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Archive for the ‘Education’ Category

The world of medicine is changing rapidly. For those who are aware what is happening around the world, we know how the perception of public towards medical profession has changed. Unfortunately, there are many out there who are living in cocoons, do not even know that sooner or later they can be charged for manslaughter!. The recent case in UK involving Dr Bawa Garba has sent shock waves around the world. A senior trainee paediatricians were given suspended jail sentence of 2 years for gross negligence amounting to manslaughter. GMC ( the guardian of medical profession) appealed to High Court to struck off her registration despite Medical tribunal giving only 12 months suspension. Two weeks ago, the court allowed GMC to struck off DR Bawa Garba from medical registry. A detail reading of her case will remind us that what has happened to her, happens on a daily basis everywhere in this world! Unfortunately , the world is changing.

Many still believe that medical indemnity will cover their butt if and when they make any mistake. Unfortunately, any negligence leading to death can now be charged under manslaughter and no more a civil negligence case. IN Malaysia, similar case is currently ongoing involving our very own DPM’s son in law’s death. The doctor who gave sedation is now being charged for manslaughter which can carry a prison sentence of up to 10 years. If he is convicted, it will set a precedence for any other such cases in the future. Similarly, another doctor was charged in December 2017 for circumcision gone wrong. He is being charged under Section 338 of Penal code for causing grievous hurt which can give you 2 years of imprisonment.

IN the US, just 2 months ago, an anaesthetist was charged for murder, “killing” a patient undergoing plastic surgery procedure by giving overdose of an anaesthetic agent. In fact, the first time a doctor was charged for second degree murder in US was in 2015.

Doctors around the world are rallying behind DR Bawa Garba. The fact is , the case just portrays how the healthcare system has failed. She was overworked, just came back from maternity leave and covering 2 person’s job without a supervising consultant. Sounds familiar? Unfortunately, the court do not take into consideration of all those shortfalls. It just concentrates on the negligence part and sentenced her accordingly. Any gross negligence leading to death is now considered a manslaughter! Is anyone still living in dreamland thinking that doctors are “gods” in the eyes of public? You are treated similar to anyone else when you cause a death due to negligence. Nothing special.

DR David Sellu’s case in 2013 is another good example. A well renowned colorectal surgeon of 66 years old was sentenced to 2 and a half years imprisonment for causing death of a bowel perforation case. A patient who developed bowel perforation following a knee surgery, deteriorated while waiting for surgery and subsequently succumb to sepsis. This happened in a private hospital with limited facility for emergency anaesthetist and OT. Thankfully, after 15 months spending in jail, the court of appeal reversed the decision when new evidences emerged regarding the lack of facility and why he could not do the surgery immediately. Unfortunately, damage is done and he had spent 15 months in jail together with other criminals convicted of rape, murder etc! After saving lives for 40 years, at the age of 66 he was treated as a criminal and even labelled as Dr Death! He was also subsequently subjected to GMC’s suspension. This is a good article to read as well : https://health.spectator.co.uk/david-sellu-a-surgeon-wrongly-jailed/

These cases have created a new term : ” Medical Manslaughter“! The list of such cases in UK till 2014 are listed in this article and attached below.

 

Looking at those cases above, we will wonder that these are nothing unusual in day-to-day medical practice. It happens on daily basis. Sometimes complications can never be predicted. Errors do occur and it is not entirely due to the doctor’s fault but the system as a whole. There are many factors that can cause such negligence to happen or how the complications are treated. Unfortunately, the court only considers the healthcare professional’s mistake. This applies to paramedics as well. Nurses have also been charged for manslaughter. This WEBSITE has some information of other health professionals who have been charged similarly.

 

The above video made last year is worth watching. Doctors are humans and do make mistakes. However, the society is not willing to accept these mistakes anymore. I had written much about civil litigation that is increasing day by day. Criminal charges are now increasing day by day as well. As long as you are proven to make gross negligence leading to death, you can be convicted for manslaughter. This can be as simple as giving a medication !  For example, if you give IV Pethidine for pain and the patient stopped breathing and dies, you can be charged for “murder”! And subsequently, the medical council will struck you off the register!

As I had always said, the world of medicine is changing. Modern medicine is infected by virus of mistrust as written over HERE. Commercialisation of medicine is one of the reason behind these issues. A profession which started during ancient times as a science to help people has been systematically and gradually converted into a multi billion dollar business. A business to suck people’s money in many developing countries. Generally, countries which have a universal healthcare system will have lesser number of negligence and complains, as patients do not pay much. Unfortunately, NHS in UK is dying day by day due to lack of funds and overcrowding.

