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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.

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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 :

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Continued………..

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 …………

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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.

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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.

 

 

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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……..

IS THIS A TRAGEDY OR A COMEDY……………..

 

 

 

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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:

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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.

 

IS THIS A TRAGEDY OR A COMEDY…………………..

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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…………………

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So, finally it has made the headlines. After many years of me talking about it, finally the reality was reported by mainstream newspapers few days ago. When many of us in the medical line brought up the issue of too many medical schools and too little training position, we were condemned. This is partly because the government itself, till 2014 denied that such a thing will happen. For those who know our government very well, surely know that not all said are trustable. Despite overwhelming evidence, people refuse to believe. As I had always said, people would only want to listen to good stuffs. When I tell them the truth and reality, I am accused of discouraging, very negative etc. No job is going to be guaranteed….. The only difference is , you will be spending RM 300-600K for a medical degree locally!

On 19/01/2017, The Star as well as Malay mail published an extensive report regarding contract HO post and no guarantee of a civil service post thereafter. Since I wrote about the contract HO post in November 2016, a Malay mail reporter was trying to get in touch with me to get my views on the issues. However, I did not respond to her since I was overseas till mid December 2016. She contacted me again few days before the articles were published and I gave my views. She was more interested about the JPA scholars. She wanted a copy of the contract which I refused, as the doctor’s name is written on the contract.

As usual, all these happened because there is no such thing as “planning” by our ministries. Each ministry works on its own without proper consultation with other ministries. For Ministry of Education(MOE), their goal is to make Malaysia an education hub, quality aside. It is a money-making business. My stand has always been that education should never be commercialised! License to start medical schools were given like peanuts. Only in Malaysia, colleges in a shop-lot can be given license to run a medical program. Accreditation works on minimum criteria and not based on an expected standard. As long as the college achieve a minimum standard, they will get the green light to continue. It’s like saying, 20% is enough to pass. You don’t need 70% to prove you are good and excellent. MOE treated medicine just like any other educational program!

Medicine is not like any other course. The 5 years undergraduate program is just the beginning. It is a life long learning. You learn by apprenticeship. You are dealing with life and death mater. A simple prescription error can cause a death! Training can only be done in accredited training centres. Many parents live in a delusional world thinking that jobs for doctors are guaranteed. The fact is, not anymore. Even in countries like US, UK, Australia etc, doctors work on contract basis. However, most of these countries have enough internship post for their graduates, due to proper planning strategy. Apart from internship, there is no guarantee that you will get a permanent job. Some survive by doing locum. Malaysia is now entering the same situation. And don’t forget that if your degree is not recognised elsewhere, you can’t work in another country without first sitting and clearing their qualification exam, with no guarantee of a job. This will cost you more money!

From the newspaper report, it is also obvious that all HO post will be given under contract basis from now onwards, even for JPA scholars. Permanent post is only eligible after you complete your housemanship and there is no guarantee that JPA scholars will be given a permanent post. As I mentioned earlier, this is good to kick out the poor performers and retain the best  in civil service. However, the selection process must be transparent. If not, many accusation will be floating around in the next few years. Please be informed that if you do get a permanent post after housemanship, you have to go where the post is vacant! You cannot choose or appeal. If you don’t want to go, someone else would be willing. You can’t choose where you want to work. You are also not eligible for car or house loan from the government if you are not holding a permanent post. Even bank loans can be a problem is you don’t have a permanent job.

With 32 medical schools and close to 38 medical programs, oversupply of doctors is inevitable. As of 31/12/2015, based on MOH statistics, the doctor : population ratio is already 1: 656, not including doctors from non-MOH public hospitals. So, we are already 2 years ahead. Chasing after numbers do not make any difference. Quantity does not equate to quality!

Well, I had spoken enough about these issues many times before, including in my books that was published last year. So, I will not repeat it all over again.

It is time for medical graduates to look for other jobs. GP market will be flooded in few years time and as I had mentioned in my last article, unethical practices will become a norm in the name of survival……..

Gong Xi Fa Chai everyone…………..

