In my earlier 2 posts , https://pagalavan.com/2012/06/17/for-future-doctors-the-deppresing-side-of-being-a-doctor , http://pagalavan.com/2012/06/22/for-future-doctors-the-depressing-side-of-being-a-doctor-part-2/ I wrote about how difficult our life as a doctor has become; Ungrateful patients, patient who shout and scolds you, patients who demand certain things to be done with no proper indications and the ever-increasing litigation rate in this country and all over the world. The real art of medicine is slowly dying due to these issues.
The doctors on the other hand have started venturing into unethical practices and trying to earn as much money as possible. The competition is getting so tough that many doctors are finding other ways to make money. I know many private doctors who do so many unethical practices to make money. I had mentioned about this before in some of my earlier postings. One of my friends in private sector told me that doctors are the BEST businessmen. This is because patients trust that their doctors will do the best for them and thus they do not question what you do. So, patients get cheated all the time. Most ethical doctors don’t earn much in private sector in comparison and will be labeled as useless doctor by patients themselves. Imagine when you tell a patient that he does not need to remove his incidentally found asymptomatic gallstone but another doctor tells him that it must be removed and does the surgery? The doctor who does the surgery becomes the good doctor as far as the patient is concerned. In fact there are also patients who are unhappy when you tell them that they do not have any illness and do not need any treatment!!. These are the issues that an “ethical” doctor needs to face on a daily basis. BUT the unethical doctors are laughing to the bank by earning money cheating the uninformed patients! Sometimes I laugh at people who tell me that “so and so” relative of theirs are earning more then RM100K in a private hospital. Have they bothered to find out what unethical things that this doctor is doing? I know of cardiologists who do angiogram on anyone who walks into their clinic and puts a stent into everyone despite having only 10-20% stenosis!! I am not saying that all private doctors are doing this but it is becoming more and more common due to stiff competition and wanting to keep their income at a certain level! That’s how money can corrupt people!
Another new trend is beginning to appear recently. Many doctors, especially general practitioners(GPs) are cheating patients with the incorporation of traditional and complimentary medicine (TCM) into their practices. It is wrong ethically and legally from MMC’s point of view. I just saw a Rheumatoid Arthritis (RA) patient from a district in Johor who has been suffering from RA for atleast 7 years. For the last 2 years, she has been seeing a clinic near her house, which is run by 2 MBBS doctors ( the patient quoted this). However, these doctors are also practicing TCM. The patient’s blood is taken on every visit and even her saliva is taken to send to India for development of specific “drug” for her disease!! None of these results were ever informed to her despite requesting for it (which is obviously against the Private Healthcare Facility Act). I saw some of the treatment that was given to her and I noticed that except for 1 drug, the rest are traditional medicine. The drug that I can recognize is Prednisolone! The clinic also refused to tell her the names of the medications. AND you know how much they charge her for every visit? A whooping RM 500-1000/visit, so much so, she now owes the clinic more then RM 1000!! This is what I call daylight robbery! The patient’s disease has progressed tremendously to the extent that her joints are severely damaged now.
Then I saw another patient who has been suffering from Psoriasis for many years. He saw this doctor in his hometown who offered him Ozone therapy which the doctor claim can cure his psoriasis!! This patient was also given Prednisolone!! I know many doctors who are practicing Ozone and chelating therapy. Some of these doctors are claiming that they can cure your ischemic heart disease (confirmed stenosis by angiogram) with this form of treatments. Mind you that these treatments are expensive and not regulated by the government unlike doctor’s charges. The therapy can cause RM 1000-2000/session and the patient will need about 10-20 sessions depending on their disease. Infact, I had a GP who even promoted this directly to me. I just laughed at him! I asked for evidence and the only evidence he could give is that the patient’s symptoms have improved! NO repeat angiogram evidence! Everyone in medical field will know of placebo effect!
MMC has issued a warning last year about doctors practicing complementary medicine, especially ozone and chelation therapy http://thestar.com.my/news/story.asp?file=/2011/10/18/nation/20111018134806&sec=nation. Actions can be taken against these doctors including revoking their license to practice if they are found promoting TCM by claiming that it can cure the patient’s disease. The patient’s are vulnerable to whatever the doctor says, as patients trust doctors will always do their best for them. Unfortunately, I am sorry to say that doctors are becoming the best robbers and conman in this country with the poor enforcement of law.
