Archive for the ‘Education’ Category

In my first post with the above topic , I mentioned about the government’s intention to introduce contract HO post. Sometimes I do not know whether to laugh or cry. Few years ago when I predicted that the time will come for graduates to wait in a “Q” and jobs will not be guaranteed for doctors, I was scolded, laughed at, humiliated and given numerous sarcastic remarks. Few years down the line, when what I predicted happened, the situation has changed. Now, these very people claim that I am boasting and self-glorifying. I don’t know what these people really want. When you tell them something , they don’t listen and when it happens, they throw back their tantrum to the very same people who predicted it will happen. What precaution did you take ?

There was a meeting between MOH officials with HODs of a big hospital in Malaysia recently. In this meeting, the current situation of doctor’s post was discussed. Please be informed that MO post is currently 16% oversubscribed! Interestingly, some of the HO post are being converted to MO post to cater for this oversupply. This happens because , all those who are appointed into civil service are on a permanent post currently. Thus, the government is now in the process of trying to get contract HO post to fill up the gap and to shorten the waiting period . However, this new situation will only reduce the waiting period from about 8 months to about 6 months. With the increasing number of graduates from this year onwards (all 32 medical schools will be producing graduates from 2016 with increasing numbers), the waiting time will only shorten for a short period of time before climbing back to about 1 year or even longer.

It is expected that the contract HO post will start from this October if approved by cabinet. The question is “what happens after HO?”. It seems that the government is not obliged to provide jobs to everyone, which is a fact. Thus, if you do not get a permanent post after HOship, your contract may be renewed for another 2 years to complete your compulsory service. After the 4 years compulsory service, you can do what you want! The GP market is going to be severely affected by this as those who can’t get a job in MOH will open their clinics in every corner of the town. The struggling GP market will continue to struggle.

As I said in my previous post, this will affect post-graduate education. At the moment post-graduate education can only be done in public hospitals. I also heard rumours that those with MRCP, MRCS Part 1 etc will have a better chance to get into a permanent post. Another good news is the fact that some of the public universities are building their own teaching hospitals which can probably employ some of these MOs. UPM, UiTM, University Sarawak and Sabah etc are all in the process of building their own teaching hospitals. However, these will take another 3-5 years to materialise.

It is also informed that no more contract extension will be given to those who had retired from civil service. This “post retirement contract” is something which I had always felt is not appropriate. Those who had retired should not be reemployed to the same post under contract unless it is a very much-needed service with no replacement found. In many instances, HODs who had retired continued to become HOD under contract. That is not right as far as I am concerned.

I still get questions from foreigners who are interested to do internship/HO/MO in Malaysia. Let me tell you once and for all, Malaysia DO NOT provide housemanship to foreigners. Foreign Spouses of Malaysians were given internship post till 2014 under contract but stopped since then. In February 2016, MOH came up with the following circular to confirm the fact that foreigners will not be given housemanship post till further notice. It also mentioned on those who has quit housemansip or terminated.

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With the introduction of HO contract post, it will become very much easier for MOH to terminate any HOs who go missing or have poor performance.

And for those who think that being a doctor guarantees you a job anywhere in this world, don’t live in a delusional world. Doing medicine for migration is the worst thing to do. It is the most controlled profession in the world and most difficult to migrate. Just recently, there were suggestion that Australia should stop recruiting foreign trained doctors.  Please check how much easier it is for people of other profession to apply for “Skilled Migration” Visa to Australia compared to medicine. With the new PM in UK who supports anti-migration policy, the situation may not be any better. Singapore has also stopped conducting qualification exams for foreigners with unrecognised basic degree. Unless you want to migrate to an African or 3rd world country, doing medicine is the last thing you should do.

The world of medicine is not the same anymore. Majority of those who I talk to are intending to retire early. For those who intend to do medicine, PLEASE read my books. You can buy it online as mentioned HERE. It should be available in Kinokuniya bookstores very soon. Popular will be next………..


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Almost 3-4 years ago I predicted that there will come a time where HO post will be given under contract. In August last year, I again predicted and heard rumours that HO post may be give under contract, after which you need to apply for a permanent MO post. There were even a suggestion than that en exit exam is being considered after housemanship. Well, looks like once again my prediction may become a reality soon.

