I am very sure  a lot of us would have read the article in The Sun 2 days ago. It was about the petition that was sent to DPM from a group of Malaysian students graduating from Australian medical schools seeking our government’s intervention in securing an internship place in Australia. I wrote about this issue and the petition concerned almost 3 months ago over here. I had given my views. The person who initiated this petition is a self sponsored student but majority who signed it were government scholars. BTW, I don’t think our Minister of Higher Education knows anything about internship in medicine based on his reply over here. He probably thinks “internship” here means equivalent to internship in other fields where they do it as part of their course. This reply in The Sun is interesting to read.

Now, coming back to the topic above. I mentioned in my last post that I will reveal some changing strategies of medical schools in getting students. IMU, the first and most established private medical school in Malaysia, has sent out a survey to their alumni and students asking for their opinion on the introduction of USMLE preparatory course. What interest me the most was the content of the message that was sent out. Every single issue that I had written in this blog that many refuse to believe over the years has been reinforced and confirmed by this message below:

However, I would like to reiterate that sitting and passing the USMLE exams do not guarantee you a residency post or  a training post in US. Yes, US is still short of doctors simply because many of their own citizens are not interested in being one. The high litigation rate and demanding population are some of the reasons quoted. Oh, don’t forget the high indemnity insurance rate, so much so, it is even higher than the income they earn in a year for some speciality. There was once a saying that there were more doctors resigning in US than being produced, not sure how true was that statement.

USMLE exam is needed for anyone to be able to work in US. It consist of 3 Steps with 2 parts in Step 2. It does not come cheap either. Just this year, the fees has been increased again as mentioned here.  Despite spending huge amount of money, there is NO guarantee that you will get a residency post. If you look at the ECFMG fact card over here, you will realise that only 40% of the Non-US citizen IMG got a matching for the year 2012. If you look at the ECFMG annual report over here (page 20), you will realise that Malaysia is not even in the top 45 countries from where the IMGs are coming from! The highest IMGs are from India (16%). Despite that, I just received a comment from a doctor from India who said this “Fed up of applying to every match, sir. Not getting matched. So quit trying. Looking for other opportunities based on usmle credentials like abu dhabi, malaysia, sir” .

I got no issue of IMU conducting this course but they make it sound like it is very easy for students who pass USMLE to get a training post in US. I think it will be as tough as getting a specialist training post anywhere else in the world. You are competing with the whole world! BTW, IMU is not the only university encouraging students to sit for USMLE. Few of the newer medical schools in Malaysia  have also started to promote USMLE for their students.

Well, once someone said that we will become a maid (aka graduates) exporting nation by 2020. It looks like we will also become a doctor exporting nation soon………………

Welcome to GTP, government  Transformation Program…………………

I am writing this article as a celebration of achieving 1 Million views, today! I started this blog in January 2010 but the article that really caught everyone’s eye was the title above. I wrote the 1st Part on 07/09/2010 and it achieved almost 2000 views in a single day. At that time, my blog views were just less than 2500/month! My 2nd part published on 08/09/2010 shot the number of viewers to about 2800 in a single day. These 2 articles were followed by various other articles, which contained a lot of information regarding our healthcare system in this country (see For Future Doctors page). Till today, these articles are still viewed and commented on a daily basis. Since the publication of these articles, the number of views to my blog increased tremendously reaching almost 40-50 000 views per-month currently, the highest being 62 351 views in March 2012.

My latest article published 3 days ago on 7/03/2013 seems to have attracted a lot of attention. It achieved the highest single day view in the history of my blog. On 8/03/2013, it achieved 7 222 views in a single day!! Incidentally, it is also the 5^th anniversary of the 2008 General Election (the political tsunami)!

Thus, as a celebration of achieving a million views as well as the highest single day view on 8/03/2013, I am writing the third part of this infamous topic. I based this 3^rd part on what people think about a doctor that is NOT the truth. Somewhere in this blog, a commentator by the name of cardiprin (an MBBS graduate who quit housemanship and doing something else) wrote some interesting quotes from non-medical people. I will elaborate on these quotes.