If criminal charges against doctors left unchecked, we may be seeing many doctors behind bars despite saving many lives! I wonder whether AI will come to the rescue? Can AI be charged in court for making a mistake? These are the reasons why many doctors are feeling the overwhelming stress at work(burnt out) all over the world. After years of training and money spent, a simple mistake will land you in court. What use to be civil has now become criminal offence. I can only see more and more doctors retiring early and leaving medical practice. Many do not even encourage their offsprings to do medicine.

What I foresee is that the society will dig their own grave. More and more people would not do medicine. Many doctors would not take high risk cases. Consent forms will become as thick as “Harrison’s Book of Medicine”. Finally, mistakes will be hidden and notes will be fabricated!  The art of medicine is already dying due to CBM (Cover backside medicine) but eventually medicine itself will undergo a silent death………..

Gong Xi Fa Chai everyone………

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On the eve of the official release of Star Wars Episode 8, I thought of writing something new, since I had not updated my blog over the last 3 months. Medicine has a long history, going back to the time of Hippocrates(460-370 BC). He is known as the Father of Medicine. Hippocratic oath was one of the most widely known Greek medical text. It forms the basis of medical ethics.

Medical profession is the most widely regulated profession in this world. Degree recognition, disciplinary actions and standard setting is part and parcel of medical life. Our ancestors decided that medicine can be easily misused and thus a proper regulatory body must be formed to prevent any ethical abuse. I had written enough about these issues since 2010. Unfortunately, as I had written in my previous post, the commercialisation of medical education and healthcare system had led to “prostitution” of medicine. Doctors sell their soul to businessman for profit. Some say it is a “win-win” situation but to me, the day a doctors charges a fee for service, the nobility of being a doctor disappears in the eyes of the public. The businessman uses that to do business and the private healthcare is born to squeeze the people. There are 2 things that a government should never commercialize: health and education! The day these 2 sectors are commercialised, that’s the day you will see deterioration of the system. Almost all countries that commercialised these 2 sectors are seeing the outcome of such move. That’s why most developed countries other than US maintain their healthcare and education system under their government’s control. One of the major side effects of commercialisation, is litigation! And when litigation increases, who takes the brunt of it ? Not the hospital but YOU!  The businessman will just wash his/her hands off and disavow any knowledge of your existence!

Medicine is regulated by multiple rules and regulation. It all started with the Medical Act 1971 which regulates registration of doctors, recognition of degrees and disciplinary actions against errant doctors. The Poisons Act 1952 regulate the import, possession, manufacture, compounding, storage, transportation, sale and use of Poisons. Many doctors still do not follow what the poison acts has mandated them to do, like labelling of prescribed drugs etc. Dangerous Drugs Act 1952 specifically regulates the import, export, manufacture, sale and use of opium, dangerous drugs and related materials. This act is more related to opiates and benzodiazepines. Many doctors have been caught selling these dangerous drugs over the counter.

In 1998, the infamous Private Healthcare Facilities and Services Act (PHFSA) was passed. The regulation came into effect in 2006. Prior to this act, any doctors can open any shop-lot to run their clinic/provide service. With the enforcement of the act, anyone who intend to open any medical services clinic have to comply with the rules and regulations stated. The size of the doors, mandatory equipments, storage of medicines etc all all regulated since then. Together with PHFSA Act 1998, the fee schedule was made into a law! The 13th Schedule determines the maximum fee a doctor can charge to a patient for consultations and procedures. Unfortunately, it DOES NOT control the fees charged by the hospitals! The last review of this fee was in December 2014 after 1998! Again, we lost to businessman!

IN 2012, the Medical Act 1971 was amended. The regulations came into force in July 2017 which mandates compulsory registration of specialist, compulsory CPD points for renewal of APC and NSR as well as compulsory indemnity insurance. I had written about this over HERE. The APC fee increased to RM 100/year and there is also a RM 1500 specialist registration fee every 5 years. The doctors also have to pay PHFSA fee for registration and renewal of their clinic license. Just recently, few of the local councils have mandated that clinics must also pay the business license fee to local authority which was deemed exempted before. Not to forget waste disposal fee, minimum wage for staffs etc etc. IRB on the other hand is going after all the doctors to collect more taxes. As long as you sign an agreement under your name, all payments must be declared under personal income tax and not under your company’s tax.

On the other hand, the world of medicine is changing. The beauty of medicine is in making a diagnosis via clinical examination and interviewing a patient. I use to tell my students that interviewing a patient is like a police interrogation to find evidence to charge a criminal. This will be followed by clinical examination which together, will give you a diagnosis almost 80% of the time. Investigations is just to confirm your suspicion and diagnosis. This is called the Art of Medicine. Unfortunately, with increasing use of technology and rising litigation rate has created something known as CBM: Cover Backside Medicine. Why do you need to sit and take a history of headache or cough when you can do a CT Brain and CXR is a few minutes? What is the use of auscultation of the heart when you can ECHO anyone, anytime? For matter of fact, is stethoscope really necessary in this era? Has it become a mere symbol to say “I am a doctor” and that’s it? I have seen doctors who hardly take 4 lines of history and orders a battery of test to exclude whatever diagnosis he can think of. What is the difference between you and a technician? If that is so, why do you need 5 years of medical school? We see private hospitals promoting their latest gadgets to the public to make money. The public now beliefs technology more than a doctor!

