Two days ago, someone by the name of ThiruKCS wrote a letter to at least 3 medias, namely theStar http://thestar.com.my/news/story.asp?file=%2F2012%2F3%2F8%2Ffocus%2F10874444&sec=focus, Malaysiakini http://www.malaysiakini.com/letters/191405 and FreeMalaysiaToday http://www.freemalaysiatoday.com/2012/03/08/the-darker-shades-of-a-houseman%e2%80%99s-life/. I got no idea what he is trying to say and what is his intention but he sounds desperate!
I will say this again that if you want good, nonstressfull life, then go and find another job! Being a doctor needs a lot of commitment and stress management as life’s are at stake. If you can’t handle that, you can always quit and find another less stressful job. The last I can remember, housemen are doing shift duties now! so, if even shift duties are still stressful, then what does this guy wants? Does he really think that other jobs are less stressful and have better life? No doubt that the others may not be dealing with life but do you know how many hours an accountant spends doing accounts, a lawyer spends in preparing a case etc etc? Every job has it’s stress but medicine is different in the sense that it deals with life and since you chose this job voluntarily (hopefully by knowing all these before), you just have to go with it and learn how to cope.
There is no such thing as “office hour” job for a doctor. You need to make sure that every of your patient is well and properly managed before you leave the ward! That what makes you a good doctor. Of course, I am not saying that you should work 36 hours straight but working shift hours does not mean your responsibility is less! The stress of doctors only increases as you go higher in hierarchy as the responsibility increases. And don’t forget the litigation rate and lawyers ever waiting to sue you. BTW, where did he get the figure that 60% of housemen are having psychiatry disorder? That means 6 out of 10 housemen are mentally ill!! That’s scary. Are these the people who are going to treat us/public in the future?
BTW, this guy has just come up with a new theory for a cause of Cushing’s syndrome: Housemanship. So, medical students can now put this as a differential diagnosis. “Medical studies have determined that stress causes our bodies to produce more Cortisol. This “stress hormone” is normally only released into our bloodstreams in emergency situations. When we become scared or excited, Cortisol is flooded into our bodies to help us deal efficiently with the situation. Too much of this hormone in our bloodstreams can and does cause adverse health conditions. These conditions can include, but are not limited to, cardiac problems, strokes, obesity, a lower immunity system, and insomnia” WTH!!
So, for those who intend to do medicine and expect a good job, good life, good future and good money, please think again. It is people who have this perception who end up writing these sort of articles to newspaper and making a fool out of themselves. This was one of the purpose of this blog, to educate the youngsters about medicine and being a doctor.
THis was one of the comment that I just received in my blog yesterday, by a housemen: “I realize that quality of doctor are dropping. Compare to senior 2-3 year older than me, i can see huge different between us. For example, during their HO time, maybe just 2 HO allocated in one 30- 40 patient ward,during my time it is 15 HO per ward. So, training is lacking.
Then, we also realize that our future was really unpredictable. After you complete your housemanship, where will you choice to go? I also find out that majority of the doctor will choose field which had relax life, they don’t mind to be a chronic MO, such as at KK, district hospital, or some posting with no active call like ENT, radiology, pathology, opthalmology, psychiatry. So, these posting become hot posting when it come to the time to apply as a medical officer there. When these posting are full of the chronic MO, then, it was a bit unfair for those who really had interest in the field and plan to be specialist there, because when a department is full, you will had to go to other department which you don’t really like.”
Asta Levista babe……………………………
The darker shades of a houseman’s life
–>March 8, 2012
FMT LETTER: From Thiru KCS, via e-mail
Lately, there has been a lot of discussion on the plight of medical house officers in our country who are compelled to work long hours uninterruptedly. The most important asset of a country is not its natural resources, but rather its human resources. This is especially true in a knowledge-based economy, which, of course, will be the trend in the future if not already the trend in most of the Western countries. When noble professions are ever discussed, the first that comes to mind is none other than medical doctors. The big unsolved question is that are we giving enough importance to this profession?
Stress and burnout are concepts that have sustained the interest of house officers and researchers for several decades. These concepts are highly relevant to the workforce in general and house officers in particular. Despite this interest and relevance, the effect of stress and burnout on patient outcomes, patient safety, and quality care is still at the tip of the iceberg when it comes to solutions and action plans.
The Employment Act 1955 (EA) mandates that overtime pay at double the normal wage-rate and triple the normal wage-rate must be paid when employees work on rest days and public holidays, respectively. I’m aware that civil servants do not come under the purview of the EA; and doctors, housemen and the medical fraternity in government service are specifically excluded due to “work, the performance of which is essential to the life of the community” [EA Section 60A (2)(b)]. It’s almost absurd when authorities are convinced that they have looked into the matter by comparing the improvements introduced from a decade back. The issue that crucially awaits justice is what could be done to further improve the lifestyles of these house officers.
The utmost important issue to be addressed over here, apart from the payments and incentives which has always been debated despite the rise in the cost of living is the quality of life that these house officers lead in their daily lives. As the flow of life force energy moves through the physical and emotional bodies, it can become imbalanced or blocked. Although the hazards associated with the prolonged hours worked by resident physicians and house officers have been documented in numerous studies, limited attention has been paid from the administrative point of view on how to curb this issue. It’s distressing looking at the rates of house officers that seeks for psychiatry consultation at an alarming 60% in total at year 2008. Is this the kind of situation that we anticipate being healthy for these group of professionals? I can safely call this a crisis that screams for immediate remedy!
The development of trust in the physician leads to a proper patient-doctor relationship and is part of the healing process. A major element necessary for patient trust is with an individual whom is able to respond to the patient with focus and diligently gather information from the slightest reactions exhibited by the patients; and this in no doubt is only possible when your mind and body is in synch. How would you even try to develop this professional relationship with your patients with these factors; red, puffy eyes and a haggard appearance, lack of mental clarity not mentioning your aching physical body!
Medical studies have determined that stress causes our bodies to produce more Cortisol. This “stress hormone” is normally only released into our bloodstreams in emergency situations. When we become scared or excited, Cortisol is flooded into our bodies to help us deal efficiently with the situation. Too much of this hormone in our bloodstreams can and does cause adverse health conditions. These conditions can include, but are not limited to, cardiac problems, strokes, obesity, a lower immunity system, and insomnia. An overworked house officer is prone to make unavoidable mistakes that would simply cause the lives of their patient not forgetting a huge blow to their career.
Based on current empirical evidence on stress and burnout in house officers, it is highly recommended that these issues are looked into precisely to enhance patient safety. May the relevant authority ensure that these public service doctors are happy and capable of providing the best service to the nation. So to the powers that be, wake up and smell the coffee.
Pagalavan's Avatar 
I think the complainer’s intention is to release stress by complaining and thus improve his fiction essay writing skill. The rates of house officers that seeks for psychiatry consultation is 60%, I think it means that vast majority of HO are stressful >50% and prone to seek for psychiatry consultation but not already sought for it.
I do believe most of the students study medicine for a good life , a good name and a good pay.These “motivations” may not be strong enough to help them overcome the trials and tribulations of housemanship.
I am a student studying in 1st year at Monash University Sunway Campus, and I can see that many of my course mates are really taking medicine for the sake of ‘good job, good life, good future and good money’… for example, in a recent lecture, the lecturer asked us who came to do medicine to make money? And guess what, more than 90% of the class raised their hands… oh my goodness, I really have no idea what I can do to help them realize the cruel reality…
As I said, majority do medicine for these reasons and that is what makes them to write like what this guy has written and majority who develop psychiatry disorder also have the same perception about medicine. Most self paying Monash students are from rich family and surprisingly, most of their parents are not doctors!
glad that i just deal with the oral cavity…
Dear Dr. Pagalavan, this issue has been very well discussed in the past. I am becoming sick of it. One thing that I gathered through reading your blog is your attitude. You said this a lot of times ‘if you want a stress free job, you should quit medicine!’.
FOR GOD SAKE NO, i am not quitting medicine just because it is hard. I am not giving up my passion just because things cannot be changed! That is rude and stupid to say!!! I believe there are people who become a doctor because they want to help others, but the horrendous working condition had failed them miserably. I believe doctors like you from old school system should change your attitude and should support the young doctors who seek betterment in working condition. I totally disagree with you when you said ThiruKCS sounded desperate in his letter. Again it is rude, outrageous, corrupted-minded and displays your disagreement with free-speech and pressure-free discussions.
I believe there should be a massive change and overhaul the way medical services are delivered in Malaysia, and you should hv the attitude where ‘let the long hours, heavy work be the thing in the past and make medicine this day more enjoyable, liberal, professional, full of passion and fun’. Just because you worked long hours in the past, that doesnt mean we the new doctors should do the same. And that doesn’t mean, we will be less of a good doctor either. Things change for GOD SAKE!!!!!!! If a vespa scooter was relevent in 1970’s and big boxy NEC phone in 1980’s, they are no longer relevent in 2012 as we now have alot more technologies that make life simpler and easier. Just because you had them, that does’nt mean we want the same. We want things that are improvised, researched, studied, current, fun, practical and relevent!!!!!
Doctors in the UK and European countries are progressing well as the systems are becoming much more organised. They enjoy doing what they do, they have more time to talk to patients and embrace the true meaning of being a doctor! Yes NHS now is having a lot of problems (with all the new bills and stupid proposals), but doctors’ welfare still remains a priority. There are a lot of public talks and discussion taking place between senior medical staff, politicians and junior doctors. The debates are always healthy and dynamic and fuelled with desire to change for the best.
