Archive for the ‘Uncategorized’ Category

It has been 8 months since I wrote my last article, the conclusion of my post-Wawasan 2020 series. The year 2022 started with relaxation of border rules in many countries. Being in Western Australia (WA), which had one of the toughest border rules in the world, we were happy that the border was going to open on 5th of February 2022. Unfortunately, 2 weeks before the date, the WA government decided to postpone the date indefinitely due to rise of Omicron cases all over the world and a new target was set for booster doses before the border opens. I had to postpone my flight that I had already booked for end of February 2022.

By mid-February 2022, the WA government announced that the border will open on 5th of March 2022. However, Malaysia still had a 5-day quarantine rule for those vaccinated. We decided to delay our first trip back to Malaysia in over 2 years, to May 2022, just in time to celebrate Raya in Malaysia. Thank fully, by then, not only the quarantine rule was removed for those vaccinated but also the pre departure PCR test. Thus, on 4th of May 2022, me and my wife stepped our feet onto Singapore Airlines Boeing 787 for the first time in more than 2 years!

It was a smooth flight to KL via transit in Changi airport. Changi airport will always be the best airport I have ever been. This is also the first time since 2014 that I am landing in KLIA. Since I lived in JB, I had always used Changi airport for my international flights. The “Malaysia Boleh” phenomenon hit my face the moment I landed in KLIA! Welcome to Malaysia! We walked towards the Aerotrain upon landing only to see the entire area was cordoned off without any signage to guide us where to go. There was a lady sitting inside the cordoned area but too busy looking at her handphone. All of us were wondering where to go till one of them “woke up” the phone lady and asked her! She pointed the direction to the bus terminal. It was a long walk from there with stairs going down, right at the end, after which you will see the bus waiting. Took the bus to the main terminal where our bags were waiting. The immigration clearance was the fastest as we used auto gate. Then came the custom screening.

1 scanning machine for the entire crowd! Everyone had to que up to scan our luggage, one by one. No green lane. As we finally exited out to the arrival hall, we were looking for the car rental booths. None to be seen! We had already booked the car online, but we could not see any booths or even any signage to direct us to the car rental area. My wife frantically went around asking people who were working at the arrival hall (money changers etc), none seem to be aware! Finally, I found a small signage on the right side of the arrival hall, you can only see it if you pay close attention on small wordings. It took us almost 10-15min of walk out of the terminal, sweating till my entire shirt was drenched like I just got wet in the rain! The efficiency of the car rental company was at another level. It took them almost 30-40min to give us the car. Of all the airports I have ever been (mostly developed countries), I have never seen the car rental booth being situated 10-15 mins walk from the arrival hall into another building. Most will be situated in the arrival hall, and you can collect the keys within 15 min.

Finally, we made it to the highway, heading north to my wife’s place. Cars speeding, motorbikes all over the place brought back my memories. No one follows the rule. Back to my Malaysia. Somehow, I felt the lawlessness has gotten worst. Grabfood and Foodpanda riders don’t seem to care about road rules. Even traffic lights can’t stop them. My 30 years’ experience driving in Malaysia was reactivated. As suggested by my friends, we bought a dashcam before coming to Malaysia. Getting a Touch N Go card was another nightmare. None seem to be in stock and thus we had to use our good old IC as our touch N Go card while we searched around. Finally, we got one from Watson in my wife’s hometown. Along the road, one thing was obvious to us. The maintenance culture has gotten worst. Maintenance of roads, buildings, public infrastructure etc was down the drain. I had always wondered how a tourist would feel when they arrive in Malaysia.

Overall, we had a wonderful time with our family and friends, whoever we had time to visit. From Perak to KL to Seremban to Melaka and finally to JB. Malaysia is always the best place for food! Something we always crave for when we return to Malaysia. Shopping and buying cloths that we are familiar with, is another heaven. Unfortunately, the politics in Malaysia never changes and has turned to the worst. I can clearly see that election is coming very soon. Whenever racial and religious rhetoric goes overdrive, we know election is coming. I can see more people have become poorer. Currency value is dropping day by day. The last I heard 1SGD is now RM 3.20. 1USD is about RM 4.50. The lower the currency falls, the poorer the people will become. After being in Australia for 3 years, I can see how the value of our currency is very important. The stronger the value of the dollar, the lower the cost of living. We left Malaysia after spending 24 days, on 27/05/2022.

I received many emails from young doctors asking for advice to migrate, especially after reading my last article. Unfortunately, as I had always said, medicine is the worst profession to be when it comes to migration/moving around. Unless your degree is recognised in the country you are intending to migrate, you need to sit and pass the entrance exam with no guarantee that you will get a job. It is an investment with a possibility of not getting any return. The border closure in Australia resulted in work force shortage in many fields. Covid pandemic also resulted in many states increasing their pool of doctors by creating more post. Unfortunately, they could not fill up this post as borders were closed. Not all local graduates like to work in hospital setting. Many IMG (International Medical Graduates) who were already in Australia manage to get these jobs if they had AMC Part 1. Most of them have been in Australia for years, some even citizens and PRs. Once the border opened, many IMGs with AMC Part 1 were also recruited from overseas. These are all mainly for MO and service registrar position.

My regional hospital advertised for 3 new senior registrar post. There were 15 applications, none from locals/Australia! All were from overseas and almost all of them only had AMC Part 1. They were senior doctors from their country of origin with at least more than 10-20 years of experience. Most of the applications were from India, Sri Lanka, Iran, Turkey and Egypt. It is a risk that you will need to take as the Limited registration will only be given for a maximum of 5 years. By then you must either pass the AMC Part 2 or complete the WBA (12 months ward-based assessment) program in an accredited hospital. Because of this, the hospital can only provide you with a yearly contract. Those who are recruited as GP with just AMC Part 1 have another option of completing your RACGP program to be awarded FRACGP within the 5 years period.

It is a tough life for many of them who come for greener pastures. Some of them were paediatricians, anaesthetist, psychiatrist, surgeons, neonatologist, gastroenterologist back in their home country but willing to sacrifice everything to start from scratch.  Even then, there is no guarantee that their contract will be renewed year after year. The more regional you are, the better the chance of getting a renewed contract.

Thus, this is what I advised those who intend to migrate with a medical degree which is not recognised in Australia. Be prepared to start from scratch with no certainty. You must take a gamble. Some may succeed and some don’t. That’s why you will hear some coming back home, not necessarily due to family reason, but they fail to get a job or training post to become a specialist. Be prepared to go to rural and remote areas to get a job.

With the increasing number of queries that I am receiving about migration, I can feel the pain the people on the ground are going through. The contract issue, while has been extended to about 10 years to complete your specialisation, it is very clear that the government will never be able to absorb everyone into permanent civil service. I had written about these many times before. Thus, it is not unusual for MMC to reduce the compulsory service to 1 year. So, now you can leave the service after a total of 3 years (2 years HO and 1 year MO). In fact, even before the announcement by the DG, for the past 3 years MMC has been approving exemption, usually if you have completed 18 months post housemanship. Even JPA has made an announcement that JPA scholars who are under contract since 2016 can break the bond and leave civil service. It is a way of saying “get lost”! But who created this mass in the first place! As for me, this is an inadequate training for any doctor to be able to practise medicine independently after 3 years. With no proper training system in place for GPs etc, we probably giving them a “license to kill”…………………

Oh Gosh, didn’t I predict all these were coming ………………………….