Contract doctors judged on merit, not government scholarship, MOH says

BY BOO SU-LYN

Published: January 19, 2017 08:50 AM GMT+8

Dr Noor Hisham confirmed that permanent positions for graduating house officers were not guaranteed. ― Malay Mail pic

KUALA LUMPUR, Jan 19 — Permanent positions will be offered to contract house officers depending on their performance rather than any government scholarship they may or may not have received, the Health Ministry said today.

Health director-general Datuk Dr Noor Hisham Abdullah confirmed that the government started the first intake of contract housemanship last December 5, with Public Service Department (PSD) scholars among the graduate doctors on contract as no permanent positions were offered at all.

“Based on merits, not based on scholarships,” Dr Noor Hisham told Malay Mail Online, when asked if PSD scholars will be prioritised for permanent positions given that they are bonded to the government.

“Bond still the same and when they are absorbed to permanent post, their service from Dec 5 will be taken into permanent service too,” he added.

Dr Noor Hisham also confirmed that permanent positions for graduating house officers were not guaranteed.

“If you are competent and good, then no worries. Those non-performers and MIA [missing in action] should be worried as it’s based on merits. For this, anywhere you go it’s the same — public or private.

“Who wants to employ incompetent and missing in action doctors?” the Health DG said.

Dr Pagalavan Letchumanan, a consultant physician and rheumatologist, said he was made to understand that 1,300 contract housemanship placements were given out, including for PSD scholars, after the last Public Services Commission of Malaysia interview in October 2016.

“There is no guarantee that you will be continued to be employed just because you are a PSD scholar! This comes as a surprise even to me as the scholarship contract specifically says that you will be bonded with the government for 10 years,” Dr Pagalavan posted on his bloglast November.

“What happens if the scholar is not able to get a permanent job with the government? Does he need to pay his bond? An interesting question,” he added.

Dr Pagalavan told Malay Mail Online that a PSD scholar had told him that he was given a contract post and was informed that the government bond was between the scholar and PSD, and had nothing to do with the Health Ministry.

Among the criteria listed on the house officer’s contract for the offer of a permanent position, “depending on the availability of positions”, were completion of one’s housemanship, a good track record and a recommendation from the head of department.

The copy of the contract that Dr Pagalavan posted on his blog also stated that the government could terminate the contract at any time if the house officer’s performance was not satisfactory and that a 30-day notice, or one month’s basic salary, would be given.

“Somehow, I feel this will remove all the dead wood graduates from the system. However, I am also worried about lack of transparency in making such [a] selection,” Dr Pagalavan said, adding that a committee should be formed to ensure that such decisions were fair.

Malaysian Medical Association president Dr John Chew claimed that before the implementation of the contract housemanship system, 20 per cent of doctors holding such posts were not performing.

“So the new system will be better,” Dr Chew told Malay Mail Online.

“For most of us, employment and work are more important. Most people are happy that they have started work”.

Health Minister Datuk Seri Dr S. Subramaniam reportedly said last October that offering contract housemanship would help about 2,600 graduate doctors on the waiting list every year, saying that they could wait for up to a year because there were not enough permanent positions.

– See more at: http://m.themalaymailonline.com/malaysia/article/contract-doctors-judged-on-merit-not-government-scholarship-moh-says#sthash.2nwRcPoG.dpuf

Medicos no longer guaranteed civil service employment

BY LOH FOON FONG

‘Permanent appointments will be based on their merit during housemanship training and recommendation by the Health director-general.’ – Datuk Seri Dr Chen Chaw Min

EXCLUSIVE: PETALING JAYA: Permanent employment for doctors, pharmacists and dentists in the civil service is no longer guaranteed.

The Government has started issuing jobs on a contract basis for them since last month as announced in Budget 2017.

According to the Health Ministry, if doctors successfully completed their housemanship within the three years of contract, they would have another two-year contract for compulsory service as a medical officer.

Pharmacists will be hired as provisionally registered pharmacists (PRP) for one year, with a maximum contract offered for two years and for the compulsory service thereafter, one year, with a maximum contract offered for one year.

