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After a very exhausting month of October, finally I am taking 2 days off to celebrate Deepavalli with my parents in Seremban. I must say that the month of October was a very busy month for me. Almost everyday I had patients in my ward and clinic. I even had a very ill patient with Severe Pneumonia who was finally ventilated in our ICU and transferred to Hospital Sultanah Aminah’s ICU. I heard the patient died 2 days later despite the best treatment. We are still loosing our battle to the brainless bacteria and viruses!!

I hardly had any time to blog or even reply to emails in October. Imagine almost everyday, going to the hospital at night to see ill patients!

The situation in my hospital seem to be cooling down over the last 2 days, probably due to the long weekend that is coming. I will be taking off from 6pm 4th November till 6pm 6th November for a short break with my parents. I thank Dr Chan for helping to cover for me during my absence. Thankfully my house kitchen renovation has been completed in time.

I would like to wish everyone a very Happy Deepavali 2010.

Our country seems to be taking a 360 degree turn. First, when I saw our new Proton Waja replacement model on TV last week, I was laughing my head off. What replacement model? It is back to square one!

Proton started by using Mitsubishi cars way back in 1985, with Proton Saga and Proton Wira. Proton Wira was basically Mitsubishi Lancer in 1980s. After about 15 years, they came up with their own model, which was Proton Waja and subsequently Proton Gen 2, Savvy,Persona and finally Exora. In stead of moving forward, we are now back to the basic! Go back and rebadge Mitsubishi Lancer 2009 model! Way to go , man! If I am the CEO, I rather commit suicide then appearing on TV claiming it is another new model of Proton!

Then, in the worst and most useless Budget (2011) that I have ever listened, we have our beloved PM going back to mahatirism! Build big towers of erection to look great of yourself. Petronas twin tower is almost more than 50% vacant. Dayabumi is also half vacant and now, our PM wants to build another 100 storey tower worth RM 5b! Where is the logic!. No doubt it will stimulate the economy by producing jobs and companies but only for short term. It does not bring any long-term benefits. This is the reason why you don’t see many countries doing this type of development. Just look at Dubai and what happened during the economy downturn.

We seem to be moving backwards than forward. The below video is interesting

For Future Doctors: Housemanship, Medical Officer and Postgraduate Training (Part 2)

It has been more than 2 weeks since I last posted on this topic. I have been quite busy lately with increasing workload in my hospital as well as some renovation work going on in my house. In this Part 2, I will write more about what to expect after finishing your 2 years Housemanship posting in Ministry of Health.

1)      Compulsory Service

I am sure everyone knows about the compulsory service for doctors in government service. According to Medical Act 1970, a medical graduate has to undergo compulsory service with the government for at least 4 years. This includes the Housemanship which is now 2 years. This means that you need to serve the government for another 2 years before you decide to leave the service.

2)      District/Rural postings

As I have said in my first part, after completion of your housemanship, you will likely be transferred to rural clinics or district hospitals. With the recent influx of large number of doctors, almost everyone will be transferred to rural areas, mainly Sabah and Sarawak. You can see this from various letters posted in almost every newspaper recently, embarrassingly by parents of “so-called” grown up doctors!

From my experience, district posting is a wonderful experience. Working alone without anyone to consult immediately, gives you a lot of experience. Remember, other than X-rays and some simple blood test, you don’t have anything else in these hospitals. Usually there will be about 3-5 Medical Officers (MO) in each district hospitals. When you are “on-call”, you are all alone and need to manage the A&E department as well as all the wards including obstetrics cases. It is really scary at times, especially if you are working in district hospitals which are far away from the nearest General Hospital. If you are preparing to sit for any exams then this is the time to do your revision as the workload is generally lower than in general hospitals.

The same goes for those who are posted to health clinics (Klinik Kesihatan). These clinics are usually situated in rural and semirural areas. Most of the time there will be 1-2 MOs in each clinic. The major bulk of patients that you see in these clinics are antenatal and outpatient cases. There will also be a lot of administrative work to do in these clinics including school visits, running various health campaigns and public health talks. In cases of any outbreaks, you will be called to assist in containing the outbreak. Basically you are the primary healthcare providers. Many doctors do not like the administrative work that they are supposed to do, and the meetings that you need to attend!

Even though it is a good experience to do rural/district postings, please do not stay long in these clinics/hospitals if you intend to do postgraduate studies. A maximum of 1 year should be adequate. The reason I say so is because you will lose the momentum to further your studies after some time of good life in these centres. Since the workload is lower, you will get carried away with relax life compared to your housemanship training.