Read Full Post »


It’s been 6 months since I last wrote an article in this series. In between, I was interviewed by various organisation in relation to contract doctors etc. This will be my last article in this series. 

Despite all the hardship that I went through since my childhood of being a “non”, one thing that was guaranteed for me was a civil service job! This is simply because, there were only 3 medical schools producing about 450 graduates annually and some returning from overseas. There were plenty of post available for us to fill. Interviews by SPA and MOH were conducted in the universities even before we sat for our final year exams. The moment our results were out, we would receive our appointment letters within 2 weeks! I had written about this many times before and thus will not go into the details. I was asked to report to Hospital Ipoh within 30 days. While the salary was pathetic to say the least, we were grateful that we had a permanent job. Two months before we due to finish our housemanship, we need to apply for district posting and induction course (Kursus Induksi). At that time, district/rural posting after housemanship is mandatory. We must make our 3 choices. I was asked to go to Pontian Hospital in Johor for my district posting.

While there was subtle racism wherever I worked in MOH, it is hardly noticeable. This is simply because the staffs consist of mixed races. There were nurses, MAs (Medical Assistant), attendants from all different races. This reminded me of the time I was in school back in 1980s. While the schools were becoming monoethnic in composition of teachers by late 1990s, hospitals and klinik kesihatans were still consist of multiple races working together. In fact, most of the HODs were non-Malays in JB hospital. Unfortunately, things have changed since then. We hardly see any Chinese or Indian MAs working in MOH nowadays. Nurses are predominantly consisting of a single race and the composition of doctors are also becoming predominantly of a single race. I am not saying that these people are not doing their work or discriminating against non-Malay patients, but it is an unhealthy development in a multiracial and multireligious country. Many of the non-Malay consultants and HODs moved to private sector, mainly due to financial reasons. They have accepted the fact that their children will not receive any privileges in education or scholarship. Thus, they have no choice but to move to private sector to earn better revenue to support their children in the future. Nowadays we even have shariah compliant hospitals, whatever it means. An Ustaz or Imams are allowed officially into a hospital to say prayers, but similar permission are not given to other religious bodies. 

I used to say to my friends that the last government body that use to be multiracial will eventually come to an end, and it happened. Sometimes I should just keep my mouth shut! With the current contract issues and limited permanent position, I doubt the situation will get any better. This coupled with quota system in master’s recruitment and limited post graduate opportunities, will only make the situation worst. What really shocked me the most is when I found out that some of my Malay friends who I worked with as Medical Officers openly expressed their opinion that they would prefer all HODs to be Malays as this is a Malay country! When even highly educated people can think as such, what hope do I have? By mid 2000, I began to realise that this country is heading the wrong direction, the direction of destruction and no return.

The first 10 years of my medical life was a turbulent one. Getting married halfway through my 2nd year of working life (district posting), passing my Part 1 MRCP on 1st try and moving to JB Hospital to continue my training was the easy part. With a pathetic salary, busy work life (JB Hospital is one of the busiest hospitals in the country) and studying at the same time really pushes you to the limit. By the time I sat for my Part 2/3 in 2002, I had 2 child and got my 3rd in 2004. By this time, I was in debt! Looking into the future and where the country was heading, I had to make difficult choices. I quit MOH halfway through my Rheumatology training in Selayang Hospital and joined Monash University in 2006. My wife who sacrificed a lot with me, had to discontinue her Family Medicine Master’s program in 2002, as it was just too difficult for us to manage the whole family with both of us doing postgraduate education at the same time. We lived by ourselves. 

With the help of Professor Khalid Kadir, I was encouraged to complete my Rheumatology training in Singapore while I continue to teach in Monash which was based in Johor Bahru. I am forever grateful to Prof Khalid for this arrangement. This allowed me to complete my Rheumatology training by 2008. Working in Singapore gave me a different perspective of how such a small country could succeed! It is all based on meritocracy and knowledge-based economy. The way they encourage research and development and how they support you to develop new skills and new departments is fascinating. How they attract the best brains from all over the world and keeping their own best brains is something that Malaysia can learn from. Unfortunately, Malaysia is too engrossed with Malay nationalism with race and religion tearing the country apart. The best brains leave to be better received by another country.

Upon returning from Singapore, I encouraged my wife to continue her discontinued post graduate education. She was very eager to complete her post graduate training in Family medicine. She enrolled into the Academy of Family Physicians MAFP/FRACGP program which was a 4-year program. The advantage: you are eligible for FRACGP which is registrable in Australia. As an appreciation of her sacrifice taking care of the family while I was doing my post graduate education, I paid for her course. While Monash gave me a much better salary than MOH, with rising cost of living and higher tax that you must pay in private sector, it was still an uphill task to earn enough for my children’s education, especially tertiary education. As I had mentioned in my past articles, by 2010 I had to remove my children from national schools to private national schools (not international). The racial and religious issues that was happening in the national schools (despite being a missionary school) was not something that I could accept. I do not want my children to grow up with racial and religious dogmatism. It hurts you when your son who is just 10 years old asking you why the Ustaz in his school distributing free food to only Muslim students in the canteen!

Thus, by 2010 with my eldest already 10 years old, I need to save enough money for him to pursue his tertiary education in 7 years’ time. Again, I had to make a difficult decision in my life. While I loved academic life, publishing at least 5 papers in major international journals within 4 years and loved teaching, I had to give up and move to private sector. Columbia Asia Nusajaya invited me to join them as they opened their first hospital in Johor. After much deep thought, I accepted their offer. I was also the Chief of Medical Services for the hospital, for 7 years.

Life working as a consultant in private hospitals in not rosy either. Yes, you may earn much higher than public sector or universities, but it is no work, no money system. The more hours you work, the more money you get. The more patients you see the more money you get. After some time, you will realise that you are earning enough money, but you do not have a life! I have written about this in this blog as well as in my books. There is no work life balance. The unethical practices that happen in private hospitals is something that I could not accept either. In Malaysia, everything seems to be about money. As one of my friends who is a businessman said, Malaysia is the best place to make money! 

By 2015, my wife has cleared her FRACGP. By this time, the country was in turmoil. The 1MDB scandal and billions of dollars being swindled right in front of our eyes was sickening. Politically, the government has lost it’s 2/3 majority since 2008. Racial and religious politics went into overdrive. What more can politicians use other than race and religion, the well-known propaganda known time immemorial. The government started going after the citizens to collect more tax and penalties to patch up the loss. By 2016, the private specialist doctors became a fresh new target. GST was introduced. With just a single letter, LHDN decided that the private specialist can’t form a company and divert their income to the company (something that has been happening since 1980s and considered legal) and have to declare their income as personal income. They backdated these 5 years (2010-2015) with reduced penalty of 15%! After much discussion between MMA and LHDN, it was reduced to 3 years. We had to rush to settle this by end of December 2016 which was the due date for the penalty of 15%. This is when I realised that the government could screw you when they run out of money. LHDN is the most powerful organisation under the Ministry of Finance who can even charge you in court without going through the police/AG. The DG has absolute power to order any audit or change the rule and can deem anything as a form of tax evasion. 

