Practicing Medicine In The Age of Doom and Gloom

Recently I attended a talk by MMA Kedah held at my hospital auditorium. The topic of the talk basically revolved around the future direction of our health system with the major part of the talk consisted of the speaker’s derision towards the quality of junior doctors and our future problems due to the same.

 

The talk had also said that the minimal requirement for doctors are now below than that of teachers (seriously, I found that hard to believe. I listened hard for the speaker’s source of facts but alas, he didn’t mention it).  He also said that we are having too many junior doctors who are not exposed to some of the common procedures that they had performed during their time, and the voice of doom and gloom echoed throughout the talk. It was relentless, I assure you.

 

I had wanted to ask some questions at the end of the talk but they did not open the floor for questioning due to the time constraint. However they did invite the audience to talk to the speaker personally afterwards. I did not have the opportunity for the personal talk with the speaker because I had PSY Liaison Round to attend to with my specialist immediately after.

 

I would love to know his source of reference when he said that the minimum requirement for taking medicine these days are below that of teachers. Are we talking about private med schools or what?

And I would like to know the SOLUTION to the alleged low-quality junior doctors that he had so gloomily presented. Listening to junior doctors getting the bad rep is counter-productive without presenting us with effective solutions, n’est ce pas?

 

***

 

I am a realist.

I am not by nature, an optimistic person. However, I too don’t like to be around people whose regular utterance consists of consistent ‘doom and gloom’. And this ‘doom and gloom’ only come about when they talk about others…never themselves.

Or rather, it comes about when they talk about other generation; never their own.

How thoroughly exasperating, don’t you think?

Is it possible that it has escaped their notice that it was THEIR generation who had come up with all sorts of asinine policies that shaped our generation into its current form? Did they suppose that our generation come about magically with nary the touch nor the influence of the past generation?

When they talk about the current generation of doctors, their voice with just the right touch of arrogance and self-righteousness, it is positively nauseating. They went on and on about how OUR generation is the most spoiled, most entitled generation in the history of humankind, failing to appreciate that they were the one who brought us up!

 

Our failure – if it is a failure – is theirs as much as ours.

 

So rather than going around feeling unnecessarily self-satisfied with themselves while looking down at others, they should take the problem-solving approach rather than the finger-pointing approach. Stop badmouthing our generation, and start coming up with better policies to fix the problem that THEY started, in the first place.

 

***

Let me elaborate on some of the asinine policies that result in us having the bad rep:

  • Russian-grad doctors are not competent, they say.

Whose wonderful policy was it to send our brilliant students to Russia, in the first place? That ‘dazzlingly bright policy’ did not originate from OUR generation, surely you know that.

Please know that when you train students overseas – not only in Russia – the students are shaped according to the needs and the system in THAT country, whose needs and system may or may not be compatible to our country.

It was YOUR policy to train students overseas, and this is the result. Deal with it in a mature manner by helping them and shaping them into what YOU want them to be, and that cannot be done by belittling them during your rounds or in public forums.

 

Furthermore, let me enlighten you that people are biased against the Russian grads without really knowing the situation at that time.
I went to Australia, scored straight As in my SPM.

But my SPM 2002 batchmates who went to Russia were more brilliant than I ever was. They went there based on their SPM TRIAL results (everybody knows that trials are much harder than SPM; I didn’t get straight As in my trial). 

Almost all my SPM 2002 batchmates who went to Russia scored straight As in their SPM, just as their trial results had predicted they would.

It was the government policy at that time to send brilliant students to Russia based on their trials – while us less brilliant students didn’t get any offer yet until we get our real SPM results and applied through a much delayed process (some of us spent/wasted two years in IB and A-level before we got to fly).
Thus, it is quite common for those who graduated from UK, Australia and Ireland, to have our batchmates who grad from Russia being our MO or JMO – they get to save 2 years of their age.

The point is: Contrary to populour ‘specialist’ opinion, MOST Russian grads who are on government sponsor to Russia were among the best in their batch in SPM. They were crème de la crème.
FACTS.
Do some research.

 

  • Too many doctors as a result of having too many medical schools

How is it our fault that YOUR generation allow too much medical schools in the country? Now you have a problem of adequately training junior doctors, deal with it without blaming us! YOUR generation DO NOT have the right attitude in dealing with the problem that YOU caused. If you are interested to know what is the right attitude in dealing with this, please read on because I DO have an example of how the Australian older generation deal with the problem of current generation without finger-pointing at us.

***

 

The adage that ‘History repeats itself’ is true, you know. Not just in the issue of current generation of doctors, but also in other aspects of mundane daily lives. We just LOVE to make comparison, especially when that comparison results in us being the more superior. Isn’t it laughable?

