Well, Budget 2013 was announced last Friday and as I had mentioned last week, it is truly an election budget with a lot of goodies thrown all over the place. As I mentioned over here, more 1Malaysia clinics are going to be opened with extended care of screening services like cholesterol and blood sugar checks. It is good for the people but for the GPs, it is another nightmare! Who can beat the RM1 check and free service for senior citizens?
Now, coming back to the title above, it is not always a good news when your names appear in the newspaper. Few days ago, I received a comment in this blog accusing me of being unprofessional for exposing the unseen side of medical field. This guy who do not even know what a Rheumatologist do (other than giving painkillers!) seem to say that we should just keep quiet and just let the “unethical” fellows out there to continue cheating the public. I had written a reply to him for which he did not reply. From his comment, I can say that he is a young fellow who do not know much of what is going on. FYI, most of the cases that I brought up over here has been reported to the authorities but whether any action has been taken or not, I am not sure.
Today, MMC has announced few doctor’s name in the news. These doctors are being suspended or reprimanded. One of the person involved in a well-known figure who appears in almost all Malay newspapers, promoting his products which supposedly can reduce weight, treat diabetes etc. In fact, that was his main business and someone told me that he is now a millionaire ! Remember what I wrote over here? If MMC truly wants to take action against doctors doing this sort of promotions, I think many clinics will be closed down. Unfortunately, MMC only acts when someone complains to them as they do not have enough manpower for enforcement purposes. I was informed that under the amended Medical Act 2012, MMC will be given more authority and power for enforcement. Whether they will have their own enforcement team or not, remains to be seen.
Any action taken by MMC is done after multiple discussions and deliberation. It has to undergo various stages before the final decision is made. Some may take up to 1-2 years to be decided, as the cases above. You will be given opportunities to defend yourself by appointing a legal expert (your indemnity insurance lawyers). It is equivalent to a court enquiry. Once MMC makes the decision, it will be announced to the public in their bulletin as well as the newspaper. In Singapore, even your photo will be published in the news!! The more developed a country becomes, the more work the medical council has to do as the public will complain more. MMC has already announced that the number of complains they are receiving is increasing day by day. Same goes to the litigation rates. Most general hospitals in this country seem to be receiving legal letters on a monthly basis so much so, some hospitals had made it mandatory for specialist to see all new admission cases and review all cases over the weekend. Now, the MOs have become HOs and the specialists has become the MOs.
As I have written over here and here, the situation will only get tougher for doctors to survive. There is a saying now that you will be sued for at least once in your lifetime as a doctor. No matter what good deeds that you have done in your career, a small mistake can destroy your entire reputation and practice. For the doctors whose names are mentioned above ( not the first name!!), their misery will not end here. What are the other implications? I would leave the readers to ponder upon.
There are even cases where patients are suing doctors almost 5 years later!! I know an O&G friend of mine who is currently in private practise, being sued by a patient who he saw only once when he was “0n-call” in a government hospital then. The child turn out to have Cerebral Palsy due to some delivery complications. After 5 years, he and the government hospital is being sued for almost RM2.5 million!! One case like this is enough to cause you nightmares for months.That’s the reason why the government may soon make it mandatory all government doctors to take indemnity insurance to reduce the burden of the government. I heard indemnity insurance will be made compulsory to renew your APC, under the new Medical Act 2012.
These are the reasons why in developed countries, many of their citizens do not want to do medicine. Many doctors close shop as their income is not even enough to support the indemnity insurance. It is only in developing countries that people are still obsessed in becoming a doctor by hook or crook hoping to have good life, good money and good future. Well, things are changing and I hope everyone who are interested to do medicine will do it for pure passion, willing to work hard and sacrifice family life. This is the purpose of this blog; to educate the public, future students and doctors regarding the “unseen” life and challenges of a doctor. If you think you can’t handle it, then by all means, leave……………. so that you do not regret later……..
Despite writing so much in this blog since January 2010, I still have queries from medical students that sometimes make me wonder whether did they really know anything about medicine before they stepped their foot into medical school!! There are still people who think they can go to UK to do Cardiothoracic training after HO with unrecognised degree, become a surgeon instantly etc. However, it is my duty to explain to them. That is the purpose of this blog!