1. Have a very secured future

This has been proven wrong many times in this blog; the latest was the last article, which I wrote on 7/03/2013. Many countries are now struggling to create jobs to all their medical graduates including Australia, UK and some European countries. Jobless doctors are a norm in Thailand, Vietnam, Philippines and even India. With 36 medical schools conducting close to 46 medical programs plus thousands more from overseas, surplus of doctors is inevitable in Malaysia by 2016/17.

As I had mentioned recently, MO post in Selangor, N.Sembilan and Malacca is full. Johor Bahru district, which has only 90 posts are being filled up to 110 posts, utilizing posts that are for upcoming Klinik Kesihatans. This means that the post for the upcoming Klinik Kesihatan has already been filled!

As I have written over here, based on the government’s own statistics, it is obvious that we will have surplus of doctors within the next 3-4 years. The new housemen are being warned that they may not be able to secure an automatic MO post in the future. How they will select is yet to be determined. When this time comes, you have to go where the post is available and the maldistribution of doctors will eventually be solved.

2. 
Nature of Job – sitting in a cozy consultation rooms, joking along with their patients, and ends up with big bucks every month.


This is the most ridiculous statement that I hear from non-medical people. Do they really know what doctors do behind the scene? Many has this impression that a doctor’s job is just sitting in a clinic and prescribing drugs after hearing your complains. It is NOT as easy as that. It may be true for many General Practitioners (GPs) out there who do not do any ward work but as I have mentioned many times before, post-MBBS GPs are a dying field. In the future, even to become a GP, you will need postgraduate degree.

As for specialist, sitting in a clinic is only part of their job. They have emergencies to handle, patients in the ward to manage, surgeries to do and complains to answer. You are “on-call” 24hrs a day and 7 days a week as your patients are your responsibility. There are NO housemen or medical officers in private hospitals to do your job. It is just you and your patients! A small mistake will invite a lawyer’s letter at your doorstep. AND don’t forget that to reach the status of a consultant in private hospital, you would have undergone at least 10-15 years of training post MBBS!

3. Are rich


Another big misconception. The era of rich doctors are gone. Many of the current doctors are struggling to survive. Many clinics had closed down and the incomes of specialist in private hospitals are slowly declining day by day. Many private hospitals have started to “employ” specialist with a fixed income unlike before where every consultant is self-employed. BTW, don’t think the hospital is going to pay you huge amount of salary! I know one private hospital chain, which is offering only RM 20K monthly salary, which after PCB and EPF deduction will come to about RM 16K net salary per-month!

As you will be aware by now, the only way you’re going to make huge amount of money in medicine (return of investment), if ever, is by going to private sector. To do this, you need to complete at least 10-15 years of training after graduating. Being in private means, you are working almost 24hrs a day, 7 days a week and can be called at anytime of the day. The stress level is high and it is not an easy life as many would like to think.

In private, it is a business, with one big difference: you are the ONLY asset to your business. Your business runs only if you are physically there! Patients come to see you and not your clinic! If you take leave or go for a holiday, your income will be zero. If you meet with an accident and unable to work, your income is zero. If you become handicapped, your income is zero forever after that. This is the huge difference between a business in any other sector and medicine, which many do not realize.

4. One can become a specialist merely by attending lecturer classes and passing up assignments/coursework, like MBA


Oh Gosh, what kind of society are we living in? To be frank, I have had medical students (3^rd and 4^th years) who think that Master’s program is a fulltime program like undergraduate. They think that they just need to attend lectures, tutorials and will be thought like an undergraduate!! What they don’t understand is that it is a FULL TIME working with part-time learning! You are practically doing your full-time clinical work and part-time studying. It is learning while working! NO formal teaching is involved.

Worst still, we have parents and students who think they can become instant specialist after graduating!

5. Highly respected

This era is GONE. Most of the younger generations do not give a damn who you are! I had been scolded and given sarcastic remarks by some young fellows who have not even entered university!

