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OH! Not again………………..

Posted in Education on April 14, 2012| 43 Comments »

For so many years, ever since my housemanship days, the issue of overworked doctors have been appearing on and off in the newspapers. Today’s Star headline is about the same issue all over again http://thestar.com.my/news/story.asp?file=/2012/4/14/nation/11106586&sec=nation, http://thestar.com.my/news/story.asp?file=/2012/4/14/nation/11106584&sec=nation. Nothing happens after that,as the usual Malaysian style. All talk but no action! BTW why only HOs are overworked? what happen to the overworked MOs and specialist!!

When the shift system was implemented I wrote this https://pagalavan.com/2011/05/15/for-future-doctors-shift-work-for-housemen/. The whole idea of the shift system is to reduce the number of housemen in each shift so that they will have a better exposure to patients and more rest time. If not, 50 housemen will be running around in the ward every morning !! However, it will definately increase the workload of the housemen during each shift as they will end up seeing more patients at any one time, especially in busy and big hospitals. The entire shift system was not properly implemented and thought of. Our DG, with just a single circular forced all the hospitals to implement the shift duties in September 2011 without proper discussion. Before the implementation, only 2 “small” hospitals were used to run a pilot project. The same principle cannot be applied throughout the country as different hospitals have different problems, different number of ward etc etc. That was my concern then. It is now proven to be correct.

SCHOMOS had a discussion with MOH and came up with the flexi system with total number of hours capped at 60 hours/week. Thus, every hospital was given the authority to implement the shift system based on the best model for the respective hospitals. I was informed that the shift system only made the situation worst in some big and major hospitals in the country. Whatever it is, the rest time was adequate in total.

I have said this before and I will say this again that being a doctor in stressfull. If you can’t handle the stress then leave! If you are incompetent to be a save doctor, then you must be sacked as patient safety should always be the priority. From my experience, most housemen who can’t cope are people who did not realise a life as a doctor and forced by parents. Parents were only concerned about glamour, money and nothing else. So, when they see their child working like a “dog” they get upset and start complaining. I feel the generation Y youngsters are over pempered and unable to handle stress. Probably there is something seriously not right about our education system or the parents!

Everyone is talking about housemen nowadays just because there are too many of them and many are from well to do families and VIPs. If not how can you afford RM 500K to do medicine locally in all our dubious medical schools. Quality is dropping very fast and the consultants are having tough time handling this situation. That could be the reason why the MOs and specialist are beginning to shout at the housemen nowadays, thus labelled as “bullies”. I pity all those medical officers and specialist who are also overworked but never appeared in the newspaper!! This is because, these people have gone throu worst scenarios and able to handle all these situation. Wonder how I can work 24 hrs a day, 7 days a week? good training when I was a housemen.

BTW, the dead of the housemen has nothing to do with being overworked from what I gather and he never worked 5 consecutive days. The director of Kajang hospital said that he has 180 housemen, which means each department should have atleast 30 housemen!!

Housemen still being overworked and bullied, sending some into depression

Stories by LOH FOON FONG, LIM WEY WEN, P. ARUNA and SHAUN HO

Under the Graduate Medical Officer Flexi Timetable system, introduced last September, housemen can only work up to 60 hours a week with two days off. But implementation has been reportedly poor at some hospitals.

Health director-general Datuk Seri Dr Hasan Abdul Rahman said the ministry would seek explanations from hospitals found overworking their housemen, adding that the ministry was willing to help them implement the system effectively if they were facing a shortage of housemen.

However, he said he had checked timetables in Kuala Lumpur Hospital, Ampang Hospital, Serdang Hospital, Klang Hospital, Selayang Hospital and Sungai Buloh Hospital but had not seen any houseman made to work for more than five days a week or to do double shifts.

Earlier, Malaysian Medical Association president Dr Mary Cardosa urged the ministry to review the shift system and conduct a study on the mental health of junior doctors.

On the death of Dr Lee Chang Tat, 29, who was found dead in a restroom of the paediatrics ward at Kajang Hospital with a used syringe beside him, she said there was no data to show the number of housemen who suffered from depression due to their long working hours and stress.

“There should be some kind of mechanism to assist troubled doctors, whether they have personal or work-related problems or can’t handle the stress.”

The Malaysian Medical Council, meanwhile, reviews an average of five cases of doctors with mental health issues each month. It is learnt that there were 20 cases last October.

“Most of them are housemen, but we have also heard cases on medical officers,” said former Health director-general Tan Sri Dr Ismail Merican.

“The types of issues range from psychiatric problems to anxiety and coping problems,” Dr Ismail said.

Dr Ismail, who is also former MMC chairman, said the working hours for housemen may not be as demanding as before the shift system was implemented, but they were exposed to other sources of stress in their work including demands from patients, their superiors and other colleagues,” he added.

System that’s a burden to many housemen

PETALING JAYA: A 27-year-old houseman lamented that although the shift system was good, it was poorly implemented at his hospital.

He claimed that it was up to each department to implement the system.

The houseman alleged that when he first joined the hospital, he had to work 92 hours a week and on 24-hour shifts for up to one and a half months.

But things improved after someone brought up the issue to the management.

However, for departments that lacked housemen, they had to work long hours and without on-call allowance.

This was because allowances were not provided for in the shift system and housemen were not expected to work more than 72 hours a week, he added.

The houseman said they were paid a fixed RM600 a month but without the RM100 to RM200 allowance for each on-call duty.

He also claimed that eight housemen suffered depression and were under psychiatric observation as they could not take the bullying from senior doctors, whom he said constantly shouted and belittled them.

They were also burdened with a training duration that was extended from four to six or seven months for each department.

“One houseman went into depression after he failed his assessment twice,” he said, adding that some housemen got themselves transferred to another hospital or just resigned.

Another houseman Dr G.M. Pillai, 28, said Ipoh Hospital was trying its best to adhere to the rules set by the Health Ministry.

“We work 60 to 65 hours a week and sometimes up to 70 hours. But if we have to work up to 70 hours, we are given less hours the following week,” he said.

Before the shift system was introduced, he had worked up to 36 hours.

But, after it was implemented, the hours were capped at a maximum of 20 and they get a whole day off the next day, he said.

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Star: Trainee doctor found dead after suspected overdose

Posted in Education on April 12, 2012| 34 Comments »

What is happening here? After this report http://thestar.com.my/news/story.asp?file=/2012/4/12/nation/11090364&sec=nation appeared in the newspaper today, I received few emails and even friends asking me about this incident. I have always said that doctor’s life is stressful but before jumping into any conclusion, just review the article below critically. Did the police say that it is a suicide?

I was made to understand that bullying is rampant in this hospital. Something that I do not tolerate but our civil service is rotting anyway. Most of the HODs nowadays are good for nothing. Sorry to say this but it is the reality on the ground. How many of them do teaching rounds, grand rounds, supervise housemen and Master’s students? I am sure most of you will know that the universities do pay a fee to the HODs for every Master’s student that is posted to his department. It use to be RM 1000-2000/month! Do you also know that every medical school attached to the hospital have to pay RM 600-1000/month to the HODs? All these money suppose to be used to facilitate the teaching of Master’s student and medical students. BUT I am sure you know what happens on the ground.

Now, coming back to the story below. The police said that it is an overdose and never said that it is a suicide! I have seen doctors who were pethidine addicts before who stole pethidines from OT. Furthermore, he was found in the hospital’s toilet and not at home or in his room. If at all he wants to commit suicide, I am sure he will do it at home or in his room. If it is true that he worked 5 days in a row then the HOD should be taken to task!! No one can work 5 days in a row. Even in those days when I was a housemen, the longest I have worked is 56 hours ( 2 consecutive calls) but it was a passive call. Generally, we work 32-36 hours the longest. Could the system have made him to become an addict to stay awake and energize himself?

