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Didn’t I say so…………..?And,

Here……. We…….. Go………..!

                        “Life is like a box of chocolates”, a famous quote from the movie “Forrest Gump”. We never know what is going to happen in the future and I always said “Hope for the best but prepare for the worst”. Whatever said and done, a lot of our destiny is determined by us. Unfortunately we are taking the part of no return but again, there may be reasons behind this. “Why do you fall, master?”: “so that you can get up and be stronger”!

                        I chose the topic above because many of the events that have been happening lately in the medical fraternity was predicted by me many years ago. I will quote the articles that I have written before which predicted all that is happening now. And, here…… we…… go…….:

1Malaysia Clinic and the future of General Practitioners (GP)/doctors.

There is no doubt that GPs have contributed a lot to the healthcare services in the country. They were the people who started general clinics in the urban and suburban areas to cater for the people, before many government polyclinics and “klinik kesihatan” began to appear. I still remember my father bringing me to a GP when we were small for simple cough and cold. The GPs were highly respected by the community and they were considered equivalent to a specialist.

Today, these GPs are being attacked from left, right and center. The government built many health clinics in their vicinity bringing down their income. Then, came the opening of government clinics till 9pm with RM80/hr tax free allowance for the doctors which did not only take away the GP’s regular locum doctors but also affected their patient load. Patient who use to attend the GP clinic at night due to their work commitment in the morning, now have the opportunity to go to the night government clinic for RM1. Finally the last straw came with the introduction of the 1Malaysia clinic.

We all know that it is purely a political move. The multiple doses of 1 that and 1 this sometimes make me to vomit blood! Even though there are only 50 such clinics in the country, it will definitely affect the GPs around the vicinity of the clinic. Their income will definitely drop and there is no doubt about that. Our Malaysian mentality is to get everything free! The worst part is the fact that different rule applies to different people. 1Malaysia 2system! There is so much emphasis on the need to comply with the Private Healthcare Facilities Act in the private sector but these laws are considered “null and void” in the government sector. Talk about “leadership by example”.

Well, let me tell you this. Problems will arise with these 1Malaysia clinics. It is just a matter of time. We should be moving forward rather than moving backwards. We know that Medical Assistants (MA) have contributed a lot to our healthcare in the past but we should be moving forward. Furthermore, with the quality of our new MAs, the quality of care is questionable. We even have “Mat Rempits” becoming MA nowadays! Trust me! We can’t compare them with the older generation of MAs same like how we can’t compare the older generation of teachers and nurses to the current generation. We are digging a big grave for the country if not already!

Who to blame? Some of the black sheep among the GPs have created a bad impression of the doctors in general. This is a reality! We can’t run away from the truth that GP practice is a business and thus profit counts. Some of the doctors wanted to make a lot of profit out of their business and undermined their service commitment. This goes for the private specialist as well. Thus, we dug our own grave and created a lot of unhappiness among the people. When the punishment comes, it affects everyone! Doctors are poor businessman. If any GP thought that he/she can survive many years down the line with just the income from the clinic, then he/she must be really leaving in “Bolehland”. Doctors should start to diversify their business and be bold in venturing into other businesses. I have a GP friend of mine who have invested as far as in China and Singapore to diversify his business. This is the way forward.

Dr. Krishna Kumar’s and Dr. Kuljits’s article (Berita MMA Feb 2010)

Dr. Krishna Kumar had said it right. The future of GPs is bleak; unless and until there is a change in the structure of our national healthcare system which I hope will come true soon. If not GPs will undergo a slow and agonizing death, with no offence to anybody. As Dr. Kuljit said, many GPs are finding it hard to cope and some have even closed shop. A total of 4 000 new doctors are coming into the market annually since 2009. MOH is struggling to place them in hospitals around the country. I understand there are up to 40 housemen in each department in some hospitals. They have even started to use district hospitals for “so-called” training. Definitely they are not being supervised and trained properly. Soon, all “Klinik Kesihatan’s” will be run by these “half past six” doctors and very likely, the 1Malaysia clinic will be manned by medical officers in near future.

