Tuesday, November 15, 2011

malaysiakini: 'Storm is coming' for our medical profession ....... by Keruah Usit

'Storm is coming' for our medical profession
There has been a recent rash of angry letters and articles in the press, detailing the incompetence and lackadaisical attitude of many of the new generation of junior doctors, known as interns or house officers.

Most writers are contemptuous about the majority of the 7,000 new doctors entering the ranks of the medical profession every year.

Some letters, on the other hand, are written by house officers or their families, complaining of long working hours and harsh treatment by specialists.

It is obvious that feelings are running high. Traditionally, most Malaysian doctors do not write in much to the press. Doctors rank among the most conservative citizens in the country.

Even when the profession was faced with the torture of 106 prisoners of conscience in Operation Lalang in 1987, most doctors remained silent.

But in recent months, like other urban, educated and Internet-savvy Malaysians, many doctors have been changing tack.

Senior doctors took a concerted stand in July against the tear gas and water cannon used in a police assault on Bersih 2.0 protesters sheltering in the grounds of Tung Shin Hospital.

NONEFollowing the arbitrary arrest and imprisonment of Dr Michael Jeyakumar Devaraj (left), one of the Emergency Ordinance Six (EO6), a large group ofPerak doctorsworking in public hospitals looked squarely into the camera, and called for Dr Jeyakumar to be freed.

The Malaysian Medical Association (MMA), the professional body representing over half of all registered doctors, also criticised the detention without trial.

This mutiny by middle-class Malaysians augmented the efforts of Parti Sosialis Malaysia (PSM), PAS, PKR and DAP, as well as civil society groups like Suaram, Aliran, the Bar Council and religious groups, in pressing the Home Ministry to release the detainees.

Vocal debate over ‘substandard’ interns

Some concerned doctors are now warning of future disaster in our health care, caused by substandard new interns.

“The storm is coming... Commercialisation of medical education will soon affect all of us. The glut of doctors is getting worse and many of them are being under-trained,” wrote Dr Pagalavan Letchumanan, a consultant rheumatologist and prolific blogger on crucial issues in health care.

Prominent doctors argue that profit-seeking degree factories in Russia, Ukraine, Romania, Egypt and Indonesia, as well as local medical schools with low teaching standards and inadequate lecturers, have condemned thousands of house officers to a hollow career they are not qualified for, and ill equipped to cope with.

The number of medical schools in Malaysia is 35, a staggering number for a population of 28 million. This is twice the corresponding ratio for the United Kingdom, with 33 medical schools for a population of some 62 million.

Of these 35 local institutions, 18 in the public and private sectors have already passed out house officers. Another 17 medical colleges will produce graduates between 2012 and 2017. Understaffing in local institutions is endemic.

The government claims the new doctors are needed to improve the ratio of doctors to patients from the current 1:1000 to 1:400, a level typical of developed nations, by 2020.

The Health Ministry has reneged on last December’s promise of a moratorium on new medical courses.

Several senior government doctors, requesting anonymity, blame political patronage by ministry officials, in this lucrative business of producing doctors, for the huge excess of house officers.

Greed, they claim, has been the prime mover behind the proliferation of officially recognised, but substandard, medical degrees from deficient medical schools, both inside and outside the country.

But many of these same senior doctors in the public service fail to report the poor performance of some of their new interns to the Malaysian Medical Council (MMC), the licensing body.

Some supervisors dread the paperwork involved in blocking the inept doctors from being registered. Others are simply reluctant to rock the boat.

These established doctors clearly lack the mettle of more vocal colleagues, like the current MMA president, Dr Mary Cardosa, who spoke up for Tung Shin patients, and for Dr Jeyakumar.

‘Pampered and reluctant’

Several specialists tasked with training the new doctors say many of these interns are pampered, reluctant members of the profession, cosseted by unrealistic, well-to-do parents.

Firsthand accounts by these specialists indicate the average quality of interns has plummeted, even though there has been a surge in quantity.

One surgeon said he received a telephone call late one night from the angry father of an intern. The father complained bitterly that the surgeon had ticked off his daughter for a mistake, earlier that day.

hospital heart surgery patientsThe surgeon asked to postpone the conversation until the next morning, explaining he was on his way to the operating theatre, but the father kept up his barrage of verbal abuse.

A specialist in Sabah recounted an episode of a house officer going absent without leave for several days. When challenged, the young doctor claimed he had been admitted to a private hospital for a “heart attack”. A check with the private hospital confirmed it had never heard of him.

“Some house officers just don’t know the basics,” one exasperated consultant told Malaysiakini.  “I was trying to teach two house officers, both of whom had been working for a year.

