It has been a hectic 2 months for me with too many holidays and personal matters to take care of. It has been 8 years since I started blogging and almost everything that I had said and predicted has become a reality. As I had predicted as well, in the end no one takes responsibility and blames each other. IN a typical Malaysia Boleh style, we chase after the numbers and forget about the quality. Many do medicine without being well-informed. Many do medicine without knowing where they are putting their foot into. I had written enough in this blog and even published 2 books to explain all these issues. Despite that, I still get young school leavers who keep asking the same question again and again. I wonder what they are actually learning in schools. Our education system has messed up the student’s brains well enough for most students not to know what the hell is going on in this world. Do you know that most SPM students do not even know who is Abraham Lincoln and why is he famous for? Do you know that they do not know anything about American and European history and history of the World Wars? Ask them who is Mahatma Gandhi! You will be surprised and shocked to the amount of knowledge these students have despite scoring strings of “A”s in their exams! Oh, BTW, according to TITAS textbook which is a compulsory subject for 1st year public university degree program, Mahatma Gandhi is “Tokoh Tamadun India” !! I give up!
With all the hoo-haa that has been going on in KKM regarding the HO issues, one thing for sure is the fact that almost 50% of graduates will not be offered a permanent civil service post after 4 years of compulsory service. Recently, MOH claim they will be introducing a “tagging” for those graduates who are waiting for posting. MOH claim that the waiting period should not be more than 6 months since the introduction of contract post which do not need an interview. However, I am not sure whether they had taken into consideration the increasing number of graduates since 2016 as few more medical schools have started to produce graduates and the final list of recognised medical schools will be out this year when the last few medical schools which started in 2012 becomes recognised by MMC. The number of graduates produced by these universities will subsequently increase over the next few years. Can MOH cope? The answer is obviously NO. One more interesting thing about the “pre housemanship tagging” as proposed by MOH is that it will be done in hospitals without housemen. These hospitals are technically district hospitals without specialist. So, who is going to guide who? Will it become a story of ” blind leading the blind……”? UM has also started a similar program for their own graduates as mentioned HERE but this is done in their hospital
Recently, there was a post in Facebook from a specialist asking a questions on why many doctors are discouraging their children from doing medicine. He claim that despite the increase in litigation, rules and regulation , it is still a noble profession. I do agree it is a noble profession BUT saying that medicine is the only noble profession is wrong. WE must move away from the notion that medicine is the only noble profession in the world. The world has changed. The day a doctor started to charge a fee for service, medicine as a noble profession has died. If you still believe medicine is a noble profession, than you should go back to government service and serve the people. Anyone in private sector cannot claim it is a noble profession as without money, you would not be able to treat a patient. It is a business and nobility takes a back seat or probably not existent. There are so many jobs out there which is also noble. I have an engineering friend of mine who is actively promoting greening of earth and promoting clean environment. Isn’t his job noble? Let’s take Mark Zuckerberg. He created Facebook without charging a single fee to anyone and connected the entire world! Long lost friend became close within seconds! Isn’t what he did noble? What about “Whatsapp” and many other social networking apps which is free? If you say charging a fee for service is noble than a mamak shop which charges a fee for food is also noble as he is providing food to everyone, without which people can die as well. Almost all philanthropist that I know are not doctors. Are they not being noble by donating to charity and foundation to help people? Are they not providing scholarship to needy students to pursue their education? What about teachers? WE should stop saying that we are the only noble profession in this world. A senior consultant friend of mine once told me that Tan Sri T J Danaraj, the founding dean of UM medical faculty once said ” The day medical education is commercialised and medical practise is commercialised, that’s the day prostitution of medicine starts“ How true! At the end of the day it is all about money and survival.
Some will say that I will sacrifice my life for humanity and serve mankind till I die. For them, I have the story below:
“A Dr graduated to be the best and finest surgeon in the world. At age 30, he got married.
The joy of marrying a surgeon attracted his wife to him.Few weeks after marriage leave he got back to work, thereafter he hardly spent some quality time with his wife.Their relationship began to go sour.
Not that he’s flirting around with other ladies. Not that he now had a bad company. But, at his work place, he was seen as TOO IMPORTANT.Every patient wanted him. The nurses loved him to handle all the surgeries at hand.
