sue you!
i respect that. Just to highlight two links to brighten our days ahead
http://9to5mac.com/2011/09/08/jawbone-up-iphone-connected-health-bracelet-coming-sept-25-video-details/
http://www.rinkworks.com/said/predictions.shtml
Yes surgeons are necessary to operate and physicians are necessary to manage diseases. And what if personalized medicine obliterates diseases altogether?
http://learn.genetics.utah.edu/content/health/pharma/
Pharmacogenomics only tailors the drugs based on your gene profile. A long way from “obliterating disease”.
Chillax : And what if personalized medicine obliterates diseases altogether?
Then you’ll wish you became a surgeon! 😀
Or more accurately, you’ll wish you became a *trauma* surgeon!
There is no gene for fate. Gattaca, 1997
Gattaca! Im so going to re-watch that. One of my all time fav’s.
well it does not matter where you graduate, it is how you learn as doctor from than on. Human touch is important but the same time you dont need brains to be good doctor you just need determination. So work hard and smart K W MD; I am sure you will attain you goals
I find it most amusing whenever I hear this often repeated viewpoint about intelligence, hard work and people skills as if they are mutually exclusive traits.
Fact:
The best doctors are the ones who possess all these traits – intelligence, hard work and people skills (and more!). These individuals do exist in the medical and surgical fraternity. There are many, and I have and had the privilege to work alongside some of them.
When I was a very junior surgical trainee, I had the great experience of training under a truly excellent cardiothoracic surgeon who possessed the traits above and much more. He always said, “Just because you are an excellent doctor does not give you grounds to be socially inept”.
As far as medical schools go, so long as the course ensures graduates have sufficient core knowledge and ability to deliver their care safely, then I have no issue with where the individual graduated from. Sadly, some medical schools have truly abysmal standards. And in case anyone thinks I’m bashing eastern european institutions, I am going to point out that I have also had to train some truly abysmal Italian and Spanish houseofficers.
Dear Arvo20a
You sure doctors do not need good brains? lol, I think you have been brainwashed by our lovely government.
These imbeciles in the government still have no clue as to what they’re doing:
http://thestar.com.my/news/story.asp?file=/2011/10/21/nation/9742864&sec=nation
I hope you’re right. Ignorance and gross stupidity is at least an easier explanation to swallow.
The alternative is more likely true. Political pandering to the public perception in order to gain/retain votes so that the oligarchs and their cronies can continue to rape our nation for the enrichment of a select few. The house is burning, but do they care? No, the looting will continue until the roof comes down.
The ills of the medical system in our homeland is but a microcosm of the greater sickness affecting our nation at large. Political fingers in every pie, supposedly for the sake of quality assurance; but really to facilitate selfish motives. How to fix the system when there is no regulation with full independance, transparency and accountability? There is no cure in sight of this affliction.
MALAYSIA BOLEH!!!
Vote these morons out before it’s too late…
We need a change.
“Muhyiddin, who is also the Education Minister, urged more private institutions of higher learning to join the Government in its effort to produce more medical graduates in the country”.
Did our Mr. Deputy PM know what is happening in Malaysia( i suppose he never been to any GH before). Malaysia, a country having 40+ medical schools, producing more than 10,000 graduates per annum in the coming 5 years. Another world record that we should be proud of. Welcome to the BOLEHLAND!
One day he may even urge all institutions of higher learning to conduct medical course in Malay language.
i just obtained medical degree and registered with MMC. i havent apply at SPA and KKM. can i apply and sit MRCS before i start HOship?
If I am not mistaken, you need 1 year od practise before being able to sit.
for part A?
what I said is for Part A.
hi doctor,
can u please let me know, is it possible to do hoship in Brunei? and if its possible, can i easily come back to malaysia and continue working as mo after that or do i need to start back from Hoship? i am a medic student from russia and graduating soon. i dont feel like working in malaysia, and Brunei is my other option.
Your degree must be recognised in Brunei. Yes, you can do housemanship in Brunei after which you need to apply to MMC to get full registration. MMC will then decide whether you need to do any further training before being allowed to practise as MO.
They will ask you to complete all the postings as a houseman which you did not do in Brunei.
ivy, i m from russia too. another option is you can go vietnam:) i think they recognised our degree because their goverment had sent some student here which is under scholarship. same goes to Brazil,Ghana, UEA etc. dont worry, follow ur dream 🙂
I presume your are being sarcastic!