Gone were the days when a doctor can palpate an abdomen and diagnose Appendicitis. Now, we need to prove to the patient that it is appendicitis. So, every patient gets a CT scan! If CT scan is normal, insurance may decline the case and patient may refuse the surgery. Interestingly, the Radiologist get pressured and reports it as appendicitis! It is a “win-win” situation I guess. The day medicine was commercialised which in turn caused litigation to rise freely, the pressure builds up for the doctors to prove everything. Unfortunately, in medicine, not everything can be proven by blood test or radiological investigations. At the end, doctors become technicians who orders investigations no matter how accurate his diagnosis is.  The trust is gone. Matters are made worst by article such as THIS. All these issues are affecting doctors all over the world. Depression among doctors, burnt out phenomenon are common in many countries. A recent article in BMJ ” Why has Medicine become such a miserable profession?” says it all!  ” The Dark Side of Doctoring” by DR Eric is also worth reading on how doctors are being used by businessman for profit and why he feels miserable. We have become a glorified prostitute to sell ourselves to businessman. Even US hospitals are feeling the pain of physician burnout. Probably we should also come up with a  “Drop Out Club” like HERE.

Will AI take over medicine one day? My answer is YES. Technology is going into healthcare. I predict radiologist will be the first to extinct. Already Ultrasounds are being done by ultrasonographers in many countries. THIS article talks about the 3 latest advancement in AI. The rise of the machines is coming! THIS article on “AI vs MD” is a long and interesting read. We will one day become like Star Trek and Star Wars where AI will diagnose the condition and even administer the medications. Doctors will merely become a technician. IBM Watson is already revolutionising the oncology treatments.

As Episode 8 of the Star Wars saga (The Last Jedi)  opens tomorrow, it may be the end of the Jedis. The title of the Movie reminds me of the fate of physicians. The Art of Medicine is dying. The beauty of medicine is dead. What is there left in medicine for everyone to be screaming to do medicine? Do people really need us when even now, most do not even listen to our advise? Most do not trust what you say and rather buy thousands of ringgit of supplements, but refuse to pay RM 90 for a consultation?

May the Force be with us……………………… Are we the remaining Jedis who will surely go extinct one day, not long from now………..

 

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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’

Dr Leslie Lam has been completely cleared of all the allegations made by a patient who claimed the cardiologist performed an unnecessary procedure on him in 2011 for monetary gain.

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.

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Finally, over the last 1 week, a Malay local newspaper had published several articles regarding the issues concerning medical graduates. This is when the blame game starts. Each authority will blame the other and finally no one will take responsibility. Eventually, it will be blamed on the previous administration and probably we need a RCI to investigate this, 10 years down the line!

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Let me put it this way. For years, many in the medical profession had voiced out their concerns regarding medical school’s approval. I first talked about this in 2006 and wrote an article in MMA magazine. Many accused me of over exaggerating. Dato Dr Chua Soi Lek realised it and issued a moratorium in 2005 which was subsequently lifted in 2008 when the new government got elected. NO one did anything! Tons of new medical schools were approved between 2008 and 2011 till the new moratorium was announced in May 2011. By that time, it is too late. Too many schools were already approved which no one can order to be terminated without legal repercussions.

Who gives the approval? Everyone seems to be washing off their dirty hands. All licensing and the need for an educational program is under the jurisdiction of Ministry of Higher Education. This is governed by Private Higher Education Act 1996. MOHE treats medical education as any other educational program. MMC do not have any authority in approving/terminating any medical program.  The role of MMC is only in 2 matters: assisting MQA in accreditation process of a medical program and recognition of a medical degree. Under Medical Act (Amended 2012), MMC is the only authority who can recognise a degree which enables a graduate to be registered as a doctor. Accreditation comes under MQA Act 2007. Only MQA can issue certificate of accreditation. However, for professional programs, under section 51 and 52 of the act, MQA will work with the relevant professional body in recommendation of accreditation of a program. As far as medical program is concerned, MMC will work with MQA in the process of accreditation. A Joint Technical Committee(JTC) is formed under MQA act, consisting of 5 government bodies(headed by MMC Chairman) who will then undertake the accreditation process. The recommendation of the JTC will then be forwarded to MMC for approval at each stage of accreditation.