I have a feeling that the current generation do not read much!
Pagalavan's Avatar 
Hi Dr Pagalavan,
I’m a med student, regarding “Now, the MOs have become HOs and the specialists has become the MOs.”, I don’t really think medico-legal issues is a factor for it. From my views, it’s more of the attitude of an HO or their work rate or even their shift system. As following morning ward round, I do found that in 3 days 3 different HO’s (d/t the SS) get scolded from the same specialist over the same pt over the same issues all the time. This shows the pass over system between HOs are poor if not they would have taught each other n learn from each other instead of making the specialist doing the HO jobs by re-clerking n re-examining the pt. N some of HO that doesn’t even see their pt before the ward round really makes things worst. To be honest, I got to agree on your view that my generation of med student do not read much as my lecturer once said said oversea med student tend to read 50 textbooks per year compare to Us, local med student who’s on a average of 12 textbooks per year or lesser. Thank you.
Yup, you are right. It is one of the factors as I have mentioned some time ago. However, the litigation rate is definitely another factor which is putting more stress to the specialist nowadays.
Most students nowadays prefer lecture notes than books………….Maybe lecture notes shouldnt be given in the first hand to encourage reading….
In most developed countries, lectures are NO more given. Everything is self directed learning facilitated by lecturers. That shows how confident there are with their students.
And in some countries, the lecturers give “tuitions” but don’t lecture much in the lecture hall. Some even say ” if you wish to get more info, join my tuition classes”… You know which countries I’m talking about.
Some lecturers tend to ask questions in exam using lecturer notes and this worsens the situation especially in pre clinical year………
I don’t think Rozmey is affected by this suspension. The guy is more of a businessman than a doctor now. He has testimonials, which is enough for the mass to buy his products, Dr. or no Dr.
And after 2 years suspension then what? Suspend again? MMC is really a bit too late too often. The guy has been on TV, radio, papers etc for how many years?!
I’ve nothing against Dr. Rozmey, I’m sure he’s a nice fella tending to his business. MMC failed at the enforcement part.
‘I have a feeling that the current generation do not read much!’
I have a feeling you are right!
I think Rozmey is just doing what you’re advising these young doctor wannabees. If you can’t take the clinical work anymore, even you’re an O&G specialist, you can always do business. MLM! Just make sure to have that hair of Rozmey, then the customers will come LOL!
You can always do business but never use your medical degree to cheat people
Dear doctor,
I salute what you have done and keep on doing. Please don’t stop “educating” us and the public.
Today, a father in tears for her daughter who got a scholarship in Russian medical school. All I can say is Good Luck for her in Russia. This maybe the beginning of a nighmare.
That MMC list of doctors repremanded was actually in MMC website since THREE months ago but somehow the newspaper decide to publish this as a new maybe because Dr Rozmey has some news worthiness. MMC had been refularly publish disciplinary Inquiries result every 3 months in MMC website.
As for the medical indemnity insurance for public doctors, I think this is a good move. The cost for is abour RM350 per annum which is about RM30 per month (one hour of locum). I am not sure the same rate is applicable for gov specialist or not. But this maybe a good thing for extra help especially in case that you think you may not be guilty one. This is more to preserve your reputation and dignity. Sometime for saving trouble gov may ask you to ‘admit’ the guilt and settle the case of out court. Having medical indemnity insurance will not save any money for the gov because the cost is always the same since we got Jabatan Penguam Negara which deal with all these medicolegal case. Most of the time the cases go no way, the gov usually won these cases 99% of the time. But most cases will be settle out of cour to save time and money.
P/S as for your case that the doctor is being sued 5 years later for cerebral palsy, I have seen case being sue 20 years later. beside causing much hassle, I can say the patient has almost no chance to win that case unless they put in hugh resources of getting good lawyers and tons of money to hire expert witnesses (which is diffciult to get locally because many don’t like to give opinion against peer) to prove their cases. The case may take years and most of them go nowhere and just being forgoteen or dropped. I had work in public hospitals O&G specialty for many years, if it is an obvious case the gov will settle out of court. If the cause is not obvious like in CP, shoulder dystocia, IUD etc, the cases can go on for years and almost for sure the gov never lose because the patient got great difficulty to prove incourt beyond resonable doubt that the bad outcome is caused by a particular act of a particular doctor.