Junior doctors in the UK have a union that protects their interest. Our medical colleagues in the UK have more time for their life and family. They have plenty of flexibility, they can have a career break, they can opt for less-than full time training, get paid for study leaves and to attend courses, have time to travel around the world and gathered plenty of medical and non-medical experience. At the end of the day we should remind ourself, we dont live to work, we work to live, and there are other things equally important in our life. If you die at the age of 60 and had dedicated 35 years of your life being a slave in KKM without much time for other things, don’t you think your life had been rather PATHETIC??????? FOR GOD SAKE YOU LIVE ONCE AND SHORT, surely you want to do other things too. I became a doctor because i want to dedicate a portion of me to patients, equally to my god, to my parents and to myself. I enjoy travelling, back packing in Australia and working in the rural area. I also intend to take few months of career/sabbatical break and work as part of a voluntary mission in Africa or Cambodia with MERCY MALAYSIA, training for marathons, doing research and many others.
Yes you can be a well paid consultant with hundreds of publications, with worldwide peer-reviewed researches, but if you dont achieve other things in life, don’t you think you should consider yourself as a boring, and sombre person with a pathetically mundane life ??? (yuck). But if you enjoy what you do, then carry on, I am not like you and I ain’t interested!!!!
I used to work with few brilliant old school consultants in the UK, one of them qualified in 1974 (so you can tell he’s old, still working at the silver age of 60) but he never moaned about his junior doctors, he never complained how hard he used to work, and how lazy junior doctors these days have been etc. He guides them through, he supports them. He criticizes, if there is something the junior doctor had done wrong, he will take him to a side room, and give comments about the attitude and what should be done right. No shouting across the ward etc.He never mentioned to us about his 89 hours oncall shifts etc. He always put a smile on his face and says ‘be gentle to your patients, take your time and be effective’. Junior doctors complained for being put in a difficult positions without appropriate senior cover, he intervened and the case was brought to directorate level, and things changed. He didn’t get back to us and say ‘suck it up you wimp, I worked harder than you do!’ No he never does that!!!! There was a day when his junior team members happened to be oncall, so he continued on doing his ward round alone and took bloods from an unwell patient himself. This is the guy who had garnered a lot of experience and worldwide recognition. yet he remains humble and awesomely cool!!! The point here is be humble although you are old and experienced!!
Just because you undertook loong hours of oncall and underwent miserable work experience in the past, that will not guarantee you to become a great doctor all along. In the UK, I observed there is an increasing number of young counsultants in their 30’s who are very confident, opinionated and radical. They practise evidence-based medicine heavily and they can take on their senior coleagues like a piece of cake. They are not easily intimidated by those old consultants. Hands down to these medics who proudly label themselves as ‘brand-new consultants’!!
Doctors nowadays should be treated just like other PROFESSIONALS, and they should be perceived as a PROFESSIONAL! We should be equally protected by labour law. If Malaysia doesn’t change, believe me we will be left behind, when medicine in other countries have glorified so much. Malaysia is at risk of massive brain drain and remains stuck where it was tens of years ago. I’ve come accross in your blog where you suggested ‘if you not sponsored to study medicine abroad, don’t bother coming back to work’. Pardon me, you kidding me? That’s again a rather short-tempered, corrupted, poorly-sensitive and ill advice to give to those who genuinely want to work in Malaysia. They just need to be given a chance to change!!!
Cut the craps, shut the non-sense, kill the politics, f**k the old mentality, and for a moment, LISTEN TO WHAT WE SAY, AND WHAT WE WANT, AND WORK IT OFF!!!!!! We are not lazy, we just happened to enjoy our life!!!! Just see it this way, we are different sets of doctors, you do what you like, and let the young doctors make medicine in Malaysia safer, more fun and ejoyable! ditto
I’m sure after reading this comment you will say ‘oh look, there’s another lazy bastard, opinionated, highly-motivated, self-eccentric, self-rightoueos, young doctor giving unrealistic suggestions’. Believe me I don’t need the spotlight here, I just want to enjoy a low-profile but fun life experience. I want the opinions to be heard and shared. No matter how unrealistic you think it is, the change should start somewhere sometime soon, and we should make every effort to support it. Im sure this discussion had taken place within medical fraternity in the US/UK/France/Germany in 1980’s but look where they stand now. If we continue to ignore, the medical climate in Malaysia in 2020 will just be like those in 1970’s except there will be modern equipments which we buy from other countries anyway. Now I’m laughing coz I’m rambling like a mad cow. Take care xx
R.I.P. PC Rathband
Jessica Sanchez
Straw Man Fallacy
While there is a tendency to glamorize/glaze-over events of the past (ie. The “good ol days” fallacay), what Dr Paga blogs about does reflect the scenario on the ground. You have not really responded to his critique/opinions. A few ad hominems and straw man deconstructions mean nothing.
Dr Paga has blogged about:
1) A decline in the quality of students graduating from medical schools due to the privatization of the med-ed sector.
2) The low pay and ineffective doctors union (MMA) who cant lobby for excrement.
3) The unethical working hours in Malaysian hospitals.
The funny thing is, you seem to agree with all of the above.
Dr Paga is doing what should be done… Shouting loudly and making known what plagues the system. What would you rather? Leaving all to your civil discussion via the MMA? Do you really think that would achieve anything? Do you think that has not already been tried?
So yeah, I hope this blog continues to do what it does… stirring up discussion and debate and increasing public awareness. It’s the first step to change, and Dr Paga is working hard to that end… even spending a considerable amount of time replying comments and maintaining the site. I maintain a site myself and it’s not easy…especially when working fulltime.
I am a doctor to and I have just about never finished on time. Love the work though. Never complained. So yeah, I guess it’s all about the individual. But my point is… regardless of what *you* are like, the issues (#1, #2 and #3) highlighted by Dr Paga affect the medical fraternity as a whole and there is grave need for more public awareness about this. Awareness is the precedent to change.
Dr Crunch.
Wah, that was a long rant!I presume you really do not know me personally and I am also not sure whether you are in UK or Malaysia? Yes, I will say this again ” if you can’t handle the stress of being a doctor, find another job!” I am sure you are aware that since September 2011, housemen are doing shift duties (except for some hospitals). So, why is this guy still saying that he is stressed to the point of needing psychitaric help and developing Cushing syndrome? FYI, I am not just talking about long working hours(which I DO NOT agree either!!) but the stress of the entire medical profession. I was the SCHOMOS Chairman of Johor for 3 years and National SCHOMOS treasurer for 3 years. I fought for the betterment of the medical profession especially housemen and junior medical officers since I was a medical officer!.In fact the promotion that the doctors are enjoying now were single handedly written by me n 2006 and handed to Minister of Health on behalf of SCHOMOS. So, don’t tell me that I have not done anything!! You can ask any housemen who have worked under me and see what they say. You know how many people I had helped? You know how I brought the issue of poor housemen “call” rooms and got it rectified with new airconds etc in early 2000 in JB? If you don’t know me personally, pls do not throw your own judgement. The SCHOMOS HO handbook which was published in 2009 was also single handed written by me in 2007!
As a government servant, you have 25 days leave in a year, 2 weeks unrecorded conference/study leave, unpaid leave and various other benefits. So, who said that you can’t take leave or travel when you are doctor? No one works till death( even though I know a few). It is all about how you manage time and do your work such that you finish everything in time. When I was a housemen,I will always finish whatever task given to me by 6pm everyday, including discharge summaries. So, if I can do it more than 15 years ago with much more smaller number of housemen, why the current generation can’t do it? The patient load has always been the same. In fact the number of private hospitals were much less than.
To me it is very simple, as you said : attitude!! the current generation of medical graduates are only interested in enjoying life , get good money but not keen to work! This is not just for medical field but you can ask anyone in any other field and they will tell you the same thing. Blame it on our education system or our poor quality control of graduates. If people who can’t even speak a sentence of English can graduate as an engineer, what more can you say about our education system.
Now, coming to your comparison with developed countries. Firstly they have a completely different healthcare system. They have a very strict entry qualification to do medicine and their respective medical councils are also very strict in monitoring their doctors. Incompetent ones can be removed much more easier than in Malaysia. In Malaysia, incompetent ones can still get the same salary as you but do not do any work! The only way the working condition will improve in Malaysia is when there is a complete restructuring of the healthcare system which needs a strong political will which I dont see it coming anythime soon. Till then, you just have to live with it! If you can’t cope, you can always leave, that’s what the administrators will say. Our government’s mentality is always ” you tak suka, you boleh keluar”, trust me I have talked to these fellows long enough !
There is nothing great of being a professional! It is just another profession to earn a living as you have rightfully said. I have also said this in my blog elsewhere but trust me again, there is NO money in medicine anymore. For those who enter medicine to have good job, good money, good life, you are sure to go into depression and seek psychistry help. And of course, writing letters to medias which is NOT going to change anything. IF you want change, firstly, you must be competent and hard working. Then get together and fight under 1 umbrella. At the moment the only option is via MMA. How many of you do that??? rather than ranting away……….
Yes, if you are self sponsored student overseas, don’t bother coming back before finishing your postgraduate. Here is an example of an email which I just received last week:
I am writing to seek some light from you. Till now I cannot understand what political health system that our big boss in ministry running. And I myself one of the victim.