6. Are angels and are very passionate about their profession

Angels? Yes, doctors are still the most trusted profession by the public but sorry to say, the number of doctors with unethical practices and profit driven are increasing day by day due to stiff competition. They are not passionate about their profession but more passionate on how they can fill their pockets! It is about survival nowadays! Just look at this news that just appeared today

As what my friend once said: doctors are the best businessmen as the public fully trust them and get cheated in broad daylight! Looking at the trend of students doing medicine for money and good future, it is not surprising at all.

7. Can issue MCs and prescribe drugs (including graduates)


So what? Even pharmacists are selling drugs without prescription. Traditional medicine practitioners are dispensing drugs, which, most of the time contains modern medicine and steroids. According to our great Health Minister, even Sinsehs/TCM practitioners can give MCs ….………. It is up to the employer to accept or not. BTW, housemen are not allowed to give MCs as you are not a fully registered doctor.

8. Can easily retire at a young age


Has anyone seen any doctors retiring young? Please enlighten me! The only doctors who I have seen retiring young are those who quit medicine and go into some other business or profession. Most doctors will die working, as the day they stop working the income is zero! That’s the reason why many doctors are venturing into other business nowadays. I know many who had started food business so that they can leave their job as a doctor one day and relax at home.

Looking back, many regretted not investing the money they spend to become a doctor in some other business! I use to tell the same to many budding doctors whose sole intention in doing medicine is for money! Why waste spending RM500K and endless years of studying when you could have done something else at less than RM100K and use the rest to start-up a business?

9. Had gone through tremendously difficult exams – failure rates are high

Another joke of the year! Do you know that almost all medical schools in Malaysia have almost 100% passing rate? Those who fail just have to repeat the exam in few weeks and eventually will pass the exams. That’s the reality. That’s the reason why you see the deteriorating quality of graduates in Malaysia, not only for medicine but for everything else as well. We also know how many “so-called” graduates from overseas who buy their “certificate”.

10. Can solve all their health problems

“To Cure Sometimes, To Relieve often and to comfort always” has always been the motto for medical profession. To survive you need a lot of luck and fate. Many budding doctors or students feel that doctors can cure and save lives all the time. Yes, we can treat many people with drugs! Without drugs, what can we do? Did doctors create these drugs? Surgeons can operate and correct many disorders but can they do it without anesthetic drugs, antibiotics, equipments etc?

I use to tell medical students that doctors don’t save life. They prolong life! If doctor’s can save life, no one should die. That’s the reason you see many VVIPs dying despite the best medical care and with all the money they have. I have had medical students who went into depression when they entered clinical years. This is because they create a bond with a patient who eventually dies in the ward. Frankly, to be a doctor, you need to be emotionless! Any emotional attachment will lead to depression and resignation from clinical duties.

Medical profession is probably the least exposed profession in this country. Many non-medical people do not understand the real life of a doctor. They also refuse to accept the fact when it is revealed to them. They always accuse us of trying to protect our “rice bowl”. I use to tell them that by the time the person who enters medical school becomes a specialist like me (15-20 years), I would have retired or gone 6 feet underground. So, why do I give a damn about my rice bowl?

Students on the other hand are either totally ignorant or refuse to believe what people say. Furthermore, current generation do not read much and wants everything to be spoon-fed. I would blame it on our education system for creating parrots! That’s the reason the number of medical graduates being referred to Psychiatrists is increasing day by day. Soon, probably the psychiatry department should start a separate clinic days for “depressed” housemen! One of the main reasons for this problem is due to the fact that they had the same perception as written above coupled by pressure from parents in forcing them to become a doctor.

Well, the SPM results will be announced soon. I am sure many will still do medicine. My advice is always the same: NEVER DO MEDICINE FOR THE WRONG REASONS………………….. you will regret it later……………

Next: how medical schools changing their marketing strategy, knowing very well, surplus of doctors is inevitable in the next few years…………

I received the following circular (see below) via a Facebook friend of mine. It is a very interesting circular from the office of the Deputy DG(Perubatan) of MOH. Again, didn’t I say so? Via this letter, it is confirmed that MOH is running out of post. It is clearly written that almost 95% of the MO post in MOH has been filled with some hospitals/kliniks being oversubscribed. I had a chat with some senior doctors in MOH and was reliably informed that all MO post in N.Sembilan, Malacca and Selangor is FULL. Many who finished housemanship in these states are being transferred out of the state. The district of Johor Bahru which has only 90 MO posts for health side are being filled up to 110 post. Where are these extra posts coming from? It is being borrowed from the upcoming Klinik Kesihatans which is being planned in near future or under construction. It basically means that the post for these upcoming KK has already been filled! How many more post can the government create? Pilot project has also been started in some KKs for shift duties till 10pm.