TheStar reported today that MOH is waiting for green light from the cabinet for creation of temporary HO post. This basically means the HO post will be given under contract. What happens after housemanship? It basically means that you will need to reapply for a permanent post as a MO. There are pros and cons in this system. Firstly, how do SPA or MOH decide on who will receive permanent post and who will receive contract post? I presume JPA scholars/government scholars might be given preference for permanent post as the contract guarantees a bond with the government. Secondly, how do you assess who will get permanent MO post after the contract expires? This is where the said exit exam may come into force. BTW, 300 contract post were created this year for dental graduates as reported by DG and written by me in March 2016.

On the other hand, it will keep all HOs on their toes. If you don’t complete your housemanship in 2 years (usual duration of any contract post), you may not be able to continue the contract. It is also easier to terminate HOs who are missing in action. If you perform badly during housemanship, you are likely to have a lesser chance of getting a permanent MO post. Be also aware that if you do not get a MO post in government, you have almost zero chance of pursuing post-graduate education.

As i had always said, there is no such thing as job security in medicine anymore. It is considered as just like another job but medicine is far more complicated than any other jobs out there. Without housemanship, no full registration. Without full registration, you can’t practise as a doctor etc etc.

What’s next ? A reduction in compulsory service from 4 years to 2 years ? Open clinic after housemanship? Another of my prediction which may come into reality. Then we may have a lot of doctors with apparent ” license to kill”……………

Temporary posts can reduce waiting time for medical grads

KUALA LUMPUR: There is good news for medical students who will be graduating soon as they may not have to wait too long before being offered a job.

The Health Ministry is in the final stages of implementing a plan to introduce temporary posts for medical graduates who face a long wait to do housemanship.

Its deputy director-general (medical) Datuk Dr Jeyaindran Sinnadurai said the rigidity of the current system did not allow the ministry to offer permanent positions to more people as they serve their housemanship.

The plan for temporary posts, he said, needed the Cabinet approval before it could be introduced as “we have to ensure that it is fair to all and no one is marginalised”.

On whether the ministry can justify the number, he said “yes” as it had developed many new services.

“The workload has increased, so we need those numbers to deliver care to the public.

“Presently, we take in about 4,500 house officers annually on permanent posts and upon completing their housemanship, they become permanent medical officers,” he told The Star after chairing a lecture at Hospital Kuala Lumpur on Thursday.

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It’s been 7 years now since I started to blog. Over the last 7 years, I had at countless number of times explained in detail about degree recognition, license to practise, job opportunities, quality, apparent “license to kill” and changing landscape of medical practise. Unfortunately, our society especially students and parents are still living in an ignorant world.

Today, there was an interesting letter to theStar(attached below). As usual, it has to come from a parent , similar to what I wrote in my blog post dated 10/06/2016. We have too many naive parents out there who refuse to listen to advise but will complain when it happens. The letter that was written clearly shows that he is not aware how the field of dentistry works, similar to medicine. You must understand that Dentistry had 3 years compulsory service since 2001 till 2012, after which it was reduced to 2 years. In June 2015, the compulsory service was reduced to 1 year which means that ONLY internship is done in government service for the purpose of full registration. I wrote about this in March 2016. The reason for this reduction is due to shortage of post in civil service.

The ignorance of the writer is clearly visible on this letter. Firstly, you don’t become a “dental surgeon” after graduating. The term itself is wrongly used. The one year compulsory service is ACTUALLY Internship. Without internship, you will not be able to be fully registered. Without full registration, you WILL NOT be able to practise as a dentist. I am not sure what “world-wide standards” is he talking about BUT there is NO such thing as practising without completing internship. Without internship, which is a supervised training period , you are NOT eligible to practise medicine/Dentistry. Graduating as a doctor/dentist DOES NOT give you a license to practise. License to practise is totally a different issue than having a degree. Unfortunately, at the moment, internship can only be done at government sector. Anyone caught practising dentistry or medicine with temporary registration or without any registration can be regarded as bogus doctors! Parents should also understand that spending huge amount of money does not guarantee you a job. I had always said that taking huge amount of loans to do medicine/dentistry does not make any economic sense. NO private or public colleges can guarantee you a job.