To start, I was fortunate to study overseas and then completed my internship abroad in ireland. Decision to return home was a big headache for me as people say lot of things happen in malaysian hospital. But, after thinking back, I take this as a game. Partly, thanks god I has my part 1 mrcog before touched down our lovely tropical land. Also, I received a call from local university to be a trainee lecturer as i am really interested in teaching.
After whole lots of interview, I was shocked that a stray ” pekeliling” come out to hold any intake for staff in academic position. Then, i discussed with respective university and head my way to finish my so called ‘ obligatory posting’ for a year.
Then, problems arises. I applied with KKM and was safely guarenteed housemen position in one of the craziest hospital in east penisular malaysia. So call shift system is not working properly as number of housemen still unequally distributed between department. Even, after postcall, We have to help in theater with half eye closed. Mentally tortured, shocked with our native culture of teaching, I then say that I have to do something.
Then, I resigned and head off to ireland for interview. Unfortunately, my registration in ireland delayed because i applied late and I miss some of the jobs.
Now, I back to malaysia, waiting for “contract” job from KKM. And again, this funny this happen at KKM for my application.
MMC approved my full registration but with “obligatory posting”. Even, the head of MMC has said that my previous post as HO in malaysia was a mistake because this ” obligatory posting” is MO post. My provisional registration form was drawn as I actually should be registered under full registration.
Because of this confusion, KKM boss querry about my status and asked MMC to clarify whether I should be given HO or MO. I don’t know till now who will win ( will inform you who win) . It’s so funny that this technical things happen, and my application for contract job is running over two months and still processing.
What frustrating me is that this is not the first time, but when I worked for few months as HO, MMC called me saiying that they got mistake with my post. What on earth.
And now that I realised this is Malaysian healthcare politics. Rules are being revised every seconds, and funniest thing is that the statement made always ambigous. Even the new SBPA etc, all give ambigpus statement and when probs come, no one can solves and let it float till rotten.
I just want to get your advise on what should I do for my future. It seems that I can’t take my part 2 mrcog after 4 years due to this issues and my period of unemployment. So sad even part 1 mrcog cannot be a ticket to be trained for this specialty in fast tract, or at least doing so called ” obligatory posting or compulsory posting” in O&G dept only. How come those who hold O&G training book can stay in paeds dept? Forget about MO or HO. I know I resigned from gov and have to apply contract job, but they don’t understand that I am willing to step into any dept even with HO post for MMC requirement just to save my time for part 2 .
This is Dr Paga’s blog and he is free to say what he wishes here. I believe what he says and I think his efforts are sincere and very helpful to those wanting to be Doctors. I do not know of anyone is sincere as he is. Does anyone here notice that Dr Paga answers all questions posed to him?
An accident victim does not choose when the accident is to happen to him and what injuries he is to get. Jessica Sanchez is implying that for these cases and other similar urgent cases, the attending Doctor should have a nice working environment that is stress free and he/she should be on par with other working professionals and enjoy equal protection under labour laws!. Accountants don’t face these life and death situations, Doctors do. How on earth can a Doctor be treated the same with an Accountant? No stress when attending to a serious accident case? Accident case enjoyable and fun? Let the patient die, I need to go home as it is 5pm already! No long hours for me mate.I’m from the new school and I want to enjoy life!
My ex classmate recently told me he worked until he fainted! and he’s doing his residency in the US! Gosh, these “new age” Doctors are really something. If these new age doctors want to enjoy life so much like other professionals and not make sacrifices, maybe society should not call them doctors anymore. Let these new school doctors be on par with the man on the street.
Dear Jessica Sanchez,
Yucks? F**k the old mentality? Good lord, I hope you don’t speak the way write.
Anyway, back to the issue at hand, indeed the old school consultant with worldwide recognition you mentioned in your lengthy letter does sound like a humble sort of fellow. Though without a name, we are really not sure who you were talking about.
But, what about you? ARE you a humble doctor. I failed to detect any humility in your letter. You called Dr. Pagalavan’s words as being rude, stupid, short-tempered, corrupted, poorly-sensitive etc, in essence accusing he himself of having the same attitude. Evidently your senior consultants in UK failed to imbue you with any sense of humility. And I doubt you personally know Dr. Pagalavan or had worked with him. Do you even know what kind of physician he is? How is he with his patients? What the patients think of him?
What about you? What kind of doctor are you? What do YOUR patients think of you?
Indeed life is short. And in that short time you can’t possibly do everything you want and excel at the them. Definitely everyone want a fun and all-rounded sort of life. But excellence comes at a price. If you haven’t heard of Malcolm
Gladwell’s 10 000 hours rule, this is a good time to go and read it.
When you are dealing with patients, all they want from you is to help them get well. Frankly they don’t care if you went back packing in Australia or scaled Everest.
I wish you have written to tell us want kind of excellent doctor you are and all the good things you did for your patients. But all we read was you travelling, back packing, intending on marathon etc.
Finally it’s not “cut the craps”, it’s “cut the crap”. Craps is a dice game.
Hello fellas,
thanx for responding.
Few things:
1) when I said ‘you’, I didn’t mean Dr. Pagalavan personally. I was referring to those old senior medical staff/managers/directors/KKM bosses, who don’t listen to what we say.
2) I agree with Dr. Pagalavan, those who do not qualify should not be allowed to continue on to be a doctor. Thats why a nationwide guideline should be produced on how to assess junior doctors, and how to allow them to progress in their career. At the end of the day, we need to be appraised regularly and this should be as objective as possible. Doctors again should be allowed to compete to get the best job in Malaysia (ie meritocracy). Jobs should be ranked, the best academically / performance wise, deserve to get jobs in big cities like KL, JB, Penang etc. Those who just made the cut, can do KK job in Palong for example. Again this needs a lot of commitment from senior managers / pen pushers / decision makers within the ministry. Thats why I said WE NEED A RADICAL CHANGE and OVERHAUL!!!.
3) I think we should initiate a union for junior doctors, Probably we should invite all junior doctors in Malaysia to attend our first grand meeting? Or may be we can take over MMA and revamp the whole thing? Isn’t that great? or too ambitious? But what if the old chaps want to stay at the top of hierarchy? don’t you think there should be an open competition to allow the young doctors to take on the elderly? (OK now I’m talking crap although there’s a little hope there)
4) When I rambled, why do you want to know what I do, how well have I done etc Can you just not listen to what I say? Or you will only listen If I have published 50 articles in British Journal of Cardiology is it? Sooooooo pathetic. I agree I’m the not the cleverest cardiology trainee in Harefield Heart Hospital nor cardiothoracic surgeon in Papworth Hospital, or the best paediatric surgeon in the Great Ormond Street Hospital, but I feel I am still a good doctor. Patients appreciate my presence. I changed people life, thats what matters. Consultants give me good reports. I finish jobs on time. At least I havent killed a patient, at least I receive cards and chocolates from thankful patients. Opps I forgot to put MRCP at the end of my name, but to be honest thats not necessary cos nowadays everyone has them, and it is not hard to get afterall. I am not going to put myself down, nor to be intimidated by you SPEEDY GONZALES who is rather interested in knowing me and my reputation. Coz I know I am worth it (thats soooo cosmetic adverts you remember?) Seriously, why do you want to check my integrity to approve what I say??? for god sake this is not a literature publication duh. and also very busy-body lerrrrrr
5) WHen I said shorter / safer working hours, that doesn’t mean you strictly work 9-5 and if theres cardiac arrest at 4.55 you should leave bla bla bla. According to GMC, patients safety and hospital cover is the main priority, should there is a gap in rota it is the doctor’s reponsibilty to fill. If you get called to see your sick patient at 5.15pm, YOU SHOULD NOT LEAVE THEM TO ON-CALL doctors, and you should sort them out and do proper handover after initial assessments and treatments, and only leave after patients have been stabilised. This is what I meant. why you so rigid and so tunnel-viewed?????? (hello GuestPJ please get this right)
6) I love travelling, I enjoy working/traveling trip, run 15 miles a day etc What’s the problem with that ? I can still look after the acutely unwell, I can still revive patients heart, I can still lead MDT meetings, I can still speak to family about their concerns. So it doesnt bother me. There are doctors in Malaysia who are fake and so kiasu for god sake. please get a life. Not too mention those who talk alot infront of the consultants to impress (i.e ass licking). There was one day during a ward round 3 MOs and Specialists argued with each other just to get their points right in front of patients. I feel embarrassed that I had to stay shut and continue writing.
7) GuestPJ, have you worked in the US?? Do you know how amazing their system is? yes they work long hours, but they purely do doctors stuff. their consultants demand them to do a lot of research, plenty of exams to undertake etc Basically in America it is an open market, you do well you will get a job in Mayo Clinic, if you dont you end up somewhere boring. Doctors in America don’t usually do bloods, paperworks, and all those tiny trivial jobs. They have plenty of nurse practitioners / specialist nurses. They don’t need intensivist to intubate, nurse practitioner can do them. Doctors just look at the result, obtain history make diagnosis and plan treatments. Isn’t that cool?