In all fairness, given the circumstances faced by malaysian students, there is a possibility that a genuinely bright student did not have the opportunity to study medicine anywhere else.
Or maria could just be sarcastic :p
Hi Dr Pagalavan,
I’m a UK graduate having done FY1 in the UK and has now returned to serve my 10-year bond with the government.
I feel really disheartened and deflated with what is becoming a joke in our health care system. I am extremely concerned about my future and training opportunities in this country. I intend to go into O&G and has passed my Part 1 while in the UK. I’ve been told by KKM that I need to work for a few years as a service MO possibly in firms that are lacking in doctors in hospitals in Sabah and Sarawak before thinking about specialization. Also, doing the Masters programme is not an option for me. (politics surrounding it, extra 5 years bond, not recognized anywhere in the world).
I would need at least 4 years of O&G experience before being eligible to take Part 2.
1. What are the chances of me getting to choose the department I want to work in without cables?
2.How is the quality of training from consultants like in the hospitals in general that would prepare me for the exam?
3. What is going to happen in a few years time, are they going to de-recognize memberships exams and replace with the Masters? If so, would I then need to move to other country , like Singapore which recognizes them?
What is your advice for me?
Yes, with the current glut, it is going to be extremely difficult to stay on in the same hospital to con’t your O&G training. MOH will decide for you. The MO post for the state of Selangor, N.Sembilan and Malacca is deemed FULL. Probably the only way will be to be close with the HOD of the O&G department but it does not guarantee anything. MOH calls the shot. Sometimes, mutual agreement with another colleague may be usefull.
There is no such thing as FORMAL training in gov hospitals. It is purely service based. You just learn on your own while working.
Unlikely they will derecognise MRCOG as they are still short of specialist.
Since you are bonded, you have no choice but to follow what the MOH dictates.
The time i enjoyed most was when i was a houseman. Because i don’t have any responsibility.What i did, just following orders from MO/specialist. i don’t mind came early as 5.50 am and went back at night everyday. Tried to learn their management and makes a notes. I hate most when i a MO at district officer. I was alone, no guidance, a lot of responsibility.
Now i am a specialist taking care of HO in my department for almost a 2 years. i have minimum of 30 and max of 60 HO. i tried to remember their names. My department used to receice all the first poster HO. From there i have seen many HO with different attitude, knowledge, missing in action, taking EL, we ask something else then they write something else ; from different University all over the world.
What can i say is, if they committed, make their own effort to learn/ask, be nice to their colleague/staffnurse/JM/attendant in the ward, follow orders that has been ordered; they will be a good doctor. BUt..if they are just standing there like a consultant and quite, have to ask then only they move..BIG problems!.
However…since we are ‘forced’ to start shift system, everything is haywire. i don’t know which patient is being taken care by which HO. 3 shift means 3 HO, MO..not always in the ward because number of MO less than number of specialist. Patient also does’t know which doctor they want to speak to after ward round, staffnurse also does not know which HO to call.
If we do teaching during rounds, next day we asked the same question. No body can answer because, it was a different HO. so..
To all HO, don’t think that you are overwork or asking why you have to do all ‘clerk’ job. You have to know the basic how to trace result, how to get appt, putting IV line/taking blood, that will make you as a doctor. All this will connect you to other people in other department. This will make your job easy in the future. You will realize that once you become MO/specialist.
no responsibilities as houseman?didn’t know that happens in Malaysia
HI Dr Paga,..
This is a true story.. My school friends named was passed away (24 oct 2011 at 2.50am, 19yo ) at Hospital Kuala Lumpur because of brain tumor. And there are story behind his death that makes me feel so upset and want to share this story to your friends especially for those who going to be a DOCTOR.
A friend of mine in Banting just passed away, maybe Allah loves him more than we can love him, but that is not the issue here. What happen to him is inevitable but there is possibility it could be detected earlier, but the doctors who treated him at Banting never really treat him seriously. He was suffering, constant headache, pain, he couldn’t even sleep for nights, could eat, my room was just 3 rooms away from his and across him room is the only way to the shower. Imagine the pain, i still remember what one doctor said to him, ” saye taw awak nak mc, xpayah r nak berlakon saket”,
i was shocked to here that.