Yes, MMC publishes the list every 6 months. Most of the time it does appear in the paper but relatively late. MPS has come up with a special rate for government doctors. Specialist got their own rate unlike MO’s rate of RM350.
From what I gather, the government is settling a lot of cases out of court by paying the complainants. That’s the reason why the government can’t cope with the payment anymore. The case I mentioned above, the mother refuse to accept out of court settlement. Once all doctors have their own indemnity insurance, the government will not entertain any complains directed against a doctor for negligence purposes. You would have to deal with it by yourself, using your indemnity lawyers.
In public hospital, the decision is always made ‘collectively’ as a team. All the cases I saw, they put the first defendant as MOH, second defedant as the hospital involved and then doctors involved as subsequent defendant. Usually no doctor is singled out unlike in obvious cases like leaving an instrument in the patient’s body. Most of the medical errors are related with the systemic defect. A HO injected the drug wrongly into artery cannot be blamed 100%, it is the sytem error that allow this to happen. So even with medical indemnity insurance for every public doctors, the bill will be footed by gov as well UNLESS the gov purchase extra medical indemnity insurance as a whole for ALL doctors and divide the cost to each individual doctor.
I heard that soon the specialist will be put in charge of each patient and anything that happens to the patient, the specialist have to answer.
I know another case where a patient is suing a government hospital for RM1.5 million for bladder injury following LSCS. The LSCS was done by the registra but the specialist on call is now being interrogated and blamed. The MOH enquiry really demoralized and ripped him apart.
In many developed countries, it is the consultant in charge that have to take the blame for any negligence issues. Of course, if it is the system issue then the government have to answer.
Even the doctor is sued indivdually, this will not work. The private medical indemnity insurance companies will set conditions on the scope of work of each doctor depends on the level of competency of each doctor. If the case is due obviously a systmic error in MOH, they will not have the resposibility to pay. This will prolonged the cases and eventually the claim will be back to MOH. Unlike the private sector where one specialist take care of the patient from start to the end. In public hospital the patient could have seen 10 doctors before a hysrectomy is done. Is the patient going to sue the 1st doctor who made the decision or the doctor who did the operation or the doctor who manage the surgical complications? In public hospital the resposibility is solely on MOH as employer who set the standard and quality. To sue a particular doctor is just waiting time and money and both patient and doctors will get no where and eventually will increase the cost for gov.
Bladder injury is an inherited risk in any LSCS case. This may not mean negligence by the registra. If the injury is dicovered in prompt manner and correctly dealt with, this is no negligence and I can assure that the patient will not win such case. Only if the condition like if bladder injury happened noted by assitant nurse or the surgeon himself BUT no help is called. This is negligence and patient will have a case. Can you blame the registrar? You can’t, because the system allows registrar with certain experience to be privileged to perform such procedure.
MOH tend to take the knee jerk action. No doubt this interrogation after each bad incident is demoralising but as long as they don’t change the system we work, this will continue to happen. And most important of all such system is an offical stance by MOH, the patient can’t win the case because this is the standard unless the patient can prove the MOH wrong by proving that system should not in place in the first place. This is a complicated problem which can’t just be solved by private medical indemnity insurance. Whoever suggest this is just having another knee jerk reaction.
The patient can win the case, trust me. The issue will be ‘did you inform the risk of bladder injury’ to the patient before the surgery? In the west, most cases are won by patients just because no proper explanation is given. Our consent forms in the government hospitals is not worth the paper it is written on.