I am also surprised to see that this doctor graduated from Uruguay? There is no university from Uruguay recognised in Malaysia. So, if it is true then he must have sat and pass the MQE exams, thus explaining his age of 29.

I am not sure what exactly happened to this guy. We need more info before we can conclude that it is due to work stress. Whatever it is, I hope MOH will conduct a detailed investigation into this matter. I also hope that the housemen in this hospital will contact the state SCHOMOS rep or MOH if indeed it is true that bullying is rampant in this hospital to the extent that extension etc has become a norm!

Trainee doctor found dead after suspected overdose

By M. KUMAR kumar@thestar.com.my

KUALA LUMPUR: A trainee doctor was found dead in a restroom at Kajang Hospital.

Police believe he had overdosed on an unidentified drug.

Lee Chang Tat, 29, was found dead in the men’s room of the paediatric ward at 7am yesterday by hospital staff who went looking for him after they noticed that he was missing.

He was found with a used syringe beside him, which police believe he had used to inject himself with a drug to fight off fatigue.

It is learnt that Lee, who had been working at the hospital for the past three years, had been working on call for five consecutive days.

Selangor health director Datuk Dr Azman Abu Bakar said hospital staff, who found Lee, tried to resuscitate him but were unsuccessful.

“He was rushed to the emergency room but it was too late,” he said.

Lee, he stressed, had no previous medical problems.

A security guard at the hospital said they found him when someone tried calling Lee on his handphone and heard the ringing tone coming from the restroom.

“We broke into the toilet cubicle and found him lying there with the needle,” he said.

Kajang OCPD Asst Comm Abdul Rashid Abdul Wahab said Lee, who studied medicine in Uruguay, had been complaining to his family about the hectic working hours.

“His family said he had also been planning to go on a holiday to Cambodia soon with friends,” he said.

ACP Abdul Rashid confirmed that an initial post-mortem indicated that Lee had died of an overdose, adding that the case was being investigated as sudden death.

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2011: Pharmacist, 2012: Dentist, 20??: Doctors

Posted in Education on April 5, 2012| 41 Comments »

Last year in October 2011, the government reduced pharmacist compulsory service from 4 years to 2 years https://pagalavan.com/2011/10/06/i-told-you-so/. It was reported that almost 90% of the post in government sector has been filled. Subsequently, MOH has also allowed pharmacist to do their internship training in private sector. I was also informed that the 2 years compulsory service for pharmacist are now given on contract basis. The only good thing for pharmacist will be that their opportunity in private sector is still open especially when the government introduces the 1Care system which will need a lot of community pharmacies.

Today, MOH has announced that compulsory service for dentist will be reduced from 3 years to 2 years! This sentence really surprised me as well “For those who have served their compulsory two years, they may wish to join the private sector,” she said before launching the Colgate Oral Health Month 2012 in Bandar Utama yesterday.She said that last year, 415 graduates had registered with the Malay­sian Dental Council. This represents an almost 400% increase from 2002 to 2011 (112 in 2002 to 415 in 2011),” she said.

Even though the increase is almost 400% in 10 years, the total number is still small (415 last year). Compare this with medicine, where the total number was 7000 last year, from just about 2000-3000 in 2008!! An increase of 4000- 5000 in just 4 years with 50% of the 36 local medical schools yet to produce any graduates!

I know for sure that MMC is being pressurised to reduce the compulsory service to just 2 years of housemanship. Once this is implemented, you need to apply for a job after housemanship ( which will be given on contract basis) in government service or wherever else! There are also some plans by private hospitals to offer themselves for post-graduate training!! God save us all!

So, when will be the doctors turn? 2013? 2014?……………….keep guessing but for sure it is coming.

Shorter stint in govt hospital for dental grads

By WONG PEK MEI pekmei@thestar.com.my

PETALING JAYA: Dental graduates will only have to serve the Health Ministry for two years instead of three, Deputy Health Minister Datuk Rosnah Abdul Rashid Shirlin said.

She said the Malaysian Dental Council had approved the shorter national service on Feb 29.

“Due to the tremendous increase in the number of graduates, it is timely that the compulsory national service be shortened. This will ensure that new graduates will continue to serve in the ministry.

“For those who have served their compulsory two years, they may wish to join the private sector,” she said before launching the Colgate Oral Health Month 2012 in Bandar Utama yesterday.

She said that last year, 415 graduates had registered with the Malay­sian Dental Council.

“This represents an almost 400% increase from 2002 to 2011 (112 in 2002 to 415 in 2011),” she said.

Rosnah said with the setting up of new facilities and upgrading of existing facilities at the primary care level, the ministry would continue to require the services of dental graduates.

She said there were 4,289 active dental practitioners, with 58% of them serving in the public sector as at Dec 31.

Malaysian Dental Assocation president Dr Mohamad Muzafar Hami­rudin said he was shocked to find that 90% of adults had cavities, according to a survey by the ministry.

He said that since oral diseases might be linked with a higher incidence of life-threatening diseases, it was important to educate Malaysians about regular dental check-ups.

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Trained “Specialist” ??

Posted in Education on April 4, 2012| 16 Comments »

The news below appeared in Berita Harian today http://www.bharian.com.my/bharian/articles/Kapastertinggaldalamhidung/Article/ . If you all remember, just a few weeks ago I did bring up an issue of poor regulation to monitor the so-called foreign trained “specialist”. The government has now allowed doctors (Malaysians) who have been in service for 10 years and more overseas to return to the country without the need for compulsory service. Previously they still need to do the 3 years compulsory service and during this time, they are put under supervision and then properly gazetted as a specialist by MOH.

Unfortunately now, anyone can come back and claim that they are a specialist and can practise in private hospitals and clinics. MMC only gives them the license to practise as a doctor but NOT as a specialist. That was the reason the National Specialist Register(NSR) was created in 2006 to register all specialists in the country BUT again, it is not compulsory. It will become compulsory only after the Medical Act 1971 is amended. The amendment of the medical act suppose to have happened in 2009 but till today it has not reached the Parliament!

So now, it is up to the respective hospitals to credential them as a specialist!! definitely this is biased. All private hospitals are profit driven and what they look at is the money. Whatever screw-ups the doctors do is up to the doctor to handle. The hospital has made the money anyway! So, some of these hospitals have started to recruit so-called foreign trained “specialist” from certain particular country to practise freely in their hospital without any supervision and without proper credentialing. The case below is an example of what is happening. Even before this, I have already heard some horror stories. If your vision is good, you can see the hospital’s name!

The situation will only become worst when the government liberalise the health sector and invite foreign doctors to set up hospitals and clinics in Malaysia!!

God save the rakyat!

Kapas tertinggal dalam hidung

Oleh Mohd Fahmi Mohd Yusof bhjb@bharian.com.my 2012/04/04

SITI KHADIJA menunjukkan laporan polis dan botol yang mengandungi kapas yang tertinggal dalam hidungnya ketika ditemui semalam.

SITI KHADIJA menunjukkan laporan polis dan botol yang mengandungi kapas yang tertinggal dalam hidungnya ketika ditemui semalam.

Pelajar dakwa sakit pada bahagian pernafasan, tekak selepas dibedah
JOHOR BAHRU: Seorang pelajar institusi pengajian tinggi awam (IPTA) terkejut apabila mendapati segumpal kapas sepanjang tujuh sentimeter (cm) tertinggal dalam hidungnya, selepas seminggu menjalani pembedahan hidung bagi merawat masalah sinus di sebuah hospital swasta di sini. Siti Khadija Aziz, 24, berkata, beliau menjalani rawatan pada 14 Mac lalu selepas mengalami selsema dan sakit tekak sebelum doktor hospital berkenaan mengesahkannya mengalami sinus dan perlu menjalani pembedahan segera.

