26th February 2014 was the day I woke everyone up. When I wrote an article with the title ” A Wake Up call? “, I never ever thought that it will go viral in social media and indeed, waking everyone up! I posted the article on 25/02/2014 at around 11.30pm. The next day I had a staggering 51 113 views in a single day, the highest ever recorded, equivalent to what I usually receive in a month! Almost 4000 came from Russia. It received almost 450 comments to date. 7 000 people shared in Facebook and 96 tweets were made. I spent almost the whole day trying to reply to many of the comments that I received, replying mainly from my iPad and Blackberry Z10 mobile phone.
I had a lot of nasty comments but many of it were from people who did not really understand what I actually wrote. Many were accusing me of degrading Russian graduates etc. This is a problem which I commonly see among many of the younger generations. They pick a single sentence and accuse people of something. I saw many “would be” doctor’s attitude which is rather shocking and just proved some of my comments on quality! When you read an article, the interpretation should be based on the entire article and not a single sentence. The fact remains that there are many unqualified students who are doing medicine overseas, including Russia, Indonesia, China and Middle East. Some of the comments that I received proved that as a fact. This is one of the reason why the quality of products of these universities are poor. No matter what people think, you need certain level of intelligence coupled with true passion and interest to become a good doctor. This is what the entire article is all about. Of course, I did mention that there are good, hardworking graduates from Russia/Indonesia etc but majority of these graduates are those with good entry qualifications who had no choice but to go to these countries due to financial constraints or government sponsorship. This fact was again supported by many of the comments in this blog. Many comments also supported the fact that graduating from these universities are not difficult. Trust me, the same scenario is happening within our own country.Of course there are also students with good results but turn up as a “bad” doctor but the probability of these happening is very much lower than the other. This usually happens as they were not interested in medicine anyway.
Then, there was another issue on using SPM results as an entry qualification. Despite me mentioning very clearly that I would prefer a good established, standardised Pre-U course as an entry requirement into medical course, there were many who accused me otherwise. The SPM minimum requirement is from MMC and not by me! I believe that it was the SPM result that I posted in the article that attracted visitors from all over the world. Many were shocked to see a person with such a result becoming a doctor. You can argue till the cow come home but it is a fact that you need a good entry qualification (established Pre-U course), at least top 10% of the cohort, to enter a medical school in many developed countries. For those who say otherwise, why not you try to do that in countries like US, UK, Australia/N Zealand and many of the European countries? They will ask you to fly kite! These countries also have a good quality monitoring system in place, after graduating.
It is also a known fact that the quality of doctors are deteriorating. This is due to reasons such as the one mentioned above, mushrooming of medical schools with inadequate academics and inadequate housemanship training (due to oversupply). These poorly trained doctors are then released to the community with a “license to kill”! Frankly, a doctor can kill a patient with a stroke of a pen. Many of these doctors do not even know what they don’t know (lack of insight)! Imagine a patient with Chronic Renal Failure being given high dose NSAIDS leading to a fatal Acute Renal Failure! Yes, it has happened! Imagine a postmenopausal bleed being told to be normal and discharged ! A 74-year-old lady with 1st episode of seizure being discharged after a pint of drip (Na 115)! These are just the tip of the iceberg. I can give you dozens of examples which is happening on a daily basis. These doctors who are completing the housemanship are the ones who are forming the backbone of the entire healthcare system in this country. Klinik Kesihatans, District Hospitals and even in general hospitals, MOs are the most important front liners. The deteriorating quality of doctors will bring down the entire healthcare quality of these country! Numbers does not matter, quality matters! Thus, when I said that many of these poor quality doctors will end up as GPs or chronic MOs, many GPs were unhappy with me. Again, they quoted a single sentence in my comment and said that I am degrading GPs. My sentence was from a series of comments that I was replying. I was saying that, many of these “poor quality and poorly trained” doctors will end up as GPs, and who monitors them? Once they open their clinic, they answer to nobody. Again, don’t misquote me. I know many good doctors who have become GPs. Many of them are my good friends and they know what I am talking about. I am talking about the future. We can’t compare the training that we got from what the current generation of doctors are receiving. Same goes to some of the junior specialist who leave to private sector too early without adequate experience. We need a proper monitoring/upgrading system in place.