The bladder injury was picked up the next day and attempt was made to refer the case to urology centre but patient took AOR and went to private hospital. You can say that it is a known complication but did you inform the patient regarding the possibilities? If you read the case books by MPS, most cases that they have to settle are related to such incidences
No, the patient will not win this. I had seen enough of such incident. Even if in LSCS risk of ureter injury is a known risk. But are you going to tell patient that by having LSCS your ureter can be injured or your bowel can be injured and you ended with a colostomy? Or by having spinal anesthesia, you have the risk of high spinal block and you can actually die of repiratory arrest? Or you may have blood trasfusion and when this happen you might even get HIV or anaphylactic shock? Or even anaphylactic shock from the anaesthetic drug they administrated? LSCS especially the emergency LSCS cannot have every risk explained. The fetal or maternal condition is usually the priority. No doubt consent is an important aspect in court case but this is often not good enough to prove the doctor is negligence.
It does! That’s the reason why in any other developed countries including Singapore, there are separate consent forms for each procedure including separate anesthetic consent forms!
YES, you need to explain all the risk involved. You cannot assume that it is a known complication and thus don’t need to inform the patient before hand. Remember the case about the spine surgery that ended up with paralysis?
Also, remember how the blood transfusion consent form came about?
In Malaysia, the court usually don’t use the MPS cases as standard unless you can hire all those foreign experts to come to Malaysia but eventually this will leads no where. They will just prove that in Malaysia public sector, we don’t have enough experienced surgeons and we have to privileged certain non specialist doctors to peform certian procedures. This is perfectly LEGAL in Malaysia. Thism is why in Sabah or Sarawak, you can privileged MO in rural district hospitals to perform appendiciectomy or LSCS but the same experienced MO cannot do same procedure if in a big hospitals who got enough specialists to do so.
NOT YET but it is coming. That’s why MOH is working on it.
Dear Poor Doctor,
You wrote : “But are you going to tell patient that by having LSCS your ureter can be injured or your bowel can be injured and you ended with a colostomy? Or by having spinal anesthesia, you have the risk of high spinal block and you can actually die of repiratory arrest? Or you may have blood trasfusion and when this happen you might even get HIV or anaphylactic shock? Or even anaphylactic shock from the anaesthetic drug they administrated? LSCS especially the emergency LSCS cannot have every risk explained.”
I am an anaesthetist working in a developed country that has a very low medical litigation rate due to various govt policies (which I won’t elaborate on here). Even then, we are quite clear with informed consent. The procedure is explained in lay terms. The common risks are mentioned even if relatively insignificant, and the significant risks are mentioned even if relatively uncommon. Where appropriate, we may discuss alternatives to a procedure.
For a spinal (since you mentioned it), i outline the risk of hypotension, nausea/vomiting, headache, backache at insertion site, itching, shivering, allergic reactions, infection, nerve damage, prolonged block, incomplete block, conversion to GA. I mention the risk of death to any patient that has significant comorbidities and have a conversation with them and their family regarding what resuscitative measures I would be prepared to offer in a given situation.
The key is whether or not a doctor has been negligent in their care. If you have failed to obtain informed consent, you are negligent. There are tons of case reports involving surgeons who have failed to mention certain risks or alternatives when taking consent for procedures, with the patient then developing a complication and successfully pursuing a case against them or the hospital.
Using your example of an anaphylactic shock during an anaesthetic, negligence can be proven if a drug was adminstered despite the patient being known to be allergic to it OR if the management of the anaphylaxis was poor. If the patient dies in an unanticipated anaphylactic crisis despite appropriate care, then there is no negligence (this is where documentation is important).
Any patient receiving blood has to have the risk of anaphylaxis and infection mentioned to them. Both are extremely rare and are weighed against the obvious benefit of what is probably a life-saving intervention. It is our duty as medical professionals to explain this to the patient, for them to be able to make an informed decision. If they defer to us, then we do what is in their best interests.
I am sure laws differ from country to country, but many of the principles are the same – especially within the Commonwealth countries.