Can’t u even c his face, he could even barely walk, someone has to hold his hand. Another doctor even said,” dalam sebulan, dtg bwat appointment, br bole further”, is that even humane? i know that maybe there are cases where students play truant n act sick n all, but when it comes to your profession as a doctor, there are responsibility not only that of a doctor to a patient, to Allah and as well as to yourself, i believe a doctor or what so ever person u’ll be should carry out ur responsibility to a full extent. The doctors didn’t even examine. They should have been more thorough. I am furious with this fact that doctors are slacking from their responsibility. What is the mindset of a doctor? is it wage or is it to help?
At the end, it is too late to help and he has been diagnosed by HKL, having a brain tumour.. Doctors! dont just expect that all student who come to u just for MC.. At the end, someone is died..!
This is when you call a lawyer… for “gross negligence”.
KMB?
yes…
out of curiosity (this is so irrelevant to this thread I apologize), did he have any focal neuro signs?
I have said before that the frontliners are the most important person to diagnose certain condition. IF not the patient will never get properly treated or referred to the proper unit. No doubt most of these doctors in OPD and KLinik Kesihatan has a lot of patients to see in a day but the very fact that this patient went to the clinic many times with constant headache tells you that something is NOT right. Furthermore, he should be examined properly. A doctor who don’t take proper history and examine a patient is not worth to be called a doctor! He should have been referred for a CT Brain. The final outcome may be the same, though.
As what I have said before, the attitude of doctors nowadays is pathetic.
well other than doctors dont forget that Malaysia has what we call medical assistant lol I have seen them sent away a viral uri home with abx but septic patient home before
“He should have been referred for a CT Brain. The final outcome may be the same, though.”
Mass lesions are the opposite to having a lack of intracranial mass. However, i do see your point in how both conditions lead to death.
=P
Actually I am talking about brain tumour where whether the diagnosis is made early or late, the outcome might have been the same.
btw, I have deleted his name..
This is very sad indeed. This is unfortunately the result of overproducing doctors to a point where quality is compromised. Now with the poor postgraduate training in place for all MOs, the same thing is going to repeat itself when the MOs become specialists.
Thanks Dr Paga for you advice. I guess I just have to bite the bullet and let them dictate my life ;(
I refer to Young doctors mollycoddled by S.A., and quote ‘Too many medical schools recognised overseas, with the standards, especially of Russian ones, being extremely low.” I’m a Malaysian medical student studying in Russia and I just want to clarify on how we can improve on our competency , in what areas are Russian grads weak at? I keep hearing about this incompetency that always have been spoken of Russian grads but I have no regard as to what it actually is and what aspects they comprise of…and also how we can improve on them? Is it concerning work ethics or our blatant inability at practical skills? Please, acquaint me and the rest of the Russian qualified grads on how we can improve on our weaknesses. We are after all becoming doctors not assassins, and that license to kill hallmark is something we don’t quite fancy. Thanks
You should read all the comments in this blog and you will know the answer. Some of the grads are like never been to a medical school! That is the problem. Of course I have seen good ones as well. It mainly depends on your entry qualifications, interest and the medical school that you attended. Not all medical schools in Russia are good.
The way you ask is exactly same as the russian medical student I taught before : spoon feeding way of teaching. I guess the specialist is not going to tell you. Pls find and read the comment from Dr Goon, he already stated many clues in his comment. You need intelligent to pick up your own weakness, be more observant and not to let anyone to tell you what you need to do. You are becoming a doctor not robot.
Curious, how much clinical experience do you guys get in medschool?
Hmm, well there are lots of excellent resources out there.
First of all, ditch kumar & clark. Practical medicine is not about knowing every damn thing in depth.
Get books that focus on practical approaches to patients. Eg the Lange Case Files series. UpToDate and BMJ Best Practice are also excellent resources on how to approach patients.
You may be able to list out the umteenth cause of say haematemesis… But if a patient comes to you with haematemesis, would you know what to do next? That’s the question really… and knowing how to treat all the common things… and what needs to be excluded in all patients of a given presenting complaint.
TLDR: It’s all about managing presenting complaints, working them up, and treating appropriately.
Having read all these comments, I am prompted to write about my recent experience.
I am a medical officer in OBGYN for the past 5 years, currently a postgraduate trainee.