By this time, I had no choice but to decide my next step. While I was doing well in private sector, it was a one man show. My wife was still a civil servant and my children’s education was totally dependent on me. My eldest son was going for SPM in 2017. We decided that it is best to send our children overseas for education. I wanted them to get a degree which would be more widely recognised all over the world. The world in shrinking and we can’t be living in a cocoon. Fortunately, my eldest was not interested in medicine. I let them do what they are interested rather than coercing them to do what the parents wanted them to do. To date, none of my children are interested in medicine. 

After my wife cleared her FRACGP in 2015, we started receiving calls from recruiting agencies in Australia, offering her a GP position. We rejected all the offers. But something happened in 2016. While I was talking to one my friend from KL, he suggested, why don’t you apply for Skilled Migration Visa (using my wife’s FRACGP) which would give you a PR status in Australia? I was baffled. Is there such thing as getting a PR status without even stepping your foot into a country? Surprisingly, there is such thing and he recommended me to have a chat with a migration agency in Subang. We met with the agent, and everything changed! We thought of giving it a try. It involved a lot of work, from getting the medical registration from Australia (including visits to Australia to confirm job contact), numerous amounts of documents, certification of degrees, English test, police clearance etc etc. It took us almost a year to get all these documents sorted, not to mention the money involved. Finally, by March 2017, we submitted.

There were so many things that went through our mind. Are we really going to leave a country where we were born and grew up? Will our children be able to adapt to the new environment? Would we be able to adapt to a new environment and culture? The worst part, what about me? I am not registrable in Australia as I do not have a registrable degree. It is another long process and money to even apply for assessment. While we were considering all these, and my son was going to sit for his SPM (November 2017), we received another shocking news! In June 2017, my wife’s application for Skilled Migration Visa was accepted and we need to do some final document submission such as medical check-up, police report etc within 60 days. We did it in 30 days and submitted all necessary final documents. Woolah, within 3 weeks, our Visa was approved, and we are officially an Australian permanent resident! This visa is for the whole family, not just for my wife! My children will now be able to enrol into Australian university as domestic students with heavily subsidised fee. 

Why am I talking about this? A country which does not even know who we are, gave us permanent residency without even the need for us to step our foot into the country (except I have been to Gold Coast as a tourist). There were NOT a single question of what race or religion we belong to. Those who know me knows that my wife is not an Indian, she is a Malay! What mattered most was your skill and documents! And despite my wife being the main applicant, the entire family received residency status. This is how a country valued your talent and invites you to be part of their country. We are considered equal to their citizens except in voting rights. This is how they attract the best brains. Where are we Malaysia? Race, religion, and nationalism chased away the best brains, only for us to be proud of saying “Malaysian Born so and so……….” Foreign professionals married to Malaysians have to wait close to 10 years to receive their residency status, not to mention the various insults they receive at immigration office. We have a long way to go……

I moved my family to Perth, Australia in December 2017. My wife started working as a GP in January 2018. My eldest son started his university in February 2018 and my other 2 children started their schooling. What happened to me? Well, I had to start my ball rolling. With an unrecognised degree in Australia, I am not registrable in Australia. But as a senior physician I can apply to be recognised (not guaranteed) via the College of Physician. Another long process of degree verification, document collection, English test, interviews etc was conducted by the college (RACP). I submitted my documents in April 2018, called for an interview in Melbourne in May 2018 and finally in July 2018, I received their verdict. I received a “substantially comparable” status which would allow me to work as a consultant with 12 months of peer review before receiving specialist registration. This verdict is only valid for 2 years, which means I must find a job for the 12 months peer review within that timeframe. 

Based on RACP report, there were 145 applications in 2018 from all over the world for specialist assessment. 112 were considered “substantially comparable”, majority of these were from countries where specialist training is recognised by Australia such as UK, Ireland, USA etc. Out of 11 applications from Malaysia, only 4 were deemed substantially comparable and I am one of them. The other 2 options are partially comparable and non-comparable. Partially comparable means you need to do top up training of about 1-2 years as a registrar and may or may not need to sit for Part 2 exams. Non-comparable means, case closed. Once again, as my wife’s visa application, I was extremely lucky to receive the substantially comparable status. This, together with my status as a resident in Australia, I was able to look for a job. This was the next hurdle that I had to endure.

While I was going through all these processes, I was travelling between JB and Perth quite frequently. Then came the 2018 General Election. Everyone was euphoric after the historic result. Many wanted me to stay since a new Malaysia has emerged aka Malaysia Baru. Yet again, based on evidence and sentiments on the ground, I knew this excitement is going to be short lived. I wrote an article in this blog dated 4th June 2018 with the title Towards Malaysia Baru? I predicted that if the new government do not perform at a supernatural speed, either the government will fall before the next election or at the next election. My friends laughed at me and said it is unlikely due to overwhelming majority. Nowadays, they asked me to keep my mouth shut as everything that I predicted seem to be happening!

It was only in January 2019 I was invited for a job interview (after trying for 7 months). Again, I was lucky to be given a full-time consultant job in a regional hospital in Western Australia. Hopefully this would be my last leap of faith. I decided to take it and left Malaysia in May 2019. ……. I received my FRACP in 2020. It saddens me to see what is happening to Malaysia since I left. The vision of Wawasan 2020 remains an elusive dream. The country is more divided than the time I grew up in 1980s and 1990s. Racial and religious rhetoric is tearing the country apart. When even a vegetarian food prepared by Gurdwara Sahib can be questioned on halalness and cleaning a temple by Muslims can be haram, where are we heading? 

I can go on writing and ranting but I will stop here. It has been a tough 2 years for most of us. I hope and pray that 2022 will be a better year with disappearance of Covid.

I wish everyone a very Happy New Year 2022………………………





Read Full Post »

I was invited to give a talk at the UKM Career progression workshop which was held on 17/04/2021. I did mention this in my blog on 29/06/2021 where I showed some of the slides from the talk. Many have emailed me and asked me whether I can upload the talk that I gave. It took some time for me to get the recorded video from the organiser and I also had to do some editing to make it shorter.

So, here is the video of my talk and it is almost an hour long……… Some of the documents might not be clear but those documents are available in my blog.

Read Full Post »

It has been 4 weeks since my last post on the Black Monday campaign by SCHOMOS and the hartal that is being organised by a separate group of junior doctors. I had received a lot of feedbacks for my previous post personally and via my blog. In the background, SCHOMOS/MMA has been working with MOH and finally had a direct meeting with PM on 23/07/2021. On the very same day, the PM’s office issued the following circular:

As I mentioned in my previous post, absorbing all graduates into a permanent position is NOT a long term solution. I had explained the reasons for this very clearly. It is almost impossible for the government to do this looking at the number of graduates being produced. My recommendation is for all doctors who are into post graduate training should have their contract renewed till they complete their training and get gazetted. The postgraduate training should be standardised. I also said that the permanent government positions is not sustainable anymore and all positions should be changed to contract from now onwards but they need equal opportunities etc, similar to other developed countries.