One day, he got home very early from work. The wife was glad that he was at least early today. Just as he was dropping his briefcase, his phone rang and the following conversation went on.
Nurse: Sir, we need you now at the hospital. We have an emergency.
He said : I’m on my way.
The wife was angry with him. As usual, he told her, “Sorry”.
This went on for so long.
But one unfortunate day, he had an accident. And….
He died!
The other doctors and surgeons mourned him. They gave his wife cash to take care of herself.
But, can money replace love? Can some one ‘ replace a whole man?
You know the answer…
Not too long after, the wife went to that same hospital for some check up.
She was shocked to see someone in her husband’s former post. Not only that, she heard someone calling the new surgeon as the best in that town.
She wept bitterly…
Do you know you are replaceable?
Do you know you are NOT too important?
Do you know someone else can do better than what you are doing or what you can do?
Do you know you are cherished now just because you can still perform your right?
Do you know you are celebrated because you are available and useful?
No one’s saying you should not help out. No one’s saying you should not be a celebrity. No one’s saying you should not help others. No one’s saying you should be not punctual
BUT,
Take time to rest. Take time to relax. Spend time with yourself.
As bitter as those truths, many of you fail to accept that…
Tread softly… Go gently…
Your family Values YOU
Only they miss the presence of you not the rest of the world.“
The above story is the reality out there. In the end, family comes first, unless you decide to live a single life till death. No one appreciate what you had done once you are gone. They will talk about you for one day and that’s the story.
Recently, there was another sad story in our neighbouring country(see below). Dr Leslie Lam’s story is exactly what is happening out there. These are the side effects of “prostitution of medicine”. The day medicine was commercialised, that’s the day patients start seeing doctors as leeches who are out to suck their bloods/money. You could have saved hundreds of life but a single patient can bring you to hell! The number of complains in each hospital is increasing by leaps and bounds and almost always it is about money. They want their money back because their wound got infected! They want their money back because your surgery was not succesful and had complication etc. If you admit your mistake, they sue you to glory. If you don’t admit, they sue you anyway! BTW, I was informed that the patient who was responsible for Dr Leslie’s ordeal is a Malaysian.
The world has changed. Artificial intelligence and technology is taking over a lot of jobs. Medicine will not be spared. What you see in Star Trek and Star Wars is not far away. Skynet is not far away………….
Are these the jobs of the future(below) ?……… You can ponder upon…….
For those who are sitting for SPM 2017, Good Luck and choose wisely…………
Heart doctor Leslie Lam’s ordeal: Three decades to build a name… then ‘gone to bits’
Leslie Lam, cleared by Court of Three Judges, says his clinic never does things just for money
To this day, he still charges them the same rate of $25 for each consultation. At the same time, he counts among his patients Bruneian royalty who are willing to pay to have him close his Mount Elizabeth clinic for an entire day so that he can attend to them.
“I like to play a bit of Robin Hood,” said the 75-year-old grandfather of three, who has been doing volunteer work in countries such as Myanmar for more than 12 years.
That was why it came as a shock when he learnt in 2012 that a patient had gone to the Singapore Medical Council (SMC) to complain that Dr Lam had performed an unnecessary procedure on him in 2011 for monetary gain.
To Dr Lam, who was completely cleared of all the allegations last Friday, the accusations levelled at him were just “crazy”
After all, his first lesson to medical students doing their internships at his clinic has always been: “You don’t do anything for the patient unless the patient benefits from it.”
THE RELIEF
Today is one of the best days of my life, because suddenly I feel I’m completely free from this unnecessary complaint.
DR LESLIE LAM, in a phone interview after he was cleared.
Dr Lam, one of the pioneers of coronary angioplasty – a procedure in which a balloon is used to open up blocked heart arteries – said he cannot remember ever doing an unnecessary procedure.
He stressed that he often agreed to requests for discounts from less well-off Singaporean patients.
Registered nurse Siti Sundari, 61, who has been working with Dr Lam since 1988, described him as “kind”.
In 2015, after selling the premises that his clinic – The Cardiac Centre – occupies for $10 million, he distributed 5 per cent of the proceeds to his staff. He now rents the space.