Nav, you are in an almost ideal situation. We are NOT in developed country. I used to work in a hospital with annual delivery of approximate 20000 (when we told this to our British counterparts, they thought we are joking) with about 15 consultants and specialists and a team of MOs and HOs. The anesthetist counterparts consist of SINGLE specialist only and a team od 4-5 MOs as well. Both teams do take their time to explain the risk for consent of LSCS as best as we can to patient if time allow (especially the elective cases). But often when we decide for emergency LSCS, the sole poor MOs (2 MOs + 1 specialist during office hour, one after office hour) is still doing the cases in OT and when he got to see the patient, he often got 5 min to explain all this to patient and not to mention the ability of the patient to understand this medical complications during this 5 min. SO should we wait till she fully understand before we proceed the LSCS? Thus we have to be practical in such situation and court do take this into consideration (trust me, we have been in these cases and we won!). However with the ever increasing no of doctors I hope the situation will improve BUT again I doubt that because the experience doctors are leaving and the relative inexperience is flooding the system. So with these doctors and ever increasing demand of patient and thin margin of error in obstetrics, are all these contribute to negligence? Again maybe yes or no, but we have no choice but to do our best and the same time push MOH to improve the system.
We cannot compare various countries standard by using only one standard. We cannot compare Malaysian practice with UK, US or even Singapore because we are not in the same league especially in the public health service but we must strive to do better than yesterday. Take another example, by having 1Malaysia clinic run by medical attendant, can we sue the medical attendant for misdiagnosis as negligence. If yes, should the MOH or the medical attendant be sued? Or should we continue to allow medical attendants to carry out anesthetic work by giving GA or spinal in east Malaysia especially in Sarawak? If yes, can they be sued individually if complication arises EVEN with consent taken? This is a complicated issue to solve!
No one is denying these facts but things are changing. The courts will not side you all the time. When the litigation rate increasing every year, the court will start looking at the best standard of care and not what is practiced daily at every hospital. As we move forward to become “developed” country, the outcome of the cases will also change as the public would not tolerate the same situation anymore. As you said, we are going to have a serious quality issues in near future and the litigation rate is only going to go up and up. The government probably knows this and thus the introduction of compulsory indemnity insurance to pass the bulk to the respective doctors. Also remember that corporatization of public hospitals is also coming. Do you thing this private company will take any responsibility? I don’t think so. We will eventually become UK, US and Singapore, it is just a matter of time.
It all depends on how the community reacts. In rural sabah and Sarawak, we still have the forgive and forget generation. That’s the reason why they just accept what is given to them. The same cannot be said about the major towns. Informed consent is the only way you are going to protect yourself from any legal suits on surgical negligence. Proper documentation is another way. We can’t run away from these. Those who just attended the medico-legal conference held few months ago will know that “there is NO excuse” in not documenting!!
While the acute workload is obviously different where you work Poor Doctor, we deal with emergency cases too. When taking consent is not possible due to an emergent situation, the doctor acts in what he/she thinks are in the patient’s best interests. That is the case here and I’m sure it’s the case in Malaysia too.
Taking consent immediately before a procedure is never ideal because the patient is placed in a situation where they are indirectly pressured to agree to what the doctor is suggesting. Most of the time, it is in the patient’s best interests anyway. Nonetheless, we must do what we can in the time available, even if it is 5 minutes. That is how I would expect to be treated as a patient.
Medical consent especially those in public hospital is actually piece of useless paper as you mention. With or without consent the patient have the right to sue for any complication. With consent don’t free the doctor from negligence claim. Similarly for patient even a well explained consent donesn’t mean the patient loses right to sue a doctor. Same for that piece of AOR discharge paper.
As long as it is documented, the patient can’t sue. BUT not the other way round.
Patient can still sue even if documented because there is an imbalance knowledge of the patient and doctor. This is often argued in court as I have seen it myself. This often made the consent meaningless.
http://jrsm.rsmjournals.com/content/100/2/97.full You can refer this for risk to explained to patient:
“The issue of how much to explain to a patient is debatable4,5 with the following quotation highlighting the dilemma faced by many doctors:
‘A patient may make an unbalanced judgement because he is deprived of adequate information. A patient may also make an unbalanced judgement if he is provided with too much information and is made aware of possibilities which he is not capable of assessing because of his lack of medical training, his prejudices or his personality.’ (per Lord Templeman in Sidaway (1985) 1AC 871 at 904, as cited by Lord Woolf in Pierce)6
Ultimately, the decision of what to mention lies with the consenting surgeon. Currently the Department of Health advises that a doctor:
1.
Should warn the patient of anything that poses a substantial risk of grave adverse consequences;6,7
2.
Should mention significant risk that would affect the decision of a reasonable patient;6,8
3.