The other money-making business that doctors are flooding into is aesthetic medicine. Even though aesthetic medicine is recognized as a branch of medicine and is allowed to be practiced by medical councils around the world, it has to be done properly. At the moment, there is no guideline in Malaysia on how an aesthetic physician is going to be recognized. MOH did issue a guideline in 2008 on the practice of aesthetic medicine http://mmc.gov.my/v1/docs/Aesthetic_Medicine.pdf but no concrete registration was implemented. Today’s Star reported that soon, all aesthetic medicine practitioners will be required to be registered and show proof of their training http://thestar.com.my/news/story.asp?file=/2012/7/15/nation/11667960&sec=nation . So, from now onwards you can’t claim yourself as an aesthetic medicine practitioner without proper training. I know it is a money making business as a glorified beautician but also remember the high litigation rate involved. The indemnity insurance rate is only second to O&G: http//www.medicalprotection.org/Default.aspx?DN=c3681b59-1313-41ab-9fd5-dd11fe97c622. The rates are lower for GPs who are only doing part time aesthetic but always remember that you can get sued anytime for any unsatisfactory work.
Whatever passion and interest you have in medicine will eventually disappear as the time passes by. I know many of my friends who said the same when they entered medical school but I know what they are doing now. At the end of the day, it is all about earning money as a profession and to feed your family. There are very few doctors who really have the passion after some time. With the oversupply and over flooding of doctors soon, the situation will only get worst. That is the reality.
BUT how much money is enough? Don’t let money buy over you…………. Money can’t buy you everything as what Dr Koh has admitted after the death of his son, yesterday http://thestar.com.my/news/story.asp?file=/2012/7/14/nation/11660162&sec=nation
Guidelines soon on aesthetic treatment, says Liow
KUALA LUMPUR: Guidelines on aesthetic medical practice are being drawn up to protect the public from botched jobs.The draft is expected to be completed this month, which would lead to the setting-up of the National Registry of Medical Practitioners Practising Aesthetic Medicine next month.
Health Minister Datuk Seri Liow Tiong Lai said a committee comprising government and private practitioners had been selected to oversee the maintenance of the registry.
He said the registry would have three different categories of medical practitioners providing aesthetic medical services – general practitioners (GPs), dermatologists and other specialists and surgical specialists and plastic surgeons.
“We welcome GPs to practise aesthetic medicine but they need to take courses and be regulated by the ministry,” he said after the 1st Malaysia-Singapore Conference of Aesthetic Medicine opening ceremony here.
The minister said GPs would have to take up a course requiring up to 56 hours of study before they could be validated by the committee to be included in the registry.
Malaysian Society of Aesthetic Medicine president Dr Louis Leh said the main aim was to promote safe aesthetic medicine and cut down on people turning to fly-by-night operators.
“Many don’t know where to go for such treatment and they end up with botched jobs,” he said, adding that beauty consultants were not supposed to handle tasks that required the use of needles or knives.
On whether beauty consultants could hire trained aesthetic doctors to do minor procedures at their centres, he said doctors were not allowed to do so because the Private Facilities and Services Act required them to practise in a proper medical set-up
Pagalavan's Avatar 
Very well conveyed! 😉
excellent depiction of reality!
Stenting at 20% of coronary lesion ? the acute stent thrombosis may cost the patient’s life. That is very unethical !!!
That’s just the tip of the iceberg of what some private specialists and GPs do.
Welcome to Malaysia. It is happening anywhere and our patients got no idea of this happenings. I have seen patients with 3VD being stunted all over the place without even counseling them for CABG.
3VD and DM, should have a group discussion with surgeon first before making the next step unless is not a surgical candidate. So sad and disappointed….I won’t be able to sleep well every night for making the unethical money!!! Money is not everything !!!
I would suspect or think ministry just TALK only because the case mentioned above like aesthetic practitioner, GP practice TCM or cardiologist all are SOLO player so it is easier to take action or to show public that ministry is doing something to ‘protect’ public but in fact they are toothless against
1. Medical centers that practice unnecessary medical check up with all sort of CT scan and up to MSCT angriogram and KIV stenting. (include BMD, all sort of tumor markers, CT from brain to lung for every patient).
2. Government orthopedic surgeon that use to persuade or direct government patient to go to their ‘private’ clinic / center with all sort of discouraging advice like may take very long time to do procedure in the government but can do immediately in their private clinic. Government should stop government doctor from owning private medical business.