On another note, our Minister had said that medical graduates can do some other jobs while waiting for housemanship posting. The waiting period currently stands at 8 months. As I said in my blog post last month, i know a graduate who is working as a pharmaceutical rep while waiting for housemanship. The situation will only get worst from this year onwards. AND I still get emails from students who are intending to do medicine in an unrecognised university! Sometimes, I feel I should just give up trying to educate the public! MMC has introduced a new fee structure for MQE examination. I did write last year that MMC had increased the registration fee to RM 1000 with maximum of 4 attempts. This year they had introduced a common theory paper for a fee of RM 3000.  Yes, this will be the way forward. MMC should conduct the MQE exams themselves rather than allocating to various universities where the exam standards vary. I hope eventually, the clinical component will also be standardised. Will this lead to a Common entry exam for all foreign graduates? I understand that MMC is gradually reducing the number of recognised universities overseas.

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A blog reader sent me a message in my Facebook today asking me to update my blog more regularly. Yes, I have been busy for the last 3 months with all these tax issues against doctors and would continue to be busy for another 2 months till all the issues are settled. Till then, I may be slow in updating my blog post unless something “hot” appears. Anyway , all information needed by students are available in this blog OR they could just buy my book and read.

The world of medicine is changing. Doctors are getting sued almost daily basis. Complains to MMC is increasing by leaps and bounds. It is shocking to see the latest disciplinary actions taken by MMC which is available at their website. The numbers keep increasing. A lot of black sheep are appearing in our noble profession as I mentioned in my last blog post. A new medical indemnity scheme has been introduced this year. Interestingly, since the new scheme started, in just 7 months, they have 4 cases filed in court for medical negligence! That shows how the society is changing. I have almost daily complains in my hospital for various issues. At the end, everything boils down to money!

Think before you decide on the life that you want………………



Abolish compulsory government service

MY son graduated as a dental surgeon from a local private university on December 2015 after five years of intensive study and spending a few hundred thousand dollars. Sadly, he is still waiting to be called for an interview for the one-year compulsory government service and is not gainfully employed.

I understand from reading the newspapers that there are not enough vacancies for dental surgeons in government hospitals. In this situation, I certainly do not understand why the one-year compulsory government service is still not abolished. Can the Health Ministry or Malaysia Dental Council (MDC) offer some sensible and more logical explanation? I am sure others who are in the same boat as my son, and their parents too, will appreciate being enlightened on this.

This waiting period is a trying and demoralising time for my son who is eager to serve the people in this beautiful country.

And while he is waiting, he is wasting his life away and suffering financial loss too.

Why can’t the MDC issue a temporary annual practising certificate to newly-graduated dental surgeons to allow them to work in a private clinic until the Government is ready to take them? After all, they are fully qualified to practise in accordance with worldwide standards.

My son borrowed RM100,000 from PTPTN to finance his course. If he is gainfully employed now, he can start to repay the loan.

I look forward to an immediate solution from the intelligent and efficient officials at the Health Ministry and MDC.


Subang Jaya

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3 years ago, i wrote an article about a pharmacy which was treating patients like a doctor‘s clinic. In fact that was the 2nd time I wrote about the same pharmacy. For the first, I sent an official complain to Jabatan Kesihatan/KKM and for the 2nd I sent the letter to JKN. However, I never received any further feedback from any one of them. Typical of any government agencies which never provide any feedback. Wonder whether it is under Official Secret Act!

While over the last few years, I do see patients being prescribed medications by pharmacist which they should not be prescribing in the first place, I just kept quiet as I felt it is worthless complaining. I have seen Prednisolone being given by pharmacist without prescription and even NSAIDS being given continuously without even knowing the patient’s renal status. Worst still, I have even patients buying Methotrexate from pharmacy without even my prescription.

Last week, yet again I saw the VERY SAME pharmacy/pharmacist prescribing the following 2 medications to a patient with poly arthritis of 1 year duration!



According to the patient, she was not even examined by the pharmacist. He just listened to her complains and gave her the medications above. One is a steroid(Betamethasone) and another is Sulphasalazine! Patient developed allergic reaction to Sulphasalazine and THANKFULLY, she stopped the medications. Sulphasalazine contains sulphur and allergic advise should always be given as it can cause Steven Johnson Syndrome and Toxic Epidermal Necrolysis. I will always advise patients about allergic reaction whenever I prescribe Sulphasalazine. Furthermore, this is a generic Sulphasalazine! Finally, one fine GP referred this patient to me.

So, what action has the JKN taken to this pharmacy? How in the world they can continue to prescribe these type of medications to the general public? I forwarded yet again this picture to a colleague of mine in JKN for further action. While I don’t expect anything much but at least I have done my job to protect the public.