He said the complaint weighed on him, resulting in many sleepless nights. His family said that he even became ill-tempered.
“It took me 30 years to build up a name like this, and (for it) to be just gone to bits over something so small, it’s crazy,” said Dr Lam, whose wife is a general practitioner. They have two daughters – one is a housewife and the other a branding consultancy owner.
Good friends advised him to appeal all the way, telling him that his name was worth everything.
Dr Lam, who has had 17,000 patients under his care, said he had had three full consultations with the patient from Malaysia.
In 2006, the patient had undergone a percutaneous coronary intervention (PCI) with three stents at Raffles Hospital. PCI is another name for coronary angioplasty.
Then in 2011, the patient consulted Dr Lam for the first time.
Dr Lam recalled that the patient had argued with him, insisting on doing a CT scan even though the specialist told him it was a waste of money because the scan would not capture the lumen, or the inside of the arteries.
Seven days after the CT scan results, the patient returned to Dr Lam and consented to a coronary angiogram – a type of X-ray used to examine blood vessels.
After the angiogram, Dr Lam advised the patient to undergo a PCI with stenting. During the procedure, the first stent slipped, requiring a second stent to be deployed.
Dr Lam said that in hindsight, perhaps he was too honest in telling the patient what had transpired. “If I had not mentioned it, if I had been dishonest, no one would ever see it.”
He revealed that after the procedure, the patient wanted his money back even though his condition improved. Dr Lam had charged the patient $1,500 for the angiogram and $7,500 for the angioplasty, which he said are considered low.
The SMC brought three charges against Dr Lam: leading the patient to believe he needed to undergo the procedure when there was insufficient basis; failing to perform the procedure with skill and care; and failing to obtain informed consent.
The first two major charges were thrown out by a disciplinary tribunal, which was satisfied that Dr Lam had carried out the correct course of action. Last Friday, the Court of Three Judges cleared him of the third charge.
The ordeal has underscored the importance of documentation and keeping good notes, he said. The brochures in his clinic are now more detailed than before, listing all the possible risks and complications.
Dr Lam said he now goes through the list with patients, ticks off each one, signs and then gets the patient to countersign with the date stated.
During the interview after he was cleared, his phone rang non-stop with calls from colleagues and patients. “Today is one of the best days of my life, because suddenly I feel I’m completely free from this unnecessary complaint,” he said.
Pagalavan's Avatar 
Hello, Dr. Pagalavan.
I’m a new reader of your blog while obtaining informations regarding the new Contract HO policy in Malaysia. It’s really informative for someone like me who’s very infamiliar with the systems back home. If I’ve asked some silly or repeated questions please do forgive.
I’m currently a graduated Malaysian medical student from a recognized university overseas who’ve completed housemanship overseas as well. I’m planning on going for a shot on oversea license exams & interviews next year but don’t wanna miss the chance for housemanship application back in Malaysia as soon as possible, since delaying application will only cause the decaying of clinical skills. Therefore, I would like to enquire some questions regarding the current new contract HO postings.
1. Under the current contract-HO policy, can I take 1-2 months break (for exam & interviews) with documented proof while running my housemanship? Won’t mind extension of HO training if necessary.
2. If I leave my housemanship halfway due to oversea vacancies, do I have any chance to retake it in the future? Or do i have any chance to work back in Malaysia after obtaining Specialist?
Thank you!
Have a nice day, sir!
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Hi there.
Before I give you some advice. Which country did you graduate from? If it’s from UK, Australia or New Zealand stay where you are. If not, take the respective exams to go there. Do not waste your time coming back to Malaysia to serve your housemanship. You will only feel heartbreak and disappointment once you have seen how our health care has degenerated to. Once Dr Paga’s generation retires altogether, there will be few individuals with their steel and quality to lead our profession here. I have seen the new specialists and the soon to be ones either taking masters, mrcp or other alternative pathways. I am not impressed with them. Half baked is the description I would use. So save your time and money and go overseas. For your own sanity. And look at the bigger picture too. Malaysia is a sinking ship. Don’t drown with it.
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Dear dark avenger, your opinion n thoughts are really dark indeed. Please do not insult the intelligence of current generation doctors who have decided to commit their life in the service to others. You may give your advise but you do not have to degrade others. By all means, you can ask him/her to stay back wherever he graduated from but not at the expense of humiliating other doctors. Its easy to make comments using pseudonyms, as you dont have to be responsible for what you have said.