Let me give you several scenarios to demonstrate just exactly what I mean.

 

Scenario 1:
“Ala…zaman sekarang SPM straight As pun macam nothing. Tak sama macam zaman dulu. Pangkat 1 dah kira hebat dulu.”

Scenario 2:
“houseman nowadays…” sambil geleng kepala.

Scenario 3:
“Ala…zaman aku buat MRCP dulu lagi susah …. specialist yang dah pass MRCP sekarang belum tentu bagus”

 

Scenario 4:

“Tok Wan dulu umur 12 tahun dah kerja, dah ada pendapatan. Bukan macam hangpa la ni. Tok hang dulu umur 10 tahun dah masuk ceruk dapur….cekap segala. Hang ni pula, nak pegang senduk pun tak reti….”
This is CLASSIC standard predictable generation snobbery where each generation think themselves as better than the generation after them. Nothing so phenomenal and surprising here.

They are only saying what other generation had said about them once.

How about realizing that it is YOUR generation that shaped the policy and the environment for the next generation. Our failure is YOUR failure. Our success is YOUR success.

So next time a student get straight As, just congratulate her nicely. No need to reminisce on your good old days because frankly speaking, your time has passed.

 

***

When I was a 5th year medical student, I was attached to a kind palliative care specialist at a rural hospital in Tamworth. He is a religious Christian, full with empathy towards his patients, very humorous and humble towards everyone. Some arrogant Muslim specialist should really learn how to talk towards their subordinates. Just in case you don’t know, there are ways to teach others without making them feel stupid, knowing that doing so would make you feel more clever and self-satisfied with yourself. Feeding your ego at the expense of others is the behaviour of someone with self-esteem issues, in my opinion.

 

When he talked about his training more than 25 years ago in Australia, it was always with humility and a sense of gratitude that some things have changed. He talked about how little supervision he’d had back then when he was desperate for a guiding hand. He talked about how much he wished he had not unknowingly caused any harm towards his patients just because he’d had to do what he had no idea to do at that time. He thanked God that back then the public did not go around questioning their doctors. He talked about how little medicolegal issues there were back then. He talked about how there were no high-end, sophisticated and discerning imaging technologies that would make it absolutely unacceptable to not have the right diagnosis.

 

Thus, comparing your time and our time – when other variables have changed – is not exactly fair, is it? I still remember how a houseman in my batch was extended after a surgeon’s FAVOURITE VIP patient had complained about her brannula setting. Hmmm…

 

Back then, staff nurses were not burdened with reports that need to be done in the computer. Back then, discharge summaries could be done by hand, as the round was taking place. There were no time-consuming computer-based documentation that took the time away from our patients. Paperwork was much less than now. Doctors back then focused more on patients than documentation. Subspecialties were a rare luxury. Defensive medicine was unheard of.

 

So please, adopt the paternalistic attitude in guiding our young. Not the attitude of US against THEM. It does NOT serve any good purpose whatsoever other than exacerbating public anxiety of going to the government hospital (for fear of being subjected as guinea pigs for Housemen, thus compounding the problem of their lack of training), and trampling the morale of our junior doctors.  At the end of the day, everyone will suffer if this lambasting of junior doctors continue.

 

***

This is the section where we focus more on solutions rather than the enumeration of our problems and frustrations.

 

So the MMA speaker was saying that our junior doctors are going to be incompetent as they are no longer exposed to some of the common procedures that the older doctors were exposed to during their time.

 

However, this is not only happening in Malaysia. We all know that. This is happening all over the world especially in the developed, Western countries. Time has changed. And we need to adapt to it.

 

In Australia, interns are glorified clerks. They did not even perform brannula setting or venopuncture during office hours, let alone other common procedures like peritoneal tapping, plural tapping, peritoneal dialysis (which was done under GA at the operation theatre in the West,hahha. Unlike here.), chest tube insertion, intubation, bone marrow aspiration, ray’s amputation, desloughing, etc etc.

Forget doing episiotomy because O&G rotation is optional ONLY, and very difficult to get into as an intern.

When do they get to do venopuncture and brannula setting? When they are working the night shift or anytime outside the office hours when there were no phlebotomists around.

How about attending patients with impending cardiorespiratory arrest? The intern’s job consists of pushing a button at the bedside that would activate the MET call  (I think now, they call the system as RRT a.k.a Rapid Response Team) and at the push of the button, a team consisting of an ED physician, an ICU resident, an ICU SN, and medical registrar will run to the bed with a trolley bag to attend to the patient, while you perform mostly the redundant minor role.