8) Again speedy Gonzales what’s the matter with you being grammar conscious? Are you a walking thresaurus or somethhing? Now why dont you just cut the whole thing I said, rececck thegranmnmar and wordss andd correcttt them, thing ive made a lot of mistakes opsieesss
tara now fellaas
JessicaSanchez MRCP(UK)
You seem to be shooting all over the place without a proper direction. If you want to change the system, go ahead and proof it. Why you can’t set up a junior doctors union as you have mentioned? Anyone who has a will can do it. I tried my best during my time to change the system and I must say that the system is just too screwed up for it to change. With the deteriorating quality of doctors being produced now, I don’t think it will get any better. The current generation just don’t want to work but yet want comfortable life and money! That is what I am talking about in this blog, to create awareness before these people jump into doing medicine as a glorified profession.
From my years of experience and taking care of housemen, the housemen who needs psy help, complains about stress etc have few things in common:
1) not interested in medicine but family forced him
2) didn’t know being a doctor is this tough, assumed that he can become a GP instantly. Sit in clinic and see cold cases, never thought of ward work
3) from “manja” family background
4) thought can work office hours and earn big fat money
5) glamour
6) some even thought that they can become instant surgeons etc after housemanship!! and go on to earn big fat money.
7) thought private hospitals will pay you RM 50K per month…………
I think I have mentioned this all over the place in this blog. You should read all my post again.
So, I will say this again that if you can’t handle the stress, quit!
LOL I did realise I was rambling like a headless chicken. I dont think we are talking at the same level. Let me tell you my POV:
-Mental health issue is becoming a recognised sickness syndrome among medical professionals, and it should not be ignored. These doctors should be supported
-Among those who seek psych review, I dont think ALL of them have the issues you mentioned above. Although there seem to be a logical explanation to say so, I believe it is wrong to make such generalisation to relate wimpy doctors to mental health disorders. There should be a proven study to support your point. I suggest if a study is to be undertaken, these parameters should be determined: SPM grades, pre-med grades (Alevel, matriculation etc), Universities attended (grouped into Malaysia – private versus govt, UK, US, Australia, India, Indonesia and RUssia / Ukraine, and Sponsorship status as well pre- (medical) course perception of being a doctor.
– Those needing psych review may not be physically and mentally prepared to work as a doctor. And if necessary they should be deemed unfit to practise, henceforth be medically retired if patients safety are put at risk.
– I agree there is a rapid deterioration in the quality of doctors these days. But this is multifactorial!
-Those who don’t fulfill the merit to be deemed competent, should not be allowed to progress, hence there is a need to do regular appraisals on these doctors (again realistic and current standards should be set and regulated, not comparing now with those from 30 years ago!!)
– Put the above group aside, there is still a high number of doctors who hasnt gone that mad but still feel the stress and difficulty to cope. Myself for example. There is a huge group of doctors who excelled in SPM, got good grades in matriculation or A-level and qualified from top unversities in Malaysia/Australia/UK but still struggled to work as a junior doctor in Malaysia. I dont think I fancy big money, I did not think money as the main motivation (although I felt there is a higher job security in medicine), I just wanted to do medicine because I enjoy it (and also Im really crap at math / physics and other thing). I drive MyVI and am happy with that. But I couldnt spend time with my family, I couldt do things outside hospital, I couldnt even find time to do an audit/research. I need my regular gym sessions, I need to do my regular runs, I need to pray. My quality of life just deteriorate so rapidly that I felt this is not right. I just feel lost as to what I want to achieve in life. I want to be a good doctor, but also I want to be a good daughter/son, be a good husband/wife, be a good mother/father, be committed to my religion, and be healthy and fit as a fiddle. With all this busy commitments, I fear to lead a sedentary lifestyle and have layers of fat around my belly as I grow old.
-ThiruKCS for example, can you tell whether he is the psycho doctors with wimpy attitude? or he is one of the doctor who feels he should enjoy medicine, but its too hard as it is compromising his personal life?
-When you said doctors these days are too manja to do anything, I think you should be more guarded in making such suggestion coz it might not be true, and your opinion could be possibly falsely grounded
-What I fear is you came to such a conclusion because you underwent a tedious medical training in the past, and doctors these days should be put through the same, and those who can’t, will be labelled manja. Things change worldwide, standards are revised all the time, hence standards used in 1980s are no longer relevent now, sorry to say!
Jessica Sanchez
FYI, the standards of medicine is the same since 1980s and has not changed. Only things that changed was the technology that are being used to diagnosed diseases. IN fact this technologies have actually increased the workload of a doctor as they are under more pressure not to miss anything! When did I say that doctors these days are manja to do anything? I just gave some examples of why some doctors are unable to handle stress, from my years of observation and communication with my psychiatry colleages. Of course you can always do a study to prove this and I can bet you you will find the same answers.
The more tedious training that you get, the better you will become! and this is just NOt for medicine but for any other field as well. When you start a working life, there are many sacrifices to be made, no matter what field that you choose. Do you seriously think other profession got no sacrifices ? BUT in medicine, your sacrifices are more and will affect your family lifes etc. BUT, no matter how busy you are, there is always time for recreational activities, it is how you manage your time that matters.
BTW, you are too idealistic. Do you know how many doctors have been diagnosed to have manic disorder etc but still treating patients in Malaysia? That’s how screwed up our system is. There is no way any action can be taken to incompetent doctors as it is dificult to sack any civil servant.
Dear Sanchez,
I am working in US and just want to correct some of your point 7-
1) Doctors in US HAVE TO DO PAPERWORK. probably most of all the countries you have known due to the litigation problem.
2) WE DO PROCEDURES. What good are doctors if they cant be better than Nurse practitioner/specialist nurse in these skills?You DON’T DO THEM if the NPs want to learn but if ALL ELSE FAILS GUESS WHO DOES IT
3) About America as an open market, uhm…that is partially true. If you get tons of publications and good exam results you are as competitive as an American graduate from a good med school without any publication.
I am in my mid 20s but I enjoy my life working in the hospital. I don’t think that is something that is pitiful especially you can make a difference.
And your point 6 is really…pointless…
Peace out
Such a tangential train of thought.
Deserves a psych referral IMO.
Am I the only one who seem to agree with JessicaSanchez here? Especially the part about mental health problems among health practitioners which are getting worse by days. I hate the fact where doctors with mental health issues, aka “psych” issues are being labelled as “weak” which most of the time, it is not the case. The underlying cause of it will be its stressful environment without adequate support. In Australia, there are so many health lines where you can seek help from if you are down with mood issues, ie bereavement, feeling depressed, lack of motivation etc and they are all private and confidential and FOC. They treat doctors as valuable assets hence trying their best to protect the best brains in the country. And, I think if you move all Aussie doctors to Malaysia, all of them will be really depressed because of the crazy working hours and lack of remuneration. (hence why so many of us will never come home)
By the way Dr Pagalavan, I do not think the author is writing here to complain about the stressful life of doctors. He is trying to highlight the fact that the mental health issues among doctors in Malaysia are in fact, alarming, and something has to be done down the track or we will have sick doctors treating sick patients. Not a good sign.
I am not saying what Dr Pagalavan stated here is wrong. This is the Malaysian system, if you are stuck in the system you just have to live with it. And I cant help to agree that the system is so screwed up that it is hard to implement changes anymore.
Dear PGY1: You do procedures but I bet you dont need to do it on every single patient on every single day, in contrast (i think) in Malaysia you have to do it on every patient on every single day, what a waste of time. America is definitely an open market, hence you are there, not in Malaysia. You enjoy working because you can see a tunnel of light in front of you, ie, you will be board certified at the end of your training, and while you are in training the remuneration is not too bad. You know you have options. And everywhere in the US is probably good to live in, not TOO rural. In contrast, some HOs and MOs in Malaysia do not see a tunnel of light in front of them, the Master application success rate is slim, and if you are of the wrong skin colour, even worse.
Dear Mint Berry Crunch: I presume you are working in a regional area in Victoria (correct me if I am wrong). You never finished on time, I also never finished on time and I also never complain, it is pretty enjoyable when you manage to sort out of patients and go home without having to worry about them. But I guess the difference is the remuneration which is tolerable (and of course you enjoy your job) whereas in Malaysia, try working like 80 hours/week and get paid in peanuts, with uncertain future/master applications, it would be really difficult. Hence I do not think it is appropriate for you to comment about JessicaSanchez tangential thoughts, lol.
Dear light of ambition and peaceful: In Victoria, the selection of internship is by merit, as a result the better scoring doctors ended up in those popular big cities, and the lesser scoring doctors ended up in regional/rural, with the exception that when a doctor him/herself opt to serve in regional/rural area. So yea, at the end, the serving doctors in regional/rural area might not be the best scoring doctors, but heck, they are still damn good okay! They were all ducks in highschool and year 12! So yea, I agree that the top doctors should be given priority to choose where they want to go to, afterall the cities are where the tertiary hospitals are. A Prof who can perform YAG laser treatment for Twin to Twin transfusion syndrome would most probably have his or her practice in London. And who should be the apprentice? Of course some top scoring doctors la! And where would they get trained? London, of course, not some small regional random hospitals.
Actually, based on my info, the number of housemen seeking psy consult is NOT as high as this guy has mentioned (60%). He is just trying to exxagerate the scenario. The stress level for housemanship has always been high since those days but how come the same situation of psy disorder did not happen then? Is it because the older generation were able to handle stress much better? When I was a HO more than 15 years ago, despite a more hectic life then, only 1 housemen had to be sent for psy consult!! This was simply because, the guy was not interested in being a doctor but forced by the parents. In fact when he could not cope, his parents came to see the HOD and requested to be exempted from calls!! THe HOD ask them to fly kite and to resign. Finally he dissapeared.