“I was soon reduced to asking the most basic questions. Even then, they couldn’t tell me the normal range for the heart rate. One guessed ‘60 to 80'.

“Even Wikipedia has the correct answer. They couldn’t tell me what a normal blood pressure was either.”

Another specialist added, “Some of these house officers did not make the grade to enter reputable universities for a good reason. Their parents shouldn’t have forced them to become doctors, they’re simply not interested.”

There are, undeniably, a number of bright, dedicated potential doctors in the ranks of the new house officers. But the lack of motivation among many of the interns is plain to see.

One government specialist tried an age-old trick to elicit some empathy for a patient who had been treated badly by an obdurate house officer, by asking him: “How would you feel if this were your own mother, lying here in this bed?”

The specialist was taken aback by the young doctor’s reply.

“My mother wouldn’t be in this bed. She’d be in Singapore if she fell sick.”

KERUAH USIT is a human rights activist - ‘anak Sarawak, bangsa Malaysia’. This weekly column is an effort to provide a voice for marginalised Malaysians. Keruah Usit can be contacted at keruah_usit@yahoo.com

Comments in Malaysiakini: 

dkay Blame parents too....parents want their children to be doctors by hook or crook....thus the demand for substandard unis and interns.Vast majority of interns don't know,dont bother to know and dont want to know "what mdeical care and practise" is all about.When they are questioned,they brag about their uncles,relations etc who are practising doctors....with subtle body reactions;;;they give u the impression " hey you are just an ordinary consultant in govt...dont talk so much"....Hmmm...thus consultants dont say much.....they are force to pass them as interns(everyone knows why)......thus the quality......GOD help us when we get old......
Onyourtoes I know most house officers especially from medical schools of certain countries are totally hopeless. When asked, they do not know the normal body temperature, normal sugar level and normal blood pressure. I am not exaggerating. But then I also want to ask who are the patients of specialist doctors in government hospitals? Try to get a appointment, they are usually not available. Are they only treating the Tansri and Datuk seri and the vvips?
ksn There are two professions that no govt. should NEVER mess with- doctors and second teachers. Here include the U teaching staff as well. You mess with them, you mess with the country's future. We have a fair idea of the FACELESS LISTLESS TEACHERS (LKY's words) exceptions granted, of our teaching profession, judged from the standards of the products. For these two professions, aptitude, devotion, care and inclination should be the criteria, the only criteria: not race, not numbers and not NEP. They are like our vital organs to the nation: the heart and the lungs.
ONE HAND COVER THE SKY This is all the faults of our present govt. They prefer quantity rather than quality ! Churning out substandard graduates who know nothing of what they are studying. The future will be worse if they insist to change the teaching of science and maths subject from english to bahasa malaysia.
Jimmy Ng Finally, the cat is out of the bag ! The rumours that we have been hearing about all this while have finally been confirmed to be true ! This is what happens when we have ill-qualified people running the govt suffering from the obssession with churning out incompetent numbers instead of focussing on quality !! Worse yet, in the noble field of medicine & health care , where one's life and health is probably at stake !!
DontPlayGod This is what happens when the NEP comes into play. NGO's and pressure groups like PERKASA, and a host of other fanatic groups will keep up the pressure to maintain the NEP. I am afraid things will get worse and disaster will strike our medical profession. Thanks to this quota business where even below average students are pushed into medical courses, and for which they may not even be interested in. We all have this 22-year PM to thank for. Malaysia to be a developed nation by 2020? I can only say we may be like Greece, Iceland, and now Italy, maybe even before 2020. Our Asia tigers like S. Korea, Taiwan, Hongkong, Thailand, and Singapore will be so far ahead of us in development that we will be like Somali and Zimbabwe by then, if not sooner. Even Indonesia will soon surpass us, and we will be sending our maids and labourers to Indonesia and other places.
Sankar @ Chandran a/l K.C. Pillay One woman complained that her daughter was rejected by a prestigious local private uni. The daughter did not get to do dentistry even though the woman said she was prepared to pay the fees for the entire course upfront. According to her, the uni. refused. Now the daughter is pursuing a dentistry course in India. This woman thinks her money can buy her a seat in a prestigious uni. Good unis need good students; not some half-past six candidates. I have renewed respect and confidence in the kind of medical graduates that this uni is producing. Local private unis must endeavour to maintain their prestige and reputation.