Oh im sorry sattian. Not half baked. That’s wrong of me.
No worries..
Sattian, half baked isn’t the proper term. More like the type of pastry you get when the dough isn’t kneed properly and tossed in the oven for 2 and half minutes and passed off as bread. That’s what I would describe most of them after working with them for almost 10 years in the government service. That’s what you get when you mass produce specialists and have a poor postgraduate training programme. Like most Malaysians, their favorite past time is makan and Rasa syiok sendiri.
1) if you are under contract, you are not allowed to take such leaves. As contract cannot be extended for fun
2) With the current situation, KKM had made it clear that if you resign, you will mot be reemployed. But you may be able to get a job if you do return after specialisation, assuming it is recognised by NSR.
i think the ghandi part is because they consider the modern era for eg hamka
if its really the indian civilization should be someone like ashoka
btw titas isnt taught with the same quality as high school history
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Whatever it is Gandhi is NOT Bapa Tamadun India. He is father of Indian independence and a symbol of non-violance
hello dr, im a medical graduate that been waiting for my ho posting.
i just want to know about the pathway to become a family medicine specialist. can u please explain it?
Either Masters or the FRACGP pathway conducted by academy of family Physician of malaysia
Hello Dr Pagalavan and other respectful doctors. My sister sat for the MQE exam 3 times and they said failed without even letting us to recheck results. how is it possible?She is so scared to sit for her last attempt. Please advice DR.
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The MQE exam is now a standardised exam by MMC. Of course it is possible for someone to fail the exam and never get to practise as a doctor. It just means that your sister does not meet the required standard to practise as a doctor. She got no choice but to sit her last attempt. I think you can request for your marks.
Hi Dr Paga
I’m 8 months into my housemanship and I just sent in my 30 day notice of resignation last week. I’ll admit… I am a terrible houseman and maybe I would be useful elsewhere.
Could you offer any advice for where to go from here? Or anyone with a similar experience could advise me as well. I’m willing to do anything at this point, so long that it is good and useful. And anything that is convincing enough to my parents that it’s better for me to quit.
I was hoping someone would reply but obviously not. By now you would have resigned and most likely jobless. You should do an in-depth self assessment to understand your core values of strength and weakness including your personality (introvert or extrovert).
Make full use of your MBBS degree to advance your standing. You need not practice medicine to earn a living. There are many roads and venues to explore to match your personality and characteristics. Here are some that you could consider to spark your thinking.
1.Further studies. Proceed to Master- MSc and then PhD to strengthen your position for a career in the academic, industrial and research sectors. There are many private universities and colleges out there looking for suitably qualified candidates. A CV with MBBS, MSc/PhD(Epidemiology,or Parasitology, or Microbiology, or Virology,or Pathology, or Nutrition-Dietetic, or Physiology or Toxicology, or Food Techno-Safety etc etc) is useful for positions in lecturing and researching. The advanced academic standing also helps in seeking industrial jobs such as Product/Technical Specialist-Consultant, QC Officer-Controller, Scientific Officer-Researcher, Product/New Business Development etc etc…Research positions are limited but there are out there, both locally and overseas.
2.A classmate of mine who completed his MBBS in Taiwan (late1970s) was unrecognized then, further obtained his PhD in Chinese Medicine from a top Univ in the USA and has been doing extremely well in practicing TCM cum manufacturing herbal-health supplementary products. I can’t be too explicit without revealing his identity.
3.If further study is not your cup of tea then toss the MBBS aside and move on as a Hard-Knock go grabber in any sector that best suite you. There are numerous success stories of successful entrepreneurs or businessmen who could inspire you. That MBBS is a sunken cost that need not hold you back from moving forward and unleash your inner potential.
Dear Dr Pagalavan,
can I ask, being a research assistant (RA) while waiting for e-Ho, does it help in gaining permanent post after housemanship as it kinda improves my CV/resume ? Or it’s only applicable if I were to further study in Internal Medicine/ becoming an academician?
No one got any idea about this. Personally I don’t think it will make any difference as it is your work related performance that matters.