No where along this line, MMC can either revoke or terminate a program. If at all, they can only advise MQA or MOHE to terminate the program. This advise may or may not be entertained. For example, even the minimum entry requirement suggested by MMC have to be approved by MOHE. When MMC/MOH suggested the minimum entry requirement to be increased to 5As last year, MOHE did not agree and thus it was never implemented! The only other area where MMC is involved is in the allocation of total student intake of each batch. However, JTC allocates the intake based on accreditation guideline. As long as the college can prove the capability of having adequate lecturers(full + part-time + sessional) and facilities , JTC cannot deny the requested number of intake. On what basis can JTC/MMC allocate lower number of student intake? Legally they can’t do that unless during their accreditation process they find that the college is not ready to take the requested number of students. And if finally MMC refuse to recognise a degree, we will see the politicians and parents standing in front of MMC’s office demanding fairness!

This is not the first or the last time we will see such issues. It has happened in almost every field that we know. Unfortunately, no one in our government will take responsibility or commit hara-kiri. It is a culture of “tidak-apa” attitude. No one thinks long-term. It is always a knee jerk reaction. We can talk till the cows come home but no one listens. Their KPI is making the country an Educational Hub to generate income for the country. Who cares whether there are job opportunities or not? Who cares whether our graduate’s qualities are declining or not? As long as we can produce a graduate with a certificate , it is good enough! Numbers more important than quality.

We are only seeing the tip of the iceberg at the moment. When the first batch of contract housemen, which started in December 2016 finishes their 4 years contract in 2020, we will be seeing almost 2000-3000 doctors being released to private sector every year!. This will average out to about 200 doctors/month being jobless! This is assuming that 50% of the graduates will continue in civil service. However, we must also realise that the permanent MO post are also almost full! Can the government create 3000 MO post every year from 2020? Personally I don’t think so. Thus, the number of MOs getting into a permanent post will decline over the years as the number of post declines. So, the actual number of doctors being released into private sector will be much higher than expected. The GP field will be flooded……..If even now, clinics are closing, what more in next few years. The entire health care structure has to change to accommodate this tsunami.

One of my friend told me the other day that I probably had a crystal ball in my house. Another friend told me that it is scary to see whatever I predicted happening right in front of our eyes. Well, I did not have any crystal ball and I am no Nostradamus. It is just simple mathematics and statistics. Something that we learn in school. Unfortunately, some people never use their brains when they do something for this country. Once a mess is created, it is difficult to turn back. History teaches us that. But then, who learns the real world history anymore? Our school history books have become a political propaganda book rather that teaching the future generations what we can learn from world History!

God Bless this country…………

 

 

 

 

 

 

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It has been a while since I updated my blog. Too many events and personal issues to settle along the way. However, the medical field in Malaysia is undergoing some new changes since early this year. It started with the contract HO post and multiple complaints in the news regarding the delay in housemanship posting etc. In May 2017, MOH announced that ozone therapy is banned from July 2017! Beauty centres are also being monitored for providing unlicensed beauty treatments. Sadly, there are many doctors who are providing such services to beauty centres. Since beauticians can’t inject any substance into a person, they need doctors. Doctors/Paramedics are the only one licensed to inject substance into a person. Drugs under poison act can only be administered by a doctor. As I had always said, in the end it is all about money and survival. There are many GPs who are struggling to cope with rising cost of running a medical business and turn to aesthetic medicine. While there are guidelines issued by KKM in practising aesthetic medicine, the enforcement is rather weak. BUT always remember that whenever you go to a beauty centre to do a procedure, it is ILLEGAL if the centre is NOT registered under your APC as a place of practise. Furthermore, any centre that are using medical equipments and drugs MUST be registered under Private Healthcare Facilities and Services Act 1998. If not, you will end up like this doctor in court!

As of July 2017, as I had mentioned in one of my earlier post, MMC will be corporatised. The Medical Act(Amendment 2012) will come into force after almost 5 years being passed by Parliament. I have been waiting for this amendment to take place as it will put certain rules and regulations in place. The regulation can be read over HERE. 

The 2 most important new rules that will affect everyone will be the specialist registration and APC renewal. Firstly, APC renewal from 2020 will be limited to those who have at least 20 CPD points/year and an indemnity insurance. Indemnity insurance will become mandatory for APC renewal. I was informed that the CPD collection will start officially from July 2018 till June 2019, most likely under MMA and Academy of Medicine. MMA is working hard to standardised everything with a phone app being developed. Once you have the points, you can apply for APC 2020 after June 2019. For those budding doctors who do not know what APC is, it is your ANNUAL PRACTISING CERTIFICATE. Without APC, you can’t practise clinical medicine. I know many GPs who do not have indemnity insurance. With this new rule, every doctor must have an indemnity insurance in order to practise medicine. Please visit MMA website for further information regarding indemnity insurance.