If you look at the letter carefully, MOH is now concentrating on improving the quality of care by asking MOs to become housemen. Housemen will eventually become a 6th year medical student who would not need to take any responsibility. It is also mentioned that shift system MUST be implemented in ALL hospitals. Any shortfalls should be covered by the MOs since there are enough number of MOs to run the service. There is nothing to cheer about for the housemen as you will become a MO soon and need to follow the same orders. Worst still, you will be under trained and underexposed. I can already see that happening around me. I have junior MOs who just finished housemanship who do not even know that ACE inhibitors can cause cough, Amlodipine can cause leg edema and Hydrochlorothiazide can cause rise in uric acid! These are information that I knew when I was a final year medical student! The “training” is getting bad to worst and many are being released with a “license to kill………….”. I just saw a 74-year-old lady discharged with Pottasium tablet 1200mg tds and Mist KCL 15mls tds after 1 day of admission in a hospital. Thank GOD she came to see me the next day! Do they know that Potassium can kill?

I was also informed that very soon, HO post will be given under temporary post. This means that you are not going to be guaranteed a job after housemanship. You also cannot choose where you want to work as you will have to go where the post is available. Remember what I said over here. Again, can anyone deny what I have been saying all this while? All evidence is pointing towards an oversupply and jobless doctors…………….

Way back in October 2011, I wrote this. In just 6 years, the government reversed their decision from a 4 year compulsory service for pharmacist to 2 years ( including 1 year internship). The reason was obvious that the government was running out of post. Yesterday, our government has further liberalised the situation by allowing fresh graduate pharmacist to do their internship in private sector! It was reported here and attached below. It is a clear indication that the government is not being able to provide a job for all pharmacy graduates like before. Would the same situation happen to doctors soon? Only time will tell.

Personally, what are these pharmacists going to learn from private retail pharmacy stores? Who is going to guide them ? Are they going to become a mere shopkeeper? At least if they are given a job in a private hospitals, there are senior people and doctors who may be of help in their training. I seriously feel that our entire medical system is going down the drain with poor planning, inadequate training and with a “license to kill”………….. Would they soon ask private hospitals to conduct housemanship training? Well, being in bolehland, nothing is impossible!

Whatever said, we still need a lot of pharmacists in rural areas. This is the reason the government is mulling special incentives for pharmacies to be set up in rural areas. This was also reported 2 days ago over here ( see below). Right at the end of the news, it is mentioned that we will achieve the WHO pharmacy to population ratio of 1:2000 by 2016! Sounds familiar? what happens after that? Jobless pharmacist?

The Malaysian Pharmacy Society has already started the zoning system in preparation for the 1Care system. I had written about this over here and it is also mentioned below.

So, can anyone still deny that doctors can become jobless? We are just producing too many graduates in every field. The private colleges are having a field time producing half baked graduates for the sake of money……………. The realisation is simply tooooooo late!!

Read more: Ministry relaxes pharmacists’ training scope – General – New Straits Times http://www.nst.com.my/nation/general/ministry-relaxes-pharmacists-training-scope-1.224323#ixzz2M0yeMb6E

Health Ministry mulls incentives for opening community pharmacies

I had written on how a life of a doctor is changing gradually with increasingly demanding patients and patients who do not hesitate to take any action against you, over here and here . I had also written about doctor’s dilemma over here, here and here. I just had a chat with a medico-legal lawyer and what I heard from him is rather scary and I can see where the future is heading for medical doctors. The number of legal cases against doctors seem to be increasing by leaps and bounds. The number of complains against doctors to MMC is also increasing day by day. This could be the reason why the government is making it mandatory for doctors to have indemnity insurance in order to renew your APC from next year onwards. Whether this fee will be paid by the government for government doctors still remains to be seen.