ON another note, why did this patient even landed up with a pharmacist? Sometimes, we are to be blamed for all these issues. Patient had seeked multiple consultations from various GPs and Klinik Kesihatans but was only given NSAIDS. Patient has clear-cut Rheumatoid Arthritis. Her RT wrist is almost fused now.

Then we have TCM practitioners who are happily treating patients with “so-called” herbal medications which obviously contains steroids. The moment the patient walks into my clinic, I will give them a spot diagnosis and most of them will be shocked! An obvious Cushing’s syndrome. Serum Cortisol levels will be < 16 in almost all these cases. I do this just to prove to the patient that they have been taking exogenous steroids. Interestingly, recently I came across a patient who was given intravenous infusion by a TCM practitioner over the last 2 months. It was given periodically with tapering dose durations. The patient has Rheumatoid Arthritis. The patient definitely looked Cushingoid. Was he giving steroid infusions? “ Hari ini masuk ubat, besok boleh lari lor“, exactly what the patient told me! Obviously it is steroids! I wonder whether the person giving it knows that these are all steroids and nothing miracle! Or are they giving western medicine in the name of herbal medicine?

I call a spade, a spade all the time. Many do not like me because of this but I have my principles. Patient safety comes first in all instances. Sometimes, we doctors are to be blamed for all these distrust going on out there. While I have said that patients are becoming more and more naturalistic, claiming we are giving chemical to destroy their kidneys etc, doctors are also venturing into unethical medicines. Unethical practices are NOT uncommon nowadays. I have seen enough steroids being given by doctors themselves. Just saw a 76 year old man with OA knees given betamethasone daily for the last 3-4 years. The daughter is asking me why is his skin becoming thin with easy bruising! How am I suppose to answer that when I know exactly what’s the answer.  I saw a patient with generalised body-ache being given Prednisolone 5mg tds! Am I outdated or something? Many doctors out there still do NOT label their medications despite the law mandating it. Eventually business and profit takes over you, either consciously or unconsciously!

It’s called “Prostitution of Medicine“, a word described by the late Prof TJ Danaraj, the founding Dean of University Malaya medical faculty. Commercialisation of medical education and medical practise will eventually lead to this. Medicine is used to make money. It’s not a noble profession anymore.

The world on the other hand is going mad, especially in Malaysia where race and religion is used for business. WE have doctors promoting anti-vaccination (circulating in Facebook) and home birth. In fact, my wife just saw a HO who refuse to vaccinate her child! She is still doing her Housemanship. Interestingly, her husband who is not a doctor is not against it !We have doctors promoting supplementary products claiming can cure every illness in the body. We have an apex University promoting miracle water, suppose to cure 150 illness. We have syariah compliant dental clinics , whatever it means! What’s next ? Halal and Non-Halal clinics/hospitals? Trust me, we will be seeing more and more of these type of issues creeping into this country.

The practise of medicine is never the same anymore. I enjoyed practising medicine during the first 10 years of my service when patients listens to you and unethical practices were almost unheard of. Now, it saddens me when I see patients refusing medical treatment, refusing vaccines, unethical doctors, lost of clinical medicine and the rise of investigative medicine(make money for corporate guys). The rise of vaccine preventable infections like Diphteria and Measles are part of the consequences of our society’s ignorance. Wondered why our medical forefathers created medical councils run by medical practitioners to control the ethical practise of doctors? They had predicted few centuries ago that medical practise can be misused for profit and the world of medicine will eventually undergo slow death.

Many youngsters will realise all this when they start their practise. With more and more doctors being produced with huge debts behind them, medical business will only get worst! While my books will hit the stores within the next 2-3 months, I am now preparing for my 3rd book which hopefully will be released next year.

Selamat Hari Raya 2016 to everyone……………

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One of the reason I published my books is to educate the younger generations and parents regarding the reality of being a doctor. Even up to this day, I still get questions after questions regarding many issues in the medical field which people do not seem to understand. Just 2 weeks ago, for the first time I saw a fresh medical graduate working as a pharmaceutical rep. Interestingly he is a JPA scholar. In one way I salute him for his courage of doing a sales job while waiting for Housemanship posting. He graduated from a local university in March this year and up to last week, he has not even been called for SPA interview. The chances are, you will be waiting for close to 6-8 months for your posting. This period will further increase when all remaining medical schools start to produce their graduates from this year onwards. The number of graduates will only increase further.