“Susulan cadangan itu, saya menjalani pembedahan hidung keesokannya. Sepanjang tempoh selepas pembedahan, saya mula merasakan kesakitan pada bahagian pernafasan hidung hingga ke tekak selain kerap berlendir dan berdarah.
“Selain itu, saya juga mengalami kesukaran bernafas apatah lagi selepas pembedahan, doktor berkenaan tidak membenarkan proses pernafasan melalui hidung dilakukan. Saya juga sukar bercakap selain kedua belah telinga selalu gatal.
“Jika bercakap, suara saya menjadi sengau sehingga ramai bertanya apa yang berlaku hingga saya malu untuk berkomunikasi dengan rakan dan ahli keluarga yang lain,” katanya ketika ditemui, semalam. Katanya, susulan kejadian itu pada 20 Mac lalu, beliau kembali mendapatkan rawatan susulan di hospital berkenaan dan memberitahu segala masalah yang dihadapinya tetapi doktor terbabit mendakwa keadaan itu adalah normal dan hanya memerlukan rawatan biasa.
“Selepas pulang daripada hospital, saya masih rasa sakit seperti sebelum ini selain kesukaran bernafas dan kerap keluar darah dan lendir dari hidung.
“Keadaan itu berlarutan hingga pada 23 Mac, saya tidak tahan lagi dengan kesakitan itu lalu menghembus nafas agak kuat melalui hidung dan apa yang mengejutkan, segumpal kapas bercampur darah dan lendir keluar melalui hidung.
“Selepas bahan asing itu terkeluar, pernafasan saya kembali normal dan boleh bercakap tanpa mengeluarkan suara sengau seperti sebelumnya.

Pada 25 Mac, saya bertemu dengan dengan doktor terbabit dan menunjukkan kapas berkenaan,” katanya.
Bagaimanapun, katanya, doktor terbabit tidak menjelaskan penemuan gumpalan kapas itu, sebaliknya meneruskan rawatan seperti biasa dan cuba mengalih perhatian ketika persoalan mengenai kapas itu diajukan.
Sehubungan itu, katanya, beliau membuat laporan di Balai Polis Johor Bahru pada 28 Mac lalu selepas mengeluarkan perbelanjaan pembedahan dan rawatan kira-kira RM13,150.

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World Class Education?

Posted in Education on April 1, 2012| 8 Comments »

When I read what our DPM said in the newspaper today, I almost fell off my chair. I think our politicians are becoming clowns to entertain us all the time. Just look at another article that was published in the Star yesterday “EIS sets parents abuzz” http://thestar.com.my/news/story.asp?file=/2012/3/31/nation/11024129&sec=nation which I have attached below. Two contradicting reports!! I wonder why our politicians send their kids overseas then?

Before anyone get excited, please read this report http://www.themalaysianinsider.com/malaysia/article/guan-eng-calls-muhyiddins-education-claim-preposterous/ The last few paragraphs in this article clarifies how the survey was conducted and misinterpreted.

When I see what is happening around me at times, I wonder whether our National schools are only for the poor and underprivileged students. More and more rich and well to do parents are sending their children to private schools, international schools and Singapore. The elite Malays have taken over the MARA colleges which suppose to be for the poor. Interestingly, MARA is implementing Cambridge curriculum for the students in their 45 colleges nationwide http://blog.limkitsiang.com/2011/08/10/why-can-mara-teach-maths-and-science-in-english/  & http://thestar.com.my/news/story.asp?file=/2011/8/6/nation/20110806160512&sec=nation where as national schools are not supposed to teach Maths and Science in English!! What a double standard? Do you know that UiTM also teaches everything in English!!

Frankly speaking our education system is in the mess. We have national schools, vernacular schools, MARA colleges, agama schools, boarding schools, matriculation, STPM and all sort of pre-U courses without any standardisation. Some are even reserved for certain race only! Then we have universities which are reserved for certain races, run by political parties etc etc. Our university rankings are dropping yearly and our graduates are of poor quality . Teachers who can’t speak English but teaching english. Our SPM results are becoming the best every year as we have the “best” students in the world who scores most number of As. Almost all students in urban areas are attending tuitions on daily basis which is nothing to be proud of. That simply shows the trust that the parents have on the education thought in the schools nowadays.

Well, I can go on ranting but who cares? At the end, as long as the politicians can keep the rakyat stupid, they will be at the top all the time.

BTW, all registered and prepared to vote?

Muhyiddin: Our education system is one of the best

 KUALA LUMPUR: Malaysian youngsters are receiving better education than children in the United States, Britain and Germany.

Quoting the World Economic Forum’s global competitiveness report, Education Minister Tan Sri Muhyiddin Yassinsaid Malaysia was ranked 14th among 142 countries and second in Asean for quality education.“For those who have come to me complaining about our education system, it seems the report contradicts their claims,” he said when closing a national higher education carnival at the Putra World Trade Centre here yesterday.Muhyiddin, who is Deputy Prime Minister, reiterated the Government’s commitment to give quality and affordable education to every citizen.

“Only with quality education can we increase the nation’s intellectual and human capital capabilities towards becoming a high-income nation by 2020,” he said.

“As we head there, wages will go up and labour intensive industries will become less competitive as investors look elsewhere for cheaper labour,” added Muhyiddin.

“Our nation’s success will be determined by our ability to produce intelligent, highly skilled workers for these industries.

“In this context, investment in the education sector is critical,” he said.

At another function, Muhyiddin called for closer rapport between the public and the police to combat crime.

“Once a close relationship is fostered, the community will not hesitate to work together with the police to relay information on crime as well as participate in crime prevention activities,” he said when opening the 19th annual general meeting of the Malaysian Crime Prevention Foundation (MCPF).

EIS sets parents abuzz

By MOHD FARHAAN SHAH farhaan@thestar.com.my

JOHOR BARU: Excited parents here cannot wait for the opening of an international school right in the city here.

Bank officer Muzaffar Musa, 35, said that he had planned to enrol his children at a Singapore school next year.

However, he would send them to the Excelsior International School in Seri Alam.

Muzaffar said he always wanted to send his children to a Singapore school, saying that the island state has a better education system.

“But now I’m inclined to send my daughters to Excelsior School as it is located nearer to my place.

“This means I no longer need to travel so early to the school in Singapore,” he said yesterday.

Businesswoman Dalilah Bakar, 49, welcomed the international school, adding that parents now have a good opportunity to get the best education for their children.

“Many parents send their children to schools in Singapore instead of international or privately-run schools here.

“Some of these type of schools here only care about making profit without taking the students’ needs into account,” she added.

Sales executive K. Kumaraguru, 38, whose son is studying in Singapore for the last two years, said he might transfer him to Excelsior School as it is nearer to his house.

“I feel bad for my son who has to wake up at 4am and comes home after 8pm,” he added.

Excelsior School, due to open in September next year, will include elements of the Singaporean school curriculum and cater to the growing expatriate community in the state capital.

It is jointly developed by Raffles Campus Pte Ltd (RCPL) education group and Seri Alam Properties Sdn Bhd.

Spread over eight hectares, the school offers classes from kindergarten to high school for children aged three to 18.

It would be equipped with laboratories, an Olympic-sized swimming pool, football field, running tracks, drama and dance studios and an auditorium

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Have the standards and the attitudes of current doctors gone this low!

Posted in Education on March 29, 2012| 48 Comments »

Case 1:

2 weeks ago, a 60+ year old man came to see me. He came with 4 days history of inability to open his mouth completely, unable to protrude his tongue, stiff neck muscles and upper back. He denied taking any medication such as Maxolon. He has a chronic venous ulcer of the RT ankle area over the last 1 year.