There is no compulsory internship for dentists and compulsory service for them is one year, with a maximum contract offered for three years.

Health Ministry secretary-general Datuk Seri Dr Chen Chaw Min said from last month, 1,219 candidates had been offered jobs on a contract basis by the Public Service Commission.

“Permanent appointments will be based on their merit during housemanship training and recommendation by the Health director-general,” he said in an e-mail to The Star.

The move, he said, is expected to reduce waiting time for housemanship training and compulsory service.

Dr Chen said competent staff who fulfilled specific requirements will get permanent posts but they may not immediately get the posts until there are vacancies.

Their salaries will be backdated to the date of appointment once the posts are available, he said.

He said for government scholars who have not been offered permanent posts in the ministry upon completion of their compulsory service, they could seek jobs in the university and military hospitals and the private sector.

He also said that for this year, the ministry planned to take in 9,300 candidates – six batches of intakes which will involve 5,425 candidates for house officers (housemen), three batches (1,921) for dental officers and four batches (1,954) for pharmacists.

He added that housemen will enjoy the same benefits received by permanent house officers as stipulated in a 2008 circular on contract of service with additional advantages.

Those under this “modified contract” will have full-pay medical leave up to 90 days, and the extension of medical treatment for parents in government hospitals and clinics, he said.

But only those who are appointed as permanent medical officers and have obtained their confirmation in service are eligible to apply for government housing loans, he said.

The monthly basic pay of a houseman is the same as the grade category UD41 of the permanent service which is RM2,947, while a dentist (grade UG41) gets RM2,844 and a pharmacist (UF41) RM2,740. With allowances, they could get RM4,000.

On the criteria for a permanent medical officer post, Dr Chen said doctors must fulfil the service requirements, including attaining a good level of competency and performance of at least 85% in the yearly performance review during their house­man­­­ship training or compulsory service.

The permanent posts would also be given to the best talents who have the potential for specialty training and are willing to serve at any place in the ministry’s facilities during their tenure, he added.

PSD confirms no permanent spot in public hospitals for scholars

Published: January 20, 2017 03:00 PM GMT+8      

Health director-general Datuk Dr Noor Hisham Abdullah confirmed that the government started the first intake of contract housemanship last December 5, with PSD scholars among the graduate doctors on contract as no permanent positions were offered at all. — File pic

KUALA LUMPUR, Jan 20 — The Public Services Department (PSD) has confirmed reports that only performing scholars will be offered permanent contracts at public hospitals.

In an email response to a query by Malay Mail Online, the agency said that the government is currently looking at alternatives on how to absorb scholars who failed to secure permanent jobs despite being offered housemanship contracts by its hospitals.

“Students who qualify for our scholarships are excellent students. With that we hope that they can continue to display similar performance as they do with their studies, and show high commitment when executing their duties under their housemanship contracts so that they can be offered permanent jobs,” the agency said.

“Nevertheless, the government is currently looking at several alternatives should PSD medical scholars already offered housemanship contracts fail to secure permanent jobs once their contract ends,” it added.

Yesterday Malay Mail Online reported that public hospitals will only offer permanent contracts to  house officers based on their performance, and not to any government scholarship students.

Health director-general Datuk Dr Noor Hisham Abdullah confirmed that the government started the first intake of contract housemanship last December 5, with PSD scholars among the graduate doctors on contract as no permanent positions were offered at all.

“Based on merits, not based on scholarships,” Dr Noor Hisham told Malay Mail Online, when asked if PSD scholars will be prioritised for permanent positions given that they are bonded to the government.

“Bond still the same and when they are absorbed to permanent post, their service from Dec 5 will be taken into permanent service too,” he added.

Dr Noor Hisham also confirmed that permanent positions for graduating house officers were not guaranteed.

Health Minister Datuk Seri Dr S. Subramaniam reportedly said last October that offering contract housemanship would help about 2,600 graduate doctors on the waiting list every year, saying that they could wait for up to a year because there were not enough permanent positions.