In US, doctors spend almost 10-30% of their entire career on medicolegal claims as mentioned in the table below. The highest was Neurosurgeons followed by Orthopaedic surgeons and General Surgeons. Even though more than half of it may not end up with a claim but the hassle that you have to go through will affect your life, your reputation and your daily practise. That’s the reason some doctors retire early in many developed countries. This is also the reason why doctors in US practices CBM ( Cover Backside Medicine) by doing all sorts of investigations to cover themselves. The situation will eventually be the same over here as you can already see it happening in major towns especially in Klang Valley. The very patient that you tried to help will turn against you. This is despite a flat salary growth for physicians in US over the years as mentioned here and attached below. It is the same over here where most doctor’s income are gradually dropping, especially in bigger towns.

The medico-legal lawyer that I spoke to represent one of the largest legal firm which handles medico-legal cases. The sentence ” patients are your worst enemies” was mentioned by him! When you least expected, a letter will reach your doorstep for a claim! That’s when your nightmare begins……………..

As the election comes closer, I seem to be getting nauseated every time I hear the mainstream news. The word 1 this and 1 that never failed to be portrayed in the news/commercials. I stopped watching the mainstream TV news and newspapers almost 5 years ago as I felt like a fool sitting in front of the TV box. No wonder they use to call it ” A fool’s Box”! However, sometimes I end up listening to the news while I am eating or drinking a cup of coffee at a tomyam shop. There is nothing educational in the TVs nowadays for the younger generations. It is either some rubbish news for idiots or entertainment to keep the population as dumb as possible. Just compare the news at CNN, BBC, Al Jazeera and our TV3 news !!

The latest series of 1 this and 1 that is SPP1M. Just when we thought we had enough of BR1M, KR1M, CL1M etc, here comes another genius idea from our government to anaesthetise the people. I simply don’t understand this scheme. With PTPTN being the biggest scam in this country, making some private colleges and universities rich by producing sub par graduates who instantly becomes a debtor, we now have another scam in the making. I wonder how this scheme suppose to help the people. As far as I am concerned, it will only create more debts which will take a life time to settle. Remember, the interest rate is BLR-1% during the study and BLR for the rest of the years ( the BLR now is 6.6%). The total repayment period is 15 years, excluding 5 years of education. You must start paying back the loan after 6 months of completing the study. The monthly repayment can range from RM 800 – RM 1300/month for 15 years, based on my calculation. For your information, house loan have a much lower interest rate of BLR-2%!

Are we creating a future generation who will be in debt for the rest of their life? Don’t forget the car loan and house loan that will come along the way. Why can’t the government invest more money to build more public universities and subsidise the education? Commercialisation of education should not happen. It will only make a few people rich in the expense of the rakyat who get poorer by the day.

Another interesting thing about this scheme is that it specifically mentioned postgraduate medical education! As far as I know, all Master’s students will be automatically given JPA scholarship on top of the monthly salary that they continue to get ( since they are working full-time during the course). So, why do they need the loan? Is it an election gimmick or is it a prelude for something that is coming? As you know, KPJ has started the first private postgraduate education for ENT which took in their 1st batch this month. I had written about this before over here and here. I was informed that 5 students has been enrolled, 2 being sponsored by MARA , 1 of their own chronic MO and 2 self sponsored. They will be given an allowance which will be equal to their last drawn pay! I think I had given enough views about this program in my above articles before. There is still a question hanging unanswered about their gazettement process and job after their Master’s. So, is this SPP1M a prelude for more private postgraduate education in the making? Knowing Malaysia, rumours will always come true!

Everyone, including the government knows that we will be having surplus of doctors by 2016/2017. So, the money-making business now is turning to postgraduate education. More money with low quality products is going to make our medical field equivalent to Indonesia. Their own people do not trust their doctors. Will the same scenario happen in this country 10-20 years from now? Almost all countries that privatised their medical education has gone to the drains. The same will happen to our beloved country. Unfortunately, I was sad to read the latest Berita MMA article written by the president of MMA. During the dinner with PM held in December 2012, our President has proposed that reputable private medical universities of long-standing should be allowed to run postgraduate courses!! He suggested that it should be done in the government hospitals but conducted by the private universities. I would only support this if we can have a common postgraduate exams like MRCP, MRCS etc. This exams should be conducted by the Academy of Medicine (AMM). When even our MMC could not conduct a common MQE exams, I can’t expect AMM to conduct such exams. It is a long way to go……….