Is under a clear and legal obligation to tell the truth if asked a direct question.6,8,9
In practice, a complication that is likely to occur more than 1% of the time is often mentioned, but certain less frequent complications may be so grave that the doctor feels it wise to mention them. For example, permanent loss of vision following routine cataract surgery occurs in approximately 4 in 1000 cases10 and should be routinely mentioned. Some complications are so extremely rare that they need not be routinely mentioned; however, if asked a direct question concerning the possible occurrence of such a complication, the doctor must answer truthfully.”
Even in medical community there is no consensus for what kind of risk to disclose for EACH particular procedures even among those in the same specialty. What’s more for the judge or jury who are not medical trained and depend wholely on the expert withnesses opinion. Thus the consent part will not be a big part in proving the negligence of a doctor. The role of consent will be even smaller in those very emergency procedures. In spinal injury paralysis is a significant complication even though it is rare as it got life long impact but is bladder injury during LSCS a significant complication since we know bladder usually heals well without any complication and quality of life usually not much affected. You can argue this in court but would the court consider this negligence? The spinal patient may change mind after given that fact of risk. Would this mother change her mind of not having LSCS even if she is given ALL the dire rare risk related to LSCS? I suspect no.
Nope. As long as the patient is not in the category of ‘temporary incompetence’ any consent form that they have read and signed will mean that they have understood the surgery and it’s complication. I am talking about proper consent form with all risk mentioned and NOT out gov consent form which is worthless and can be challenged.
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Ya I agree. The gov consent form is too general and worthless. There should be procedure specific consent forms. However my point is even if you have those forms, the patient can always turn around and said they don’t really understand the risk stated there and is the doctor the one who influence them to sign. Medical negligence is not based on the availability of the informed consent, this is just part of the picture. Good medical practice includes dealing with complications. Consent don’t really free a doctor from negligence. The whole system of medical practice have to be taken into picture. A consultant can get the consent for LSCS but if a MO is allowed to do the LSCS because short of man power and end up with complication, is this negligence? Maybe yes maybe no depend on how the lawyer argue the case. It is like a will, the will can be challenged by the offsprings if they don’t agree.
Arguments like this will be thrown out of court unless the consent was taken when the patient was under ‘temporary incompetence’ scenario, like taking consent in OT etc. otherwise as long as the patient has been given enough time to read the consent form and sign it after discussion with the consultants, the patient can’t sue you. The consultant should also document in the notes of issues and concerns that was addressed.
Legally, only the person who took the consent can perform the surgery. If anyone else is allowed, it must be under the supervision of the consultant involved and the consultant takes the responsibility.
Even with the blood transfusion form, the patient can still prove negligence if they can prove that the lab didn’t do the screening properly. I think this happened before in Kedah where gov paid RM1 million.
He Kedah incidence was the reason why the consent form was introduced!
So do you mean by signing the form, the gov let go the resposiblity? I don’t think so. With or without the consent, if the MOH don;t set a standard for blood tranfusion they can be sued. I think this is the reason that private hospitals are now only allowed blood being sourced from gov blood banks.
Yes, prior to that incident, there were no such thing as blood transfusion consent form. Thus the patient could easily sue the government for NOT informing the risk. NOw, the patient must read and understand the risk before the blood is given and sign the consent form. Once they sign, the patient can’t sue. Of course, the consent form also says that proper blood screening standards are followed by the gov.
Private hospitals never had blood banks. Too costly to run.
‘I HAVE THE FEELING THE CURRENT GENERATION DO NOT READ MUCH ” sir the current generation does not READ AT ALL .
Selva, Spot on.
Yesterday I took yet another HO for re-assessment. He graduated from one of the Uni in Russia. Three months in our department, clearly he is poor in basic knowledge. The questions asked were similar to 4th year (local) medical school. Problems with doctor nowadays are the MBBS they have is a licence to NOT continue reading. Just look at the MMA CME meetings, how many would bother to attend except for old (senior) GPs? HO/Young MO are just not interested. Even the makan in 5 star hotels failed to attract them!