I examined him and found a locked jaw, inability to protrude his tongue with stiff muscle of the neck. His venous ulcer was dirty and full of slough. As a benefit of doubt, I gave him stat dose of IM Kemadrine but after waiting for more than an hour, no response was seen which excluded oculogyric crisis. A diagnosis of TETANUS was made. Since I did not have Tetanus Immunoglobulin in my hospital and the patient unable to afford admission, I referred him to the general hospital. I wrote the word “TETANUS” huge enough in the referral letter that any “monkey” can see it . I thought everything would have been taken care.

Today, I heard the horror story of what happened to this patient. He was seen by a doctor at the GH who did not even bother to read and take note of my letter, not sure whether he/she even examine the patient, did a TMJ Xray and referred for an appointment to see a dental surgeon!!! The patient then decided to go to another nearby private hospital despite his financial constraints, to get admitted and be rightfully treated as Tetanus.

Case 2:

A 3 months year old baby was brought to a district hospital for recurrent jerky movement of the limbs and up rolling of eyeball to left. He was seen by a doctor and discharged claiming that FBC was normal as thus nothing to worry about!! The baby was brought to our hospital the next day with almost persistent on and off jerky movements and my pediatrician said that it was a clear-cut seizure. A diagnosis of meningitis was made but unfortunately, it is probably too late. The seizure was resistant to anti-seizure medications and had to be intubated and sent to general hospital for ventilation. Most likely the baby might have developed hypoxic encephalopathy and may develop CP in the future.

Case 3:

A 86-year-old man was admitted to a GH for fever, cough and lethargy. He was diagnosed to have Left basal Pneumonia and treated with antibiotics. He was discharged after 2 days and given appointment 2 months !! We all know that a simple pneumonia can cause death in an elderly man. He was brought to see me today with worsening condition.

Has our standard of healthcare gone this low? Is this going to go into a vicious cycle of mediocrity? The first case is a blatant disrespect to the physician who referred the case. I presume the decision was made by an MO who probably would not have seen a single case of Tetanus in his/her life! Probably, he/she do not even know what is tetanus!! If you don’t know, please ask a senior or call and ask a specialist. Worst come to worst, just admit the patient based on the diagnosis given by the private physician. I find this as a serious attitude problem which is affecting some of the current generation of doctors. No respect to other doctors or colleagues, especially if the referral comes from a private doctor. I have seen many cases like this but I am just giving an example.

I don’t know what to say about the second case! How can a recurrent jerky movement of a 3month year old baby can be normal!! This was exactly what Dr Wong YO was saying in his letter yesterday. Doctors nowadays depend on investigations then taking proper history and examining the patients. Just because FBC was normal, the patient was sent back home!! Do you know that FBC can be normal in sepsis? Whenever a medical student tells me that the WBC is normal and thus infection is excluded, I will tell him/her to fly kite!

The 3rd case just proves that there is lack of empathy to elderly patients. A pneumonia can kill an elderly patient. This is a well-known fact. It is one of the commonest cause of death in the elderly. How can you discharge the patient and give an appointment after 2 months!! Even if your bed is full and need to discharge this patient, you should have arranged an appointment to see him within the next 4-5 days or even earlier.

I have a feeling that the situation is only going to get worst with the glut of doctors that are emerging and lack of good trainers. What Dr Wong YO said will come true that doctors nowadays do not have the passion, empathy and genuine interest in treating patients. I feel for the patients.

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For Future Doctors: Do you want to be a Doctor? …. By Dr Wong Yin Onn

Posted in Education on March 28, 2012| 29 Comments »

This is a beautifully written letter by Dr Wong Yin Onn, a Consultant Physician and Associate Professor at Monash Malaysia which you can also read over here http://myhealth-matters.blogspot.com/2012/03/do-you-want-to-be-doctor-by-prof-wong.html and here https://www.facebook.com/groups/179465178830655/#!/groups/179465178830655/doc/198885280221978/. Dr Wong is a senior Consultant Physician who is running a private clinic in JB town. When the Monash campus started in JB in 2006, he was one of the first to offer his service to teach the students. He is an excellent teacher who was thought by the giant, Prof TJ Dhanaraj, the founder dean and Professor of Medicine of University of Malaya, my alma mater as well. University of Malaya medical faculty was one of the best medical school in the world back then! I am sure you know why it deteriorated!

His reply is to the same person who emailed me and said that I am dampening the spirits of many budding doctors. Well, I am just saying the truth and the future prospect and Dr Wong do agree with me in this letter. However, if you have genuine interest in medicine and willing to put up with all the frustration that will come along the way, then by all means go ahead but it will never be a smooth sail.

Do you want to be a Doctor?