3. Chain clinic that practice chelation therapy for hypertension which cost about RM150/session/week. So rich people with poor reasoning power used to be the victim like this.
an many more.
The cases and solutions mentioned above are just to kill small fish but it is also a way to eliminate them so that big fish (medical center, private hospital and chain clinic) will have all the share. This is indirect monopoly.
As I said ” poor enforcement of law”. The MOH do not have a proper enforcement unit of their own. The UKAPS unit of each state only have less then 5 staffs for the whole state. How many cases can they investigate? MMC also do not have any enforcement unit. If I make a complain to MMC, I have to provide solid proof and have to attend their enquiry few times. Many doctors don’t have the time to do this and thus they just don’t bother.
I hope when the MMC os corporatised under the new medical act, they will have their own enforcement unit
I am being offered medicine by IMU and UniSZA so dr. what opinion can you give in this matter?
IMU if you can transfer overseas. UniSZA is a very new public university – if they don’t have enough qualified lecturers (try and check their website) then I’d even choose the IMU local programme.
I would prefer IMU twinning programme.
Its either IMU local programme or UniSZA. Yes they are very new and they havent got medicine graduates yet but then the government includes them in the 980+ seats MBBS this year. Will it be the same graduating from other top public Universities like UM or USM?
Same or not same, only when the graduates start working as house officer, then we shall know about the quality then
Definitely Um and USM will be better as they have around for many years with their own teaching hospital.
I totally agree with you..money can corrupt people, even the noble doctor..the TCM is a big issue, not mentioning the MLM issue. As you said, people will trust their doctor. Doctors aka MLMers simply advertise their non proven product and even use their Dr title to emphasize how good their product is..useless product with expensive price..and what is going on with these doctors?!
DATUK SERI HJ. MOHAMED KHALED NORDIN
about an hour ago
India’s Vinayaka Missions University To Set Up Branch Campuses In Malaysia — India’s Vinayaka Missions University is set to establish its Malaysian branch campuses through the establishment of the Vinayaka Missions International University College (VMIUC), with a RM530 million investment over eight years.
The multi-disciplinary VMIUC has received licence from the higher education ministry to set up faculties in Johor, Penang and the Klang Valley.
“The VMIUC dental college is set to be established in Pasir Gudang, Johor while the post-graduate medical faculty and distance education directorate will be set up in the Klang Valley.
“Pre-university, art and science, business and management, engineering, hospitality and tourism, traditional and complimentary medicine and health sciences faculties will be established in Penang,” said VMIUC managing director Datuk Dr S. Sharavanan at the university college’s inaugration ceremony here today.
The ceremony was attended by Higher Education Minister Datuk Seri Khaled Nordin. Sharavanan said the Penang and Johor branch campuses would each cost about RM97 million, and the Klang Valley branch, about RM240 million.
another money making business!!
Sounds like another scam to syphon money from PTPTN
great article dr pagalavan!
what will going to happen if malaysia starts to offer private postgrad programme?
Already suggested
http://thestar.com.my/news/story.asp?file=/2012/7/17/nation/20120717175709&sec=nation
Well, it has started with KPJ as I mentioned here https://pagalavan.com/2012/06/18/specialist-training-in-private-hospitals/
Believe the government’s intention is not to be dependent on developed countries anymore (like UK or Aussie), thus allowing the setting up of specialist training in private hospital/university ( as training posts from these developed countries are difficult to get compared with 10 years ago).
Actually, even now hardly anyone goes overseas for any specialist training. So, it does not make any difference. Private hospitals are not suitable for specialist training, period! It is just another money making business and going to produce unqualified specialist.
This kind of practice is the culprit of rapidly increased in the premium of medical insurance. When you talk to this people, they would say that it is not patient money, it is insurance money…they don’t even feel guilty…
Yup, it is a money making business for this doctors. These are the people who did medicine to make money and not for the passion of it. I consider all their money as wang haram! Easy come easy go
It’s great to see all aspiring doctors speaking up and asking questions in this weblog. Sykur Alhamdullilah! I should recommend all Pakistani med students to read your blogs as these blogs are an inspiration to me. Pakistan can sure learn a lot from your country as I had served in Malaysia.
unethical = more money and muddy conscience
ethical = less money and clear conscience
i would rather have a simple blessed life than a guilt-ridden one.
now everyone want to be doctor,sooner or later everyone want to be specialists…whehter have the same quality as compared to those were trained in the government hospitals is another issue
One of the blights that affect healthcare community is how bad the information infrastructure is across the world in clinical settings. Even in the developed world, doctors rely on paper based communication. The new generation of doctors who grow up in the information rich, social networking era struggle to deliver effective care due to lack of clinical information systems.