This rural/district postings are usually given extra points when you apply for your Master’s programme even though it does not guarantee a place. At the same time you can use your free time to prepare for your exams like MRCP Part 1, MRCOG Part 1 etc etc. After passing your Part 1, you can request to be transferred to the General Hospital for continuation of your training. Again, this may become a problem in the future as the number of post may be limited and it may be increasingly difficult to get a place in bigger hospitals.

I think people who grumble about going to rural and district postings should just give-up medicine. If you choose medicine to help and treat sick people, then these postings is where you really see the real life of people. You will learn a lot about their social life and the struggle they go through daily which you do not see when you work in general hospitals. You will also realise that people here appreciate you better than urban people. I would advise each and every doctor to do rural/semirural and district postings for at least a year after completing your housemanship.

 Next: Postgraduate training…………………

 Excellent view from the German Ambassador. Spot on……………………… What has Malaysia got after chasing away all the best brains due to NEP!

Just build a building, call it a University and print a degree lah, so easy mah! Malaysia Boleh Mah…………

I wonder where is PERKASA and Mamak Kutty, sorry, I heard the latter is somewhere in Melbourne!

 

Skills, equity hurdles to investment

Malaysia doesn’t need Nobel laureates or a man who can go to the moon but qualified, hands-on people to raise their level of competence, says German Ambassador to Malaysia

Several factors are deterrents to a larger number of German investors putting their money into Malaysia, and top of the list is the lack of a qualified workforce.

“Malaysia doesn’t need Nobel laureates or a man who can go to the moon but qualified, hands-on people to raise their level of competence,” said German Ambassador to Malaysia, Dr Guenter Georg Gruber.

He said Malaysians appear to have the notion that an engineer’s work is to get suited up and sit in the office all day.

“Nobody in Germany does that. A qualified engineer goes down to the pits and repair the machines himself, if need be, and he is respected for the willingness to get his hands dirty. Here, the engineers are … different.”

He said this boils down to the lack of emphasis and importance placed in vocational training.

Possibly, it stems from the lack of social acceptance of a person who works with his hands here, Gruber told Business Times in an interview in conjunction with the 20th anniversary of the reunification of East and West Germany tomorrow.

Social acceptance is equally high in Germany whether you are a painter, an electrician or an engineer – as long as you are a master of your craft. “In fact, if you are a good electrician, you will be highly respected and earn good money.”

This appreciation of applied knowledge is probably what propelled Germany to become a world leader in innovation, science and technology today.

As a case in point, he cited his two brothers: one who is a painter and the other, an electrician. Both earn more than he does.

Malaysians are too engrossed in the paper chase that they forget about skill acquisition. Parents’ role in this obsession cannot be downplayed, Gruber said.

“You should always ask what the industry needs. But here, parents only want to send their children abroad, (probably) to some third-class university to get a foreign degree.”

Another factor which he feels is holding back German investors is the Bumiputera equity policy.

Germany’s “hidden champions” – the powerful, often family-owned small- and medium-scale enterprises (SMEs) – are keen to invest here, but are wary of having to give up a substantial share of their business to a “complete foreigner”.

“These are often businesses which have been kept in the family for possibly hundreds of years. They would not want to share their company with someone they don’t know.”

Although they have heard of many positive news from the government on reducing the equity quota, Gruber said that many were still hesitant and adopting a “wait and see” attitude to assess how the new policies would be implemented.

One major German SME which is already here, B-Braun Medical Supplies Sdn Bhd, is currently suffering from market access problems due to the Bumiputera issue, he disclosed.

B-Braun is a company with worldwide presence and an established history of supplying medical solutions in the surgical, pharmaceutical and healthcare management fields.

It does not have a Bumiputera partner, which prevents the company from bidding for government contracts.

“B-Braun has been investing since 1972 because they have had good experience here and want to continue. But they are being excluded in public tendering because of the Bumiputera issue,” said Gruber.

Although this was initially regarded as a “small issue”, it is now becoming a sore point for the company as a new Asean rule states that any company excluded from public tender in an Asean member’s market “would be excluded from all Asean markets”.

“This is not a very positive image for Malaysia if you want to attract more foreign investments,” Gruber said.

Germany has long been recognised for its “highly specialised small and medium enterprises” segment. They are often called “hidden champions” because most produce inconspicuous products but are global market leaders in their own segments.