I have always treated my house officers as juniors, in fact I treat them like my brothers/sisters
for 5 years, I have never shouted at anyone, never discriminated against any particular grad, and I have never made any judgements on where they have graduated from. This is mostly due to the fact that I was being traumatised an awful lot during housemanship and I don’t like to impose the same to my fellow juniors.
I printed out handouts, notes that I have made, so that they could learn during spare time. I have even printed out materials multiple times and tried to teach them whatever I can recall after studying the previous day.They never read it even though I was spoonfeeding them.
I got scoldings from my Head of Department because they can’t finish doing rounds, or sometimes they cant even fill in the proper names or details in the particular operating notes. I have written all the operating details and all they had to do is help me fill in the time our surgery starts, because I was being called elsewhere for an emergency, I had to leave that to them. Something this simple that even a primary school student can do, they failed to do it. Next thing I know, I got penalised again.
Still, I tolerated all this, I have even offended some senior specialists because I tried to cover for the house officers when they made a mistake.
but few days ago I decided enough was enough. Houseman A was working 7am to 6PM shift. He is supposed to finish his afternoon rounds of 30 patients before going back at 6PM. The MO has already done his rounds on the same day and plans have been made for the patients.There were no bloods to be taken. This HO did “half rounds” till bed 15 and then told the nurse that he is going home sharp at 6PM. He expects his poor colleague who clocks in at 6PM to cover 3 other wards and also finish his rounds. There was a 29 weeks pregnant lady with sepsis and URTI in Bed 16. The nurse told him to check out the patient, but he refused since the “next guy is already coming”.The poor patient spiked temperature 2 times, 39 degrees and 39.5 degrees. I was busy attending to all new cases in the delivery suite. I went to all the wards and checked on all the patients and by the time I reached the 92nd patient I noticed this neglected lady. Nobody bothered to inform me about this patient, and nobody did anything for her. Best part is they actualy tagged the patient’s case sheet” MO TO review”. This same patient has problem conceiving and she had 2 miscarriages before.
I called up HO A :
Me:are you married?
HO:no
Me:If you have a wife who is pregnant, do you want a responsible doctor to see her or an irresponsible one?
HO: of course I want the responsible one
Me: DO you think you are responsible?
HO: silence
then for the 1st time in my career I shouted,yelled and warned him then asked him to write an explanation letter to my head of department.
I know I shouldn’t have shouted, but yes, I just can hold back any longer,
First of all Mr. private it would really do good to your image as a doctor to have basic english fundamentals which clearly you don’t have. This “go find yourself” attitude is the exact reason why medical practice in Malaysia is dropping and heading for the terrains. Why are Russian Grads always criticized in Malaysia? but where else in US they seem to be doing fine. How do I know this? It is only because i have had seniors who completed the USMLE upon graduation and are serving in hospitals all around The States. If you are unwilling to teach then you should not even be speaking in this forum. My question was plain and simple, how do i improve myself prior to practicing in Malaysia. I surely hope this is not the attitude every other MO or doctor has in Malaysia because if that is the case i would not even consider returning to Malaysia to learn from arrogant and unprofessional Medical Personels like yourself. Sorry to say, but Russian Grads have sat for USMLE, PLABS MRCP FRACP and alot of other qualifying exams and they have passed currently practicing worldwide. I am sure you need intelligence but furthermore you need guidance as well. It is very narrow and shallow of you to stereotype us RUSSIAN GRADS. Russian scientist and Doctors have accomplished so much and are pioneers to so many medical practices that even YOU are using, by knowing people like you exist i am glad that i have decided to come to Russia and learn from pioneers themselves instead of un-innovative and just copycats. No matter how much a medical student studies, excellence comes in accordance with experience.I am becoming a doctor and not GOD, so please keep the hostility to yourself.
Everyone has weakness, I am sure you have it too, or maybe did you graduate from John Hopkins? i guess not but even then you need humility to learn or teach.
another arrogant medical student.. poor behavior.. poor attitude….
I think I’m just wasted my time to ‘enlighten’ a young russian medical student.
I am doing residency in US now and I do agree that I personally have met excellent Russian doctors – but all of them did not end up in Malaysia. I believe graduates all around the world (not just Russia) have sat for all kind of test but if we just concentrate on doctors in Malaysia (again not just Russian grad) – how many of them do you think can pass all these exams.