The circular above basically agrees to what I have been saying all this while. The government has guaranteed that they will provide a minimum of 6 years contract (4+2), increase from 5 years (3+2) currently. During the last 2 years extension, if you are enrolled into a post graduate training program, the contract will be extended to a maximum of 4 years. I presume this 4 years comes about due to the 4 years Master’s program. Those who are already in parallel pathway, they should be in their specialist training by the time the 6 years is done, especially for MRCP, MRCPCH and MRCOG. This 4 years extension hopefully will support their subspeciality training programme. So, overall, if you are in specialist training program, you will be guaranteed a job and training for at least 10 years. The government has also agreed to provide Cuti Belajar Bergaji Penuh and HLP if you are enrolled into the Master’s program. The only problem I foresee are for those who are dependent on local Master’s program which predominantly will be the surgical fields.

With large number of graduates applying for local Master’s program, the waiting period is going to get longer. I did mention this many years ago. The number of slots for Masters program is only about 1000 per year for all speciality included. My question is whether these doctors would even be able to get into the Master’s program within 4 years after housemanship. If they don’t , would their contract be not extended? What if they do not complete the training within 4 years, like they get extended etc? What if they do complete their training but wants to do subspeciality training? Would the contract be extended further? There are many unanswered questions but at least this circular clarifies some of the urgent matters and hopefully, further improvement could be made in the future.

However I noticed that the letter did mention about amending the Medical Act which I find it puzzling. The medical act has nothing to do with employment EXCEPT in regards to the compulsory service. Are we looking at an official reduction in the compulsory service in the future? Currently MMC (since Oct 2020) do allow junior doctors to leave the service 18 months after completing housemanship, pending Minister’s approval individually. Would this be lowered further, permanently? Or are we looking at a common licensing exam applicable for all graduates? It will be interesting to watch but again, it is all a political ball game!

Unfortunately, the above circular and reassurance did not seem to satisfy the group of doctors who were organising the Hartal. Yesterday, they issued the following circular, insisting that the hartal will go ahead today:

I also understood that many warnings have been issued to the junior doctors by the hospital Pengarahs and DG himself has issued a reminder on his FB post as below:

Interestingly, the DG has said that the Pension Act will be amended. This again goes back to my last post where I said, permanent post with pension is not sustainable anymore and all government positions should be changed to contract basis with continuous extension as long as the post is needed and for post graduate training. The hospital should be given the right to choose their own doctors based on need. I feel this is how this scenario is heading into the future. In fact, if the pension act is going to be amended, it may affect all other civil service jobs as well.

The world is changing. Jobs are changing as well. Unemployment of doctors is also a norm in many countries. Consultant without full time job is also common in developed countries but at least they get to complete their training. We need to change. We can’t keep on harping on the same benefits and perks as the baby boomers generation where the world population was a third of what it is now!

I will stick to what I have said in my previous blog post. The era of guaranteed job and permanent pensionable job in civil service is over. Every job is the same and will be treated as the same based on need. Doctors are not an exemption. Everything should be based on merit. I hope the selection of doctors into postgraduate training will be done on merit and be transparent. I also hope that a single post graduate training system will be implemented rather than 2 separate system. I might be dreaming but it is the only way forward. A total revamp of the healthcare system will be needed. A National Health financing scheme is needed to sustain at least the GP practise. A Restructured healthcare system is needed to move away from tertiary health care to primary based healthcare!

The question is , are the politicians ready to make this unpopular decisions? Looking at the current scenario, I don’t see it coming anytime soon!

At the time of me writing this piece, this is happening :

Read Full Post »


In 1989, I sat for my SPM examination. As I mentioned earlier, there were 3 science stream classes in my school, out of which there was only 1 Malay student. The rest have all disappeared to MARA colleges, Boarding schools, military college, agama schools etc. I took the maximum of 9 subjects and received 7A1,1A2 and 1C3(in BM). I applied for JPA scholarship but decided not to attend the interview as I was told beforehand that medicine is only for Bumiputera. Some of my friends who attended the interview were told point blank that medicine is only for Bumiputera but they can request for other fields. For those who are from the 21st century, scoring 8As in those days were less than 10 students per state, unlike now where we have 10K students scoring straight As in the country!

Thus, I had to bite the bullet and go on to do STPM which is a 2-year program run by national schools (not all but selected national schools). It is considered as the toughest pre university exam in the world. Two years of knowledge tested by 1 exam at the end of the 2 years. We are allowed to choose 5 subjects. It was the only way for us to attempt to enter the public universities. There were only 3 universities offering medical program. Matriculation/Asasi science were reserved for Bumiputeras till 2003 when 10% of seats, in some programs were given to non-Bumiputeras.  Most Asasi programs in major universities are still reserved for Bumiputeras, till today. By God’s grace, I scored 5As in my STPM science examination, the only Indian student to do so in Malaysia. There were 72 students who scored 5As in the country, in 1991 STPM.

As I had mentioned in my earlier articles, our universities work on a quota system. While the Bumiputeras enter via an exclusive matriculation pathway, all non-Bumiputeras must use the STPM pathway. Two different system with 2 different standards. Further to this, we had the quota system. There were hardly any private colleges except for some which were running twinning law programs. Otherwise, you need to go overseas under your own parent’s sponsorship. As far as the medical faculty is concerned, 60% is given to the Bumiputeras, 30% to the Chinese and 10% to the Indians. The total intake for the 1992 UM medical faculty was 180 students. The ratio is the same for all other faculties. It supposed to follow the population ratio of the country. The number of intakes were fewer in UKM (150) and USM (110). Chinese students will need at least 5As or 4As in their STPM while the Indians can get away with 3As, to enter the medical faculty. Well, we had to accept the fact that we are treated differently. It became part and parcel of our life. It made us a better person and a fighter as we need to fight for entry into local public universities for 40% of the seats that are allocated to the non-Bumiputeras. BUT we were all Malaysians and I only had Malaysia as my country.

It was in the university that we yet again see all the 3 major races coming together. It is also here that I realised what “educational segregation” at primary and secondary school levels has done to our social integration. Many of the Malays were totally isolated for at least 7 years before they start to see non-Malays again. Many of them were from boarding schools, MARA colleges and agama schools, before entering matriculation. All these schools were reserved for the Malays. For some, even their primary schools were predominantly Malays as they were from rural schools where there were hardly any non-Malays. Some did do up to SPM in a national schools before entering matriculation/Asasi. As a non-Malay, I could clearly see the difference among these people. The ones that mingle around without any issues are those who were in the national schools up to SPM or from a major city where they are used to non-Malays. Many seem to have a culture shock looking at the non-Malays, not to mention the inferiority complex, being brought up in a non-competitive environment. They don’t mix around much and tend to keep to themselves. They did improve along the way especially when we started our clinical years. But I must say that there were some excellent Malay students as well, who had now achieved successful career in their respective field. It is sad that the society may still look down upon them just because of the different entry pathway and the quota system. Society’s perception cannot be changed unless everyone is at a level playing field.