“We don’t want to impose any ideas on the Malaysian government. They have to choose for themselves whether they want to evolve to remain competitive. Malaysia is doing a lot of reforms as we speak and many initiatives are laudable and fantastic. But implementation, as always, has been a bit of an issue here.”

Germany is one of the top four investors in Malaysia in terms of cumulative investment value, currently at more than RM16 billion.

Even during times ofeconomic crisis, such as last year, when overall foreign direct investments into Malaysia dwindled considerably, fresh money was still coming in from Germany of about RM200 million.

Gruber said that although German investments have remained quite constant, Malaysia has to work harder to stay competitive.

“We have to be frank. A lot of investment goes to China now and to be and remain a world-class leader, Malaysia has to find its niche.”

He suggested that the country look at expending its efforts in developing the renewable energy and pharmaceutical sectors.

“Malaysia is uniquely blessed with many renewable energy sources – palm oil, biomass, sun, water – but it has not fully capitalised on them,” Gruber said. 

Read more: Skills, equity hurdles to investment http://www.btimes.com.my/Current_News/BTIMES/articles/jermani-2/Article/index_html#ixzz11CCaxiLL

It is very interesting to see in this era and time, there is a country known as Malaysia which still decide what a citizen should and should not read!!!! Probably the authorities are still leaving in stone age. With such a fast developing  internet/IT era now, we can download the entire book via the internet or even purchase it online! It will reach your doorstep in a couple of days. The government still thinks that we are school children.

If you think that the facts that are written in the book are wrong then by all means, please sue the guylah………. Obviously they will not do that because it will be like opening a can of worms!
Now, not only they ban books but also cartoons…………………………….. How to develop creativity! Cartoon-o-phobia………………
Our Mamak Kutty said that he wants to sue Barry Wain for the book ” Malaysian Maverick” but till today no action mah…………………
 
BTW, each time when they ban a book, it only makes the book a best seller! Now, people will be buying it over the net and from Singapore……………… I bought “Malaysian Maverick” from Singapore!
 
It reminds me of Hitler. If anyone were to read the history of Hitler and ” Ketuanan Aryan“, you will find a lot of similarities between Malaysia and Germany during Hitler’s era. Remember ” Burn the Book” era of Hitler! Hitler’s propaganda is very much similar to Biro Tatanegara’s racial and religious indoctrination. I think our Mamak Kutty is reincarnation of Hitler! What UMNO is practising is exactly what the Nazi party practised in Germany before World War, use your enemies(Jews ) to the maximum then screw them. Most of the German’s technology then were invented by Jews but he turned against them for his political survival.
 
BTW, please visit Malaysia Today website (www.malaysia-today.net)   by Raja Petra (RPK) who has released confidential letters/investigations paper from Anti Corruption Agency!! A good read and you will know why MACC is another component party of BN! Sayonara………………………….
 
 
Kim Quek’s book banned
//
Sep 30, 10 8:13pm
Share 17

The Home Ministry has issued a ban order against the book ‘The March to Putrajaya – Malaysia’s New Era is at Hand’, for inciting hatred against the constitution.

NONEThe ministry’s secretary-general Mahmood Adam said the book, written by author Kim Quek, is “not suitable for general reading”.

He said the book contained elements of “baseless accusations and speculations” against national leaders and could incite public hatred and anger.

On Aug 19, Chua Seong Khoon, a representative of the book’s distributor Gerak Budaya, said that some copies of The March to Putrajaya were seized by the authorities from a Popular Bookstore outlet in Kuantan Megamall, Pahang.

A week later, publishing firm Oriengroup Sdn Bhd executive director Low Chee Chong was questioned by police at his office in Cheras in relation to the book.

“Three police officers from Bukit Aman came to my office and they questioned me under Section 112 (of the Criminal Procedure Code as a witness),” said Low.

Here we go again!!!!!!!!. Another medical school! We already have 30 medical schools churning out thousands of underrated doctors and now we have this news! I am not sure when the government is going to stop all this nonsense. We have the highest number of medical schools per capita of the population. Any university can set up their branch campus here, but the question is , is there enough human resource aka academics to run these schools? The answer is a big NO!

Is it rather ironic that the government which has always prevented the universities from building their own hospitals before, seem to have taken a U-turn in this case. New economic model perhaps! Actually, Monash University Malaysia has already started to build their own private teaching hospital in Sunway which should be ready by 2013 but they will still use JB hospital. So, this will be the second university to do so if at all this plan becomes a reality. It is very difficult to run a private hospital in Malaysia with medical students running around. Patients come to private hospital for better care and comfort, thus most of the time they would not want medical students to disturb them. The situation is different in US as all hospitals are considered private hospitals.