Lets be straight. No matter where you graduate, you can only be 2 kinds of doctor – dangerous or safe. I believe you can always catch up later on if you lack knowledge but first you need an appropriate attitude. It does not matter who you learn from – whether the smartest scientist or most innovative/most updated doctor, you first learn by copying. However, way before that – you need a good attitude.
I did not want to ask this question initially but – have you passed any of these exams?
And I am really offended with the phrase “No matter how much a medical student studies, excellence comes in accordance with experience.” – If you are really taught by good doctors, I think you have heard “eyes do not see what mind does not have”. You can’t talk about experience if your basic is…you know…bad?
Peace out
By reading through all the comments, I come to the conclusion that medical university in Ukraine and Russia do not provide clinical experience. I thought the normal syllabus is that 2,5 years at class lectures and 2.5 years at clinical procedures. What kind of doctors are those who come to the ward without any clinical experience? I knew a doctor graduated from Russia who did not know what is ’emergency plate’. Just imagine if a patient needs emergency treatment but the houseman does not know anything about emergency treatment cos never experience that in his 5 year medical training.
Please stop criticizing Ukraine and Russian grads. No doubt most of them are incompetent but overall quality of the HOs now are getting worse regardless where u graduating from. I had met the Local grads and overseas grads like Uk are incompetent and know nothing about the emergency aids as well, so what? We r worry about the overall quality, after all it is all about individual effort and passion if u want to become a good doctor.
what is an ’emergency plate’?
Is it some sort of local nomenclature?
I’ve never heard of it either.
http://www.thesundaily.my/news/179109
Some feedback from the public
I agree with PY that it is about individual effort and passion if one wants to become a good doctor. However, how would one become a good doctor if one did not learn at all about clinical procedures? Are we expecting the MO/Consultants to teach them from A to Z what is happening and what is being done in the ward?.For those UK based medical syllabus, it is half on theories and half on practical in the ward. So definitely they are exposed to all the practices in the ward, and if they are not competent than it is purely their effort. I never intend to criticise the Ukraine of Russian graduate doctors but pity them for the lack of training during their undergraduate studies.. ,
Hi there. It is a GREAT blog…Do keep it up!
Recently, I attended a medical related workshop in one of the most established local university.
During the seminar, one participant asked questions to the speaker. That was not during Q&A session. However, the speaker entertained her. What shocked me was the command of English this medical doctor has. Thus, it was not too surprising the speaker need to clarify the question asked…by breaking into few components. The doctor claimed the speaker didnt understand the question and tried to rephrase it…..and I could see friends trying to help the doctor in rephrasing the question.
Such episode went for for more than 5mins in the midst of presentation.
Finally, the speaker appeared to be restless and asked :” Cuba tanya dalam BM saje lah…”
It was meant to be a workshop in English given so many international students ( mainly from Iran, Sudan, Nigeria) taking part in it.
Ironically, international students are required to show English Proficiency as a criteria to enter the Uni…..while our own students may not even master that international language.
So, what will happen in years to come….since the science and Math are again taught in BM ?
I dah pasti….anda sudah ada jawapan dalam hati/jantung U….
I have seen even young lecturers in local uni who can’t speak proper English, what more a medical student. I have had medical students who answers me in Bahasa when I asked a question! And one of this person suppose to be studying in a branch campus of a foreign university! He even wrote his nationality as “Bumiputera”.
Its good to improve writing and speaking in English..but good in English doesnt mean a person is smarter or brilliant than someone else
When come to knowledge, a good command of the language is very imperative. You may be very smart but if you do not know the language that well, then I could not figure out how would you understand a certain subject. I heard straight As students who were sent by JPA to South Korea to study engineering are struggling to pass since Korean is not their first language. Most medical references are in English so naturally a smart student who has a good command of English would naturally becomes smarter.
Anyone can give me some suggestion? I juz finish SPM and i am interested to become a doctor. But i am worried about tis issue. Since there is a surplus of doctors, should i become a doctor?
Please read throu all my postings and comments in this blog. If you are choosing medicine for job guarantee and money then forget it! Doctors will become jobless soon.