Now, we have surpluss of housemen, better salary and doing shift duties BUT still these guys are complaining. What more do they want? You will surprised how many of these guys are doing locum outside at 24hr clinics!
Queen, you are reaffirming my point – there needs to be more awareness about these issues. I want the situation to improve in Malaysia as I do intend to come back one day.
The selection process in Victoria offers strong priority to locals – non-citizen/PR graduates are only considered after all locals have been offered a place. Simply did not know at the time that the situation was so bad (international students to places available were 4:1) and applied to fewer hospitals than I probably should have. Got a call first thing in the morning on the day that the deadline for the locals to accept their placement expired. Not my first few choices (it was in the middle of my list), but had lots of friends working there and feedback has been good so I happily accepted. It’s been great so far =D both in terms of experience and teaching culture on the wards.
re: Renumeration
I agree with what is being said by Queen and
I dont know what the current cost of living is in Malaysia, but wages should be adequate for a person to cover cost of living + mortgage. ie. doctors should be able to live decently and afford to own property.
Wages may be comparatively high in developed countries, but once mortgage is considered, you realize that it still takes a good deal of work to have a comfortable living.
Putting things into perspective, a salary of AU$4500/mth sounds like a lot, until you notice that median house prices in most suburbs cost north of AU$500,000. Also, the prices for goods and services are exponentially higher due to the high minimum wage (at least AU$/17 per hr to flip burgers at McDonalds) and trade unions. Getting someone to fix up your phone wiring for example can easily run into the hundreds for a simple job.
The more egalitarian a society becomes the less disparity there is income wise amongst blue and white collar workers. Hence, the status of doctors is pretty much inline with other professionals. School teachers for example can net AU$40k/pa so income wise at least, doctors dont earn significantly more than the general population – at least for the first few years before specializing.
re: 80hr working weeks
That is a stupid amount of hours to work. Are you sure this is the case? Burnout is inevitable and there is real risk of harming patients. It is irresponsible to allow any doctor to work that many hours.
I thought there was a surplus of interns on a shift/rostered system. How can this still happen?
I max out at around 60hr’s a week before getting burnt out. After two weeks of doing that I went back to the usual 40…which leaves time for R&R and a bit of CME.
-Those who don’t fulfill the merit to be deemed competent, should not be allowed to progress, hence there is a need to do regular appraisals on these doctors (again realistic and current standards should be set and regulated, not comparing now with those from 30 years ago!!)
Fair enough. What I cannot agree though is the amount of money being “invested” in running this whole circus. Most of the private universities rely heavily on government-funded students (JPA, MARA and PTPTN) to survive – the first cohort of medical students at Perdana is fully sponsored by JPA – that’s 50 million ringgit for one Uni alone. Public funds should not even be used to prop up these medical schools in the first place. Those incompetent doctors shouldn’t even be allowed to start medical school in the first place (which I think is Dr. Pagalavan’s point), especially if their education is to be funded by taxpayers.
Dear Jessica,
Regarding ur opinion,
Statement no 2# : u mean a system where we pool doctors with good performance/academic achievement in centre and leave the one whose just made the cut in peripheries and rural? That’s so childish and immature. Medicine is about serving people, people get sick everywhere. Are u suggesting that only people in big cities only got serious illnesses and those in peripheries should be ignored and being serve by “2nd class” doctors?
I’m from around your generation,( i presumed) HO in 2007. I’m currently in peripheries serving those i think superb people like you dont want to serve. And as you know peripheries are mostly filled with poor people financially and that DOES NOT mean they deserve 2nd class treatment. And i’m proud serving people here with less equipment, not much subspecialty (doctors and nurses). I’m proud that i did intubation myself, cannulation, blood taking, procedures myself, coz i believe a simple touch can actually ease the burden of patient.
And like you, i also going thru my last stage of specialty qualification in this peripheral hospital(without high tech things). All thanx to my beloved patient who had been good text book for me. I believe, if doctors had the attitude, they dont need to depend on hi tech equipment, specialized nurse to be a good doctor. A good doctor doesnot mean he had thousands of [ublications, copious degrees, but only can act like a robot.
Statement no 6: Life is subjective, you yourself determine if u have a good life. Your definition of good life wont be the same with others. In order to have something, u surely had to let go off something (it’s rule of life!)
Medicine is an art, u need to learn and earn it.
to Dr Pagalavan,
Thanx for such an inspiring job and relentless effort of bringing Malaysian healthcare system towards a better system. i believe in a step a day will bring you there.
agreed. I wonder whether Jesicca has worked in a rural/district hospitals/KK.
By the way, Dr Paga, care to share your predictions on this year’s SPM/JPA medicine merry-go-round 🙂
Same story every year mah………..
Jessica Sanchez.
” Again it is rude, outrageous, corrupted-minded and displays your disagreement with free-speech and pressure-free discussions ”
That was your exact statement to Dr Paga.
You sound so damn idealistic. Why dont you get of your ass and start a f8cking free clinic? Isn’t that the heights of idealism?
Im sick and tired of people like you. You have all the *luck* and *freedom* to do what you want. You go to countries like US, UK and Australia on parental scholarships or skewed-government scholarships. You watch the latest crap on TV like Gossip Girl and Pretty Little Liars. You have barely lived half a decade. You have barely worked in rural area living in a small room for 4-5 years serving people who like all of humanity, suffer. You people criticise older, much older people so easily. You people just study your ass off to get some freaking qualification like MRCP and except the whole world to fall at your feet. You bring this whole bucket of pseudo-intellect and half-baked wit and sutured up with some words; and for a second… a tiny little second…. you make sense.
Than reality hits you. You are NOT a diva. And this is not House.
Dont you dare come to Dr Paga’s blog and start to criticise the man who has tirelessly written against the tyranny of poorly implemented healthcare in Malaysia. Ive always said it. EVERY MONTH we deal with people like you. And EVERY MONTH I get pissed off with people like you.
Have you even worked in this country for more than ten years? I doubt so. People like you just migrate to the ‘greener’ side and criticise us from afar. The easiest job in the world.
People, stop taking Jessica Sanchez seriously. Freaking troll.
Hi Jessica Sanchez you have no love for Malaysia. You are too idealistic and your opinions are thrash! Which does no good for a developing country like beautiful Malaysia. Just shut up and get lost! Let us handle our problems ourselves. I am very sure with people like Dr Paga we will shine!. Being Dr is all passion not money. The joy is in treating sick people and see them recovering and not money or having a holiday!! Its all passion. So please get lost from our blog!
Wow, this is the part where it gets really interesting. Docs bickering at each other, few too emotional while others too enthusiastic. My personal opinion on this matter is, the Oldies need to wake up and smell the coffee, realizing that their generation and current one will never be up par. So, stop meddling us with stories and glories from the past. Secondly, the newbies(new generation docs) are jokers man. Pampered, spoon fed, crawling life forms that despite many repetitions and scoldings, at the end of the day, still unable to get things right. Thus, i proclaimed myself to be somewhat in the middle between those 2 generations. Pretty much I applied medicine to have a stable job and income. Not really interested in saving lives, be all who I can be kinda things. In the end, I’m living off with good money, driving a BMW Z4, dealing with intermittent levels of stress which I don’t mind at and even if I do, I deal it with drilling interlocking nails on my patients. So, come on, of course you work for the money, living in this world only once, heck I won’t risk my precious life and time if the outcomes are not rewarding. So, this goes to all doctors who rambles most of the time ( either the new or old ones ), grow up and chill yourself. Man, reading some of the comments here from these clowns, enough to make me go into hypertensive crisis with raised ICP~
haha, well, the scenario of driving big cars and earning big money is slowly coming to an end! That is what the newer generation don’t seem to realise.
BTW ortho, stress full? Hmmmmmm
Houseman overwork ? A very good question. i do agree with you that it is really tough during housemanship. Houseman are not protected from labour law. You don’t have right to take MC, if u sick, even you have MC, it will still be deducted from your 25 days anual leave. But, nowadays, it is shift system. You have only about average 60 working hours per week, you get at least 2 days off in a week, compare to the oncall system,houseman need to work 36- 48 hours sleepless, if you want to compare it to maybe 5 years back, houseman had back to back call. So, actually, our health care system do improve a bit, with less working hours nowadays and you can get RM 600 allowance for the shift system, which we need to do 6 sleepless, tough oncall to earn that RM600. Even, 10 years back, houseman get RM 25 per call. Many people will said that don’t compare now with the past, you pay RM 1 for a plate of fried rice, now, you need to pay RM 4 for similar quality of food.Maybe in the past, there is not enough of doctors , thus, we have the hell like long working hours. But, we do get better training fromthat. We gain more experience from that.
Do you think that our medical officer and specialist are not overwork? When you think about yourself, have you been thinking about their workload? Nowadays, i believe that medical officer still doing oncall, they can have 36 hours of long( sometimes even longer), sleepless call as well, and their responsibility is much more greater, if a patient die, they can get sued, the life of a patient is placed on their hand. We can have 15 houseman per ward, each houseman taking care of 3 patients, but, we never had 15 medical officer per ward, maybe, 1 ward will have 2 to 3 MOs, so, they take care 10 – 15 patients per days. But, basically, they have to know in and out every patients in ward, so far, i never heard a MO say to his consultant, i dunno about bed 16 patients, as it was under responsibility of other MO, but we easily heard a HO say to his MO/specialist: sorry, i didn’t incharge of this patient. When HO cant get a branulla, your MO will do that, when patient collapse, your MO will resuscitate the patient, every newcase come to the ward,it must be review by MO ( because HO are under training,still not get their APC), some MO even will clerk the case without clerk by HO first, especially in a busy day. when MO work in district hospital, they will be the first line, clerking, examine patient, making diagnosis and plan of management, everything done by themselves.