Somehow I feel, this foreigners are not given the true picture of the situation down here. Further more, this foreign universities are not investing any money for the campus etc. All the money comes locally from the government, GLC and local investors. Good example will be Newcastle University in Nusajaya where the entire campus is being  built by Khazanah !

Johns Hopkins University to set up medical school and hospital in Malaysia

By WONG CHUN WAI
newsdesk@thestar.com.my

NEW YORK: The world-renowned teaching and research medical institution Johns Hopkins University will be setting up a medical school and hospital in Malaysia.

Prime Minister Datuk Seri Najib Tun Razak said a site at Serdang in Selangor had been picked to set up the facilities, which would become a medical research hub for the region.

The medical school, he said, would offer a four-year programme, adding that it would be a private initiative between Malaysian and American investors.

It will be Malaysia’s first private teaching hospital with research facilities.

Speaking to Malaysian newsmen here on Friday evening, he said an agreement would be signed early next month.

The Prime Minister did not give details of the project but it is understood that a Malaysian public listed company would be involved in the medical city plan, estimated to cost RM1.8bil.

There are Johns Hopkins University campuses in China, Singapore, Italy and the United States. The Johns Hopkins University in Baltimore, Maryland, is a private, non-profit institution.

Earlier, Najib met Dr Mohan Chellappa, the president of Global Ventures, Johns Hopkins Medicine International, where the Prime Minister was believed to be given an update on the 600-bed private hospital.

The prime minister said Johns Hopkins Medical International was a world-renowned medical school and had adopted a different curriculum compared to other schools.

“They are using the ‘Genes to Society’ curriculum, which is a more personalised medical approach,” he said, adding that the school provided a four-year programme and planned to take 100 students each year.

“Johns Hopkins has got a very good name. The idea is to create Malaysia as a hub,” he added.

Health Minister Datuk Seri Liow Tiong Lai in welcoming the move said the presence of such a prestigious research facility in the country would boost Malaysia’s health tourism industry.

This, he said, was another feather in the cap for the country’s healthcare industry and would also prompt more Malaysian-born specialists and other health care professionals to come back and serve in the country.

Liow is currently in London in an effort to persuade Malaysian professionals involved in healthcare to return home and serve the country.

“I am here to convince them to return home and serve. I believe many will find it more gratifying to work in Malaysia now,” he said when contacted.

He is also speaking to Malaysian medical students and fresh graduates to convince them to return home once they complete their studies.

For Future Doctors: Housemanship, Medical Officer and Postgraduate Training (Part 1)

I received more than 10 000 visitors to my blog posting on “The General Misconception of Doctors Part 1 & Part 2” since 08/09/2010. I also had many comments supporting my article. Surprisingly, most of the comments were from medical students and young doctors who just started housemanship or just completed. I also had some overseas doctors giving their comment, not sure whether they are Malaysians or ex-Malaysians?

Even though many supported my articles, I also had few asking me to tell them what is in store during housemanship and postgraduate training in detail. Thus I thought it is about time I give them the full detail, to my knowledge, about the current and future situation in Malaysia. There was a person who asked me to write some positive aspect of being a doctor. Well, I only have 1, a total satisfaction of treating a patient till recovery. But always remember, you can only cure sometimes. I have had a medical student who refused to go to the ward after seeing a young boy dying of Leukaemia. Well, this will be a daily affair once you set foot into the medical field. Be prepared to see people die no matter what you do. To comfort always but to cure sometimes should be your motto!

1)      Housmanship

I will divide this section into 3 subsections, explaining what has been happening since 1990s in housemanship training;

1a) Before 2000

Before 2000, the housemanship training use to have 4 monthly rotations in Obstetrics & Gynaecology, Medicine or Paediatric and Surgery or Orthopaedic. After the 1 year training, you will be transferred to rural or semirural areas to serve in district hospitals or Klinik Kesihatans (KK) (health clinics). Most of the time, these rural postings are a wonderful experience but a little bit scary due to lack of senior people to consult or assist you.

One of the major faults in this system is the fact that if you do Medicine, you will miss Paediatric and if you do Surgery, you will miss Ortho. Only O&G was made compulsory. Thus, the government felt it was inadequate. Many will go to KK and District Hospitals without doing Paediatrics/Medicine and Orthopaedics/Surgery. A lot of the time, you need to depend on the senior nurses or Medical Assistants (MA). I must say that during that time, the nurses and MAs were excellent. They were second to doctors, not to be compared with the current generation of nurses and MAs.