Dear Daryl,
Your aunt has asked that I share with you my thoughts on medicine and medical education today.
Let me start by saying that I am most blessed to have trained under your Aunt, Prof Florence Wang, and I recall my time in ward 12A at University hospital under her as a most formative part of my training. Thank you prof!
It has been 3 decades since then and the world has changed. The world of Medicine and medical education has changed beyond even the most imaginative of us all had dared to dream. Some things are good and much detrimental.
I will have to ask you very honestly why you wish to pursue a career in Medicine for this is very important.
Most students simply have very little knowledge of the world of medicine and some very quickly become disillusioned in their clinical years. ALL my students come to me with FULL distinctions or stand at >97 percentile of their cohort; that they are brilliant is without a doubt but sadly many are NOT that motivated to serve humanity. They come into medical school because their results qualify them too, they sing the right well rehearsed song at the interview and because they think it is prestigious, they want to be a medical student!
But the real world of sick humans with all the smell and excrement and drains rapidly reverse all those good feelings, and harsh reality sets in. Osler a great Physician whom your aunt and I both greatly admire said that THE VERY FIRST QUALIFICATION is a Love for Humanity. I believe that that quality is far more important than all the ‘A’s in your result slip.
AS a GOOD doctor, You will be very important. We have plenty of doctors but not many GOOD ones. The future of many lives and families depend on what doctors do and SAY; imagine all the Good or Damage that can be done. But to be a good doctor is NOT easy. I just had a tutorial with my students and told them that the VOLUME of information that they need to read up is so MUCH that any serious student will honestly spent ALL his time doing very little but STUDY. I hope this realisation will help you understand the quality of life you will have as a medical student, or rather the lack of it.
Modern medical education has moved far beyond lecture based learning; here in the Clinical school the word ‘LECTURE’ is OBSCENE and students learn through SDL – Self directed learning. Its philosophy being that the advance of knowledge is so rapid that Students MUST learn to teach themselves rather than being taught formally in a Lecture Hall. This demands very matured and disciplined students for to the lazy student, SDL means Sleeping DeepLy. Are you prepared for years of being a nerd?
Please remember that Doctors are first and foremost Diagnosticians… those training under me MUST not only be skilful in diagnosis and management but also in social skills and leadership. When I was under your aunt, she demanded History taking so detailed and meticulous that ‘War and Peace’ looked like a short story in comparison. Today students speak in SMS like language, and do “Focussed History Taking” instead of Detail History taking. Yes the Art of Clinical diagnosis is dying, and HIgh Touch Medicine being replaced by High Tech Medicine.
In many Once Prestigious Universities which I will not name, Final Year students now teach 3rd year students Clinical Methods!!! Your aunt will tell you that 3 decades ago, only the senior consultants in UM were allowed to teach Clinical Methods as it was considered so very2 important. Osler is certainly turning in his urn!!
In your mind, do you envision yourself as a doctor spending hours talking, feeling, touching, examining the patients….  or a doctor ordering scans and more scans with nary a glance at the nameless poor sick man lying on the bed? Ask yourself that question now.
Yes, the practise of Medicine is in trouble.
Blatant commercialisation, rampant blood tests done without any doctors ordering or supervising, scans and probes of all kinds, are being conducted by laboratories and some doctors misguilded by wants rather than needs. When your aunt was holding the fort at Ward 12A, her ward rounds will start at 8am and the whole entourage of the Professor, Dr HC Ting the lecturer, the Medical Officer, the houseman and the medical students will follow her from bed to bed. The medical student or the houseman will present the LONG DETAIL history and she will then TALK TO EVERY PATIENT WITHOUT EXCEPTION about aspects of the history and personally examine every patient to confirm or correct the juniors’ findings. This of course was a long tedious process and the rounds will stretch till 1pm. But it was the Art of Clinical Diagnosis at its finest. Today, I am sad to report that rounds are spent looking at scans and reports and its a RARE occasion that the Consultant lays his hands on the sick. Sadly I am not exacerating. I wish I am.
Hope lies in every one of us doctors, present and you the future, for the sensible management of patients; YOU remain the hope for untold numbers of patients in the future. Sadly some doctors see patients not as patients but as a disease that needs treatment which provides our source of income. This is nothing new, physicians like Osler had repeatedly cautioned against not forgetting the man behind the disease, and medicine as a calling rather than a business.
“The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head. Often the best part of your work will have nothing to do with potions and powders, but with the exercise of an influence of the strong upon the weak, of the righteous upon the wicked, of the wise upon the foolish”.~ Sir William Osler
Many doctors are unhappy with their work or simply too busy to talk, console or listen. Yes thats life in the 21st century where we sms instead of talk. Many just treat the disease and completely ignore the person who has it. We hear endless tales carried by patients of doctors who grunt instead of talk, who are capable only of monosylable conversation and who zip patients in and out of the consultation room with a speed that will make Superman jealous. I try my very best to teach my students the Art of Clinical Diagnosis but even I fear that its a losing uphill battle. My colleagues and I here are led by Prof Khalid who is a old school clinician, and we refuse to belittle the Clinical Art despite the advancing machinery all around us. Students are amazed and impressed by all the wizardry and sometimes to my frustration fail to practise the Clinical Skills as much as I want them to.
Ask yourself Daryl, what do you want? I do not want you to come to medical school and be disillusioned by what you see in the REAL MEDICAL WORLD as compared to the idealised world that we had projected.
Doctors must never forget why we became doctors in the first place, and the wonder of caring for fellow humans. Some may be a bit burnt out. We had in our careers, seen and taken care of more pain and misery than most people. We saw prostitudes, drug addicts, criminals and the worst of humanity. Yes, this is another point that I must raise to you. AIDS today is the TB of your aunt’s era, its everywhere! Most of my students come from very privileged families or they cannot afford the fees! Hence it is a shock to many when confronted with Vagabonds, homeless, addicts, pimps and Prostitutes. All the glamour flushes away when you realise that such folks are among the many that you will encounter daily unless you are in some Beverly Hills practise.
But of course we also treated decent human beings, doting grandmothers and innocent children. No doubt, the demands on our skills and the medical-legal complexities that accompany our practise would have made even the greatest of our medical ancestors shudder. And for this your training is NOT the 5 years of medical school BUT many2 years beyond. Are you prepared for such a LONG time spend in studies and training?
You had read Dr Pagal’s blog and written to him, while he may be harsh and discouraging, much of what he wrote to you with regards to THE SYSTEM has some truth to it. The system is basically dictated by our political masters, a system undeniably sick, and Dr Pagal has written frankly of much of our woes that only drastic administrative tsunamis can repair.
Yes the system only makes it more painful. Long waits for post graduate training positions is the norm now. Regulations as thick as a medical text. Pharmacies selling controlled medicines like sweets. To change that will require one of us to be the next Prof Virchow, plunging head on into politics to make a difference.
In school we rose above the hoard, we were the cream de la cream, and yes I can testify to that in my students. Some are so brilliant they frighten me. We obtained results the envy of most and we strove with pride to enter medical school. Could the same students have done well in other fields? Of course they will shine too!!
In medical school you will work like ants on a long march. You will stare at slides till you see mitochondria in your dreams and memorised volumes of facts and figures. Some of my students are NOT prepared for this; they thought that it will be a smooth passage and when they hear this old Professor here telling them to read XYZ, they simply turn off and zone away. Are you ready for a student life that has NO LIFE??
I take them for tough postings in Internal Medicine, I am among the strictest examiners, I expect the students to flourish in the drudgery of crowded wards, to work till hypoglycaemic on medicine rounds, to perform every procedure required in the book, and of course to pass their exams reasonably well. I expect them to look at X-rays until their eyes turned red. And do I have such students? Yes, I am blessed that many such students have walked the wards with me. And I am proud of them. And I know they will overcome every obstacle invented by our political masters to excel in their fields because they have the fundamental quality to be a good doctor; their love of Humanity and of the Art of Medicine.
You will finally graduate and become a house officer. Yes the field is as packed as sardines from Malaysia to UK to Australia, Dr Pagal is NOT exaggerating when he says that jobs will be difficult to come by soon. But if you are GOOD, you will be wanted!  It’s TOUGH I do not deny that, and TOUGHER as the years pass by, BUT again I emphasize, if you are good, you will be wanted, for the good doctor is a rare specimen.
A few years later, you will pick a specialty, from paediatrics to surgery, family medicine to cardiology, internal medicine to radiology, and shuffled off to more clinics, rounds grand or otherwise, work and studies. And MORE EXAMs. Girlfriend? Oh what Girlfriend!!!
About 20% of my own class are still SINGLE!
In the 80s, new diseases appeared. I still recall with trepidation managing the very first patient admitted to our hospital with AIDS. We knew very little but feared a lot. As registrar, it was my duty to examine him. But again we survived. And learned. Now at almost every bedside teaching, I see patients with HIV. In your generation, you will see many many more new ones, from Avian flu number something to any new thing that crosses species as humanity ravishes the environment. Ready for that?
Your youthful enthusiasm and dedication will push you through the initial years. As young doctors, weren’t we incredible then, if only because we came back to the wards night after night, day after day for emergencies, calls, rounds or simply a ’tissued’ drip. “Bengkak” the nurse will phone and we leave our dinner to struggle with chemo wrecked veins for IV access.
Did you know that your aunt will reprimand the ladies for coming to the wards in pants? It is NOT acceptable then but now almost all my female students come in pants! OOPs sorry Prof for leaking such old tales!
We as doctors try to hold onto our commitment to heal, that wonderful calling. Then we see another world – the realm of the business of medicine, where every disease is a “case” to be investigated.
A very senior Professor tells me she had seen doctors ordering investigations before even taking a history! Here is also the world of the grunting and monosylable doctor, the superman of 2 minute consultations and management. True, the superb rare genius of a diagnostitian may well have obtained all the data that he needed sub- 2 minutes, but the poor human called ‘the patient’ needed at least 6 minutes of compassionate conversation. (By the way, that is why the OSCE exam is 6 minutes long, or SHORT from your examinee viewpoint… now you know how the patient will feel when the consultation is even shorter than this!). Recall that the only reason the woman in labour remembered the attending medical student is because they held her hand while she screamed.
We are the descendents of Aesclepius, the inheritors of all that is noble in the Hippocratic oath. We may fail to change the ideas of many doctors however we may preach from some elusive high moral ground. But as individuals can YOU NOT lose that ideal? If you can, welcome to the world of medicine and modern medical education. You will thrive no matter what! If not, seriously reconsider another vocation.
If we tell our students that the learning of medicine is through their apprenticeship to us their seniors, then we better be sure that we are good role models. Your aunt was a superb clinician and diagnostician and had inspired many of us.
As a future doctor, you can be the hope of the febrile, the breathless and the pregnant.
Do not let what you see in the misadventures of some doctors discourage you. Instead let them be teachers to you for you now know what you do NOT want to be like.
When a doctor have taken medicine to be a business or trade, he will ask what are his achievements — material success, cars, wealth, etc..
When a doctor has taken medicine to be a calling, he will ask what has he become — his character.
I hope we doctors can discern and reflect on what we have become in the practice of medicine, and teach all our young charges, delivering them safely through the long 5 years of protracted labour into a reasonably sane medical world. Daryl, I hope I have helped you somehow. Your aunt, Prof Florence has taught me much, this is my little tribute in return, my Bunga Emas to her.
Thank you
Associate Professor Wong YO.