Secondly, the specialist register had been made mandatory under the law. The National Specialist Register (NSR) was first introduced in 2006 by the Academy of Medicine. This was in anticipation of the amendment to medical act 1971 which suppose to be tabled in Parliament in 2008. Unfortunately, with election along the way, it was delayed till 2012. Thus, it was optional and voluntary till 1/07/2017. From 1st July 2017, all specialist must be registered with NSR which will be handled by MMC, from now onwards. If your name do not appear in NSR, you CAN’T call yourself a specialist. If you continue to call yourself as a specialist, disciplinary action will be taken against you by MMC which includes suspension and fine.  For those who have not registered, please do so by end of this year. From 1/01/2018, your name must appear in NSR in order to call yourself a specialist. NSR must be renewed every 5 years with a minimal CPD point of 100 in total. This applies for government specialist as well.

Another issue that is of concern are the fees that need to be paid. Since MMC will be corporatised, they have to generate their own revenue on top of MOH grant. Thus, as expected, fees will be increased. The APC renewal fee will be increased to RM 100/year from RM 50. This is not really a big increase as the RM 50 has been around since 197os. However, civil servants who were previously exempted from paying this fee will now need to pay themselves. The DG had issued a circular to all hospitals that all civil servants must pay the APC fee from 2018 onwards. This was followed by circulars by hospitals that all APC fee must be paid by the respective doctors directly to MMC and cannot be claimed(tidak boleh dituntut):

 

 

 

 

 

This also includes the Specialist registration fee of RM 1500 every 5 years. Please be informed that all specialist in MOH must also register with NSR by end of this year. If not, legally you can’t call yourself a specialist! Another issue you must understand is that gazettement by MOH is not the same as NSR registration. NSR has it’s on guideline on registration of specialist. For example, you can only get NSR registration after 1 year of post qualification working experience for internal medicine related field and 2 years for surgical related field:

Effective January 2017, applicants must have at least ONE (1) year post qualification working experience for medical related specialties/fields of practice and at least TWO (2) years for surgical related specialties/fields of practice.”

This basically means, for those who finish Master’s, you are NOT a specialist after 6 months of gazettement as far as NSR is concerned! I hope KKM and MMC can streamline these requirements so that no confusion arises. Another interesting figure in the new fee structure is the Certificate of Good Standing(CGS) and translated documents fee! It use to be FREE but it will cost you RM 500 for CGS and RM 200 for translated documents! As far as I know, each CGS is only valid for 3 months! You will need this if you intend to do training overseas or migrating!

 

There is another interesting development in terms of compulsory service.Till 2008, we had 4 years compulsory service, which included 1 year housemanship. In 2008 when housemanship was made into 2 years, the compulsory service was reduced from 3 years to 2 years post housemanship. The total was still 4 years. We all know that what I had predicted many years ago had come true. Job is no more guaranteed in civil service. Housemanship is given under contract for a maximum of 3 years after which you will be given contract just to finish your compulsory service. Only about 50% of those who are completing housemanship will be given permanent post. How this selection will be done is being ironed out. So, what happens to those who are returning from overseas after completing their housemanship overseas? Firstly, your housemanship must be recognised by MMC. NOT all housemanship outside Malaysia is recognised by MMC. Secondly, you may need to do certain postings which you did not do overseas before being given full MMC registration. The question now is , would you be able to get a job in MOH ?

To “overcome” this issue, DG has issued a new circular dated 6/07/2017 which is rather interesting. If you are a self sponsored student from overseas and have done at least 2 years of clinical practise post housemanship in a recognised country, you can be exempted from the 2 years compulsory service. If you are returning from overseas and are eligible for full registration from MMC without any need for additional training AND unable to get a job in MOH within 6 months, you are EXEMPTED from compulsory service! This is going to open another can of worms! This basically means you will be able to open a GP clinic immediately, under trained and flooding the market with GPs. This also means that if you do not get a job in MOH, you have practically no chance of specialising in any field except the Family medicine program under AFPM. So, if you are returning from overseas assuming to continue your post-graduate training in Malaysia, you may be in for a surprise! It is another way of saying, sayonara! We will be having almost 5-6000 graduates by next year waiting for housemanship alone! Imagine how many will be waiting for MOship locally alone!

Compulsory Service Exemption Request Form

 

 

 

(source: Deputy DG presentation at MMI conference)

 

For those who do not have minimum entry requirement, please be aware that you may not be considered for housemanship at all! It is in the pipeline. Well, if only they had listened to all those who voiced out their concerns almost 10 years ago, we will not be in this situation! We are very well-known for creating a problem and then trying to solve it, by creating more problems! No one plans for long-term. Everyone thinks with a knee jerk reaction!

Happy 60th Merdeka Day……..