BTW, just to mention, the HO’s take home salary before 2000 use to be RM 1648!! Pathetic isn’t it? You won’t even be able to buy a car/house. The car loan interest rate than was 6-8%! You will get RM 20 for each on-call that you do! This “On Call” allowance was only introduced in 1994. Prior to that, you are not paid a single cent for your “On-Calls”, free labour for the government mah……………..

1b)  After 2000

Around the year 2000-2002, a new posting known as junior medical officer postings was introduced after housemanship. This is also known as the 4th and 5th HO posting. It was 3 month posting in either medicine/paediatric or surgery/ortho depending on which that you did not do during the 1 year housmanship as above. After completing the 4th and 5th postings, you will be posted to rural or district as a Medical Officer.

1c)  Since 2008

Since 2008, housemanship training has been extended to 2 years. This means you will be completing all the major postings before being transferred out.

2)      Life as a Houseofficer (HO)

When I did my Housemanship in 1990s, there were only 2-3 HOs in each ward of 40-60 patients. It was a tough life.  You are the front liners who will see the patients for the first time upon admission. You’re supposed to take the medical history of the patient, do a physical examination, take blood investigations and come to a diagnosis. In fact, you’re supposed to start the initial treatment and management of the patients. There won’t be any medical officers or specialist in the ward. Most of them will come only in the afternoon to see the patients. This means, you’re the boss in the ward and the life of the patient is in your hands! It is a very stressful life, where on top of all the existing patients in the ward, you also need to see all the new admissions. The new admissions can be about 20-30 admissions/day, divided between each of the 2-3 houseofficers.

You start your work around 7.00am everyday especially if you are doing medical or O&G postings by taking the ward patient’s blood. Then, you will be doing the clinical rounds with the Medical Officers and Specialist of the ward. After finishing the rounds, you need to carry out all the orders by the specialist and at the same time, clerk all the new admissions! You also have to run down to radiology department to get urgent appointments, go to the blood bank to get urgent bloods, trace results urgently etc etc. Of course, you may not finish your work by 5pm. If you are “On Call” on that day, you need to con’t your work throughout the night till the next morning 8am. And now, don’t think you can go back to your room and rest! You are supposed to con’t with the work on the next day as usual! You are basically a professional coolie!

As a HO, you need to do at least 10 calls a month, which means once every 3 days. I have even done continuous day calls before, never saw sunlight for 2-3 days! For each calls, we were paid RM 20 then, now it has gone up to RM 100 since 2006 ( please read my MMA article on “Government doctors: Past, Present and Future”). I use to say that you can earn better by working in Mc Donald’s!

Whatever said and done, I enjoyed my Housemanship simply because I had good colleagues who helped each other very well. I also enjoyed learning all the skills and procedures during my housemanship. Housemanship is the only time where you can learn all the necessary skills in doing procedures like CVP line, Chest tube, Peritoneal Dialysis etc etc. Thus, as I said before, if you became a doctor for passion and to help people, then you will enjoy housemanship. But if you choose medicine for glory, good life and money, it is during this time that you will realise that medicine is not for you. That’s the reason why, many will get a mental breakdown during housemanship. They never expected their life to be like this! Many still think that being a doctor is sitting in a clinic and seeing “cough and cold” cases. Being a doctor is more than that.

Of course, the situation has changed recently. With the tremendous increase in the number of doctors produced, we have almost 6-8 HOs in each ward of 40 patients. In fact, surgical department with 2 wards, sometimes has more than 40 HOs!! The workload will definitely be lower but you will lose out in your training. How many procedures would you be able to learn with so many of you in a ward? I have even seen some HOs leaving the medical department without doing a single CVP line or Chest tube. Only those who are eager to learn will succeed. The rests are just given a license to kill……… sorry to say!

3)      Rules and Regulation during Housemanship

There are few rules and regulations that you need to know as a HO. You will be given a log book for each posting. This log book needs to be signed off at the end of each posting by the department. The Head of Department (HOD) has the right to extend the training if he/she feels that you are not competent enough to be released. The extension is for a minimum of 3 months but can go on as long as the HOD feels adequate. Unfortunately, many of the HOD take the easy way out. No matter how incompetent the HO is, they usually let them go as they feel that it will not make any difference in extending their postings and of course less problem to the department. To me, I think it is very selfish for some of the HOD to think like this. Remember, these doctors are the one who is going to be released to the community with a “license to kill”.