Then, talk about specialist/consultant, do you think that they are always relax, they are overwork as well, they can have 7 consecutive oncall a week. ( imagine that there is only 3 specialist in a department). Everyday, they are oncall, maybe you can say that they oncal at home, listening to phone call, but it ‘s really stressful, you can have non stop phone call a night, especially, there is ill case in ward, keep receiving referal from district hospital. Consultant can give a plan of management through phone, but, he bare the greatest responsibility, anything happen to the patient, he is the one who answer it as the junious had inform him regarding the case. Surgeon can have long hours when they need to perform a difficult emergency surgery in night, yet , having back to back call, morning still need to work and do elective surgery.During oncall, 1 specialist cover all the respective ward in the whole hospital, a medical specialist need to do round for 5 medical wards in Hospital, plus CCU, ICU, HDW, see referal case from surgical, O&G ward ( during weekend) Sometimes a subspecialty consultant, for example, a paeditric oncologist in the northen region, maybe one person need to cover Perlis, Kedah, Penang ! So, you can receive call from every hospital in 3 states refer regading leukemia, henophilia, malignancy case. Is it stressful? The more higher your hieraki is, the more stressful you are.
So, the take home massage for houseman, medical professional is always stressful. If you think that you are stress/overwork during your houseman period, think about it, it is just a traning process so that you can cope with various type of patient and disease when you walk along the path( i mean to become medical officer and eventually specialist), I guest, no one in the country want to be a chronic HO, right?
McDreamy.. typical orthopod.
you do realize, while u come here and show off tales of driving sportscars and claim that you drill the heck out of ppl etc etc.. you are obviously not immortal.
Lets see how you feel about all your achievements; especially your sincerity in doing medicine, during your last couple of days of life.
Hah. Showing off materialism… you have nothing on your deathbed except greedy relatives. Enjoy.
In Australia… we etc et
In USA.. we etc etc…
CMon la. You guys gotta wake up and smell the coffee. This is Malaysia. We are a developing nation. Just because you see BMWs and Mercedez in the urban areas.. doesn’t mean the whole country is full of rich people.
There are some hardcore poor in this country who are dying and suffering on a daily basis. What is the value of humanity here???
Doctors in Malaysia and doctors in the big three (UK, Aus, USA) are facing very very very very different scenarios and resource limitations.
Easy for you all to criticize the system. Try staying within the system and changing it. For that, Dr Paga deserves to blog about all of this.
the rest of you…. what have you done?
Did you know until 35 years ago Australia also had 36 hr shifts for interns?
My point is, the Malaysian system is less mature than those in developed countries. You can criticize it to hell, but in the end it’s an unfair comparison. It’s like how people who critique Proton (with good reason) comparing them to Hyundai/Kia dont realize that the Korean car companies are almost double Proton’s age and have alot more experience and industrial weight – The quality of the hyundai’s/kia’s 20+ years after the companies were created were terrible btw.
That said, alot of the issues stand on their own and deserve to be brought to light.
The UK had 36 hour shifts right till they were forced to reform by the EU about 5-6 years ago.
Anyway, in your freaking USA, a blog like this would be monetized and filled up with affiliate and stealth marketing and Dr PAga would have retired early.
Thank god we don’t have anything of that and this place is still a sanctuary to bounce ideas off each other
I did get a lot of email asking me to use the blog for advertisement of their product but I declined. That is not the purpose of this blog.
Progress was achieved when at one point of time, somebody thought differently. I see here everybody has valid points, but I do think it is pointless to declare the right from the wrong, who is the “winner of this debate”.
I do hope all of those commenting are old enough to realize that both Pagalavan and Jessica, and all the others offer not answers, but perspectives. Ironically, their opinions are both against the current ruling. Pagalavan promotes current HOs to step up to certain standards via rigorous training and reassessments, via an improvised system compared to the current one, and Jessica promotes an enlightenment to the social and mental aspect of doctors, while they pursue betterment in this fraternity, which has been neglected since the “old days”. See, they gave perspectives, and neither are wrong nor right. Relevant or not is a subjective matter. Opinions can be challenged, and be condemned, but I would prefer it be done in a professional and constructive matter.
This is how i see this conversation:
1. Jessica delivers a radical point in an elaborate an emotional manner
2. Pagalavan countering like an immovable brick wall, with limited room for flexibility
3. Supporters from both sides emotionally chanting out winners and losers, validity of ideas
4. Grammar nazis, comedians, opportunists, emos, all giving thought
5. Everybody insulting everybody
6. One old man realizes the drama (as perceived subjectively by him) and decides to tell everyone what he sees as he was bored with the current TV channels and asks his grandson to type for him
Having emotional supporters, sarcastic critics, grammar nazis, comedians, wannabes, humble-but-not-so-humble, idealists, all in one comment board reminds me of the reality of the world we live in and the reality of our community.
We cannot ask people to just shut up (or maybe we can but it is like asking the government to stop being corrupt i.e. never happens). That is just how the world goes.
But we are doctors, and people are watching us behaving like emotional soap operas dramatis personae. I hope we behave appropriately. I confuse Pagalavan’s blog with 9gag after reading this discussion.
What “radical points”?
Dr Paga has blogged about:
1) A decline in the quality of students graduating from medical schools due to the privatization of the med-ed sector.
2) The low pay and ineffective doctors union (MMA) who cant lobby for excrement.
3) The unethical working hours in Malaysian hospitals.
Get a piece of paper and try to summarize what she is saying in regard to the above themes. Brush aside the rhetoric and you’ll realize that she is actually agreeing with Dr Paga. She seems intent on hinting all sorts of things about herself (eg. she’s in the UK, enjoys travelling, etc).
I know you cant really judge affect from text, but I personally get the impression of mania with a touch of grandiosity.
painkilling machine..thumbs up for your comment. maybe we should produce something like kony 2012..make pagalavan website famous.
Pagalavan are our senior regardless being a doctor or not.It is in our asian culture to give respect to him.I think when you want to have a discussion with him,try to tone down as I’m sure you have a good command in english and intact faculty.by that I mean, think twice before commit things on a blog/forum as it’s an open community after all.trying to put into different perspective, an good discussion may be underway instead of heated argument where both side are unvielding in their mindset.
Correction BOB-The-Cat, Pagalavan is YOUR senior, not mine, as I am more senior than him, either in age, or in service to our medical fraternity.
I am a retired old doctor who left medical practice some time ago. I used to teach formally but also left that behind, but the field I left did not have house officers at the time, so I was never indulged with the experience in handling house officers. I am old enough that I have to ask my grandson to type for me (yes, PC illiterate and having arthritis), which is why I irregularly write, and will only do so during school holidays.
But I am writing not to talk about myself. I am writing with the same purpose as Pagalavan and everybody else: to provide a perspective. Just like Pagalavan intends to correct those younger than him, I intend to give a senior-ly advice to him and all others.
Progress is good. Reduction in working hours is good, reduction in workload is good, but it must not compromise competency. Some would argue how can that be attained if we work less? I assure you that by providing courses and training or re-training, this problem can be curbed. Despite being old, I am in full support with improvement in a doctor’s working hours and this idea of allowing a doctor to enjoy life while working. I use to work with 15 calls minimum, and social life was really horrible. It caused me to have spent less time with loved ones: something I regret until now.
Being paid and doctors enjoying the money they were paid is not wrong at all. It does not contradict the work of a doctor, otherwise we would have all been paid with peanuts. Working for money, even as a doctor, is not wrong. I agree with the Orthopedic Surgeon despite his brag. It is a good motivator to keep a doctor working. Having a good salary as an aim is good, so long as we remain responsible with our clinical judgment i.e. so long as the primary aim is for a better patient management, and not cheating the patients’ money. Orthopedic and surgical implants keep on being improvised for this sake, proving how material aim ensures a relevant degree of progress. I am sure the good pay is also one of the reasons Pagalavan is working in the private sector. It is not wrong. We pay for food.
Lastly, I feel that Pagalavan’s views, as I have been reading for quite some time, are pessimistic and accusatory. I apologize for such harsh remarks to Pagalavan but I feel they are a necessary reminder. I read your comments on some HODs not doing their job, consultants not doing their job, specialists not doing their job, young specialists having no experience, MOs not as good when you were MO, HOs being useless etc. I agree with you that the system is corrupt, but degrading our successors does not in any way helpful.
As I have said before in other posts, If we feel the new generations are lacking in knowledge and skills, we should aid and train them, not scrutinize or condemn them. I respect Dato’ Kandasamy and Dato’ Siva, Prof. Nafeesah Adeeb, Prof Khalid Kadir, Tan Kah Kee and Khalid Yaacob, who in their retirement age, are teaching youngsters a thing or two. THEY are making the change, they are correcting the wrong. I am sure they are not politically popular, but I know they are doing something. I also see young MOs/ Specialists imparting what little experience they have through organizing programs like MOSIT, the Avicenna Project, etc. Keep them up, I really respect you, my successors. You are implementing change. Prove to those who dare to doubt your abilities and improve the future of the fraternity. I am too old and frail to aid you, but I surely support you. Sometimes we need to walk the walk, before we can talk the talk.