Similar issue could also be said about some of the Chinese students. Many were from Chinese vernacular schools up to Form 5 or even STPM. I could clearly see how they prefer to be among themselves and speak their own dialect even when they are among the non-Chinese, because they are so used to do so. They don’t realise how rude it is, to the others. While the national school educated Chinese were able to mingle around more freely and more proficient in English, the vernacular school educated prefer to stick to themselves. As they enter the clinical years, some of them do improve and mingle around more with the other races.

As for the Indians, all of us are from national schools. If I can remember, there was only 1 among us who was from a Tamil primary school. As there are no secondary Tamil language vernacular school, even if they do go to Tamil primary schools, they will end up in a secondary national school. We were among the students who can get along with anyone in the university. Almost always we speak in English as even many among us are not Tamilians. We were a rojak group.

Did religion affect us in any way? Yes, it did. When I was in the 1st year, the Malays will form their own study group and the Chinese will form the own study group. The Indians usually play around. We don’t form any study group. We only play football together. So does the national school educated Chinese. We are happy go lucky kind of people. There were also some Malay boys who are in the same category. In my batch there were 2 Indian Muslims who entered the medical school under the Indian quota, via STPM. They used to mingle around more with the Indian students at first. Both were approached by the so called “dakwah people” who are usually students from the religious faculties. They were told openly that they should not be with the non-Muslims. They should only help the Muslims. They were told that they should avoid being close friends with the non-Muslims but spend more time with the Muslim students. One of these Indian Muslim student heeded their advice and moved away from the other Indian students. He eventually came closer to us when we started our clinical years. The other student remained close to the Indian students and became one of my best friends. We were roommates from Year 2 to Year 4. He now heads one of the top cardiothoracic unit in KKM.

Every residential college in UM use to organise respective religious festival celebrations. We had Malam Raya, Chinese New Year celebration, Deepavali Night and even Chrismast night. Everyone in the college will participate as it is considered as a cultural event. I was the Director of Deepavali night in 1996 for my 6th residential college. I even worn the best director award for the college. Deepavali night is considered the biggest event of the college every year. Unfortunately, I was informed that 2 years after I graduated, UM banned any other religious celebration in individual residential college. I am not sure what is the current status.

It is also in the university days I realise that many of these Malay students do not know what is happening out there. The more you talk to them, the more you understand that they are totally unaware of the racial policies in education and scholarships. While they understand that the Malays are given privileges in boarding schools, MARA colleges and Matriculation, they felt that the “others” are also given equal opportunities. They felt that the special opportunities given to them were because they are from rural /poor areas. Some are not even aware of the quota system and lack of scholarship for poor non-Bumiputeras. Many do empathise with us as they learn about the situation.

Five years of my medical school came to an end in May 1997. What appeared to be a long journey at the beginning, appeared rather short when I completed the course. It was a fun filled journey. I made new friends and learned a lot. Our lecturers were excellent. It was the days when Professors teach undergraduate students. I could still remember those great names like the late Prof John Bosco, Prof CT Chua, Prof Siva, Prof Raman, Prof Deva, Prof Fatimah, Prof Annuar Zaini, Prof Alan Teh and many more great teachers who thought us at the time. Many of them had retired but many did resign when I was about to graduate. As the private hospitals began to mushroom from late 1990s, many of our great lecturers left for greener pastures. It was a great loss to the faculty.

It was when I was about to start my Final year that I met my wife, who apparently is in the same batch! Since we had 180 students, sometimes we only knew those who are in our group or partner group. It was very difficult to get to know everyone in our batch by name. Sometimes we can recognise that they are part of our batch but do not know the name. How ironic! My wife was in my partner group starting Year 4. We first got to know that we exist somewhere towards the end of Year 4 and became friends when we started Year 5. By the time we sat for our final exams, we had confessions to be made! The rest is history…..

To Be Continued …………

Read Full Post »

Five years ago I wrote an article in my blog ” Patient’s Confidentiality and Autonomy” . It was about an article in the Malay Mail discussing on the issue of doctors posting confidential informations of patients being treated in hospital and using it to make remarks against certain group of people on Facebook etc. I wrote in detail my opinions on these matters and did warn the doctors that every patient has the right to choose what they want. Our job is to educate and advise, period. I wrote this same article in my books that was published in June 2016 (Chapter 9, page 185). Along the way I had written numerous articles on issues of doctors and social media. Interestingly, the exact issue that I spoke about in 2015 has taken a centre stage again, over the past 1 week.

We as doctors should learn to control our emotions. The public look at us as a highly educated person and we should not tarnish our names by making mocking or defamatory statement to any particular individuals, especially if we do not know the exact details of a case or never involved in it etc. Making general statements are fine. The issue that has been circulating around over the past 1 week started in early 2018, almost 3 years after i wrote my article. The court has decided that the said doctor has made defamatory statement against an individual and was asked to pay RM 230K in total, as damages and legal cost. I do not want to discuss in detail about this court case unless I have the detail judgement, which may only be released at a much later date.

What I want to talk about are comments made by many medical practitioners claiming that doctors have now lost the ability to advise people on quack practitioners, medical notes are neglected as evidence in courts etc. Some even gone to the extend of saying that doctors should be protected from being sued by member of the public for trying to protect the public from quack practitioners.

Firstly, let me explain that a defamation case is NOT a medico-legal case. In a medico-legal case, your case notes becomes a hardcore evidence against a negligent suit. Medico-legal cases/notes are only applicable from the time the patient seeks your treatment till the time the so-called negligence happens and so forth. The court will take the medical notes as evidence. So, if the patient has lied to you, they cannot turn the case against you as our management plan depends on what patient informs you. The legal test used to determine negligence is way different than a defamatory case.

In a defamation case, you need to proof that the accusation you have levelled against an individual is, on a balance of probabilities, true and proven. The legal test used is totally different than a medico-legal suit. So, when a doctor accuses a member of public of something serious, like causing death of a baby etc, she need to proof this statement in court. Can the medical note be used as an evidence?

My answer is NO, especially if you are not even involved personally in this case. Anything that happened outside a hospital/medical facility is hearsay. That’s the reason when a patient comes to emergency department and says that she/he met with an accident, we say ” Alleged MVA”. This is because we don’t know whether what the patient tells you is the truth and nothing but the truth, as proclaimed in court of law. No such proclamation is made when a patient comes to hospital. That’s also the reason why we always say ” claimed by patient” in our history taking. I hope the medical schools are still teaching this, as I learned it when I was a medical student.

Now, let’s go back to this particular case in general. The case revolves around a doctor who supposedly made remarks on FB against another “complimentary medicine” practitioner, accusing that the said practitioner caused the death of a child. I can vaguely remember the hot issue that was circulating at that time in regards to this case. The doctor made direct accusation and thus, it can definitely be deemed defamatory. No two way about it. If it was a general advisory statement without pointing to any particular person directly or indirectly, then it is not an issue and cannot be deemed defamatory.