As a government servant, you will be given 25 days annual leave. As a HO, these 25 days will be divided equally between the 3 postings that you do in a year. Any extra leaves including MCs, maternity leave and emergency leaves are considered as an extension of housemanship training. For example, if you take 1 week MC during a medical posting, your medical posting will be extended by one week, unless you want to deduct your annual leave allocated for that particular posting. This is one of the reasons why I always advise doctors/soon to be doctors not to get married during housemanship. Pregnancy will not reduce your workload as you need to do the same number of calls with the rest and it will only extend your housemanship even longer.

 Next, Part 2: Life as a medical officer and rural postings……………………………

Another interesting write-up by AB Sulaiman. Would Najib do a miracle? I don’t think so!

 
A nation of failed economic development plans
//
AB Sulaiman
Sep 20, 10
1:45pm
 
 

COMMENT The world can be a nasty place especially in terms of planning, where your best and well intentioned plans can produce the worst unintended results. The country’s numerous development plans is a perfect example of this.

Since Independence we have always strived to be a country with strong social, economic and political credentials: a strong healthy and united people, public safety and security, great infrastructure, mature democracy, clean human rights record, good education system, governed under rule of law, and of course, a justice-minded judiciary.

To top them all off we are to enjoy a per capita income equal to the peoples in advanced economies. We wish to be an advanced country in our own right.

The current realities are anything but. The people are fragmented while some are migrating to friendlier lands, our infrastructure while adequate is wasteful, our democracy is an ugly disguise for authoritarianism, our education system produces non-thinking graduates, the rule of law has become the rule by law, and the judiciary is an international laughing stock.

The latest world indices would confirm this. There are many but I’d mention just two. First, the 2009 figures for FDI showing an 81 percent fall from US$7.32 billion to US$1.38 billion. At this paltry level we now have joined investment-unattractive countries like Myanmar, Cambodia, Laos and Timor–Leste.

Not only that, apparently the FDI into Thailand and Indonesia have overtaken that coming into Malaysia, once the darling of international investors.

Two, as for per capita income we are at about US$7,000 while the advanced countries we wish to join are at US$30,000 and above. We are less than a quarter of the way to our self-proclaimed goal.

On looking back, we started well in the arena of economic development, but somewhere along the line we faltered and very badly.

Faltered from the start

I reckon we faltered beginning 1970 when we introduced the New Economic Policy (NEP). This was when we began propounding and experimenting economic development plans beyond the parameters of sound economic principles.

NONESpecifically we made plans and projections not in the interest of the country, but in the interest of a segment of the population, namely the Malays.

Now this might be an explosive statement to make so I have to make my stand clear.

The fact of the matter is that the factors of production in an economic set-up are land, labour, capital, entrepreneurship, and in an increasingly knowledge-based world economy, on the ability to access and utilise knowledge. I ‘borrow’ these factors as principles for economic development.

For an economy to expand therefore, all scarce resources must be optimally channelled for the development of these principles.

I’d reiterate: develop land, inject capital optimally for investment, encourage entrepreneurship, enhance the level of knowledge through smart education. Only then can the economy expand and achieve sustainability.

This last element of sustainability is important – the developing economy must reach a level when it can sustain or regenerate itself without anymore support from any planning agency.
Anything less than this and we can see an economy not going anywhere, and could in fact regress, like our current situation. Lim Kit Siang sums it well – the economy would be a ‘work in regress’.

What has gone wrong with our string of development plans? In my view there are several, and I mention them here despite being aware that many commentators have mentioned them constantly. Perhaps there can be some wisdom in saying the same things again, hoping somewhere along the line the decision makers can begin to listen.

Several hundred billion USD wasted

First, after 1970 we seem to divert the elementary formula for economic development mentioned above, into some non-optimal channels resulting in massive wastage. Our planners channelled land development mainly to the Malays. We made development plans for sectarian, not for national interests.

malaysia formula one race 170305 petronas team posingIn this way the Malays gain comparatively easy access to scarce capital they cannot fruitfully use because of their lack in entrepreneurial skill and spirit. Their lack in education and knowledge have rendered their productivity level below that of their non-Malay counterparts.

I am aware of course that this resource misallocation was for a special reason and thereby meant to be implemented only for twenty years. But when this time was up the authorities would merely forget this proviso.

As events turn out, such allocations have proven to be below optimum level; even wasteful of scarce resources. External observers have noted that the NEP wasted several hundred billion US dollars!