I had always said that you should never do medicine for wrong reasons. 2 days ago, there was an interesting article in TheGuardian (see below). It was a well written article which clearly said that parents should never force their children into medicine. I have been saying this for a long time but somehow our society are still ignorant. That’s why you are seeing more and more incompetent doctors, unable to handle stress, “manjanitis” etc etc. We have parents who write to newspapers for a grown up child ! How ambarassing can that be for the “doctor”? Recently , there was a mom who wrote to a newspaper complaining that his 30-year-old son(calculated based on her story) could not get into Master’s program? Seriously, a 30-year-old grown up guy should know how to take care of himself. Nothing comes easy in life. You fight for everything and definitely there will be ups and downs. Nothing comes on a silver plate. The society also still believes that specialist training is as easy as creating more post! Cannot get Master’s , so create more post-lah? This is exactly the same scenario that happened to medical education and what do you see now? Too many medical schools with products of questionable quality. We are talking about lives here !

My books are still available for those who are interested to buy. Those who intend to do medicine and parents should buy and read the books.

My publisher has created a dedicated website for my books over here : I have some discount coupons to give away. Those who would like to get the coupons, please email me at There will be a 10-20% discount provided with the coupon which you can use at the website mentioned. The coupon is on first come-first served basis and only valid for credit card/paypal payment. You can use your credit card/paypal account to pay for the books via this website.

You can still buy the books via the method mentioned in my blog post dated 15/04/2016. I am still in the process of getting it into the bookshops.


Forcing your child to become a doctor could be the worst parenting decision you make

Ranjana Srivastava

A career is medicine is stressful enough for the doctors who see it as a calling. For those who do it because their parents forced them, it could be critical

Wednesday 8 June 2016 06.09 BST


There I was, almost at the end of the night, having spoken to a few hundred hand-picked, talented high school students about my life as a doctor. Their youth was no barrier to their determination to be the best – I met budding astronauts, focused scientists, concerned environmentalists, and as usual, a horde of kids who dreamed of becoming doctors.

The students asked penetrating questions about everything from the ethics of million-dollar drugs to whether children compromised one’s career. These were teenagers! With each question, my admiration grew and I briefly dreamed that one day, in my household, there might be such questions to replace, “Have you seen the remote?”

I was signing books when I noticed a girl, who hovered on the side, waiting till the crowd had cleared.

“I don’t know how to ask this without being rude,” she ventured, before my silence enabled her.

“My parents really want me to do medicine but I’m not interested. How do I say no?”

It was the curliest question of the night.

“I think I can get in but my heart is not in it.”

“It’s great that you recognise it,” I said. “Have you tried talking to your parents?”

“I’ve tried and tried, but they have invested their whole life in my brother and me.”

“What would happen if you said no?”

“They would be really disappointed in me. That would break my heart.”

And then:

“But if I did medicine, I wouldn’t be honest to myself. And I’d take the spot of someone who really wanted it.”

She faced a wicked dilemma: whether to obey the urging of her parents or rely on her own, admittedly young, instinct. A momentous decision hung in the air, the sort parents can help address, but of course, the parents were the problem. And though she relaxed at the opportunity to voice her dilemma, I knew that the knots in her stomach would return soon.

I wished that I could sweep away her problem; I wished I could convince her parents that a child of her poise and humility would do well in whatever she chose. I told her to see the school counsellor again and I reminded her to be true to herself but when she left, I felt hollow, musing whether she would one day be the troubled student or the depressed intern I encounter.

Although I don’t know her parents, I meet them regularly. I meet them at social events and medical talks. I meet them at seemingly benign movie nights and picnics when the conversation turns to medicine.

“He’s got the marks, he’s all set with the entrance test, all he needs is a coach for the interview,” a mother breathlessly explained. “Do you know anyone?”

“No,” I deadpan.

“I just want her to be happy,” says another. “You’re happy, aren’t you?”

“I am but she isn’t me.”

Another time an acquaintance of an acquaintance knocks on my door, a tired son in tow. “We want last-minute tips for his interview.”

Students pondering a career in medicine, I have always welcomed. Parents who do it on behalf of their child, I am increasingly wary of. The students are largely altruistic; the parents aspire to status, money and job security. I don’t blame them but what they don’t realise is that in the hyper-competitive world of medicine, even those with the marks and motivation battle to get in, so there is even less room for those with the marks but scant motivation.