Do remember Pagalavan, once upon a time, we doctors are not paid at all for our calls. On calls are considered a part of the job, despite having a minimum of 15 of them. When we wanted to swap calls or ask our colleagues to replace us in desperate times, we would give them a sack of flour, quarter dozen of eggs, or a small bag of rice as token of thanks. That was how difficult it was then. Then doctors began to organize a movement (something like a strike) to force the government to pay for calls. It was difficult and those who were overzealous with the idea of “doctors work for nobility and not money” (like a few I see here) started the dissent of labeling the movement. In the end, the government bowed down, end hence until today, the on-call pays are constantly being reviewed. So, the same story here. Now it is relevant that doctors be allowed the life as Jessica Sanchez has emotionally elaborated. I suffered when I practiced as a doctor, and I would not want future generations to endure such hardship only to prove a subjective point of superiority (the-grumpy-old-man syndrome as I would like to call it). Let doctors serve the patients’ needs, but he must not neglect his own. He also has a spouse and children or parents whom he should be responsible to. Doctors are human beings, and there is nothing wrong with being human.
I noticed a handful of overzealous emotional supporters for Pagalavan’s views i.e. those who would ask people to “f**k off” if they are not in agreement with him. I really hope you guys learn good communication and behavior. Being doctors, clashes of ideas or approaches in management are common, but hardly do we tell people to f**k off. There is no fault in expressing views, but the issue is how you express them, as doctors.
Listen to the views of the future generation, have empathy and guide them. Teach them if you can. Do not let there be a time when we rue the day of our inaction. Again, the day we give up to teach and guide is the day we ignore the collapse of future generations.
Totally agree with you. I am talking about the harsh reality that everyone should know. It may sound negative but that is the reality. Teaching is part of medicine and you teach and learn life long. BUT unfortunately, there are more and more “doctors” who do not have enough basic knowledge(which you should have known before you graduate), have attitude problems and refuse to be thought/learn. IF you do teach again the juniors, you will see this trend. That is becoming a real problem. Even simple general knowledge is lacking. I know many HODs who were excellent teachers and very supportive of HOs but even they are getting very frustrated with the current doctors. The overflow is only making it worst. You can’t be teaching them how to take history/physical examination during housemanship!
As I said, it is all about time management. If you have proper time management, you can finish your work in time and have a decent life. However, you can’t expect to have a good life but refuse to work hard. It all depends on what was your intention in being a doctor in the first place.
In defence of the profession, let me remind all that medicine is a genuinely rewarding career. You will need to be prepared to tough it out no matter where you are really.
The money is decent. Not spectacular, but decent and it will get you by. Your life will revolve around work and you will be always learning well into your forties…and even beyond.
If you enjoy medicine and like learning continuously…. then it really is for you. Im sure you’ll find it very interesting and rewarding. Sure you’re tired at the end of the day, but you know you made a difference and “level’ed up” in you skills so to speak. Every day is a learning opportunity and you actually look forward to work.
I speak from experience.
Dr Crunch.
simple as this , Dr Paga is trying to help and enlighten the public about the current situation of Malaysian health care system and our fresh graduates. He is in the system long enough to know what he is talking about . I was once a medical student and i know how it is like even before graduating. I decided to quit so here I am doing something which is new for me and I am enjoying it . So simple If YOU DONT LIKE LEAVE IT AND DO SOMETHING ELSE ! why wanna waste your time and already u have waster your money ( 100 k ++ i guess) why wanna waste you time and life if you know your are not competent enough and please la learn how to take advice from older people who are in the system they know the best . you people baru graduate wanna show your colors issit ? satu hapa benda tak tau wanna talk like some big shot . This the problem the current medical graduates have TIN KOSONG ! . I have personally seen some housemen who refuse to take in patients 30 min before their shifts end and I have also seen many housemen getting shouted from the patients and also many housemen are simply being rude to older patients who are unable to understand english or Bahasa Malaysia properly. Patients are no more stupid and illiterate like those days , please la patients nowadays know things and they even question doctors if they feel something is not right in their method of treatment. what you people know of real sacrifice and hard work like those senior doctors who took their time and effort taking care of so many patients. No offence but please dont talk thru your damn ASS and be arrogant to think that you fresh Graduates are some God sent creature ascended from the Heavens la . GET A LIFE .. Most Indian Medical graduate do what habis kerja Tongang Botol ny or go sleeping around. I am an indian and I know it . SO please dont call me a racist coz i know better of my people. If you people are arrogant and Hard headed then no need to read this blog and comment on the senior doctors who have good intention to enlighten the society in a good way. GO GET A F*****G LIFE AND DONT WASTE YOUR LIFE BY COMPLAINING ! One advice ( though i dont deserve to advice people ) go terjun dalam sungai Kelang if you pleople think life is gonna be a bed of roses.Reality Hurts big time BABY ! I sound like I am uneducated or unprofessional too bad I AM Uneducated to your standard ! LOL
I have personally seen some housemen who refuse to take in patients 30 min before their shifts end
This is standard practice. The last 30 minutes of a shift is for finishing up paperwork etc.
I think it’s a problem with the roster system or (more likely the case) people not showing up on time. Shifts should always overlap, so towards the end of a shift the new guys should already be there to cover and take patients.
my apologies i didnt know that they will have to do paperwork and stuff before they leave the last 30 min. Thanks for correcting me
This is assuming the other guy has arrived and taken over the job. If not the HO cannot refuse to see any patient till he leaves the ward.
Pheww… Uneducated… why chellam.. i see that you really sound very uneducated laa.. But all that u said is so true lar chellam.. Most people these days refuse to accept that bed of roses also full of torns. They jumped in it and scream and complaining that it ain’t as beautiful as it seems when the torns prick their butt. At same time we have to realise this is not only in medic field, it happening generally to all youngsters these days. Old times there no complain when teacher in school “rotan”, “knock” or even tampar kids at school. Nowdays the teacher scold only the kids come back home crying. Parents report to newspaper and so on. That what we as the older generation must teach childrens that life is tough.. and when the goin get tough only the tough gets goin. Life is not something they can take for granted. I feel it’s time to take very strict measure in disciplining all medical personals mainly HO’s. Let us be more constructive lar after this.. let find a way where we can reduce all this unnessasary friction and never ending gaza like war here. Even Chellam Paga will get bored to write if like this.. true or not Chellam..?
anyhow i 100 % agree with you dear Master Yoda. We can find a way to reduce all the friction and war but are the people willing to implement or follow ? anyhow it is up to them .
Well, hopefully enough interest and attention is diverted to this very important topic and a grassroots movement to improve the system will have real consequences. By the looks of it, the MMA cannot be relied upon to implement the changes necessary as they bend over to the will of the government and, by extension, it’s ill conceived policies.
pardon me for being ignorant, is it really true that we are entitled 2 weeks of unpaid conference/study leave. I happen to take my annual leave for my MRCP Exams. Any official circular about this?
You need to read the GO. However, whether you can get it or not, depends on your HOD. It’s 2 weeks unrecorded leave.
two unrecorded leave but..only the date of your exam days only….if it is 5 days then 5 days it is….other than that u have to take your annual leave
actually it depends on your HOD. If HOD is suppotive, he or she can give you 2 weeks unrecorded leave but only omce a year.
Another one of countless rants from a “Doctor” wanting an easy life.
Its so easy to become a doctor these days, pay RM100-200k to some Russian/Ukraine/MiddleEast university and you become one. Gone were the days where one needs straight As, competing aomngst the nation’s elite for a place in a prestigious center of higher learning.
4 years ago, such people were almost unheard of, yes we were short, we work long hours, but we go home happy at the end of the day. Our colleagues were on par with us in knowledge and in attitude towards the patients we took care of (nevertheless there will be a bad apple amongst the group, but a minority we could ignore).
Then the influx began, just a handful initially, increasing to almost 50% of the current house officer population. You extend them, but there’s only so much one can take and the specialist-in-charge moves them on to the next rotation. Eventually they WILL be promoted to medical officer, and start making clearly negligent mistakes which leads to morbidity/mortality. Basic things we learn in secondary school/college/university-level seem alien to these “Doctors”, imagine the anguish working with a colleague (drawing almost the same amount of salary) who is worse than a medical student.
A few lucky ones will eventually end up in administrative jobs which seem to favour chronic medical officers, get promoted to the status of Pengarah Hospital in say 10 years. This is the state of our Malaysian Healthcare. Our future indeed appears bleak.
Every time i read the articles and comments here, I’m glad that I left the Malaysian healthcare system for good. It’s rotten to the core beyond repair, sadly the civil service has gone to the dogs and now with 1care fiasco it just bring the major screw up to another level.
I tried changing the system when I was there but the problem is you cant change idiots and nincompoops. The saying goes if you can’t beat them, join them which what many of my colleagues did. I applaud them but I guess they have their reasons. Family Etc
I think PSD or Mara or any other scholarship awarding bodies should stop giving scholarship for Medicine because it is bloody waste of resources. The government spend almost a million dollar for a student only for them to go to prestigous medical school only to return to a completely different system where you are treated like slaves. It doesn’t matter if you go to Oxford, Cambridge had excellent A-levels, did international research, graduated top of the class because in Malaysia it is all about who is the most diligent apple polisher and brown-noser. No wonder there is a lot of PSD and MARA-funded doctors abroad.