2 days after I wrote the infamous article, I had a chance to meet up with the MMA President and Secretary in JB. They came down on 27/02/2014 to discuss our preparation for the upcoming National MMA AGM in May 2014. Our President just attended a meeting in Putrajaya with MOH officials, WHO representative etc. He revealed a shocking information. According to WHO representative, they had never issued any statement regarding doctor: population ratio of 1: 400 for a developed country ! WTH! All these while, it was these ratio that was quoted by our government in producing more doctors and the mushrooming of medical colleges. The news appeared in the Star on 9/03/2014 (see below). The reason why WHO never made such statement is because they are well aware that quality will be compromised to achieve the ratio. That is exactly what is happening in this Bolehland………………..
AS we mourn the lost of MH370 and being in the spotlight of the world with flying bomohs, I hope we will not see a future where our people go to neighbouring and other countries to seek medical treatment!
MMA: WHO denies setting doctor to patient ratio
PETALING JAYA: Malaysia does not need one doctor to 400 patients to be considered a developed country, said the Malaysian Medical Association (MMA).
MMA president Datuk Dr N.K.S. Tharmaseelan said the World Health Organisation (WHO) had denied setting the ratio which is often used to justify the mushrooming of local medical colleges.
“The purported WHO statistic is often quoted to deny the fact the country had too many doctors, though it is obviously so,” he said.
Dr Tharmaseelan said WHO representative Dr Gulin Gedik, during a meeting at the Ministry of Health on Feb 27, was surprised when the issue was raised by MMA.
He said the ratio had led many countries, including Malaysia, to produce more doctors without having the infrastructure or facilities in place to train them.
“Dr Gulin assured MMA no such figure existed or would be imposed by the WHO, as there were many issues to delivering healthcare,” said Dr Tharmaseelan.
He said Malaysia’s current one doctor to 600 patients ratio should not be used to build more medical colleges as these could affect standards.
“We should instead amalgamate the existing colleges into a sustainable level,” he said.
He said more emphasis should be put on raising the standards and quality of training provided to doctors and allied health professionals rather than aiming at an Utopian goal.
Dr Tharmaseelan also pointed out that the problem plaguing the Malaysian healthcare system was the reluctance of doctors to serve in rural areas including Sabah and Sarawak. He said there were wards in urban government hospitals which had up to 100 doctors when they just needed 20 or 30.
“The authorities should compel new doctors especially those who obtained government scholarships to serve in rural hospitals,” he said.
He also called on the Education Ministry to strictly enforce the five-year moratorium on medical colleges and gradually reduce the number of admissions to medical colleges.
Pagalavan's Avatar 
Waiting so long for your new articles. =) Thank you Mr. for sharing your thoughts and opinions.
i really hate incompetent doctor.your job is to save lives.if you’re going to be half assed about it,then dont do it.wanna be rich,do business instead.wanna be famous go to acting class and be an actor/actress.being a doctor mean you have to sacrifice yourself for others.put yourself in a patient shoe,do you want to be treated by incompetent doctor?heck,i wont even let these doctor diagnose me let alone treat me.
Dear Doctor. Thank you. That was a lovely insight.
p/s: If i’ve known it’s that easy to become a doctor with my SPM result 10 years back, I’m sure I would have no problem being a good one with mine today. However I didn’t know it then and money was an issue.
Definately our people who read your blogs just scan through and hyper react to certain words and sentences ! most of the time intentionally and some unintentionally . there are also another group who dont read your blog but listen to what others say and vomit out sarcasm and untruth . Do keep up your information and voluminous advise . … that is what we need in this unjust , unequal , dog eat dog society we face today .
Dr Pagal, please ignore all the negative comments/criticism and continue doing your good job in revealing us all the truth. As you’ve always said, truth hurts and those people are still in stage of denial for your truth.
MOH (i demand the minister) should respond to the statement from WHO representative. let’s hope there will be nation-wide news coverage on pertaining issue. better late than never!
SPM result today. The same old story is going to be repeated once more. A lot will demand medical scholarship, nothing les they want.
erm. Universitas Udayana you heard about this uni before? you do know right that the likes of universitas gadjah madah is in the top 20 unis in ASIA. where is imu? where is melaka manipal? WHERE? even universitas udayana in bali is a great uni, it is producing good doctors. Sometimes you need to talk about a SPECIFIC uni, rather than unis in indon Dr Pagalavan..
