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Lately, I am hearing and coming across many issues that really make me feel that our healthcare system is going down the drain. Yesterday I publish the first Part of this topic, taken from an MO’s blog. The attitudes of current doctors is simply so glaring for anyone to miss. In fact almost every day I am hearing news from my ex-hospital regarding the house-officer’s situation and how many patients have succumbed due to poor basic knowledge of the frontline doctors. The entire system seems to be collapsing day by day.

I have talked enough about the mushrooming of medical schools over the last few years. In fact, I first wrote about these and the quality of doctors produced way back in 2006 when I wrote an article in MMA magazine. Many said that I was over exaggerating. The same people who told me that, agrees with me now. Many of these medical schools were only interested in making money and not bothered about the quality. They just dump the quality issue to Ministry of Health. Unfortunately, MOH can’t do much. Once you are an HO, you have already been accepted as a civil servant and any action need to follow proper procedure under the General Order (GO). It will take years before any action is taken to any civil servant unless it is a criminal charge. I remember one of my ex-Pengarah of a hospital told me that he wrote tonnes of report about a missing Attendant, but after 4 years, his name is still on the employee list, of course his pay was stopped. I also had a Cardiologist who left almost 6 years ago but his name is still in the list because he has not officially resigned. Thus, if you follow the procedure, they have to take disciplinary action before terminating him!! WTH! The entire system is just too much of bureaucracy and procedures.

When I was active in SCHOMOS from 2002 till 2006, we use to bring up the issue of retaining senior specialist in Ministry of Health. One of the main reasons is to train junior doctors in service. Without experienced senior consultants and specialist, what guidance do the junior doctors get? Unfortunately, MOH and JPA were not interested. As for JPA, doctors are just another bunch of government servants who do not need any special attention. Thus, slowly all the senior specialists just left the system not only because of poor pay/promotion but also due to frustration with the system. Many felt that they could not do the best for the patients due to various limitations and poor support from the government in developing certain field. Political influence and bureaucracy is another factor.

This left the system with poor guidance from “good” senior consultants. It is sad to see that most of the remaining senior consultants and heads of departments are also known as “world travellers”. Most of the time they are either not around or going for conferences all over the world sponsored by pharma companies. I know one HOD who stays at home most of the time and only comes for ward-rounds about 1-2 times/month and receive JUSA C salary. I heard she got JUSA B recently! The best part, she is also the head of a subspeciality training committee! In MOH, once you become the head of a department, you will remain so forever and no one can touch you. In fact, even after you retire, you can be reappointed as HOD under contract basis. About 3 years ago, I did suggest that HOD post should be rotated every 3 years like in Singapore in my MMA article after returning from Singapore General Hospital. I heard that our ex-DG did issue a circular for HOD rotation but unfortunately there were tremendous amount of objections from the current HODs, for obvious reasons I presume!

In 2006, after much discussion and countless number of paperwork’s by SCHOMOS with JPA and MOH, finally locum was legalised. We should thank our ex-Minister of Health Dato Seri Dr. Chua Soi Lek and our ex-DG for making this a reality. Unfortunately, it is clearly being abused and misused currently. The locum should be after office hours and weekends when you are not on-call. However, we have consultants and HODs doing locum in private hospitals during office hours and leave the wards to the junior doctors. I know of one HOD from East Malaysia doing locum almost on a weekly basis in 2 different hospitals in West Malaysia!! Not sure whether he even does anything in his so called resident hospital. There are even some consultants who does locum outside during office hours and send their patients to the government hospital for certain procedures and even to collect medications. So, the patient sees this particular consultant in a private hospital and gets all the procedures and medications from the government hospital. The consultant gets the fee!

These HODs and senior consultants in government hospitals are misusing the system to the maximum. Of course, not all of them. I know some who are really dedicated and work hard but they are becoming a minority species now. Those who misuse the system know that the hospital will still run and there are junior specialist, medical officers and houseofficres to take care of the patients. This is why there seem to be a lot of mismanagement/misdiagnosis happening in these hospitals nowadays. No proper guidance from senior consultants!  And what can you do about it? Nothing! Everyone covers everyone. The Pengarahs of the hospitals are not bothered as they don’t want paperwork. The juniors will not complaint as their SKT marks depends on the HOD. The good junior specialist will also get frustrated with the department and eventually leave the service! And so it goes into a vicious cycle of mediocrity…………………….

Next: The rot from the top to the bottom……………………