I think this has nothing to do with the habit of not reading in the first place but more on the quality of the medical school training program.
hello doctors,
i am studying in Philippines, yes again it is an unrecognized university. I chose to study here willingly and now i am in my final year. I’m almost finishing. Every now and then i keeps updates myself with dr pagalavan blogs.
I am not surprising if i become a jobless fellow someday because the overflow of doctors in our country (Malaysia). hope still can grab a job in health field because i have my 1st degree in biomedicine.
I do agree that current medical students are not studying much of their textbooks and what more the students who are in questionable substandard medical institution.
Here in my university, students are really lacks of practicals. Instructors are not responsible to us. Being a only malaysian student in my batch together with other international students , i really getting lots opportunity in doing volunteer duties on my weekend and semester break.
I realized one thing that, instructors helps more when the student puts effort and interest in learning.
I always ask myself, why don’t medical students spend more times with patients and have better history taking skill, familiarize with basic procedures, involve in case discussion?
In here i found students are really lazy (sorry to say this), sometimes i find myself pity because there are situation i need to face lazy -attitude -person to do some group-dependent tasks.
i always emphasis myself in learning basics as this is the foundation for a effective-health care provider.
i really hope, i will be having equal chance to face the competition in getting jobs in malaysia among the recognized-institution and local medical students.
Thank you doctors,
i’m learning lots in this blogs.
First you have to get through the medical qualifying exam for unrecognised medical school before you are eligible for any doctor job in Malaysia. I really wonder why you choose an unrecognised medical schools. For the amount of money you paid, you probably got a place in any of these recognised Russian medical schools though could be equally bad but at least recognised and avoid such hassle. The Medical Qualifying Exam could be agonizing and frustrating for you if you can’t make it in the first or second attempt. BUT with the recent approval for the 16 private medical schools in this Bolehland to offer such exam, you maybe able to buy yourself the necessary qualification though the price maybe steep.
Dr.Paga,
My father was admitted in GH for liquid rentention in his heart and lungs causing swelling in hands and legs and his had shortness of breath. He was already admitted earlier for the same issue but when he got discharged they didn’t explain clearly the limitations of water intake, just sent him back with diuretic and other medication. We weren’t aware of the amount of water to be consumed and ended up the swelling became worse, again breathing difficulty and we had to re-admit him. This time round 3 diuretic injections a day to remove everything and now he is back home. But they could have told us earlier about the limitations and pre-caution. He needn’t had to undergo this, and he has become really lethargic this time round. If we public complaint, the standard response from docs is you are not the only person we deal with……
This is common problem in GH. Usually they would have told your father while he was in the ward, to restrict fluid intake but forget to tell him on discharge. They would have assumed that he will continue the fluid restriction at home. Furthermore, most of the time, they leave everything for the housemen to advise.
Let’s say I’m after HO & MO and I’m tired of being a doctor. What should I do? What legal business should I do? Any investment that I can make? Please give me some opinions. Thanks.
you can read all my post to start with.
hi mr. bond.
you can actually join the police force as they are always seeking a degree holder like you. After you’ve passed and gazetted as a mata-mata then you’re actually one of those ‘mat bond’.
http://www.themalaysianinsider.com/malaysia/article/malaysias-talentcorp-foray-in-melbourne-a-huge-success/ Seems like our health DG got different opinion and think that there are lots of money in our health sector especially in private. He assured those who are willing to come back to have good income and place in international accredited hospitals.
Haha, as usual the head does not know the reality on the ground
The issues regarding poor preformance by HOs and the new batches MOs are very common nowadays. But, lately, I have seen the new batch of specialist making gross mistakes/errors during their clinical rounds.
1. Saw an anaesthetist ordered Adenosine for a young asthmatic patient who developed SVT after repeated nebulization in ICU.
2. An A+E specialist ordered bolus dose of phenytoin for a patient with epilepsy who presented with ataxia.
3. An A+E specialist missed ECG changes with elevated ST segment, treated patient with acute gastritis.
4. Most general and orthopediac surgeons( new/senior) doesn’t know how to scrub properly before starting their cases. Some scrub their hands like washing hands before and after taking food. But, when the rate of post op infected wound increased, they are totally “lost”.