 

– See more at: http://m.themalaymailonline.com/malaysia/article/psd-confirms-no-permanent-spot-in-public-hospitals-for-scholars#sthash.UYFxAzZA.dpuf

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It’s been one and a half month since I last updated my blog. As I wrote in my last post, I was going for a long holiday after an hectic year dealing with IRB. Coming back from a long holiday is the worst nightmare. Clinic was packed to the brim, multiple medical reports to write and multiple reply letters to type. Then came Christmas, New Year and finally my hospitals MSQH audit which just ended today! Phew………

Unfortunately, doctors were in the limelight for the wrong reasons towards the end of last year and the beginning of this year. A daring expose by Al-Jazeera regarding baby selling syndicate in Malaysia on 24/11/2016 was a disaster for doctors. The faces of many doctors involved were clearly shown. Unfortunately this is nothing new. Many years ago, a similar syndicate was exposed and caught in Johor. The police acted swiftly and did manage to arrest few of the members of the syndicate that was exposed by Al Jazeera.

Just when we thought it was already damaging enough, came another exclusive expose from NST. Doctors venturing into unethical practices of cosmetic products. Frankly, this is nothing new as well. I have seen enough doctors practising what was exposed by the report. Injecting IV Vit C for whitening/anti ageing and many more so called aesthetic practices are common nowadays.  In 2012, MOH (tr-vitamin-c-injection) had already issued statement that there is NO evidence that IV Vit C has any benefit. In fact, ViT C is NOT approved by MOH for intravenous injections for cosmetic reasons. Anyone found doing it can be charged for unethical practice. Ozone therapy is another major complimentary medicine practise that doctors are widely involved. Way back in 2011, MMC had already issued a statement that ozone therapy do not provide any health benefit and any doctors found guilty of providing ozone therapy by claiming that it can cure diseases, can be charged for unethical practices. Unfortunately it did not prevent many doctors from doing it. In fact I even know nurses who are openly promoting such centres on Facebook and showing many VIPs who are taking their ozone treatment. Again, on 3/01/2017, our DG issued another press statement regarding ozone therapy. The press statement came after NST reported that many celebrities who were openly promoting ozone therapy for advertisement purposes expressed their regrets. I have heard of reports of people dying during the procedure and even developing cardiac and renal failure. It is not a procedure without complications.

The question is, why are doctors venturing into such practices? The answer is simple : money and survival! Since I started blogging in 2010, I had written several times regarding these issues. In fact in 2012, I wrote on how desperate have doctors become. That is the reality out there. No matter what passion that you talk about before going into medicine, at the end of the day, it all boils down to money and survival. There is no such thing as easy money or easy life in medicine. Many doctors especially GPs are struggling to survive. Thus, to keep their income and their clinic running, they venture into these unethical businesses.

I get a lot of query regarding aesthetic medicine etc. My reply has always been to ask yourself why you became a doctor! Is it to treat and cure people with sickness or to become a glorified beautician! Yes, there is a lot of money in aesthetic medicine. There are huge financial backup from big suppliers all over the world. Cosmetic and aesthetic suppliers are one of the largest companies in the world. The companies need doctors as doctors are the only people licensed to inject substance into a person! At the end, no doctor will do it if not paid well!

The situation will only get worst. My last article talked about the introduction of contract HO post with no guarantee of a permanent post. I had mentioned that those who do not get a permanent post will end up flooding the GP market. Imagine what will happen then. Issues mentioned above will only get worst day by day, in the name of survival. WE have to blame ourselves for loosing the respect and trust once given by the public. Worst still, many of these young doctors would have huge amount of debts to pay! As I had always said, never take huge loans to do medicine!

Well, it did not end there. Just when 2016 was coming to an end, 2 cases of botched circumcision were reported. Interestingly, the first clinic was reported as not having a  license to run! Interesting indeed if the report was true.

On the other end, MMC has now started their own qualification exam for those from unrecognised universities. It is now known as EPR (Exam for Provisional Registration). Is this a prelude for a common entry exam? Only time will tell……….  As the years pass by, almost everything I predicted is becoming a reality. God save this country……

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