Anything that happens outside of an hospital have to be reported to the relevant authorities to investigate. For example, if we suspect child abuse, we need to report to the police and social welfare department. It is up to these departments to take further actions. Just because the child said that she has been abused to you, it does not mean she is telling the truth and we should not depend on that story to throw accusation to anyone. Our job is to report. If we accuse so and so as responsible based on what the child said but subsequent investigations by police showed otherwise, you are liable for defamation and you can never win. Similarly, if any patients makes public accusation against a doctor in social media etc, you have every right to sue them. However, if the patient makes a report to MMC and MMC finds you not guilty, you can’t sue the patient, as she has made the right move. This is similar of us making a police report when we suspect something. The person cannot sue you for making the report.

In this particular case, police reports were made by both MOH and the person being accused of killing the child (directly or indirectly), who is the plaintiff in this case. Unfortunately, police investigations found no evidence that the plaintiff was responsible for the death of the child. This alone is enough to proof that the statement made by the doctor is defamatory. Some said that the mother lied in court and changed her statement, comparing to what was recorded in medical notes. Again, what the mother told the doctor is considered hearsay as it happened outside the hospital. In my 24 years of medical practise, I have seen countless number of patients not telling the truth. Many at times, they make up stories so that you don’t scold them or find them stupid. In the court of law, it is up to the defence lawyers to proof that the person is a liar and to expunge the entire witness statement. Till the judgement details are out, we would not know what happened in the court. I understand the said plaintiff in this case has also won another case in Shah Alam against a doctor as well, who supposedly did not turn up in court to defend himself.

Many young doctors out there do not understand the field of medicine. Defamation and medical negligent cases are 2 different entity. Medical notes evidence is only valid for something that happened within the medical facility, aka from the time the patient come to you. It is only applicable for treatment related issues. Secondly, what patient tells you is confidential and cannot be made public. A doctor who accuses someone publicly of wrongdoing by using this case notes has technically breached patient confidentiality. He or she can be reported to MMC. So, be very careful when you make emotional post on social media on certain issues when it involves specific patient etc. I have written an article on this in 2018.

Some doctors have said that they will stop advising the public against going to traditional practitioners to prevent being sued. Again, many don’t understand the scenario. You can always advise and educate the public in general terms. But what you can’t do is directly accusing someone of doing something. That is defamatory unless you have solid proof. Please do not forget that despite all the advise and education, it is every patient’s right to follow or not to follow. You can’t push your ideas into anyone even if it is based on solid evidence. Always remember your medical ethics: patient’s autonomy. My article in 2015 had explained this in detail.

Our country is in a mess right now and the world is in recession. I know this year’s Deepavali would be uneventful to many. However, I would still like to wish ” Happy Deepavali” for all those who are celebrating at home.

Read Full Post »


Recently I took part in one of the discussion in DOBBS forum in regards to contract doctors. I attach the video above for those who are interested to know how the discussion went about.



Read Full Post »

I wrote my last article on 29/10/2019, throwing a question whether our junior doctors are facing a tragedy or a comedy. I modified the sentence, from the highest grossing R-Rated movie of all time, currently playing in cinemas: JOKER. “I use to think that my life was a tragedy, but now I realised it’s a comedy”.  In that article I explained the letter issued by MOH dated 30/09/2019 on the status of floating doctors. I said, those who receive an extension of contract will likely see their final journey in civil service. The end of that contract will be their end of a job in civil service. It looks like my interpretation of the letter was subsequently confirmed by our Health Minister in the Parliament, just 2 days later, on 31/10/2019:




He has also quoted some interesting figures during his answer in Parliament. As of 31/08/2019, we have 15 246 contract officers! In 2019 alone, we have 4 202 new contract officers and 2 515 are waiting to be appointed between November 2019 to February 2020. This figures are nothing unexpected. Since I started this blog, I had warned that this is going to happen. I first raised this issue in 2006 when I wrote an article to MMA Magazine . The mushrooming of medical schools without proper human resource planning will only lead to disaster. I have spoken about this for umpteenth years and thus I would not go into it again. We are producing about 4-5 000 graduates per year (35 medical schools locally and from overseas) when we have already reached a doctor: population ratio of 1:580 last year! The peak has not even arrived! The idea of contract post has a 2 prong strategy. Firstly, you can kick out those who are not performing and another is to allow you to complete your housemanship and compulsory service. This is similar to any developed country, jobs are never guaranteed but they will provide you with an internship post under contract as it is a statutory requirement to be eligible for full registration. However in Bolehland, transparency has never been in their dictionary. Below is a circular that was issued some time ago on how they expect to evaluate those who will receive permanent post and those who will receive a contract extension. REMEMBER, ultimately it also depends on availability of permanent post, as I wrote in 2016.




In June 2019, the first batch of contract housemen (who completed housemanship in December 2018) received their long awaited letter from KKM…….



While almost 1000 applied, only about 500 received permanent post and about 50 received extension of contract. In September, I heard another 175 received extension of contract. As per the letter above and my previous article, those who received permanent post got transferred “mengikut keperluan”. The worst is yet to come! Two days ago, I received information via this blog that those who got the extension of contract just received their official contract 2 weeks ago. The contract is extended from 5/12/2019(the day the first 3 years contract ends) to 4/12/2021 which is another 2 years. So, the total contract years will be 5 years. The shocking part, which I never expected was the fact that THIS CONTRACT KEEPS THEM AT THE SAME PAY GRADE AS A HOUSEMEN, WHICH IS U41, contrary to my understanding that it should have been U44 !!!

Yes, before the year 2010, most of us will remain in U41 (or U3 as it was known before 2001) for few years after completing housemanship with just annual increment. But in 2010, under the new promotional prospect for doctors in civil service (which I personally wrote during a SCHOMOS forum with KKM in 2006) , all those who complete housemanship will be promoted to U44 from the day of receiving full registration. While those who received permanent post got promoted to U44, those who receive contract extension seem to be “dianak tirikan ” ……………..




I find this totally atrocious! If a person is going to work as a medical officer and doing the same job as another permanent U44 officer, they should receive the same pay! Yes, they should thank their lucky stars that they have a job but we should never discriminate them by paying them lower than the rest. Unless you are transparent enough to say publicly than these guys had such a poor performance that they are not fit to hold a U44 post( that we are just doing a charity work by extending their contract to complete their compulsory service), everyone should be treated the same. Under labour law, can this be considered “forced labour”? BTW, our country’s international standing in labour law is not that great either.

For those who are unaware, SPA/JPA has been requesting to remove compulsory service over the past few years as they know they can’t provide jobs to everyone. However, it will be a disaster to do so, with many having a license to kill, out there. Completing housemanship do not make you competent enough to manage patients without any supervision. MMC has refused to comply to their request as it affects public safety. MMC’s motto is ” safeguarding patients and guiding doctors”. That’s why compulsory service is important, not just to comply with legal requirement but also to make you competent enough to practise on your own.