Some years ago I interviewed a young man who was obviously bored, even in our eight-minute high-intensity interaction. His opening salvo: “Can I just tell you that I want to be an accountant?”

“Wrong interview then,” I said lightly.

“I got the marks and my dad made me come. My dad is a doctor.”

“Did you tell him you aren’t interested?”

“No point, but I hope to fail the interview.”

I was left reeling but I was told that no selection process can filter out pushy parents; we wait for the students to find their voice.

Doctors are often asked if they would recommend the profession to their children. A survey of American doctors by the Physicians Foundation found that more than half say no, citing the triumph of paperwork and bureaucracy over time with patients.

When I talk to my Australian colleagues, I hear similar sentiments. Doctors sign up to help people but are faced with growing mountains of paperwork, mindless compulsory modules and maddening meetings to satisfy performance indicators that make a mockery of patient-centred care.

Many doctors are burnt out, bullied and demoralised. Work is stressful and demanding. A 2013 Beyond Blue survey put paid to the notion that these are merely the groans of a self-indulgent, richly rewarded profession. Australian doctors have a substantially higher rate of high psychological distress compared to the general population and other professionals. An astonishing quarter have considered suicide, double the comparable figure in other professionals.

These figures are not just statistics – they are my friends and my residents. My professional landscape is strewn with doctors in trouble with alcohol and prescription drugs, doctors with broken relationships, sick of work and exhausted at home. I attend funerals and wonder how no one ever knew and I learn that no one is immune.

How doctors treat doctors may be medicine’s secret shame

And yet, I love being a doctor because there is something undeniably special and enormously satisfying about helping people at their sickest and lowest. Amid the gratuitous noise and politics, every day the door in clinic still closes and it’s just the patient and you. And you can’t help realising just how sacrosanct is the trust invested in you and how extraordinary that a complete stranger might let you into the most intimate recesses of his life, hoping that you might just mend the most fragile parts.

A friend who left medical school to pursue a lauded career in banking thirsts to this day to hear my ordinary stories about patient care. He says he’s comfortable but misses the sense of calling. This is something I have heard said many times.

A career in medicine has vast and varied promise but the happiest doctors I know have narrowed it down to one thing: medicine not merely as work but a calling. This doesn’t melt away the challenges but it puts them in perspective. On good days, it creates indelible memories; on bad days, it’s a handy shield.

If you are a parent and your child desperately wants to study medicine, the greatest favour you could do her is help her distinguish between a job and a vocation. On the other hand, if your reluctant child has a parent who desperately wants him to study medicine, step back for a moment and consider the statistics. Forcing your child to become a doctor might turn out to be the worst parenting decision you ever made.

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It’s been almost a month since I updated my blog. I was extremely busy with the soft launch of my book as many orders were coming through my email. I am still working on getting these books into major bookstores in this country. At the same time I was also busy editing and preparing  a short movie for my hospital’s Annual Dinner this Friday. Numerous meetings were also conducted for the whole of this month as everyone is trying to do everything before the fasting month starts.

Over the weeks there have been many discussions in main stream media regarding the job status of medical graduates. As we all know the waiting period for Housemanhsip is close to 6-8 months from the time you graduate. Our Deputy DG came up with a brilliant idea that medical graduates should look for other jobs in the government. It seems that MOH is in talks with JPA/SPA to offer such jobs for those who are not interested in doing clinical medicine. Shouldn’t it be decided before someone spend 5 years and money to do medicine! That’s the reason I finally decided to publish a book to educate the public/students on reality of being a doctor. It also confirms yet again that we are short of post. The worst is yet to come as the number of medical officer post is coming to almost NIL. I was informed that nursing post are being borrowed to convert to MO post. 4 nursing post is being converted into 1 MO post. Meanwhile, as expected, another 5 years moratorium will be extended starting this year, expiring in 2021.

2 days ago, there was an interesting letter written to TheStar by a Russian university student(see below). I had always maintained that all good students should be offered a place in local universities. Cases such as this is nothing new. Being in the same shoe many many years ago, I just had to take the more difficult path of doing STPM to get into UM medical faculty. Trust me, the more difficult path that you take, the better person you become. Those who enjoy smooth sailing life are the one who will fall apart, the moment life gets tougher. While he should have done his homework before falling into the hands of these unscrupulous agents, the situation in some of the Russian medical schools is nothing new. I had spoken to many who graduated from certain Russian medical schools and what this letter has described is exactly what they had told me. However, there are some Russian schools which are better. This is the reason why I keep telling all budding doctors that they should know what they are getting themselves into.