There are several firms across the world that attempt to change this. Web based medical records and practice management software company based in the UK, ClinicYou (http://www.clinicyou.com) is an example. They offer easy entry into computerising clinics and hospitals without huge IT costs.
Some unique features of ClinicYou allows seamless delivery of care across various sites, including different continents, thus promoting healthcare tourism. As you are aware, many people from the UK visit Malaysia for healthcare. Some may well have medical records on ClinicYou, thus will benefit from clinicians using the same software in Malaysia.
Regards,
Bruce
Get lost you spamming a-h*le!
I am currently doing housemanship in alor setar, I recently visited a private hospital here and noticed there was consultant dermatologist without PG in internal medicine. He has a list degrees including some diplomas and fellowship in dermatology. I am keen to know if there was a shortcut to dermatology (just light shortcut to neurosurgery/plastic surgery) coz as far as to become a dermatologist one has to undergo MRCP/master in medicine first. Please enlighten me
Are you sure? Sometimes they may not mention MRCP in their list of degrees since they have got FRCP. Currently, the only way to do dermatology is via MRCP/Master’s and subsequent dermatology subspeciality training.
Is there such a thing as a shortcut into Neurosurgery or Plastic Surgery?? Unless what you mean is that you do not need to do a few years of General Surgery specialist training before going into subspecialist training in Neuro or Plastics.
In the UK, Plastics and Neuro are specialties in their own right rather than subspecialties of General Surgery. The specialist training programme is longer (6yrs vs 5yrs) and it’s much harder to get into either of these than Gen Surg. The average age of entry into specialist training for Plastics/Neuro is 2 years later than Gen Surg due to the massive competition.
There are no shortcuts to be had in the pursuit of *any* specialist training, medical or surgical. If you want it, you have to be prepared to tough it out and compete.
well i found a website of his, http://drvenkat2u.com/
it even includes the undergrad degree. so i assume if there was postgrad in med it would have been stated. Which comes back to the initial question is there a fast track into subspeciality in internal medicine just like surgery
If those are the only qualifications that this person has, he should not be calling himself a dermatologist. He could call himself a GP with an interest in dermatology.
The Cardiff dermatology qualifications are infamous for people in developing countries doing them (can be done by distance learning – the diploma only takes 9 months) and then calling themselves dermatologists. Even the Cardiff University website says that they are for “doctors in general who wish to gain expertise in dealing with skin disease”.
There are also doctors out there who call themselves O&G specialists and have a clinic (but only operate minor procedures), even though they only have a diploma.
Another thing Malaysians like to do, which this person has done, is list as many qualifications as they can, even if one supercedes the other. For example, this person has listed the diploma and masters in dermatology, even though the masters is just further study of the diploma. Convention is that you just list the masters.
This guy not suppose to call himself as a Dermatologist. I just checked with the National Specialist register and his name is not there. However, till 1990s, some GPs do Diploma in Dermatology and call themselves as Dermatologist and they put their clinic as Skin Clinic. THis happened before but since late 1990s, diploma in dermatology is not a recognised postgraduate degree. Due to some “grandfather” law, the ministry allowed this old timers to continue their practices.
Your answer: There is NO shortcut to anything. Even Masters in Neurosurgery and Plastic Surgery is ONLY offered by USM. Their intake is less then 10 per year(around 5-7) and few will drop out along the way. It is not easy to get into these programmes either.
Thank you for explanation, I am aware that some private practitioners tend to flaunt with the law but to have a private hospital list the name as one of the visiting consultant made me wonder if any new changes has taken place in the system
Some private hospitals don’t care about all this as they are only interested in money. When complain goes to MMC or UKAPS, then the hospital will get into trouble
Just another question, is it compulsary to be registered under NSR?
From next year onwards, YES. The New Medical Act 2012 will be gazetted anytime soon.
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Hi Dr,
I was informed by my colleague regarding TCM registered under MOH and there are few KK and hospitals practising TCM. There is an exam(PHCE) which is run by faculty of homeopathy Glasgow UK, leading us to obtain LFhom. I was acknowledged it can be taken by any medical personnel. For doctors can pursue with MFhom(med) n later specialty register. This license is to practise
homeopathy in our modern medicine
setting. Do you have any idea how far is the truth?