Whatever said, we should accept the fact that no job is guaranteed. No government guarantees you a job either. People should not assume that just because they are spending RM 500K to make their child a doctor, your investment is going to produce a guaranteed job and tons of money/return. Those eras are gone for good. However, these poor souls became a victim of poor human resource planning (which does not exist in Bolehland dictionary) and a capitalist world where commercialisation of medical education became a money making business!

I was also informed that from now onwards, the number of floating doctors who will receive permanent post will further decline due to availability of post. Remember, 15K is waiting in line! BTW, please be informed that compulsory service is only for 4 years ( 2 years HO and 2 years Mo), so you can leave before you finish your 5 years (after a total of 4 years). The question is : to where? Some can consider university hospitals but they too have their limits. Not to mention that contract officers are not entitled for Master’s program and banks will think twice before giving you a loan.

Basically, those who are being extended under contract will be paid under U41 salary but will end up doing the same job as a U44 MO, with their life in civil service ending in 2 more years. Again……..





Read Full Post »

Since my last article in June 2019, there has been a lot of happenings in our country, as well as in other parts of the world. Is it for better or worst, only time will tell. The tragedy that is affecting our young graduates is something I predicted almost 15 years ago. As usual, our suggestions and warning to MOH was just for filing purposes with no definitive action or plan. It was all about money and how much you can make out of our society’s ignorance and demand. Over the last few months, I have been watching and reading numerous articles in the newspaper in regards to housemanship waiting period and what is happening to those who have completed housemanship and floating around while waiting for MOH/SPA to make a decision whether, you are going to be absorbed permanently into civil service or just an extension of the contract. The frustration among the doctors is palpable but trust me, it will not just end there!

Early this month, there was a circular from MOH:


WhatsApp Image 2019-10-29 at 7.07.01 PM

I find this circular very interesting. As I wrote in my article dated 15/04/2019, the first batch which started their contract housemanship in December 2016, most completed their housemanship end of last year and eligible to apply for a permanent post. Unfortunately, they were waiting for months. While they were waiting, they were kept in the same hospital as a floating medical officer with the same salary as a housemen. As long as the contract is not renewed, they will not receive the U44 promotion. They will remain in U41 as per the earlier contract. The first contract was for 3 years, to cater for any extension of housemanship. That’s the reason the contract has to be renewed after you receive the full registration as only then you can receive a U44 salary. Fortunately, the bright side is the fact that you still have a job till the contract expires.

In June 2019, I was informed that almost 500 of them were absorbed into permanent civil service and only about 50 were given extended contract to complete their compulsory service. Those who were given permanent post were mostly transferred out to where the post is available. A lot of them ended up in Sabah and Sarawak. Either you take it or leave it! There were actually more than 1000 doctors who had applied, following completion of housemanship, end of 2018. What happened to the rest? From my understanding, till September 2019, there were no news about the rest. While waiting, the number of applicants has been increasing as subsequent batches of contract officers began to complete their housemanship. What a mess we are in!

Then, out of no where, the circular above was issued by MOH, dated 30/09/2019. The circular basically says that while waiting for the decision, you can now be transferred to another hospital, klinik kesihatan aka anywhere!. You will not be in the same hospital as a floating officer. It also says that you will be notified of the decision of your application 3 months before your 1st contract ends (which is 3 years from your date of starting housemanship). Basically it just confirms that you will remain a floating medical officer till about 9 months after completing your housemanship (assuming you complete in 2 years on the dot) but in a different location!

The most interesting part of the letter is the fact that, if you manage to secure a permanent post, you will likely be transferred yet again to another location depending on availability of the vacant post that you are being given! Basically means, you will be transferred again within a year to another location! Is this a tragedy or a comedy? The best is yet to come: those who receive extension of contract can remain at the same place where they were transferred as a floating officer! In another word (the way I interpret this), your life in civil service ends there within another year aka completing 4 years of compulsory service. It’s just a diplomatic way of putting it !

All these just points to a simple fact: medicine is not a guaranteed job anymore. The market will be flooded with doctors and no one is going to be bothered whether you have a job or not. How many of them, who did not get a permanent post (can be about 2-3000/year) going to end up opening a clinic? As per my last article in June 2019, the GPs are already struggling to survive!

This is not something that is happening in Malaysia alone. In August 2019, Singapore Medical Council  announced that the number of recognised medical schools will be reduced from 160 to 103, effective January 2020. Many universities in Australia, India, Ireland and Canada were de-recognised. Singapore believes that they are now producing enough graduates of their own to fill the vacancies. Only UM and UKM degrees are recognised in Singapore and I heard that many who applied for a job in Singapore are not receiving favourable response compared to 10 years ago.

Similarly, as I have written in April 2019, Australia is also reducing their dependency on foreign doctors. In April 2019, I wrote that effective March 2019, Australia has introduced a new rule for employers who are recruiting foreign doctors to be a GP in Australia. They must first apply and receive a certification from Rural Work force agency confirming a genuine need to fill the position. In July 2019, Department of Health has reclassified areas which can recruit an International Medical Graduate (IMG). What use to be known as DWS (District of workforce shortage) area is now being replaced by DPA (Distribution Priority Area). These are the areas where an employer can recruit an IMG as you will not be given a medicare provider number(for medicare billing) if you are not working in these areas. Interestingly, many of the areas which use to be DWS areas till June 2019 are now non-DPA areas. DPA now only covers rural and remote areas. For example, in Western Australia, the entire Perth up to Mandurah and even small suburbs like Bunbury and Geraldton are considered non-DPA areas. And you have to work in DPA area for at-least 10 years (the 10 year moratorium) even if you become a PR. The whole idea is to cut down the number of foreign doctors. Furthermore, you can only work in Australia after passing both your AMC Part 1 &2 exams (except Monash Malaysia), where the passing rate is as low as below 20%. As for FRACGP, as mentioned in my April article, those who enter the program in Malaysia from January 2019 will not be receiving FRACGP and will not be able to work in Australia directly. Everyone works under contract in Australia and there are many specialist in Australia who can’t find a full time job. Many work on part-time or sessional basis. There is no such thing as automatic job for a specialist in Australia, upon completing their fellowship. So, don’t assume that doctors are guaranteed a job anywhere in this world!

This interesting letter from a doctor is worth reading, ” Medical Profession is no longer lucrative”.  It is well written, not to mention the increasing litigation and patient demands. Do medicine only if you are determined to overcome all the obstacles. Reading my blog/books will inform you the real life of a doctor and not what the public wants you to believe. It is never as simple and cosy as what the public tells you. Till today, when I look at the comments in social media, the public still believe that doctors can work anywhere in the world. They got NO idea that a doctor cannot work in another country unless his/her degree is recognised in that particular country. They got NO idea that you need to sit and pass an entrance exam which can cost thousands of ringgit without a guarantee of a job! They got NO idea that there are jobless doctors in many countries, Malaysia is on the way to join those countries………

Happy Delayed Deepavali 2019 greetings.






Read Full Post »

It has been a while since I last updated this blog. In my last article, I promised that I will be writing a series of article in relation to the changing world of medicine but unfortunately I met with a small accident in September while going to work. While I was OK and only hit a divider on the highway, my car was damaged and currently still in workshop. It is really frustrating when you don’t have your own car to travel around. This entire fiasco kept me busy for the last 3 months with Deepavali early this month and some travelling to do.