Whatever said, life is never easy. Most students do not know what life is at the time they pursue their studies as they have been supported by parents all the way. Only when they join the work force they realise how difficult life is. We are living in a capitalist world where people will do whatever they need to make money. That is what the agents and some medical colleges are doing. Our ignorant society is partly to be blamed. Unfortunately, I still see and hear multiple advertisements on papers and radio promoting easy route to fulfill student’s dreams in doing critical courses such as medicine, dentistry, pharmacist etc! The government on the other hand never takes any action as long as there are no complains. Which student will complain to get themselves into trouble? That’s why I salute this student for being bold and brave enough to tell what is happening, in a main stream media. I am sure he has genuine passion to be a doctor but life never gets any easier………



Plea from Russian grad

Soon to be graduating from a Russian medical faculty myself, I would like to share my thoughts on where we went wrong and how we should stop traumatizing our students studying in “incompetent” medical schools.LATELY, comments about incompetent medical graduates returning from overseas after completing their studies have been all over social media. Medical students especially from Russian medical schools cannot help but feel stigmatized every time they view these reports.

I became interested in medicine when I was eight years old after seeing my uncle collapse in front of me. He was declared brain dead a week later and I watched family members fumble for answers. I also saw my grandmother deteriorate to an unrecognizable state from cancer.

I come from a small town where English was hardly spoken outside of lessons in school. My parents are educators and both encouraged me to pursue medicine. I did very well in school, debating both in English and Bahasa Malaysia at state level, played hockey, was president of every club I could join and still maintained my grades with almost perfect scores.

I excelled in my SPM examinations, applied for all the government scholarships – JPA, matriculation, IPTA – and anything that could put me on my path to medicine. It was really heartbreaking to get no reply or just plain rejections without any reason.

And then the “leeches” came in. Unscrupulous, greedy and dishonest agents recruiting for medical institutions in countries like Russia, Ukraine, Indonesia and the Middle East see the opportunity to take advantage of a student’s dream and their parents’ desperation to fulfil that ambition.

I was 18, uninformed, fearless, and just desperate to see a path where medicine would be in sight. I jumped on the bandwagon, backed up with promises and hopes from agents and even family members studying in Russia. I should have been more careful or talked to more people but all I could think of was realising my dream of becoming a doctor without killing my parents who were already mortgaging everything they owned to send me to Russia.

In Russia, we were cramped in hostels with six people in a two-person bedroom, lived out of suitcases and were yelled at every day because we didn’t understand the language. When we tried to ask the agents for help, we were turned down unless we could provide a large sum of money for “handling fees”.

Believe me, I asked myself every day if I had made the right choice. I felt lost and helpless in a land where people didn’t think twice about telling you to pack up and leave. But if I called up my parents to tell them I wanted to come home, the money they spent on my first year tuition fees, plus my airfare, accommodation and documentation fees would be all for nothing.

So I learnt the local language, went for every class and painstakingly tried to communicate with local patients who would turn you down or tell you to your face that “you foreigners don’t belong here”. Humiliated and broken, it wasn’t easy to keep the passion for medical knowledge burning.

Students here develop immunity to criticism, yelling, being called names and marginalized. Some resort to drugs, partying and extreme socializing to mask the depression and frustration of being “outcasts” in this country.

On top of this, we don’t have the opportunity to pick up practical skills because, to put it bluntly, the university here doesn’t care if we graduate as incompetent doctors as we won’t be serving their citizens. It’s sad because there is excellent potential here, and given the right education and guidance, the students can be outstanding doctors.

When we do our practical rotations in summer in Malaysian hospitals, the first question asked of us is where we are studying. And we watch as the facial expressions show the disgust or distrust after we say Russia. And listen as the HOs, MOs, specialists and local medical students snicker about how we are the black sheep of the system.

Can you even try to comprehend the stigma that surrounds us? We suffer every day in extreme weather and social conditions here, only falling back for support from other Malaysians who are equally lost and trying to survive.

Were we told that the syllabus was in English and we would be given a well-rounded education? Yes. Is this the reality? No!