Favouring race over economics

When the leaders saw that the Malays could not cope and the non-Malays restive they use race and religion to both spur the Malay on and to push away any non-Malay disgruntlement. In other words the leaders dismissed the traditional economic factors of national asset creation in favour of Malay racism and cultural hegemony under the banner of Ketuanan Melayu; and of Islam.

malaysia stock exchange market klse 141008 06I might be out of academics but I have never known racism and religion to substitute economic factors in any country’s asset creation efforts. Surely the planners have not forgotten that this new formula was experimental in nature and to last only for twenty years.

In any case, here we see the early unintended results of the NEP. On the part of the Malays we see a community of people developing a false sense of confidence that they have progressed ahead on the platform of race and religion; whereas in actuality they have not.

On the part of the non-Malays they see the wastefulness of the country’s allocation of scarce resources in the interest of racism and religion as the sure way towards non-sustainability and regression.

And yet the authorities would prevent the citizens to even debate the issue.

No post mortem conducted

Come 1990 and the NEP report card had shown the recklessness of this development programme. Malay achievements were nowhere in sight.

Would there be some form of post-mortem analysis to see the good and bad points? To see whether the country should progress ahead in the same race-and-religion principles?

There has been no such effort, not to my knowledge anyway. It has been more of the same: more racism, more religion. And here we see the continuation of a string of failed development programmes.

mahathir malaysiakini interview 020207 denialDr Mahathir Mohamad (left) announced the Vision 2020 stating that the country would join advanced nations by this magical year. It was well-intended perhaps, but with the economic principles remaining unchanged, that is in favour not of the country but of the Malays, the country began its slide downwards.

When Abdullah Ahmad Badawi took the reins of power, many people had thought that he might just do the right thing to put the country back on the right track again. But he used religious motives (remember Islam Hadhari) to lead the people forward – there was no change there either.

Now we have Najib Razak leading the nation out of the dangerous zone of falling into the steep precipice of a failed state. He has his own plans of course, and its called 1Malaysia: people first, performance now. Will he make any headway?

I just say this to him for whatever it is worth. Go ahead with your development plans based on the proven factors of production as mentioned severally above.

But do not be distracted by sectarian interests, nor for religious considerations. Go for optimum scarce resource allocation and economic sustainability.

 

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AB SULAIMAN is an observer of human traits and foibles, especially within the context of religion and culture. As a liberal, he marvels at the way orthodoxy fights to maintain its credibility in a devilishly fast-changing world. He hopes to provide some understanding to the issues at hand and wherever possible, suggest some solutions. He holds a Bachelor in Social Sciences (Leicester, UK) and a Diploma in Public Administration, Universiti Malaya.

I have been very quiet since I posted the 2 most popular postings on the 7th and 8th of September 2010. My posting on “General Misconception of being a doctor Part 1 and 2” attracted almost 10 000 visitors! I also had many comments for the above 2 postings , almost all supporting what I have said. Interestingly, I also had some foreign doctors from US and UK commenting on my post.  I also realised many medical students who commented on my post, agree that they have chosen the wrong field!

I have been reading all the comments and to answer some of the querries, I will be posting few more articles soon, especially on the housemanship and postgraduate training in Malaysia. I will not talk on the quality of doctors being produced nowadays as I have written enough about it in my MMA articles, some even way back in 2006! Yes, I did predict the current situation more than 5 years ago. I also believe that my prediction for the coming future will also come true someday, as I have written in my blog.

I have been quite busy lately and thus did not have enough time to write the continuation. However, I should be posting a new article within the next 2-3 days.

For Future Doctors: General Misconception of being a doctor Part 2

My first Part of this topic attracted more than 600 people to visit my blog in a day. Today, I post my second part of my discussion for your reading.

1)      Being a GP

As I have written before in my MMA articles, the future of GPs are bleak. If you think that you just want to complete your MBBS and open up a clinic, then I think you are misinformed badly. Many GPs are suffering nowadays. Many have even closed their shops due to severe competition. GPs, not only have to compete with their fellow GPs but also with private hospitals, government clinics, pharmacy and traditional medicine sellers. The scenario has changed as I have said in Part 1. You are also strictly regulated by the Private Healthcare and Facilities Act which was implemented from 2006 onwards. Many GPs are only earning a net profit of RM 10 000 a month which is ridiculous compared to the amount of work that you are doing. Imagine that you have to work from 9am to 10pm daily including Saturdays and Sundays, especially during your early days. That’s the reason why you notice less and fewer doctors resigning from the government sector to set up their clinic. GPs are now moving from urban areas to sub-urban and rural areas to open up their practises. There may be a better market for GPs in these areas compared to town areas.