This clearly shows that you have not read what has been written in this blog before. Please read carefully before commenting. I had written about these unis before
Is it possible for you to give me your email? I have some question regarding medicine.
pagal72@gmail.com
I know a medical grad from this university, Udayana, who got extended for more than 1 year in a single posting. Can confirm this with MOH. A legendary HO in Perak.
i believe the word is ‘proved.’
Exactly. Thanks. what happens when you write something at 11pm!!
I’m studying in Russia and today onwards I’m not going to be afraid to say I’m a Russian grad. Stereotyping happens all the time and yes sir, indeed I’ve to agree to you. Most of the students here will manage to graduate by hook or by crook. It’s because of the system here and I still believe those who have good results and at the same time passionate of doing medicine can make the ends meet. Thanks for the very enlightening article and please keep inspiring us 🙂
SOOO, let me get this straight.you mean to tell us that if those particular student fail for the tenth time and barely succeed for the eleventh,he can still graduate as a certified doctor?i thought any university would only allow two failure maximum.even university from india and middle east work that way.if so,the thought of getting any treatment by these kind of doctor scares me a lot.i’m no cat with nine lives.dead is dead.not risking my life for the eleventh correct treatment.
Yes, it happens
Dear Doctors & Students from Rusian Universities….
There is a Statement/Comment here implying that Russian Medical Unis allow students who fail “ten time” to continue with their studies. As i understand, Russian Unis too have rules that only allow 2 or 3 failures maximum.
Can you doctors & students from Russian Unis please comment on it too.
TQ
Mh370 hijacked..?
Have you talked about University Udayana before? Mind showing me a link of some sort? I would like to read your opinion on’ really average Indonesian unis which are actually wayyyy better than IMU graduates’
Lim,
Can you post your SPM results here for us to see. Trying to correlate your comments with your SPM results if possible.
andy,dont bother arguing.your argument become invalid to those who only listen to themselves.
Sad fact is that too many Malaysians start medical school too early.
SPM should not be used for entrance to medical schools.
Yet… For my batch, it’s the JPA and MARA scholars who get offered medicine in Russia based on SPM results, do a 6 mth “matriculation course” and it’s off to 1st yr.
Private students go about this via 2 ways:
1- Immediately after SPM, head off to Russia in Jan for a 1 yr pre-u course before entering 1st year
2-After pre-u (STPM, A-levels, SAM, CPU, etc)
My personal opinion is that unfortunately, most Malaysians at 17-18 just aren’t mature enough to deal with what’s required of them in a country with a completely different system that doesn’t even speak a language that’s known to us.
Yes, these scholars had good SPM results. Most do well but even then, some dont.
I honestly don’t think SPM is really worth much nowadays. Straight As don’t determine character. Discipline yes. A certain level of intelligence, possibly. Ability to survive medicine? Hmmmm…..
It all boils down to a person’s personality and character and world vision. Russia has a lot to offer. It truly does. Russia’s got a wealth of history and knowledge for whoever’s interested.
The problem? Minimal re-inforcement. Students are given the OPTION to learn. Exams can be re-sit multiple times. (Not til 10 or 11 times la. You do get held back a year if you fail the main exam at the end of the year 2-3x.) Even then, there are leaked questions. A russian lecturer once said he never understood why we’d come almost half a world away to study in Russia and not show much interest. (Also, not know Russian)
Most students use the woe-am-I, I study in Russia, I don’t quite get these Russian lecturers and then make fun of the English these lecturers use (haha, it can get pretty hilarious at times coup,Ed with the accent). Students be students.
But the flaw happens when too much lee-way is given and people take advantage of it. As always. Yet, when you truly look at it, Russia really has a lot to offer. There are so many things to learn and bring home to Malaysia. They have all the same diseases we have and more, you don’t see many amyloidosis cases here, no?
They have TB HOSPITALS. They even categorized TB to different stages based on clinical and CXRs. It’s not worldwide, unfortunately.