The SPP1M scheme by the government does not seem to be receiving positive feedback from the people as mentioned here and below. Everyone with a correct state of mind knows that it is a 1CRAP scheme…………………….. vote wisely ………………….

Khaled: SPP1M scheme good for those in private institutions

By KAREN CHAPMAN and PRIYA KULASAGARAN
educate@thestar.com.my

Finally, what I have been saying all this while has come true , yet again. I first wrote about having too many universities in Malaysia over here and here. I wrote the first part in Feb 2012, almost 1 year ago. I have said many times that education should never be commercialised, especially fields like medicine etc. The quality is sure to deteriorate as all private colleges are only interested in making money and will not be bothered about quality ( with PTPTN in their pocket). What happens to the graduates is none of their problems. I had written about this many times before. Our politician’s ambition of making Malaysia an “education hub” will only backfire with low quality products which in turn will affect the productivity of this country. Majority of the students are Malaysian anyway.

Today, our Higher Education Ministry has finally admitted that we are having surplus of universities producing surplus of graduates. Thus, 2 years moratorium is being implemented immediately , starting this Friday (please read here and below). Well, I think it is just toooooooo late. The existing ones will continue to produce thousands of graduates which will saturate the market with low quality products.  As of August 2012, we had 502 IPTS, not including the IPTA!! I had written about this over here, way too many for such a small country like ours.

When the government introduced moratorium of nursing colleges, I wrote this in April 2010. Remember what I said, that even if there is a moratorium, the existing schools will continue to produce thousands of graduates. Exactly as I predicted, in Oct 2012, it was made official that almost 8 000 nurses are jobless as I had written over here and here. In a knee jerk reaction, the government created 1600 nursing post in government sector, end of last year. What surprised me was the fact that the PSC chairman is saying that most of the nursing graduates do not qualify to enter civil service as they do not have 5 credits in SPM which is the minimum requirement by the government to enter nursing school and most of the nurses have only 3 credits ( please read here and below)!!! What the hell is MQA and Nursing board is doing? This is the reason I keep saying that MQA evaluation is pointless. I have sat through one and I can tell you that it is predominantly a desk audit. The college can hide a lot of facts and get away with it! The PSC chairman has got this to say “Zainal Abidin said what the government did was a short-term measure to solve the unemployment problem faced by nursing graduates, while for the long term, the Higher Education Ministry would be collaborating with the Health Ministry in setting entry qualifications”  WTH!! Do you mean there were no entry qualifications before this ? Any Tom, Dick and Harry can join any course in this Bolehland?

Of course, I had written enough about the medical schools. With 36 medical schools, we will definitely have surplus of doctors by 2016/2017. Let’s see what our great Minister will say then? The moratorium still remains a moratorium on toilet paper! It seems the Ministry is asking private universities to offer clinical postgraduate courses!! These universities do not even have enough lecturers to teach undergraduate students, how are they going to teach postgraduate students on clinical skills like surgery etc etc!!

Again, GOD save this country…………………..I am nauseated!

Two-year moratorium on new private varsities, colleges from Feb 1

1.1m applications received for civil service vacancies

My first part of this topic received tremendous amount of viewers, reaching almost 1500 views/day since 07/01/2013. That shows how many were interested in the topic. I am sure by now they would have got the true picture of the pathway to become a Cardiothoracic surgeon and why there are so few of them in the country. I am not sure how many budding doctors would still want to become one after reading the article. It is always better to decide after you start working when you know the reality of a medical life.