Medicine is or “was” a noble profession. It started as a science to help humans, to discover diseases and ways to treat them. Early doctors were trained purely by apprenticeship with no formal training or degrees. They did their own research at the back yard and came up with new techniques, findings and even treatments. In the 19th century, our ancestors believed that doctors need some form of self regulation and proper training modules. Thus, registration and regulation of doctors started. General Medical Council began in 1858.

Doctors are the only people on the planet given the rights to collect and record clinical history and confidential informations of a person. It is the only profession which can take detail information about a person which include certain intimate or sensitive details and social circumstances. You need to know every detail about a patient, from travelling history, problems at home, social history, sexual history etc etc. Only then we can formulate a diagnosis and provide treatment plans. The patient trust us to keep these informations as tight as possible and not to release the information to a 3rd party or even to his/her relatives which may even include his/her partner without the patient’s consent. This is where medical records safe keeping and confidentiality comes into the picture. Every medical council in the world has guidelines on these issues. Every doctor should read and understand these guidelines as not to breach ethical and professional bounderies.

Doctor-patient relationship is a unique relationship. We should keep professional boundaries at all times. This is the main reason why we should not be treating our own family members and close friends. Emotion would not allow us to provide the best standard of care to our loved ones. We will be in denial and would not give the best advise. On the other end, patients can become a vulnerable victim to a doctor. Only a doctor knows sensitive information of a patient and thus can easily be blackmailed by a doctor. This is one of the reason why professional boundaries are important to be maintained. This is also the reason why we must be regulated!

The advent of social media has created a totally new set of problems. Many doctors do not realise that social media can blur their professional boundaries. Facebook, Twitter, WhatsApp and many other messaging platforms have created new problems in the medical profession. Let’s look at WhatsApp. Doctors nowadays easily give their phone numbers to their patients, send confidential informations such as blood results etc via WhatsApp to the patient and even discuss their problems via WhatsApp. The doctor believes that he is tying to help the patient but forgets the fact that it can be construed as blurring professional boundaries! Imagine if you message the patient at 11pm at night and the patient is a married lady with some social issues, like problem with her husband etc. Imagine if the patient starts to communicate with you via WhatsApp for her personal matters, presumably seeking advise in relation to her relationship issues etc. This can definitely lead to something more serious like the case over HERE and  HERE. Furthermore any confidential information send via WhatsApp etc can be considered as a breach of confidentiality as it is leaving your premise. You got no idea who can see those messages even though the phone number can be the patient’s. It is always advisable to ask the patient to come back to your clinic for any discussion or issues. Never discuss any issues over the phone or via text messages. In India, a reason court ruling determined that telephonic consultation without seeing a patient that lead to death can be considered as culpable negligence which leads to being charged as culpable homicide!

Another issue is Facebook(FB)! Many doctors have FB profiles and some of us are active on Facebook, posting various personal matters and views. Way back in 2011 , BMA (British Medical Association) had already issued warning in the UK that interacting with patients at social networking sites such as FB can lead to blurring of professional boundaries. WE must, at all times maintain the doctor-patient relationship status. Making a patient a “friend” on FB blurs this boundary. Once you become a friend of a patient on FB, the patient can access many personal information regarding yourself, they can probably see your family members photos, your political and religious inclination and even comments that you might have made regarding a patient that you just saw in your clinic. IN fact, I have seen many doctors posting and discussing patient’s history and details in FB. While you may not mention the patient’s name but if that patient is your friend on FB, he will definitely know who you are talking about. Many Medical councils and boards in the world have produced “social media guidelines” and the common advise has always been ” never friend a patient on social media including FB, Twitter etc”. To my knowledge, MMC is yet to issue any guideline on this. KKM did issue a minor guideline 2 years ago after the labour room picture fiasco. Not only a patient can see the “life” of a doctor but the doctor can also “spy” on the life of his/her patient. In 2017 there was even an uproar in Pakistan when a doctor requested a patient to become a friend in FB! It was deemed as a form of sexual harassment and the doctor lost his job!

Whenever I talk to younger doctors in regards to this, I see a shocking face! Many doctors out there do not even know their own ethical boundaries with patients. Some even attend patient’s personal family function and interact with patients as though they are family friends. Yes, you may think that it is nothing wrong BUT as a doctor treating such patient, you should never cross the line. If the patient becomes your family friend then you should politely decline to be their doctor, to safe-guard the medical profession and doctor-patient relationship. THIS is a good article to read “Unhealthy relationship with patients”. I reproduce one of the excerpt here:

Maintaining professional boundaries


Avoid situations that may be misconstrued by the patient – for example:

  • Giving a patient a lift home in the car
  • Seeing patients outside the surgery without a clinical reason
  • Telephoning the patient without a clinical reason
  • Having personal transactions with patients, such as lending money
  • Conducting non-emergency consultations outside normal surgery hours
  • Having conversations with patients of a personal nature.

Medical examinations can be misinterpreted by patients, and they can be left feeling that proper boundaries have been crossed so when conducting examinations:

  • Explain if an intimate examination needs to be conducted and why
  • Explain to the patient what the examination will involve
  • Obtain the patient’s permission before commencing
  • Give the patient privacy to undress and dress
  • Keep discussion relevant and avoid unnecessary personal comments
  • Encourage questions and discussion
  • If you can sense that the patient feels uneasy, offer a chaperone or invite the patient to bring a relative or friend.

Be aware of your own vulnerabilities:

  • Develop skills in saying ‘no’ whilst maintaining compassion and rapport.
  • Be aware of the impact of isolation and take steps to have as much peer interaction as possible
  • Do not to be seduced by comments that may appeal to your ego ‘you’re the only person who listens to me and understands me.’

Some of the things you need to consider include:

  • Making friends with patients or treating friends as patients can lead to unreasonable patient demands
  • Politely decline invitations from patients to be Facebook ‘friends’
  • Living and working in close rural or cultural communities means you may be invited to social and community events. You don’t need to decline every invitation you receive but do consider the nature of the event before accepting. And, you must always maintain professional boundaries if you choose to attend
  • Accessing patient records for the purpose of making social contact breaches the patient’s right to privacy.

I realise that many junior doctors and even some of my own colleagues do not understand their boundaries. They take it for granted especially doctors in private sector. These doctors feel that it is a form of marketing strategy to be friends with patients in FB, to attend functions organised by patients and make friends with patients as though they are your family friends. Some even question me when I advise them not to do so. It is ethically wrong fo a doctor to breach a doctor-patient relationship. At all times, we should maintain our professionalism and treat a patient as a patient! Never do more than that except in an emergency situation.

I see a very dangerous trend of doctors accepting patients as FB friends etc. Please be VERY careful! It can be harmful in both ways. With increasing medico-legal cases in court, it can only harm you further. We are not any different than judges who have to refrain themselves from many social events.

It has been a busy year for me. I may not be able to update another article within the next 1 month. Thus, I wish everyone a very HAPPY NEW YEAR 2019…………………

Read Full Post »

Older Posts »