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For Future Doctors: NST: Enough doctors in the house?

Posted in Education on March 27, 2012| 22 Comments »

The article below appeared in NST today http://www.nst.com.my/opinion/columnist/enough-doctors-in-the-house-1.66656#ixzz1qJoGh1k4. It looks like it is slowly coming out of the bottle. Even though the issue of oversupply of doctors did appear last year, it died off slowly when the “so-called” moratorium was implemented by the cabinet. The moratorium ended up as a joke after that! The article below has some mistakes. The number of medical schools is currently 36 in total and not 30 as mentioned. The total of medical programmes will be more than 40 as many are running 2-4 concurrent medical programmes as mentioned below as well.

The reasons given by our Deputy Health Minister for the increase in number of doctors in civil service: “Among the reasons for the big number, she said, was that more government  scholarships were available for medical studies (from 600 to 800 per year) and  more openings for medical practitioners in the ministry’s health facilities” is laughable. The number of post in civil service has not changed much over the last few years. What has clearly increased is the production of medical graduates.

And if you think it is going to stop at 36, please read the article below the NST article  http://thestar.com.my/education/story.asp?file=/2012/3/25/education/10961119&sec=education which appeared in the Star last Sunday 25/03/2012. The deputy director of Higher Education said this: “About 25 more institutions have indicated their interest but we want to be selective and work with those who are specialists in their fields such as in Medicine, Engineering or Business programmes” WTH!! in the name of education hub!!

I received an email from an unhappy budding doctor who said that I am painting a negative picture and breaking the heart of many aspiring doctors who have genuine interest in doing medicine to help people.  “in your posts, you also pointed out the fact that doctors now have little or no job security as posts are limited which really dampens our ambitions as even if our intentions were true, to genuinely comfort and assist people in need, with no posts available in the next 5 years, or opportunity to do so, really discourages students like me to even consider it as it seems like pursuing medicine is now a dead end!” 

The facts are right infront of you and it is up to you to decide on your future. There is nothing special about medicine that you must be guaranteed a job! It is just like any other profession where you need to look for a job. The only difference is that medicine is more complicated than any other professions as I have mentioned numerous times before. No government promises you a job. Thus, if you have genuine interest in medicine and not for money, go ahead but be prepared to have a tough life ahead. That is what I am trying to say.

Enough doctors in the house?

By Syed Nazri  | syedn@nst.com.my

ANNUAL RUSH:   Malaysia could be heading for a glut in  five years, say practitioners

THIS is the time of year when so many young Malaysians run towards realising  childhood ambitions, and parental pressure, of becoming a doctor.

Everyone among them seems to want to be a doctor, lawyer or an engineer,  though several years down the road, some might end up being an overworked  politician or an underpaid reporter.

It is the transformation season, one that follows the completion and outcome  of the Sijil Tinggi Persekolahan Malaysia and Sijil Pelajaran Malaysia  examinations. More than half a million of them will start looking at what they  are going to do next. And it’s quite certain that hundreds, if not thousands,  will seek to take up courses related to medicine on their way to becoming  doctors. The straight A+s in SPM came up to almost 600, and that’s only a small  fraction of the doctor hopefuls.

It happens every year; if the high achievers don’t get government  scholarships to do these courses, they will make noise, call up overworked  politicians or write to the newspapers.

But let’s look at things in another perspective and consider what was  revealed in Parliament last week by Deputy Health Minister Datuk Rosnah Abdul  Rashid Shirlin and match it with what doctors themselves think.

Rosnah said: “The number of medical practitioners in the country has  increased significantly with the ministry registering over 21,747 in government  service last year.” (It was recently also reported that there are about 33,000  overall).

Among the reasons for the big number, she said, was that more government  scholarships were available for medical studies (from 600 to 800 per year) and  more openings for medical practitioners in the ministry’s health facilities.

Now, let’s ponder over what came out in the latest issue of Berita MMA, the  monthly newsletter of the Malaysian Medical Association. The following is an  excerpt of an article written by Datuk Dr N. Athimulam. I was told it reflects  the views of most, if not all, doctors. It’s really hot off the press in more  ways than one:

“As per Dec 30, 2011, there were 11 government and 19 private medical  colleges, with about eight offshore recognised medical programmes. The strength  of medical students in each medical faculty varies. Two private colleges in the  southern region with twinning programmes have 1,457 students here and another  1,229 overseas, with a total of 2,686. A newly opened prestigious private  university college has a total of 95 medical students.

“On an average, if there are 500 students in each college, then there should  be 15,000 medical students in Malaysia,” Dr Athimulam, a past president of MMA,  wrote.

He added that about 10 years ago, the authorities introduced a requirement  referred to as NOC (no objection certificate) to regulate the number by making  sure that only really qualified students could take up medicine.

This ruling, however, has not been adhered to. And as a result, he said, the  number of Malaysian medical students overseas has increased to “easily more than  25,000”, mostly in the Middle East, Indonesia, Russia and Ukraine.

Dr Athimulam further wrote: “The government intends to achieve a target of  87,177 doctors by 2020, by which time the country’s population is projected to  be 35 million.

“The Health Ministry has set a target ratio of one doctor to every 400  people by 2020”, but he expressed fear that there could now be as many as 10,000  medical interns every year, which means that the government target for 2020  “will be reached by 2017”.

Then the cruncher: “Unless the government controls medical education, there  may be a glut of doctors by 2017 or 2018.”

The way things are going, I don’t know for sure whether it is good or bad.  On one hand, Malaysians aspire to take the country to become a developed and  high-income nation in a few years.

Which means a sufficient number of doctors.

But on the flipside, are we doing it the right way and not compromising on  quality?

Whatever it is, this paper is offering a timely service to post-school  Malaysians about career choices and the right courses, including medicine.

The New Straits Times will publish a weekly pullout starting today that will  serve as a guide to students intending to pursue higher education. Be sure to  get your copy.

Read more:  Enough doctors in the house? – Columnist – New Straits Times http://www.nst.com.my/opinion/columnist/enough-doctors-in-the-house-1.66656#ixzz1qJoGh1k4

M’sia set to be education hub

By KAREN CHAPMAN educate@thestar.com.my

The country aspires to become the regional learning centre by focusing on its strengths in four key areas.

THANKS to a landmark partnership agreement between the Higher Education Ministry, Universiti Teknologi Mara (UiTM) and the world-renowned Massachu­setts Institute of Technology (MIT), the country is set to become the knowledge capital for logistics and supply chain management in Asia.

 Dr Mahender says a supply chain comprises everything involved in creating a product, from raw materials to finished goods.

This has resulted in the formation of the Malaysian Institute for Supply Chain Innovation (Misi) in Shah Alam.

Dedicated to postgraduate supply chain education and research, Misi will serve as MIT’s Asian hub in the university’s international network of centres, which is known as the Global SCALE (Supply Chain and Logistics Excellence) Network.