There are students here on government scholarship or Mara loans who have no passion for medicine. They do the bare minimum just to pass and go on exclusive trips to Europe or buy expensive gadgets. Some have even set up small businesses here.

Then there are the super rich Malaysian students who couldn’t qualify for other medical institutions. Forced into doing something very difficult, they skip lessons, do the bare minimum and still graduate as doctors.

Today, barely a month into graduating, I am writing this letter hoping for some guidance and compassion in dealing with medical graduates like me who are coming back already disheartened. We seek refuge in our own country, the very country we are proud of and want to come back to, to serve its citizens.



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I had always maintained that doctors should not discuss cases openly in social media, especially in Facebook etc. I use to see many of such post which I had never contributed. I did write about this before. When I first started this blog in 2010, there were many students and junior doctors who asked me why I am not using this blog to educate the doctors on interesting cases etc. While I do give talks during CME sessions in JB and had also been Johor MMA CME Chairman for 2 years (2013-2015), I had always felt that social media is never a good platform. In this blog I had only given some examples of common mistakes by junior doctors who could lead to major complications to patients. I had also used some examples to show how doctor’s life is not as easy as what the public assumes. But I had never used this blog to discuss cases openly or posted any pictures of patients.

Case discussion should only be for medical personals. Even though we do not mention any names or details, it is open for public viewing and as such, the patient can sue you if he/she had not given consent. This is more so for pictures or videos. The popularity of WhatsApp, BBM and Telegram had further contributed to this. Doctors are now sending patient’s particulars, history and pictures to other doctors for discussion purposes. Of course it is a quick way of getting help from consultants etc but these pictures should never reveal any of the patient’s information or the patient’s face.

Finally, MOH had produced a guideline on the use of social media among medical personals. The Guideline, released on 31/03/2016 clearly says that Facebook, Instagram, Blogs, Twitter and You Tube are banned from being used as medium of discussion. You can view the guideline here :Pekeliling Media sosial. The Star had also reported on this issue.

Unfortunately, this guideline does not prevent the patients from making remarks or comments on doctors/hospitals in social media. We see a lot of such comments in Facebook etc. In fact, I have had patients in my hospital threatening the hospital management by saying that they will viral the issue on social media! But as doctors, bound my MMC’s professional and ethical conduct, we just have to keep quiet and do our work to help people…………… Any emotional rant will lead to MMC’s disciplinary enquiry!

Doctor’s life never gets any easier…………………..

‘Don’t discuss patients online’


SEREMBAN: Social media may be the “in” thing for Malaysians nowadays to post instant alerts but not for doctors.

Doctors in government service have been told not to discuss their patients’ medical issues on social media such as Facebook, Twitter or Instagram to prevent breaches in confidentiality.

Neither should they carry out clinical consultations on these platforms where such information could be accessed by other people, said Health Ministry director-general Datuk Dr Noor Hisham Abdullah.

The order came about to minimise the risk of ethical and legal complications and to uphold the integrity of the medical profession, he said in a circular.

“Social media sites cannot guarantee confidentiality with whatever privacy settings currently in place.

“Once information is published online, it can be difficult to remove it as others may have already distributed it further, thus easily breaching patient confidentiality,” he said.

He explained that the directive came about as more health care providers were using social media in their work.

However, Dr Noor Hisham said doctors could set up a social media platform for group consultation provided there was a “moderator” and there was a profile of the members and where the content of the conversation was not accessible to public.

“However, the uploading and transmitting of still images or in video format should not include any information which could reveal the patient’s identity,” he said.

Doctors in such group consultation must also get written consent from their patients before uploading any information about them on social media.

“The only exception would be in an emergency where the patient may not be able to give consent,” he said, adding that doctors were responsible for the confidentiality of any information they send out via social media.

Dr Noor Hisham said doctors were also duty-bound to delete all stored information of their patients in their mobile devices after the completion of the consultation.

All personal information or images from any consultation could not even be used for the purpose of health education to others.

“Social media platforms cannot be used for referral cases as they include patient-identifiable information,” he said.

Despite the advantages of social media, Dr Noor Hisham said doctors should always opt for direct consultation or over the telephone whenever possible.

In cases of emergencies, he said doctors or other healthcare providers were supposed to consult their peers over the telephone first before opting for the social media.

Pekeliling Media sosial

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