5. Many junior specialist nowadays, dont know how to do central lines( a dying art).
6. A senior consultant Hematologist gave a wrong regime of chemotherapy to a patient( luckily the patient is still around now)
I can go on and on abt this, but the trend medical-legal errors done by HOs nowadays are changing and things which are rare in past are becoming very common nowadays. e.g:
1. Investigation results kept in wrong patient’s medical file( So, on every encounter with patient, the docs have to check patients name and I.C before doing anything else)
2. Cases of patients with very low Hb and low Na+/K+ despite them being asymptomatic – Blood taken from arm with intravenous drip. Unfortunately, some of them are given blood before the errors were picked up.
3. HOs – in some hospitals – Don’t check patient’s medication/drug charts during round. Claim it is “unaware of it”- common answers by 1st posting medical grads from Russia.
With these types of mistakes and with the young specialists coming in, the quality of our health care system is going down hill.
how u can easily noticed this while the corresponding people did not?
is there any action taken?
I am jobless, so I got a lot of free time to read the case notes, page by page.
I am just curious. Are you jobless because too many doctors and thus too much time and nothing to do. Or are you actually have no job but if you were indeed don’t have any job, then how you get the authority to read those case notes?
I’m jobless bcos too many manpower in my unit.
Ppl involved in the above mention cases don’t know abt their mistakes cos they manage those cases for a short period only before others took over, mostly not bothered to follow up their patient once their duty were over.
In case involving the hematologist, no one will dare to point out the mistakes, all kept quite cos “Boss always right”.
I mean “quiet” cos Boss always right. Even, the cytotoxic pharmacists kept quiet til a new person came in the middle of the management and inquire abt the diagnosis and chemo drugs which doesn’t “tally”.
It will only get worst!!
Hello Dr. Paga… How are you? It has been a while indeed. I am graduating in 3 weeks and will be going back to my home country Malaysia with mixed feelings. Sadly, I had to turn down my job offer here in WA, Australia because of sponsor’s demand which is fair enough.
That put aside, I wanted to ask about intern teaching in our hospitals. Here in Australia, the teaching are done weekly and properly to avoid all the above mentioned mistakes and for the senior doctors to be able to pick up any inadequacies in skills and knowledge of junior doctors. Seniors must point out common errors to juniors and ways to avoid them. How about grand rounds etc?
And aaahhhh, hahaha…. issues with consent? seriously consent needs to be taken seriously… not only for covering yourself from litigation but to make sure that patient care is put as first priority. That is basic, it is the responsibility of the doctor to find time (a suggestion, during antenatal clinic maybe? Take your time, i mean take your time to explain the possibilities of complications no matter how scary or unlikely it is – it is still a risk that needs to be explained thoroughly).
It is a bit sad and scary to be honest seeing how you have to swim and survive in Malaysia.. I am not asking for interns to be spoon fed but you have to teach juniors and monitor them so that preventable fatal errors could be avoided. Above all do no harm, if you do have to do any form of harm, it must have a well assessed benefit over harm. PATIENT CARE IS FIRST. IT HAS ALWAYS BEEN IN MY BOOKS.
Haha, I think you are going to get a culture shock when you get back home. You are coming from a developed country to a developing country. You are coming from a organized society to a disorganized ‘tidak apa’ attitude based country. There is no such thing as proper academic teaching sessions in our hospitals. Everything is informal. It all depends on the department and HODs. Some departments got none and some may have a weekly sessions. In most hospitals these type of sessions are dying because the juniors themselves are not interested. Most housemen do not even bother attending these sessions. They rather take the time going shopping or doing Locum, since the shift system started.
Most MOs nowadays have become like housemen. Specialist seem to be doing all the decision making. Our consent form is only good to become a toilet paper. I was told that now only surgeons are allowed to take the consents.
“during antenatal clinic maybe?” Easy to say but when you are doing a antenatal clinic(starting 8am till 430pm) with at least about 250 pregnant ladies each session, how much time need to be allocated for each patient? My manpower is 2 consultants, 3 specialist, 5 MOs and 10 HOs. Only specialist and cinsultant make major decisions such as LSCS and induction. Take your time is not a priority I suppose.