So in terms of exposure, theirs were so much less than ours and this is not a recent development. It has been going on for more than ten years.

So, following the logic of our older physicians, the current specialist in Australia now must be way more mediocre compared to our own specialist in Malaysia, right? Are we arrogant enough to actually say that? On what basis?

So, since the interns in Australia are very underexposed of the most common procedures that we were exposed to in varying degrees as Malaysian Housemen, how do they train their specialist over there to become as good as they are? Because believe me, their interns ended up becoming good specialist anyway, regardless of their earlier internship training.

 

So, how do they get to produce good specialists despite of the highly-disadvantaged internship training?

The answer is, they do MORE than just badmouthing their young interns. That’s for sure.

 

We need to look at how they design their rotations and training, so that their underexposure during their internship would not compromise their quality as specialists. Since I did not hang around long enough in Australia to look at their specialty training system for a thorough analysis, I am unable to answer that. But I am just saying that, they did MORE than presenting the voice of doom and gloom.

 

Furthermore, even though the interns are based at a tertiary hospital, but every few months they will have a rural posting or regional posting to go to. This is where they get exposed with some of the basic procedures.

So, knowing that not all district hospitals in Malaysia are good enough for housemanship training, we should however consider the district hospitals as a place for rural rotation, where they get to learn how to manage patients with only very basic rudimentary facilities. The district hospital as a rotation basis is good exposure and most interns look forward to it.

 

***

I have the utmost respect towards the older generation of any field; make no mistake.

I am just tired of listening to them making the junior doctors feel like we are never going to be good enough and never going to measure up. I am tired of their failure to comprehend that time has changed.

There are days when I just take it philosophically, telling myself that they are merely doing what their own previous generation had done towards them. I told myself that this is merely a rite of passage that all junior doctors will go through, being made to feel like their older generation is always going to be better than them.

Maybe, we should just let them have their fun and tolerate their criticism – no matter how unjust –  the way we tolerate our old relatives who love to reminisce on their good old days.

But then, maybe once in a while, we should correct their own delusion of doom and gloom because remaining with that worrying outlook about life must be stressful for them. We don’t want them all stressful now, do we? So let’s lift them out of their ‘doom and gloom’ overview by correcting their delusion.Take it as an act of kindness from the new generation to their respected elders.

 

So, relax! We’re all going to be okay.

***

Dear respected elders,

We thank you for everything you have done to enable us to practice medicine in this current outlook of ‘doom and gloom’.

Please accept the extension of our profuse gratitude for all the policies you have made that result in this current situation we find ourselves in.

We try not to complaint at you. So, I hope, are you.

 

Yours sincerely,

The Current Generation.

 

37 thoughts on “Practicing Medicine In The Age of Doom and Gloom

  1. April

    While I applaud your bravery in pointing out the flaws and inconsistencies of the arguments mentioned, by lumping all those not of your generation into the proverbial ‘them’, you are essentially doing the same thing you accuse ‘them’ of doing. ‘Everyone’ from that generation is responsible? The current generation bears no responsibility at all for their weaknesses? Many things have changed, yes, but some things are timeless…honesty, integrity, selflessness. Generalizing will not take us forward. I trust you will continue to critically appraise the situation and provide thought-provoking, but fair analyses.

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    1. Oh no, April,
      We all – at the individual level – made mistakes and we SHOULD bear the responsibility of our own weaknesses and strive hard to improve on them.
      There are many young doctors who are irresponsible at their work with frequent MIAs and ELs. I am not trying to excuse such lackadaisical attitude towards work.

      However, in the MMA talk and most other talks, the junior doctors are lumped together as future incompetent doctors, regardless of their attitude at work. And I am just pointing out that the current system emerge through no fault of ours. It is all the policies of the previous generation.

      I have met several old generation specialists who are very nice – at an individual level – towards their young juniors. But they DO, in their own way, feel that their training ‘during their time’ was better than ours.

      I am just proposing that their training suits the requirements AT THAT TIME. But circumstances have changed and we should all adapt to it without blaming the next generation.

      I am just providing them a scenario where there ARE other places where the interns were trained as glorified clerks but they ended up being good specialists anyway.

      Thank you for commenting.