2)      Being a Consultant in a Private Hospital

Only in medicine I can earn RM 50 000/month when I work in private hospital? I had many friends and budding doctors who feel that medical specialist earns the highest in private sector compared to any other profession. Again, I would say that you are mistaken. Even though you may be right in terms of the earning capacity but what you are not aware is the fact that the private hospitals DO NOT pay us a salary!

Basically you are NOT employed by the private hospital. You are just running a clinic as a self-employed person in the hospital. Whatever you earn is the consultation/surgical fees that you are charging the patients. In fact, the hospital takes 10-15% of your consultation fee as their administrative fee. Furthermore you also need to pay a rental for the clinic space that you are renting! The rental can range from RM 4000 to RM 8000/month. Yes, if you are an interventionist/surgeon or have a lot of patients, you may earn as high as above but at the same time you can also earn very much less than expected depending on the number of patients that you see for that particular month. You may even end up earning less than RM 10 000/month at times! Again, with more and more private hospitals coming up, the competition will be greater and the income of each doctor in each hospital will definitely drop even further. Remember, if a patient’s hospital bill for an admission is RM 5000, only less than 25% of the bill is the consultation fee which belongs to you, of which the hospital will take another 10%!

Also, when you are in a private hospital you are all alone. There are no junior doctors to help you. You need to do all the procedures by yourself and must be available at all times to entertain any medical complaints from the patients (even in the middle of the night). It is not just a matter of running a clinic! So basically you can only charge a patient when you see a patient for consultation and that is your salary!

And also don’t forget, for you to reach the status of a subspecialists before going full-time private practise, it will take at least 12 years following undergraduate medical education, a total of 15-17 years !! By this time some of your fiends will be earning much more than you and driving bigger cars and going holidays all over the world. Many of my friends who went on to do IT, accountancy etc etc had become company managers and directors by the time I finish my subspeciality. They have started to enjoy their life when I was just beginning to think of earning money.

3)      TV programmes : ER, CSI, House etc

Don’t get carried away by watching TV programmes like ER, CSI and House. Things do not work the way it is shown on the TV. I had one budding doctor who said that she wants to become a forensic pathologist. I am sure she was influenced by CSI. In Malaysia, the reality is, any forensic pathologist just sits in the mortuary the whole day. They hardly go down to the scene of the crime. Furthermore, if you do attend a court case, you will be tortured by the lawyer. BTW, don’t think we have all the high-end technology in our mortuary like what you see in CSI. In Malaysia, forensic pathologist doesn’t work in a police department. You are just another specialist in a government hospital forever, as you won’t be able to go private. Malaysian law do not accept a report by a private specialist.

4)      Patient’s demand and increasing medico-legal issues

Many doctors are being sued nowadays. This happens in most developing or developed countries. Gone are the days where patients will forgive and forget. Even the government is asking all doctors in civil service to take their own indemnity insurance as the government may not be able to cope with the legal suits. The cost of insurance has gone up tremendously especially for surgeons and obstetrician. For Obstetrician, the yearly insurance stands at RM 40 000 – 50 000! So, don’t think that the public has high respect for you and thus they will not take any action against you. A small mistake can land you in court and your entire reputation will be affected, no matter how many life’s that you have saved.

I am sure I would have made a lot of you very depressed by now. Please do not do medicine for the reasons that I have mentioned above. You will regret it later. If you really have passion for medicine then by all means, go ahead. I give the same advice to all parents who seek my advice regarding medicine. But always remember, no matter how much passion you have for medicine, it is still a job for you to earn money for a living. Once you are married and have children, money will be the most important factor no matter what you think now.

The amount of money you are spending to do undergraduate medicine alone can easily be used to start-up a business! Most private medical colleges in Malaysia charges about RM50 000-90 000/year which comes to about RM 250 000 to 500 000 in total, not including accommodation and food. You can easily safe this money, do accountancy/engineering/designer etc etc and use it later to start your own business venture.  Don’t you think it is a better option? To get back the investment that you have made for medicine will take another 20 years, not including the money that you need to spend for postgraduate education!

Let me tell you, the money now is not in professional field. If you are smart and only want to earn money, please try technical studies like architect, interior designer, accountancy etc. This is where the money is! If you are good, you can easily become a manager or director of a company by the age of 35.