Pemerhati There has been a drop in quality not only in the medical field but many other areas. For this the country has to thank the constitutional Malay of Indian ancestry, Mahathir. He tried to prove to the native Malays that he was one of them by promoting racist policies that favoured them. During his 22 year premiership he destroyed, amongst other things, the excellent education system by making even the most incompetent Malays into teachers, lecturers, professors, engineers, lawyers, doctors, civil servants, etc. There were many able and brilliant Malays amongst this group but Mahathir preferred and promoted the apple polishers who mostly came from the incompetent group. Not surprisingly these incompetent people implemented the idiotic policies that have caused the catastrophic drop in standards not only in the medical field but in the whole public service. The racist policies have provided a few hundred thousand jobs to incompetent Malays to the detriment of about 15 million Malays.
Anonymous_4031 Four years ago, my mother-in-lawhad traumatic experience when UM Hospital changed her stent. A simple procedure almost cost her life. After being hospitalised for several days, she was finally discharged and taken to San Fransico hospital for treatment. It is now 4 years, stent change is easily done; and she could go home the same day!But, not UM Hospital!Hospital authorities can check the record of the patient, Madam Ting Mee Nguk four years ago. Do we have really qualified doctors? Qualified lawyers, qualified engineers, qualified architects, qualified dentists? Lettting loose unqualified professionals will harm the consumers.Does the Government really care for the welfare of the people?Malaysia has no place for , self-serving , uncaring leaders. Do not try to serve yourself first and ignore the welfare of the common people who flock to hospitals and clinics for treatment.Do not lower standards so that you become popular.Be honest. Have integrity.Dot sell your soul to the devil.
ksn In this situation which needs to be corrected immediately, it is essential that the good and bad interns should be identified, separated. This assessment must be done by an independent panel of eminent doctors, the good ones to progress and bad ones penalized as long as it takes until they are assessed by the same panel to be competent to treat. We had housemen working weeks at a stretch without any break and they never complained. How come suddenly the housemen are complaining about hard work and long hours, Tough learning? Then they are in the wrong profession. Is the easy going philosophy of the civil service and automatic rewards spreading to the medical profession as well without earning it? Do we need so many housemen and so many medical colleges? Is there not a need to control them at the initial stages if it is not too late already? Can we hope that our people will not end up as the experimental pigs in the hands of the housemen who will become doctors? Standards please.
Anonymous_4031 How could you "re-mark " , with the intention of addimg marks! The lady lecturer spoke to Star which ran a whoel page on this episode. By "diluting " the quality of students, you are condoning the lowering of stadards. Strangely, the Minister was re-appointed by the PM, who has also appointed non-elected MPs as Ministers.This is a serious flaw in the PM himself. For political expediency, the PM chose unwinnable candidates as Ministers.No-go in honest selection .) Graduates must be qualified to become doctors. While we are judging foreign medical Universities, at local level, we must ensure that our standard is not diluted so as to show the world that we could produce many "doctors" . There is no pride in such production in the mill. For housemanship, if trainees cannot put in honest work, then extend t he period of internship.Do not let loose sub-standard doctors, please. Tun Abdul Razak lamented that UK did not recognise MU medical degrees.
Anonymous_4031 Stop this quota business. Be honest and truthful about the quality ofmedical graduates produced. There is no pride in churning out a high percentage of doctors, who are of sub-standard. Better to have quality doctors than half-past doctros!Note care4fully, that if we allow sub-standard doctors to be let loose to the sick population, you are condoning the deaths of patients. Univesities and Ministers should bear vicarious responsibility for causing the deaths of patients.Resign as Ministers and Deans of medical faculty and VCs! You want to score political points at the expense of lives of patients.The public must condemn thiks attitude.( As an aside, I remember one law lecturer-cum-examiner as chided for failing many law students.In her protest to the Higher Education Minister,she failed to get a reply on time; and she resigned in December. The Minister replied the following year and, horror of horrors, he said that it was alright to "re-mark " the papers. Rubbish. I wrote to Star.
Anonymous_4031 All professional courses must have a higher passing bench-mark than that of non-professionanal courses.Recently Newspaper reports indicated that sub-standard housemen have been going the rounds in wards.The Health Ministry in particular and the Government in general should look at this serious short-coming and act at once. Do not wait for lives to be lost before they act.They must be proactive and not reactionary especially where lives of patients are concerned.I would like to suggest ideas to ensure that good doctors are produced. Firstly,we must set at least 40 marks as the passing mark. Those students who fail to attain this bench-mark should not pass.Universities must not try to show a high percentage of passes by lowering the passing mark.They must be ethical. If they cannot be honest, they should not be in t he University. Besides this strict passing mark system, Higher Education Min ister must not try to put pressure on Universities to allow a quota of graduate.
pity him !!!!! Blame the federal goverment UMNO for the situation in our beloved country. Despicable, naming Malaysia an education hub.

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