 

 

 

 

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Just 6 days ago I wrote on the issue of SPM BM in regards to appointment into civil service. Just after the issue was publicised by the newspaper, it became a hot issue of discussion on TV. For at least 2 days following the news report, both RTM and TV3 were having a field day condemning the decision to exempt medical grads from SPM BM requirement. All the political heroes and defenders of the country suddenly appeared from nowhere. Well, election is coming……

In my last article, I wrote clearly the historical events over the last 20 years in regards to the need for SPM BM to join civil service. I also wrote on how the opening of enrolment into international schools had led to another big issue that we are facing now. However, the original intention of the news article reported by TheStar was actually in regards to the need to sit for 6 SPM papers and the inability to sit for a single SPM BM paper. Unfortunately, it was blown out of proportion by various quarters leading to a cabinet discussion of the matter.

Yesterday, the cabinet had decided that SPM BM is now needed even for contract post! This basically means, for those who had graduated but do not have SPM BM, you are now required to sit and pass SPM BM paper before even being eligible to apply for housemanship post. This will only further delay your posting. As it is, graduates are already waiting close to 8-12 months, those affected students would probably have to wait for 2 years now! So, for those who are currently still an undergraduate student, please sit for SPM BM as soon as possible. You just need a pass! The only good news is that you don’t need to sit for 6 papers anymore.

As I had always said, when the number of post becomes limited (admitted by DPM himself), the government can pick and choose. This is just the first step. For those who are doing medicine without the minimum entry requirement or NOC since 2012, please be prepared to be next in line. The government don’t give a damn whether you are a medical grad or not. No special privileges will be given.

 

Pass SPM Bahasa and be in civil service, medical grads told

PUTRAJAYA: Medical graduates must pass the SPM-level Bahasa Malaysia (BM) paper to be appointed as contract-based doctors in public hospitals.

However, these contract doctors will not be required to take the six core SPM subjects – Bahasa Malaysia, English, History, Mathematics, Science and Moral or Islam Studies – to be in the civil service.

Once they pass the examination, they can serve as housemen in government hospitals.

Contract-based doctors are those undergoing housemanship as well as those on compulsory service.

 Deputy Prime Minister Datuk Seri Dr Ahmad Zahid Hamidi said the matter had been clarified by the Education Minister at the weekly Cabinet meeting yesterday.

“The Cabinet was told that the Malaysian Examinations Syndicate allows for professionals to take a single paper. So these graduates can take their Bahasa paper in November and then apply for housemanship,” he said.

Last week, The Star reported that some 300 medical graduates with O-Levels qualifications would be required to take the SPM-level BM to be accepted into housemanship.

Making it clear: Dr Ahmad Zahid explaining the ruling for contract doctors to the media at his office in Putrajaya.

Making it clear: Dr Ahmad Zahid explaining the ruling for contract doctors to the media at his office in Putrajaya.

A medical graduate said that they were given a waiver for SPM BM from 2003 when the country did not have enough doctors but the waiver was suddenly removed this year without adequate notice.

Before the waiver was withdrawn, O-Levels BM or Bahasa Kebangsaan A was accepted.

Following their plight, the ministry asked the Public Service Department (PSD) to waive the SPM-level BM pass requirement for contract staff and in February, the PSD agreed to the request. But they still need the SPM-level BM for permanent posts.

However, some medical graduates in Selangor said they could not register for only the BM subject but had to register for all six core SPM subjects at the state Education Department, while those from some other states were required to take only BM and History.

On Sunday, Health director-general Datuk Dr Noor Hisham Abdullah said on his website that a waiver was given on the SPM-level BM for contract-based doctors (two years of housemanship and two years of compulsory service) but not for permanent posts.

Dr Ahmad Zahid said the Cabinet decided that SPM-level pass for Bahasa Malaysia would remain a requirement for those who wanted to work with the civil service.

“We are committed to uphold what is stated in the Federal Constitution when it comes to the issue of the national language,” he told a press conference.

Dr Ahmad Zahid said that apart from the Health Ministry, no other ministry, department or agency had relaxed the ruling.

But at one point, the Health Ministry needed doctors, so this exemption was made. Now, the Cabinet wants the requirement to be maintained,” he added.

He also pointed out that only 23 medical graduates were given the exemption and not “300 or 3,000 as reported”.

Health Minister Datuk Seri Dr S. Subramaniam said the requirement for contract medical officers, including contract-based doctors, to sit for the SPM-level BM paper was re-introduced last December because of the current flood of medical graduates.

Read more at http://www.thestar.com.my/news/nation/2017/07/06/pass-spm-bahasa-and-be-in-civil-service-medical-grads-told/#sEXLrVQ65GovGxtz.99

 

 

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So, finally the issue of BM is out in the open. Today, TheStar published several articles regarding this. Over the years, I have been constantly informing everyone who was intending to do medicine that they need to make sure that they have sat and got at least a credit in SPM BM paper. 30 years ago, this was never an issue because almost all went through the same education system. SPM BM is a mandatory requirement to be appointed into civil service. Housemanship can only be done in civil service.