What PSD or MARA should have done is to have a clinical staff from the ministry or prestigious local medical schools who oversee these students, make sure they clinical ambitions are met via appropriate placements and mentoring. During summer holidays PSD can initiate programme to make it compulsory for these students to do their clinical electives or research at prestigious hospitals in Malaysia. I’m sure those who had Khazanah scholarship can relate to this.
But there’s no such staff in PSD or MARA, it is just too much work for them. Spending a million ringgit on student is way easier. In fact why bother sending just one, use that money to send student to some dodgy medical schools and get it to recognize later. Don’t bother if the quality of education in these schools is bad because in the end these doctors serve the poor and immigrants. The top civil servants go to private hospital or semi private like IJN.
Maybe common qualifying exam would be a good idea but what if some anak dato’s or anak HOD can’t pass it because they went to some university belakang rumah.But what if certain group of people or group of graduates can’t pass it? What would that reflect the quality of training they had? Again it is just too much work and too complicated.
Amalgamation of medical schools is a brilliant idea but would the share holders agree, too much interest at stake. Too many hands..too much money.
I don’t think the government is very serious about the quality of healthcare in Malaysia. They just the best bang for their bucks and whether they can make money out of it..read 1Care.
Too many civil servants, too many doctors, too many teachers…it is just high time when this country will suffer similar fate like the greeks and brazilians.
I’m worried about the new generation of post-glut MOs. I personally feel at best they are just functioning as SHOs but already some of them is acting like they have been there for ages and practice cow-boy medicine. Unfortunately in Malaysia, even if you paid your way out in Medical school, failed your SPM, gave your professor some Vodka Money, cheated your way with your logbooks, absconded work while locuming elsewhere, you are still a UD41 under system and treated like one. Nobody cares about your ethics and degree..you still get paid minimum of 3500, enjoy civil servants perks and now you only have to do shift jobs..even better.
It is a dream job..no wonder there’s so much dissatisfaction among nurses and MAs. No wonder MAs also are starting to go to medical school..the dodgy ones. The pie is just too tempting and in 24 months you will be UD44 ..”like a boss!”
My girl friend and my brother were both HO and I hardly got the chance too meet them at home due to 6-7 days continues working. My girl friend were working in Kedah Medical department. It is a joke were I saw some information on the star news where Datuk Seri Dr Hasan Abdul Rahman mention there were no over 5 days working for HO. Its a total joke, my mother haven’t got the chance to meet my brother on daytime for more than 4 months. I still try to bare with it, I hope I won’t take legal action against them via the labour law…..I won’t mind spending money to get lawyer for that.
Welcome to the real world. This will not be the first and the last of seeing your brother and girlfriend doing this. Being a “real” doctor needs a lot of sacrifice and lack of family time which is something you can’t avoid!! Unless you want to become a useless doctor.
You can’t sue the government as a government servant is not bound by labour law. They follow the General Order (GO).
Housemanship is an intense training which you will never get after that. They have to make full use of it.
Which mean doctor are not human? They are robots? They must sleep less than 5 hrs sleep per day? Looks like I had make the correct decision for not following my father wish(he wants me to be a doctor). But I do believe human body have limits, will overwork really benefit the patient? Human errors are less when overwork? I have experience overwork for weeks as a private sector worker due to my passion. I thought I can make things better, but I was wrong…the less sleep I had, the more human errors I created. I pity those patient…I wonder how much ugly case the GH have close up. But I think ppl don’t mind as long the GH cost is lower….anyhow thank for the information, I will spent my day going through the (GO).
Every person who wants to become a doctor should know this fact. That was the reason I started this blog. Even in UK, almost 30% of their doctors have psychological stress disorder.
I have been in service for 15 years and I still work 24hrs a day, 7 days a week. I can get a call at anytime of a day unless I am on leave and someone covers for me! That is our life. And I only sleep for 6 hours a day if I am not disturbed at night by a call from my hospital!! So, it is not just housemen who go throu this scenario. It will happen throughout your career unless you want to do non clinical work. Even if you open a clinic, you will still have to work from 8am till 10pm daily including public holidays!
FYI, even doctors in private sector are overworked, not just GH. So, errors occurs everywhere.
Hi Steven,
Let me put another perspective to this discussion.
Doctors in Malaysia, especially junior doctors (HO/MO), work for long stretches. They can work for over 24 hr non-stop without rest. This is the British way of training junior doctors. Singapore has a similar system, with much better pay.
The Brits only stopped these long shifts recently because the EU forced them to, via the European Working Time Directive. The EWTD limits junior doctors to 48 hr/week maximum when averaged over a period of 6 months (I believe the absolute maximum in 1 week is 56 hr).
Aus and NZ realised very early on that this was unsafe and got rid of these long hours over 30 yrs ago. They have limits of approximately 70 hr/week but average about 50-60 hr/week for most services.
The Americans also work long hours. Even med students are expected to come in at 5am and leave at 11pm EVERY DAY. The Americans though are not very left-wing (i.e. poor hours, less annual leave, etc) compared to most countries, which partially explains that attitude. Until recently, many junior doctors worked 100 hr/week – despite everyone highlighting that this was not safe practice. The ACGME, which accredits all specialty training in the US, set a limit of 80 hr/week almost 10 yrs ago. There was a much-publicised case of John Hopkins being threatened to have accreditation withdrawn because they were overworking their junior doctors. You can read about that here: http://www.ama-assn.org/amednews/2003/09/15/prsc0915.htm
I agree with an earlier posting that says we should not compare these developed countries with Malaysia. Very different systems. BUT, no one can run away from the fact that a tired and overworked doctor is an unsafe doctor. Most mistakes are minor, but occasionally a major mistake will happen that can cost a patient’s life. I know of 2 colleagues who met with accidents (luckily low-speed) driving home after overnight shifts because they had been awake for 24 hrs. I once attended a lecture given by the previous President of the Royal Australasian College of Surgeons who told a story about how he fell asleep while working in the UK as a junior doctor WHILE OPERATING ON A PATIENT. If mistakes happen in Malaysia, there is a culture of covering up. Even some patients will say ” …biarlah … takdir ..” when their family member dies, not wanting to investigate further.
So, if we acknowledge there is a problem, what can be done about it? The shift-work system works only if implemented properly. From what I’ve heard, that is not the case. I suspect they introduced it not for the benefit of junior doctors, but because they have an overflow of houseman, who are also disproportionately stationed. Even within some hospitals, some depts have too many MOs whereas some have too little (this has to do with people pulling strings to avoid certain depts and to work in others, either for an easy life or to increase their chances of getting into Masters).
There is the other fact that the less you work, the less learning experience you have up to a certain point – beyond that point you are too tired so minimal learning takes place anyway. A balance therefore needs to be struck. Junior doctor rotations need to be better structured, with the junior doctor meeting preset learning objectives before being allowed to ‘pass’ the run. Again, the devil is in the implementation. Any well-designed plan will fail if the people on the ground couldn’t care less.
Lastly, the issue of private doctors (GPs and specialists) working long hours. They do this because private-land is very very competitive now. The more patients you see, the more money you make. If you work 9-5 only, you may not make very much at all after – to the point where you might as well stayed in govt service with the better hrs as a consultant, perks, and pension! If you are a solo private practitioner and don’t work in a private group (where a group of specialists may take turns being on-call for each others patients), then you are on-call 24 hr/day, 7 days/week. I was told that private groups don’t work very well in Malaysia because the private docs in the same specialty (even those in the same hospital) view each other as competition and always try to sabotage each other – so no one cooperates with each other (I’m sure that is not universally the case though). The long hours in private-land remain a choice for some, and it has mainly to do with money.
Sorry for being very ‘cheong hei’. Hope my point got through (if there ever was one!)
Hi Nav,
Good point, everything was welly arranged and written without any “cheong hei” in it. I do agree with the 24 hrs , but what I saw with my naked eye is 37 hrs with double shift. I calculated the hours throughout the days. And I do agree with the cover up as well, too common….
Coming to think of it, from what I gather, the old system seem to be better then the shift system that is being done now. Under the old system, even though you do work 36 hours when you are on call but atleast the next 2-3 days, you only work 8 hours!!
I see. Thanks for the enlightenment.
Hi Dr Pagalavan,
Was the perintah Am general orders same as the link below?
Click to access 20100915.pdf
Heh heh …. that’s a Brunei govt document, nothing to do with Malaysia. The “.gov.bn” in the web address is kind of a giveaway.
I see. Thank you.
Nope. You can buy the GO from the bookshops like MPH or Popular
Thank you so much Dr.
BTW, do you know that under the GO, professional group are not even entitled for overtime allowance? That’s why doctors were not paid an oncall allowance til 1996!
I’m not aware of that but what I want is lets HO have good rest, on call allowance or not its not a big concern. All I know is lack of sleep and lack of proper meal will kill any doctor in a long run(I think I saw that on the star) and I don’t want that to happen.
Yup, that’s why in developed countries many do not want to become a doctor! It’s only in developing countries that you see people running around want to become doctors, mainly for glamour and money.
Dear doctor, May I know whether a government doctor allowed to do direct sales business?
Can he give health awareness talk to public if invited by such company?
No. Under the GO(General Order) whatever you do is considered as representing the government. As a government servant, you are also not allowed to do any business outside.
Can da dr just give general health talk but not selling products to public? Tq
You can with the written permission from your Head of Department. Any complains, your HOD have to answer as well as yourself.