The other centres in the network are the MIT Centre for Transportation and Logistics (MIT CTL), the Zaragoza Logistics Centre in Spain and the Centre for Latin American Logistics Innovation in Colombia.

Modelled after a leading supply chain management programme at the MIT CTL, Misi rector Dr Mahender Singh explained that Misi will offer both Master’s and Doctoral programmes in supply chain management and logistics.

“The Master’s programme will start in August this year while the Doctoral programme is scheduled for next year,” he said.

In addition, Misi will offer short courses under its Executive Development Programme as well as conduct research and corporate outreach activities for global and local firms that operate in the Southeast Asia region.

“The MIT Global SCALE Network is an international alliance of leading-edge research and education centres, dedicated to the development and dissemination of global innovation in supply chain and logistics. It was launched by the MIT CTL with the opening of the centre in Spain in 2004 followed by another one in Colombia in 2008.

“Collectively, the SCALE Network, which includes CTL, now spans four continents,” he said.

 Prof Siti Hamisah says the ministry wants to be selective when deciding on a foreign branch campus to be set up in the country

Explaining the meaning of supply chain education and research, Dr Mahender who has been seconded from MIT, said supply chain management (SCM) is one of the key areas within the business management space.

“A supply chain comprises everything involved in creating a product, from raw materials to finished goods. It is the art and science of bringing raw materials from their source, converting it into products and moving them to the multiple consumer locations in the most efficient manner to make the business profitable.

“We teach students a variety of skills since the domain of SCM needs a very diverse set of capabilities,” he said.

The students learn quantitative as well as qualitative methods to make supply chain performance improvements. The complexity in supply chain arises due to the routine movements of products and service across country boundaries.

“The students also learn about the financial and informational aspects of the business as it relates to the performance of the supply chain directly,” he added.

Using the actual data and description of their problems, he said researchers may decide to use mathematical tools to model the problem and find a better way to find a superior solution, or devise better solutions after conducting a qualitative analysis of the available data.

The signing of the landmark partnership agreement was witnessed by Prime Minister Datuk Seri Najib Tun Razak last year, who commended the three parties for their efforts, which supported the nation’s aspirations to strengthen higher education and to be a regional education hub.

“With Misi’s establishment, I believe that research and development in logistics and supply chain industry will propel and accelerate other industries for the benefit of the nation,” said Najib at the time.

Higher Education Minister Datuk Seri Mohamed Khaled Nordin said it was heartening that MIT chose Malaysia to host its overseas centre.

“The partnership is significant because China and Singapore had expressed interest in hosting the centre,” he said.

He said the ministry had selected UiTM to be MIT’s partner as the local university had a long history of offering transport and logistics programmes up to postgraduate level.

In terms of higher education institutions as of October last year, there are 20 public universities, 26 private universities, 23 private university colleges, 28 polytechnics, 74 community colleges, 434 private colleges and several branch campuses of foreign universities.

On the possibility of setting up more branch campuses of foreign universities here, Higher Education Ministry deputy director-general (private higher education institutions) Prof Datin Dr Siti Hamisah Tapsir said the ministry wanted to be more selective when doing so.

Working with the best

“About 25 more institutions have indicated their interest but we want to be selective and work with those who are specialists in their fields such as in Medicine, Engineering or Business programmes,” she said.

Giving examples, she said these included the partnerships between Misi and MIT, Perdana University and Johns Hopkins University and Royal College of Surgeons, Newcastle University Medicine Malaysia, Southamp­ton University and Reading University.

“Heriot-Watt University will set up a branch campus in Putrajaya,” she added.

According to the Heriot-Watt University website, it has been chosen to establish a new campus in Malaysia at an investment of £20mil (RM98.4mil).

It said the university was chosen as winner of a major international tender by the Malaysian Government and Putrajaya Holdings Sdn Bhd, in recognition of its strong reputation for creating diverse research and development opportunities and solid strong track record of success in linking with industry, commerce and the wider society. The new, purpose-built campus will create opportunities for up to 4,000 undergraduate and postgraduate students to study a range of courses in science, engineering, business, mathematics and design, with a view to gaining a UK-recognised degree.

Recent figures show there are 87,322 international students in Malaysia (24,617 in public institutions and 62,705 in private institutions). 9,002 of these international students are pursuing PhDs, 11,673 Masters and 35,347 their Bachelor degrees while the rest are attending diploma and certificate-level courses.

The ministry is targeting 200,000 international students enrolled in the country’s higher education institutions by 2020.

Prof Siti Hamisah said the Government is planning to expand the roles of its Education Malaysia offices (formerly known as Malaysian Students’ Department (MSD)).

“It will be like a one-stop centre where foreign students can seek more information on studying in Malaysia as well as better able to handle the recruitment of foreign students. It is similar to British Council,” she said.

To become a higher education hub, Prof Siti Hamisah said the ministry has identified four areas that will put the country in a better position to attract foreign students.

These are Islamic banking and finance, advanced engineering, hospitality and health sciences.

Mohamed Khaled said last year that by focusing on the four key areas rather than in too many disciplines, Malaysia would be able to strengthen and develop its position as a higher learning education hub.

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For Future Doctors: The Future is bleak………. indeed!

Posted in Education, Politics on March 19, 2012| 120 Comments »

Yesterday (18/03/2012), the Malaysian Medical Association Johor Branch had its AGM for 2012. It was a special occasion as the President of MMA and the SCHOMOS Chairperson were present to have a dialogue session with all the members. It was a fruitful meeting and many issues concerning the medical fraternity were discussed. We also got to know the latest happening that will change the future of medical profession in this country.

1)      Housemanship

 The declining standards of medical education and oversupply of doctors were discussed. It is indeed true that the number of housemen is reaching an unimaginable level and MOH is very much aware of this. To cover this up, MOH has come up with the shift duty system and to allocate more district hospitals for training. Most hospital’s housemanship post is fully occupied. The ratio of housemen to specialist supposed to be 5: 1. Unfortunately, the way MOH calculates this figure is rather odd as they include all specialists in the hospital including radiologists, pathologist, ophthalmologist, ENT surgeons etc where housemen are never placed. So, in reality there are not enough trainers for all the housemen who are currently in the system.

The oversupply of doctors is a harsh reality which is going to happen anytime soon. MMA has discussed this issue with MOH but unfortunately MOH puts the blame on MOHE. The moratorium is just eyewash. It is very clear that it is all about money and the only people who can stop this rot will be the general public and not MMA. Whenever MMA brings up this issue to MOH or MOHE, they are accused of being selfish and avoiding competition! Thus, it is very clear that they want to flood the market with doctors and no one is going to guarantee you a job.

The maximum period to complete your housemanship is 3 years. Anyone who does not complete the housemanship in 3 years will be automatically terminated.  Any houseman who is caught doing “locum” will be automatically terminated.

It is indeed true that MMC may soon remove the 4 years compulsory service under pressure. It is no more a rumour as I have mentioned before. It basically means that after 2 years of housemanship which is given on contract basis, there is no guarantee that you will get a job. You will have to apply to get a job in civil service or open a clinic (with license to kill). You can also forget about postgraduate education if you do not get a job in public sector.

2)      Postgraduate education

It is also true that you are only eligible to apply for Master’s programme on 5th year of service (2+3 years). The number of Master’s post is gradually being increased due to political pressure. It is way too many compared to what the universities can really handle. The quality of Master’s graduates is slowly dropping and many consultants in hospitals have voiced out their concern. We are now seeing Master’s graduates who can’t do simple surgeries. Fresh Master’s graduates are teaching Master’s students in the universities!

Those who quit Master’s programme or who failed 4 times (meaning disqualified) will still need to serve their bond with the government and repay the JPA scholarship.