In the 80s and 90s, even up to early 2000s, other than some who studied in Singapore, almost everyone completed their secondary education till SPM before leaving the country, doing PreU or entering university. Thus, almost everyone had done SPM BM. I know some friends who studied in Singapore and did not have SPM BM but were given contract civil service post. During this contract post, they are required to sit and pass SPM BM paper(usually July paper). Only after passing SPM BM paper, the post is confirmed and converted to permanent post. This new dilemma that we are in currently, started in mid 2000.

Up to 2004, International schools are only limited to foreigners/expats or to families where at least 1 parent is a foreigner. This is the same in almost all countries including Singapore. IN 2004, the then new PM Tun Abdullah Badawi announced 30% quota of international school enrolments to locals. This quota was immediately taken up and the demand increased. Just 2 years later, the government allowed 100% enrollment of international schools to locals. This caused mushrooming of International schools in Malaysia. Rich parents were sending their children to these schools in droves, to the extend some had to enrol at least 3 years earlier for a place to be confirmed. When I came to JB in 1999, there were only 2 international schools catering to Japanese and Korean expats. Now, I lost count of the number of international schools in JB, all in just 10 years!

These international schools have now created a new issue. The students do not sit for SPM or SPM BM paper. These very same students are also rich enough to enrol themselves into private medical schools. SPM BM is not a requirement to enrol into private universities. These naive students or even their parents do not understand how complex the field of medicine is.

IN 2004, our Minister of Health Dato Dr Chua Soi Lek manage to convince the government to exempt medical graduates from SPM BM requirement for permanent civil service post. They were absorbed directly into permanent civil service with a special communication BM paper being conducted by MOH itself. Once they clear this paper, they will be confirmed in service. Unfortunately, the situation has changed. At that time there were abundant number of post which were vacant. The government changed the rule to encourage Malaysian doctors to return home from overseas. However, we now have more bodies than post. Being employed in civil service is a privilege. The government is NOT obliged to provide job to everyone. Thus by end of 2014, SPA reintroduced the need for SPM BM for civil service appointment.

Early this year, I was informed by 2 parent that MOE had introduced yet another new rule. You can’t sit for SPM BM alone but need to sit for the entire SPM papers which include at least 6 subjects. Only then, a certificate will be issued. However, I could not find a circular regarding this issue. I did make some comments regarding this when some students made some queries. But now it is out in the open with the news today.

Since Housemanship is being given under contract from December 2016, technically SPM BM is NOT necessary as mentioned by MOH today. However, be informed that in order for you to be eligible for a permanent post after your contract compulsory service ends, you will need SPM BM!! So whatever it is, SPM BM is still mandatory unless you intend to open a clinic after your 4 years compulsory service. In my last post, I did mention that ONLY 50% of contract officers will be absorbed into permanent post and continued in civil service. So, if you do not have SPM BM, you might as well forget about continuing in government service. Be also informed that specialist training can only be done in government service.

Many people argue about the basis of this requirement. We must understand that we are in Malaysia. Our national language is BM. Thus, to be eligible for civil service, SPM BM is made mandatory. What they need is just a credit or at least a pass. It is the same in any other countries as well. In almost all English-speaking countries, IELTS is mandatory for even registration or work permit application. In Australia, you need a minimum of 7 in all parts of IELTS to be eligible for Medical Board registration. At least in Malaysia, you only need SPM BM for civil service appointment. Imagine if that was the case for even MMC registration!! IN some non-english speaking countries, you also need to sit and pass their national language test to even enroll into their universities.

I know some students from international schools who can’t even speak a sentence in Malay. How are they going to clerk a patient or even understand what the patient is saying? O level BM paper is way inferior to SPM BM, I was told. That’s probably the reason why JPA do not want to recognise it as equivalent anymore. To make everything equal (as what people always want) , only SPM BM is acceptable now.

I feel all this started due to poor planning. Nothing new, as far as our government policies are concerned. The class division of education system, mushrooming of medical schools and lack of post, contributed to all these mess. The mandatory need for SPM BM should have been told to ALL aspiring medical students before they even enter our private medical colleges. NO medical schools will inform you that, as they need students!

As far as I am concerned, you can’t run away from the need for SPM BM to be appointed into civil service. That will not change since they have the liberty to pick and choose now. For those who are from International schools, please sit for the exam while you are in medical school. However, asking the students to sit for minimum 6 subjects is atrocious. They should allow the student to sit for individual papers.

 Medical grads told to sit for six core SPM subjects and pass BM to get cert

PETALING JAYA: Some medical graduates are frustrated that they need to “go back to school” after being told that they must have Sijil Pelajaran Malaysia-level Bahasa Malaysia to be accepted into permanent government posts.

No more exemptions would be given and some graduates said they were told to register for six core SPM subjects in order to get the BM certificate if they want the posts.

A source said about 300 graduates were affected since the change came into effect on Jan 1. They were from private institutions and waiting for housemanship placements.