 Even-though, I agree with Dr. Krishna Kumar regarding the increase in doctors resulting in shortening of the waiting period and thus more patients will tend to choose the public hospitals/clinics but I disagree with him regarding any improvement of the standard of care! We have the highest number of medical schools per capita of the population in the world (1 for every million of the population!). Quality is deteriorating. Any Tom, Dick and Harry who got money and some basic qualification can become a doctor as Dr. Kuljit had rightly pointed out. Just look at the civil service as an example. We have a bloated civil service (one of the highest per capita of the population in the world) but do we see any improvement in the service provided? I am sure you know the answer. Unemployable graduates being recruited as civil servants just to provide a job! We have 9 Timbalan Pengarah’s in Hospital Sultanah Aminah who don’t know what to do daily. In some government departments we have 1 staff to press the number, 1 to pass the number to you, 1 to see the passport, 1 to collect the money and 1 to paste the maid’s permit on the passport. One man’s job has been distributed to 5 people and you say this is efficiency!

Yes, the number of doctors will increase. Yes, the waiting time may be reduced. Yes, we may have 4 MOs and 10 housemen in a ward of 40 patients. Yes, the market will be saturated. Yes, less and less doctors will quit government service to become GPs. Yes, “half past six” master’s graduates will continue to be produced and probably increase in numbers as well (mass production again!). But saying all that, the quality and standard of care will drop! Accessibility and quantity is not equivalent to quality. I have predicted all these way back in Nov 2005: Current Quality of medical doctors: Are we going down the drain?”, July 2006: Future of Government doctor’s: Die Another Day, Nov 2006: Government service: Past, Present and future……, Dec 2006: Malaysian Health Care System: Are we really up to the mark?, March 2009: QUALITIES OF HOUSEOOFICERS: THE BLAME GAME CONTINUES………………and Oct 2009: 2009: The Day the MOH stood still, Year 2012: The Day after Tomorrow? Those who have forgotten or missed these articles, please visit my website at http://pagalavan.com

Just look at our quality of nurses. We have so many nursing colleges in the country that you can become a nurse even if you have failed SPM. If you don’t believe me, please check for yourself! They can’t speak English, don’t understand what you are saying and they don’t understand what you have written in the notes as it is in ENGLISH! We have 1^st year nursing graduates being taken in as clinical tutor in a nursing college! What experience does she have to teach the students! This is happening everywhere including fresh engineering graduate being appointed as lecturer in local university without any field work experience. No wonder many buildings are collapsing in this country without a bomb, another great achievement in this “Bolehland”.

No matter how good of a doctor/specialist you are, the quality of medical care depends a lot on the people surrounding you. If the nurse does not give a proper care to the patient, the patient will still die despite what you do. If the houseman/medical officer’s does not bother to know much about the patient’s condition and blood results, the patient will still die no matter how hard you worked to save the patient’s life. This is the new type of frustration that is growing among the hard-working specialists and doctors. They simply can’t do the best for the patients due to the low quality of the support services. Thus many of these good doctors have left to the private sector. Yes, the market is competitive but “what goes around comes around”. Patients will eventually go around looking for the best doctor who can treat them and guess what?, majority of these doctors will be in the private sector (no offence meant)! However, the future prospects for junior doctors are bleak. Gone are the days of doctors being well respected and rich. I really hope parents will stop thinking that being a doctor guarantees their children’s future. Those days are gone……………..

We use to be the cream of the country but we are the “Dark Knights” now. We should be able to take all these insults and challenges and move forward and diversify ourselves. If not “we either die as a hero or live long enough to see ourselves becoming a villain……………………..

 ** this is the unedited version of the article published in Berita MMA March 2010, the ones in red were removed in the published version**