There’s a wealth of knowledge to be learnt in Russia. It’s how you choose to make the best of a situation, what you choose to focus on. To go prepared for lessons, learn the best that you can from the doctors and patients and prepare for exams.. OR skip classes and wait for leaked questions.
I studied in Moscow, and I’m proud to say that most of my peers are doing just as well as others from local universities, if not better.
Of course you have some bad apples. I know of a junior from my university who is a disgrace to us all, extended so many times, had to be transferred hospitals and has now been terminated. I don’t know how she did in SPM, what I do know is that she’s a danger to patients everywhere.
At the end of the day, it’s how you choose to do with what you’ve got. During HOship, I noticed that the local grads weren’t all that much better after us foreign grads had picked up all that was needed. Be it skills or knowledge wise.
As a MO, the distinction between local and foreign grads isn’t as obvious anymore. Heck, I’d go so far as to say that quite a few of a certain race is more prone to being MIA and disappearing for prayers so often they’re hardly ever around. Even when around, are so good with the bosses they get away with murder. Masters students included. But in masters, everyone has to pull their weight, so it’s not as bad as when they’re mere MOs.
All in all, I still wouldn’t suggest going to Russia, unless you’re willing to study medicine fully in Russian and god forbid, please don’t stay with the malaysian crowd.
subtle hint of racism there but that’s the truth.and you can’t stop someone from practising their belief.it’s not like they are stealing meds and selling them as side business.noone stoppping you from practising your belief right,or is there?and also,favoritism happpen with any job.even with parents.its called human nature.
Dr Paga
What is your opinion of the recent rise in consultant fees that can be charged in private sector?
I was hoping you would write about that.
Many thanks.
What rise? It was only increased by 10% after 15 years! Furthermore, it is the maximum charge. It is up to us whether we want to charge the maximum rate. Most insurance companies will need us to give about 10-20% discount anyway.
Hi Dr, how abt cases of housemans who gets extended for more than 1 yr in a single posting.this ve lead to depression of not going to work and feeling totally downgraded.the best part, these HO mostly from CSMU, Ukr..they could ve entered wout the minimal requirement to study medicine but managed to graduate.now they are very eager to work but when they put down this way due to lack of knowledge, what are their chances.
They should not be allowed to work if they ‘lack knowledge’, no?
In some other country, you will be terminated by now. Being a doctor is no joke. If you are not fit to be a doctor, you should not be allowed to practice. It has nothing to do from where you graduate.
Some of them have been extended in every single posting and now MOs, more dangerously if they are on their own in district hospitals and KK,
I am sure many are aware of the current ”problematic MOs” on the rise, something hardly heard of 10-20 years ago.I have heard that many a times, of the good responsible MOs have to take blame for issues which arose due to these questionable graduates and the good MOs having to double check the work of these questionable graduates and what not.
The thing is anybody can graduate in Russia, If one fails in one university,just start afresh or transfer credits in another university. (refer to this article which was posted to Dr Paga’s blog not to long ago
http://chronicle.com/article/Corruption-in-Russian-Medical/128200/
And as Dr Paga has pointed out many times, it is difficult to let go of government officers in Malaysia due to GO. Most developed countries have contract system in which some cases most maximum contracts would go for 2 years or so and may be renewed if they (the hospital managemen and consultant) sees the doctor useful to the hospital. This should take place in Malaysian Healthcare despite with the new MMLE coming into place in the future. Eventually the bad apples can be weeded out.
Dr Paga mentioned about termination. Practising doctors in developed nations are strictly followed by their registering council/authority and are legally bound to maintain documented competence (including audits, presentations, and even postcall case presentation to the consultants) all year long. This goes for the GPs too albeit in their own way. It is rather complicated, but their main aim is to safeguard patients welfare from incompetent doctors.
Remember. although the doctor has a licence to heal, but the same licence may kill too!
true….i have seen a lot of doc …and not most of them have real good qualifications nor experience
My sis went to see a doctor last time, contracting chicken pox
that doctor even dared to ask my sister what is chicken pox
i’m no joking this is true
its somehow scary
i think people should realize that becoming a doctor bears great responsibilities ..not about money
doctors are noble ancient job that serve to cure sickness…but nowadays people just want money,,,,sad
The world is all about money nowadays