Now, let’s look at Neurosurgery. This is another common question that I am always asked by budding doctors. Again, TV programs showing glamorous and rich lifestyles of neurosurgeon get them carried away without knowing the reality. Whenever someone ask me about neurosurgery, I always ask them to take a walk into any neurosurgical ward in any state hospitals and let me know after that, what you felt when you were walking through. Personally, it is depressing. Many budding doctors think that they are going to be operating on brain tumors and do wonders! Well, that is not the reality. Recently there was a comment in my blog of a budding doctor (just finished SPM) who wanted to become a neurosurgeon just because she heard that neurosurgeon are the highest earners!! Gosh, what kind of students are we producing? They really got no idea about the world out there. In government service, all specialists are paid the same based on your grade.

Brain tumors account for less than 1% of all cancers and 1/3 of it are malignant cancers. Most of these malignant cancers have poor outcome despite surgeries. The incidences are also low with less than 7 per 100 000 population. So, from here, you will know that these are NOT the bulk of cases that neurosurgeons are dealing with. The major bulk is actually motor-vehicle accidents with head injuries! Malaysia has the highest number of road accidents in this region. Thus, head injuries contribute to almost 70-80% of patients in neurosurgical units. The remaining are contributed by Intracranial bleeds (bleeding in brain) and finally brain tumors. BTW, most surgeries involving brain tumors will end up with neurological complications like epilepsy, limb weaknesses etc, even in good hands. Brain tumours involving children is the most depressing. I know a Neurosurgeon whose own child died of brain tumour!

Most intracranial bleeds have poor outcome as well. That’s the reason when you walk into any neurosurgical unit, you will see many patients who are bedbound, speechless and comatose. Many of them end up going back as a “vegetable”. Very few survive and go back fully conscious. However, there are some intracranial bleeds such as Subdural, Subarachnoid and Extradural bleed that have good prognosis if early intervention is done. This is where most satisfaction occurs. The procedures involved are usually simple, like burr hole, craniotomy and EVD. To be frank, these procedures are done by neurosurgical MOs in government hospitals and sometimes by general surgeons. So, you really do not need a Neurosurgeon to do these simple procedures. Nowadays, even interventional radiologists are trained to do cerebral angiogram and clipping of aneurysm !

Neurosurgery involves a lot of training and skills. This is needed mainly for surgeries involving brain tumors and spinal surgeries. These are delicate surgeries. There are a lot of advancement in microsurgery involving the brain and spinal cord. However, most of the time there is nothing much that can be done and the outcome is generally poor. I remember once I was talking to a Neurosurgeon about a patient who had massive intracranial bleed. The GCS was below 7. The neurosurgeon said that ventilating and doing cerebral resuscitation could save him. I asked him what would be his neurological recovery. The answer: well not much, his GCS likely will remain low and he will go back bed bound! So, what is the point? I am not undermining neurosurgeons but the budding doctors should understand that being a neurosurgeon is not about doing wonders. I know many who even dropped out while in training as they felt it is not worth it.

The entire state of Johor has only 2 Neurosurgeons in private sector and that’s all you need. In fact, the 2^nd Neurosurgeon just started 1 year ago. Since 1980s, there was only 1 Neurosurgeon in private sector for the entire state of Johor. There was only 1 Neurosurgeon in JB Government hospital till about 2 years ago when another 2 joined him. It is a stressful job and in private sector, you need to come and see the patient at any time of the day as long as the patient has head injury. Looking at the road accident rate in Malaysia, likely you would be called almost every other day. I also know neurosurgeons in private hospitals who do unnecessary procedures just to get some money even though they know the outcome/prognosis is poor. You can save lives in the expense of poor neurological outcome aka “going back as a vegetable” to the dismay of the relatives who had spent so much of money. That’s the reality in medicine.

Now, let’s come to the pathway. There are 2 pathways to become a Neurosurgeon in Malaysia, the shorter route and the longer route:

a)    Longer route

–       2 years Housemanship

–       2-3 years MOship

–       4 years Master’s in Surgery

–       6 months gazettment

–       1-2 years waiting period

–       4 years Neurosurgical subspecialist training

–       another 3-5 years experience before being able to perform surgeries on your own.

b)   Shorter route

–       2 years housemanship

–       2-4 years waiting period (min of 6 months experience in General surgery and 18 months experience in any other recognized field after housemanship)

–       4 years Master’s in Neurosurgery by USM

–       6 months gazettment

–       4-5 years experience before being able to perform surgeries on your own

Master’s in Neurosurgery by USM has a very limited number of posts offered, usually less than 10. So, the chances of you getting into this program are slim on first try. You also need strong cables and preference is given to those who are working in neurosurgical units.