Dear Dr,
My son had just finished his Cambridge A-Level Exam and result will be out late January 2012. He is pursuing medicine as his career. He has three medical universities in mind at the moment. 1. Yong Loo Lin School of Medicine
National University of Singapore 2. International Medical University, KL 3. Manipal Medical School, Melaka. Which one would you advice my son to enter to do his medic and why? Tq
Definitely NUS as it is more well recognised. IMU will be second but pls do the twinning programme rather than the local programme. If not Monash should be the next choice.
With future looking very bleak for doctors, it is better to do medicine in a well recognised uni.
Dear Dr.Paga,
I am a post A-level student who is thinking to pursue a career in medicine. However,I feel quite hard to make a decision since I already got 2 offers to do medicine : MbChB (Birmingham) and IMU twinning programme MBBS PhD (Sydney). I try to kind of look for some answers within this blog as well as the university’s website but still couldn’t find any. Dr.Paga, would you like to give some comments regarding these 2 universities and what is the future prospect I will have in these unis. If i were to choose the latter, is there any possibility that I can be a clinician and researcher at the time?
I can’t really comment about the situation in the UK, but I’d do well to steer clear of Australia, at least until the situation improves for international medical students (in terms of post-graduate prospects). Especially the IMU-USyd programme, which runs for 8.5 years (assuming you pass everything along the way). Nobody can really tell what will happen in 8-9 years time (that’s three Australian general elections by the way – potentially three different administrations and numerous policy changes). Who knows, the Australian government might shut its doors on foreign doctors by the time you graduate (2020 at the very least). I’m pretty sure you’re aware that Australia has seen an explosion of medical graduates over the last few years – so whatever applies for graduates today will most likely NOT apply for you.
If you are willing to commit the time and financial resources (and i can assure you they are quite substantial; I reckon USyd will probably hit 70K-80K AUD per annum by the time you transfer there) towards this cause, then by all means go for it.
Both uni are reputable unis. MBBS PhD is a research based degree where you go on to do PhD just after MBBS. Total may be 8-9 years. It is meant for you to become a researcher. If you still intend to become a clinician, you need to complete housemanship after that to even function as a fully registered medical officer. Specialising is another issue all together! So, do this only if you are going to be a reseacher.
Dear Dr,
You generous and kind advice has been very helpful. NUS is his first choice but the only problem is that an international student would be required to serve the Singaporean Government for six years after graduation. The rational is that the Government has spent huge amount of money as subsidy for tuition fees. It was stated that the annual tuition fees for medic course is S$124,280 or roughly equals to RM310,700, there is a subsidy of S$89,000 per annum, a student only needs to pay S$35,280 as tuition fees per annum. In UK, based on medical school website the current annual tuition fee is about RM150,000. Any comment? Tq
If you’re a graduate from Yong Loo Lin, you’re almost certain to enter the Singaporean system (ie residency) anyway, so I don’t see how the bond is disadvantageous in any way.
Agree with Huskies!
With such a good job prospect the bond is not a problem at all. I think the main problem for most applicants is getting a seat there, it is extremely competitive and foreigners are not so favored in their selection. My friend in YLL SOM told me that there are only 2 Malaysians in his batch, but in fact a lot have applied to it and some dint even get a chance to go for the interview after writing their selection test. Another Indian friend of mine was selected into the waiting list (ranked 2nd), but in the end still dint get a seat. (because NO ONE quit after being shortlisted!!) Just try to picture how competitive it is, however, no harm giving a try.
It is still worth doing it in NUS if you can get a place. There is no problem working in Singapore. They are all well paid. Most will not even come back.
To Huskies and Soulmate,
Thanks for the information. My son told me that it is easier to enter Cambridge University than NUS. However, he is giving his best to get a place there.
To Dr.Paga and Huskies,
Thanks for your comments and I know what to do by now!
Dear Amas,
All the best to your son and I hope he’ll receive the good news from Cam by 5th Jan 2012 (I’m one of the applicants as well). Do you mind telling me which college in Cam he applied to? Thanks.
Non-JPA Student,
My son did not apply for Cambridge University as we could not afford the tuition fee. for a medic course there. He received an offer to do Bio-medicine at Imperial College but he wants to do medic. As such he is pursuing a medic course at NUS but as Soulmate had said it is very competitive. Where did you do your A-Level? My son did his at Taylor’s College, Sri Hartamas Campus, KL. .
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