I have never heard of this before. Medical act does not allow a doctor to practise both western and TCM medicine. The TCM in government clinics is only limited to acupuncture and few well known therapies. They do not give any medications per se.
There is NO such thing as speciality in homeopathy under specialist register. You can only practise as a homeopathy practitioner at homeopathy hospitals.
I got no idea where you got this info from.
Read your article and this part
‘Another new trend is beginning to appear recently. Many doctors, especially general practitioners(GPs) are cheating patients with the incorporation of traditional and complimentary medicine (TCM) into their practices’
I think it is very wrong to come up with a statement like this. Kindly go through this site.
http://www.academycmt.com/Recentarticle.html#article33
this is the website of Dr. Ebrahim, one of our longest serving doctor in the chelation field. Please also read on why he encourages patients on chelation. If you have the time, pay him a visit before contributing to an article like this merely to tarnish the image of our noble profession. if you think doctors who use TCM are mere cheaters, please think again.
I skim tro the link u gave and lots of them are just claims and they are using “evidence based” with the inverted commas. Nothing much. Not sure if legit.
Dear Dr Sharmila,
I truly believe that there is a proportion of medical doctors who believe that so-called alternative medicine (SCAM) work because they too have been conned by the false claims. And then there are those who do not care but peddle this nonsense in order to make more money.
As lolz stated, that website merely has a list of claims, This website also has a list of claims, about the harm alternative medicine can do: http://whatstheharm.net/alternativemedicine.html
Click on the ‘Read more’ section of each story, powerful and emotive reading. Nonetheless they are also merely claims and should be given no more credence than the positive claims you have alluded to without further evidence (which is suspect is available if anyone were to make the effort).
In terms of evidence, there is next to none to support the claims of alternative medicine. The evidence base quoted by SCAM practitioners is invariably made up of poorly-designed biased-ridden trials that don’t do a good job of measuring real outcomes. When subjected to well-designed scientific trials, SCAM therapies overwhelmingly don’t make the mark (and there are hundreds of these trials) but the SCAM quacks will say “you can’t use scientific methods to measure how our treatments work” – which is of course total bullshit.
If these therapies really worked, they would be absorbed into mainstream medicine in a heartbeat, especially with the limited financial resources allocated to healthcare. They fact that they haven’t been should tell you something.
Well said. There is in fact no such thing as “alternative medicine”. In reality, there is only “evidence based” and non-evidence based” medicine.
Personally, I have no major issue with non-evidenced based medicine so long as it fulfills Browning’s principles:
1) cheap
2) does no harm
3) gives the impression of activity
4) might even work!
(Prof Browning was actually writing about nasal balloon therapy for glue ear, but hey, they apply for any snake-oil treatments)
Unfortunately most snake oil treatments fail at the first, and worse still, violate the second.
Dr. Ebrahim is well known amongst the senior medical fraternity participating in early online discussions (DOBBS), to have unusual ideas, and make lots of un-proven claims, especially about his pet subject of chelation therapy. Any person who have some basic knowledge about evidence based processes will see how the evidences provided are not evidenced based!
http://thestar.com.my/news/story.asp?file=/2013/5/31/nation/13179209&sec=nation
True??
These articles do not provide any evidence as such. It is merely stating that so and so improves etc etc. There is always something known as placebo effect which occurs in modern medicine as well. Angina improves does not mean the obstruction has gone !
BTW, I know someone who died recently during a chelation process. So, to say that it has NO side effect is not right.
I am not saying that TCM has NO role BUT as a educated medical professional, you can’t justify something by just stating that it works etc etc. MMC has issued a statement 2 years ago that chelation and ozone therapy are not proven and thus doctors should refrain themselves from promoting it.
Dear Dr,
Appreciate your views and comments I have no intentions to argue or prove myself right. You have your views and I respect it, it does not mean that NO one has benefited from these procedures and neither have I agreed that you are totally right.
Anyway, I think there is no reason to question my education because I believe the treatment works. Probably you are not exposed to the benefits and wish to believe that it does no good. I’m glad to have this comments put up, as at least we get an idea of how some Physicians perceive it.
Thank you for the time taken to look into the articles and analyse it from your angle.
Dr. Sharmila
if you believe it works than a proper placebo controlled trial should be done. On then , it can be considered evidence based.
and randomized controlled trial 😉
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