Previously, O-Level BM or Bahasa Kebangsaan A (BKA) qualifications were accepted for entry into public service but from this year, those with such qualifications were rejected, according to the affected students.

 A graduate, who declined to be named, said he submitted his application for housemanship to the Public Service Commission (PSC) a month after he graduated last August, and after obtaining clearance from the Malaysian Medical Council (MMC), his application was accepted.

But in December, he was told by a PSC officer that he did not pass the screening process to be interviewed for housemanship acceptance because he did not possess “SPM-level Bahasa Melayu or its equivalent” as per the JPA 1/2016 circular.

“The PSC officer told me that the BKA paper I took for my foundation studies was previously accepted as an alternative to SPM BM for public service, but not from January onwards,” he said.

To ease the situation, he said the PSC later relaxed the requirement for medical graduates so that they did not need SPM-level BM for contract jobs – only for permanent posts.

However, when he tried to sign up for the BM examination at the Selangor Education Department, he was told he could not get a certificate for SPM-level BM unless he took six core subjects and passed BM and History.

The other subjects he has to take besides those two are Mathe­matics, English, Science and Moral studies.

The graduates feel it’s like asking them to go back to secondary school.

“This sudden change is very frustrating,” he said, adding that this was in addition to waiting nine long months for housemanship placement since he submitted his application in September.

Another medical graduate who graduated in July last year said MMC and PSC had considered her qualifications complete in August but in December, a friend told her that they would not be able to get an interview with PSC because they did not have SPM BM.

“I called PSC to check and it was true. I asked why they didn’t tell me earlier and they said they did not know things would change,” said the graduate, who declined to be named.

According to an e-mail reply from the Health Ministry, the rule for having SPM BM to enter public service as housemen was relaxed from 2003 and O-Level BM was accepted but the exemption was removed from 2017, she said.

“If there are too many graduates and they want to restrict the numbers, they should plan ahead. We were not given notice,” she added.

A final-year medical student with O-Level BM studying in a private university said that after hearing how some of her seniors could not enter public service without SPM BM or its equivalent, she decided to sit for SPM-level BM.

However, her mother – who went to help her register for the examination – was told by the Selangor Education Department counter staff that her daughter had to sign up for the six core subjects because she had not taken the SPM before.

“I have a lot to learn (as) I am in my final year of medical studies,” she said.

When contacted, the PSC said it was only observing the requirement set by the Public Service Department (PSD) which, in turn, said it was only implementing the decision made by the Health Ministry.

The PSD said in an e-mail reply that from Oct 1 last year, the appointment of UD41-grade housemen had been carried out on a contract basis. This was to enable graduates who meet housemanship requirements, but did not have an SPM-level BM pass, to serve in order to get a full registration certificate as medical officers.

However, SPM BM is required if the candidates want to apply for permanent posts, the PSD said.

Read more at http://www.thestar.com.my/news/nation/2017/07/01/upset-over-back-to-school-policy-medical-grads-told-to-sit-for-six-core-spm-subjects-and-pass-bm-to/#QPVX0U8Y6L3SqF5g.99

 

Health Ministry confirms it has waived SPM-level BM requirement

PETALING JAYA: The SPM-level Bahasa Malaysia requirement for medical graduates to be appointed for contract-based housemanship as well as compulsory service has been waived, the Health Ministry said.

According to the ministry, the Malaysian Examinations Syndicate also said that the graduates could sit for the SPM BM paper alone through special approval from the director of the syndicate.

This, however, was not what the affected graduates were told when they went to register for the paper, as some were told that they had to sit for six SPM core subjects: BM, History, Science, Maths, English and Moral studies.

The ministry said it had asked the Public Service Department (PSD) to waive the SPM-level BM pass requirement for the contract staff and in February, the PSD had agreed to the request.

 “However, the requirement (for an SPM-level BM certificate) must be fulfilled prior to their permanent appointments in the public service,” it said on the issue of O-Level medical graduates who claimed that they could no longer get permanent public posts with the Malaysian Qualifica­tions Agency’s Bahasa Kebangsaan A qualification.

One of the entry requirements for medical graduates to be appointed to public service is an SPM or equivalent pass in BM. Article 152 of the Federal Constitution and National Language Acts 1963/67 also required that Bahasa Melayu, as the national language, be used for all official purposes, the ministry said.

“Currently, Bahasa Melayu at ‘O’ or ‘A’ level or any other similar examinations are not considered equivalent to SPM by PSD.

“However, due to complaints from medical graduates regarding the changes in government policy (the appointment of new medical officers from a permanent to a contractual basis), discussions were held to resolve this issue,” the ministry said.

Read more at http://www.thestar.com.my/news/nation/2017/07/01/health-ministry-confirms-it-has-waived-spmlevel-bm-requirement/#FSgLGbGXgg1pj8Ch.99

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