Whatever said, we still need a lot of neurosurgeons in Malaysia. BUT, please remember that the working life is not as simple and grand as what is shown on TV programs. The reality is different. It is a hectic life, needs a lot of skills and training, depressing and generally have poor outcome except for some instances.

The new amended Medical Act 2012 has been approved by Parliament end of last year. As such, effective from now,MMC has the authority to accreditate and register specialists in this country. MMC recently adopted the latest registration procedures for foreign doctors applying for work, do research or postgraduate education in Malaysia. I get asked a lot of questions from foreigners who wanted to work in Malaysia or do the local Master’s program. The standard rule still applies, that your basic degree MUST be recognised in Malaysia. If not, you need to sit and pass the MQE exams. Exemption can be given if you have more than 10 years experience working as a doctor or you have a recognised specialist qualification (for teaching and research). Those who are given registration to do postgraduate education must leave back to their home country upon completing the course unless you can show prove of any employment offered locally.

As for specialist returning from overseas claiming to be a specialist, a new Specialist Evaluation Committee has been formed to look into their qualification. Either you must be a well renowned specialist, have qualification recognised by MMC/NSR or have unrecognised qualification that have equal number of years of training as in Malaysia with 5 years of experience ( 4 years in public hospital of adequate size). They may even ask the specialist to undergo certain amount of supervised attachment before registering as a specialist.

You can read the procedures in this document. This is a good move to prevent anyone from calling themselves a specialist. Finally, something is in place to monitor this.

Just when I thought I had enough of writing about our “world class” education, here comes the joke of the year. Since yesterday, the cyberworld has been loaded with the word “listen”. It was such an entertaining video but such a tragic incident for our universities. When this video first appeared in my Facebook page yesterday, I was not totally shocked with what they were doing to the students but what amused me was the way the panelist responded. The conversation really shows who had brains and who was shooting all over the place without any knowledge, even though she claim she is a degree holder! What surprises me even further is the fact that most of the students who were listening probably got no clue of what was happening. They seem to be clapping their hands all over the place!! What type of university students are we producing? Well, I think I had talked about this so many times before. Our universities and the education system as a whole, has gone to the dogs !

These type of programs happens in all universities. It is a form of brainwashing forums aka BTN type “boot camps”. Anyone who cares to read about Hitler and the Nazis will find a lot of similarities. For those who do not know who Hitler was, please go and read. Our history books are good for nothing nowadays. Current generation do not even know anything about world history and who is Gandhi, Napoleon, Abraham Lincoln, Stalin etc etc. That’s how well our education system has “evolved”!

Following the video, there were some interesting parodies that were made within one day. I must say, Malaysians are good at this for sure. Namewee came up with this and another interesting dance remix here is a good watch. It is a national shame! The video is now being viewed by the whole world and it clearly shows what is happening in our universities. Universities are supposed to develop critical thinking, employable, knowledgeable graduates. Instead, we are producing “katak bawah tempurung” graduates who get a shock of their life when they enter working life. In my New Year 2013 post, I mentioned what is being distributed among Standard 2 students. So, together with this new video above, I am sure anyone can guess what kind of education system we are having. Whatever blueprint that our Education Minister wants to introduce will not change anything as long as the education system is politicised. Education should be left with the academics and politicians should never get involved. Unfortunately the “brain-washed” generations are now “brain-washing” the current generations. I admire the courage and “guts” that this girl Bawani had for coming up and giving her view. I understand that she is a 2nd year law student.

This would become one of the best “comical” video for this year. What an introduction to year 2013! I still remember the “correct, correct, correct” video before the 2008 General Election. For 2013 General Election, we have “listen, listen, listen” video………………… Lastly, the post below was taken from Facebook. Laughter is the best Medicine………………