3)      Insurance companies

One of the GPs brought up the issue about insurance companies cutting the consultation fees and threatening doctors. It seems that many of these insurance companies and MCOs are requesting doctors to reduce their fee if their contract is going to be renewed. If you refuse they will find another GP who is willing. The situation has reached a critical stage to the extent that some newly opened GP clinics are willing to be paid only RM5 per consultation!! How desperate the situation has made of some doctors!

With the removal of compulsory service, many of these unemployed doctors will end up opening a clinic to survive. These doctors would probably even accept RM1 per consultation! Someone in this blog commented about competition some time ago, so here you are………..

It basically means that doctor’s income will gradually reduce and many may just earn enough to survive. It is also unavoidable that the dispensing rights of doctors will eventually be removed.

The 1Care system is still in planning stages and nothing has been finalised. So, we just have to wait and see.

4)      Liberalisation of Health Sector

In Budget 2012, our PM has announced the liberalisation of many subsectors which includes health sector. The MMA has voiced out its concern regarding this matter as proper monitoring mechanism is not in place yet http://www.themalaysianinsider.com/litee/malaysia/article/mma-putrajaya-gambling-with-nations-health-by-liberalising-medical-sector/. Unfortunately, it is unavoidable once again. Since February 2012, the government has allowed private hospital of 100% foreign equity to be set up in Malaysia. They are also allowed to hire foreign consultants as long as their degree is recognised by MMC/NSR. By September 2012, foreign specialist/doctors will be able to set up their clinics in Malaysia!!

Unfortunately, the amended Medical Act 1971 is yet to be tabled in Parliament. Thus, the National Specialist Register (NSR) is not compulsory at this point in time. So, where is the monitoring system to make sure that these “so-called” specialists are indeed what they claim to be? Someone can set up a “proctologist” clinic beside yours and earn a decent living! Even now, there are some private hospitals which are hiring “so-called” specialist “trained” in some other country without NSR registration. Private hospitals are profit driven and what they are interested is only money and not quality. With the poor monitoring system, these doctors can easily get away with whatever they are doing and the rakyat will eventually be the victim.

Over the last 24 months since I started blogging I have been constantly saying that the future is bleak for doctors. Guaranteed job, good money and life are the reasons why many choose medicine. That is the fact! Forget about helping people, curing the sick etc which is actually the minority. Whatever said, at the end of the day, it is a profession to earn a living. Unfortunately, many people believe that just because they spend RM 500 000 to RM 1 million to do medicine, the return of investment is high!! It is a total misconception that the public is totally unaware.  Our society is just obsessed in getting their children to become a doctor for glamour and social status. That must change!

Secondly, doctors are so disunited that the government can just do what they want. The only organisation that we have is MMA but unfortunately how many of you guys who are reading this are even members of MMA? How many of you are even interested to fight for the betterment of future doctors? I have done my part and still contributing to the betterment of doctors in this country. I created this blog to educate the public/future doctors as I realised that many are not aware the mess that they are getting into. MMA received a lot of bad publicity recently but it is still the only organisation to fight for doctors.

The future is indeed bleak……………………….

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Doctors could face GMC action for ignoring poor care

Posted in Education on March 13, 2012| 3 Comments »

 I received this interesting link today: http://www.telegraph.co.uk/health/healthnews/9138415/Doctors-could-face-GMC-action-for-ignoring-poor-care.html. If this were to be implemented here, many doctors may be jobless! I see mismanagement and misdiagnosis on a daily basis , both from public and private sector. I am not saying that doctors don’t make mistakes but a poor care to any patient can be penalised. According to this regulation implemented by GMC today, any doctor who witness poor management of case by another doctor should report it to GMC. If not, you will get into trouble as well for compromising patient safety.

Unfortunately our MMC is not as effective as GMC. One of the reasons could be the fact that MMC comes under Ministry of Health and the DG automatically becomes the chairman. If you visit MMC website http://mmc.gov.my, you will hardly find actions being taken to doctors ( there are a few but mainly due to falsification of documents). It could be due to the fact that not many patients or doctors complain about another doctor. When the new amended Medical Act is tabled in the Parliment(hopefully soon), MMC will be corporatised and I hope it will become more effective.

We also do not have a compulsory Specialist Register. Even though National Specialist register(NSR) www.nsr.gov.my was launched in 2006, it was not made compulsory yet as the the Medical Act need to be amended. Unfortunately, even before all this monitoring mechanism is in place, the government has allowed doctors who have been in service for more than 10 years overseas to return without the need for compulsory service. Thus, these doctors can go straight to private sector! I am now hearing news of some private hospitals recruiting “so-called” specialist “trained” in a particular country and credentialing them as specialist/consultants to make money. These private hospitals do not make any attempt to make sure whether these ” specialist” are really what they claim to be. I am already hearing horror stories from these hospitals but yet the management of these hospitals are not bothered as money comes first! Imagine doing FESS surgery for 4 hours! They seem to claim that they can do all sort of surgeries etc but in reality it’s all talk but no action! The management of the hospital even got a cheek to say that NSR registration is not compulsory! I was informed that MOH is aware but no action so far as patients did not make any complain.

I just hope MMC will implement more drastic measures to monitor quality of doctors in this country, have more teeth and not to succumb to political pressures. The NSR should be made compulsory for private hospital’s consultants till the medical act is amended.

 Doctors could face GMC action for ignoring poor care

Doctors could face disciplinary action if they “walk by” and ignore poor patient care by other doctors or health professionals, under new General Medical Council guidelines coming into force today.

Doctors could face disciplinary action if they “walk by” and ignore poor patient care by other doctors or health professionals Photo: ALAMY

1:33PM GMT 12 Mar 2012

The new rules mean they may be held to account for failing to raise concerns about sub-standard treatment even if they are not involved. Doctors will be seen as responsible for the “entire welfare” of patients.

Chief executive Niall Dickson said it followed examples such as the scandal at Mid Staffordshire NHS Foundation Trust, where up to 1,200 “excess deaths” occurred due to poor care.

While some doctors did report their concerns, others “walked by on the other side of the ward”, he said.

“Doctors have an obligation to raise these concerns when they see things are going wrong,” Mr Dickson added.

He said the new rules were intended to foster a “culture of openness” in which raising concerns was not just a matter of “heroic” whistleblowing but should be an every day part of working in the health service.

Mr Dickson told BBC Radio 4’s Today programme the guidance was meant to be “more carrot than stick” but that it was “guidance with teeth”.

“Doctors who persistently and seriously depart from this guidance will find themselves possibly with their careers at risk.”

He added: “You can look at examples at the Mid Staffs inquiry, where although some doctors did raise concerns, it is also clear that many doctors didn’t raise concerns, that in a sense they walked by on the other side of the ward.

“That’s not to say that the medical care itself may have been bad, it may have been bad care by other care professionals, but our advice is that doctors have a wider responsibility.

“They have a responsibility not just for the care they give, themselves, but also for ensuring the entire welfare of patients and that includes care provided by other doctors but also care provided by other professionals

“They have an obligation to raise concerns when they have them, and doctors who are in management positions also have a responsibility to act when those concerns are raised.”

The new guidance also bans doctors from signing contracts with gagging clauses that attempt to prevent them from reporting problems to the GMC or other regulators such as the Care Quality Commission.

Mr Dickson said there were “odd” examples of such contracts which appeared to have resulted when “HR departments get some advice from lawyers” to “absolutely seal this thing up”.

He added: “What we want to encourage across the health service and indeed the private sector is a culture of openness where people feel that raising concerns is not just about whistleblowing.

“It is not just about an heroic act, it should be part of every day culture. That’s the only way in which patients will be protected.”

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