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      1. MR VASU, Surgeon

        Good to know your feelings. I would like to comment on your thoughts and interpretation of the talk as clinician.
        Firstly, generation issue is a minor factor and it is there for everything – from family matters covering upto every single aspect of life.
        In medical field, it is not the main matter as the main worry in our field is that we are dealing with human lives and our practice of medicine should have minimal errors or no errors. This is what is failed to be realised by many junior doctors.
        We should not compare our system with western. Anyway, since you want to compare let me give my experience being in UK and Germany. The junior doctors there do face the same problem – lack of experience but as you mentioned when they become specialist, their competence is rather well accepted as they take responsibility for their treatment (as you mentioned good specialist – not every trained glorified clerks). Who becomes specialist there? – those with attitude to learn, who has adequate basics and understands the risk they face if they make errors. (And they have to compete to get the job – so they have to be competent of course) (In Germany, even medical students has to compete themselves to get job in good centre – this is the young generation with different attitude we are talking about). Actually, it is almost same in our country. Those who willing to be specialist and has the right attitude to learn are the majority becoming specialist. But unfortunately,as Clinician we are worried about the junior doctors who doesn’t to have basics at all, no remorse when making mistakes and not willing to learn and progress. even in my generation, this group did exist as minority. We made mistakes but everytime we commit mistakes we make every effort to learn from it and not to repeat the same again. If we don’t know we ask the right person. If given orders, we follow. In comparison, the incompetent group is rather becoming majority. We are not running medical school during ward rounds – then how to teach practical skills and treatment to this group of doctors. The group just growing and increasing in number. Let me just give you a couple of example: there were instances when major errors made like tranfusion error, the reply from juinior doctor is that the patient didn’t die what so what is the big deal – why action must be taken?
        There are junior doctors whereby don’t even know the components of alimentary tract or how many major joints in lower limb( ankle, knee, hip….).
        I still remember my Professor’s words: he wants only the safe doctor to practice, as one day he will be treating you or your relatives. As you defend your generation without proper analysis or critical thinking, let me ask you a question: do you dare to get treatment from a junior doctor without knowing his/her creditability for yourself or your family members or you will look for someone competent? If you choose the latter, then why should the incompetent junior doctors should be allowed to treat other patients??
        Lastly, the extension of a junior doctor that you mentioned just for the sake of unable to set line for VIP patient itself showed that you do make comments without having your facts right. It is just not easy to extend someone over minor issue.
        Sorry for the long reply though I’m restraining myself from answering all the misconception that you have.

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        1. Dear Mr. Vasu,
          Thank you for your long comment.
          I bet, by the time these so-called incompetent doctors you are worried about become MOs, they are going to go around being worried about their juniors because they think their juniors are much worse than they were. Isn’t it ironic?

          This must be some sort of doomed conspiracy theory. The attitude to learn from mistakes is what they should be learning while being a HO…usually that is learned in the first posting already. If they don’t learn it well, you have the option of extending them from the very beginning. One should question the previous posting of the HO if he/she comes to the second posting without the right attitude.

          There’s always two sides of a coin. Like marriage, it is rarely the fault of the wife or the husband alone. Bad trainees is one side; bad trainers is another. The point is,when undesirable outcome happens, it’s rarely one-sided.

          I cannot comment on the attitude of doctors in UK or Germany since I have never been there. But as you yourself had agreed, it wasn’t the lack of procedural training during internship that makes someone a good doctor….it wasn’t even how many hours you put in (as they worked in shifts over there), but it was the attitude towards learning and attaining success.

          So I have again and again proved my point that the MMA talk going on and on about “lack of training and hours during housemanship as the raison d’etre for future bad specialist” is pure bullshit. It is 70% attitude and 30% knowledge. YES! Only 30% knowledge!
          I am honest enough to admit that I didn’t remember all medical facts on top of my head when I was HO but I was never extended because, Alhamdulillah, I knew how to work; not because I can recite every single medical facts that I have forgotten by the time I started my first posting. I don’t care if you think my lack-of knowledge makes me a stupid HO, but I was quite competent even though I was NOT a walking encyclopedia of facts.

          Let me give u an example. A patient with UGIB can still survive regardless of whether or not the HO knows the physiology or anatomy of the GIT tract. As a Houseman, I need to monitor the vital signs for signs of shock, run fluid resuscitation stat, inform my MO, take blood sample and call the blood bank for blood. That is what a good HO does without being told! An excellent medical student who got first place in med school does not necessarily know what to do because we were not taught how to work…we were taught how to memorize facts without its practicality. To get the idea of how to be practical at the work place with the right attitude, it takes time and some adaptation that should already be learned during the HO’s first posting! So we should question the specialist during the HOs first posting if the HOs are still incompetent by their second posting! WHY wasn’t the HO extended during her first posting?

          So, whose job is it to know the anatomy and physiology of GIT on top of his head? It is the surgeon’s job! Because he is the one who will be doing the definitive surgical treatment. And any doctor who finishes her HOship and decide to be a surgical MO, they should know the anatomy and the physiology. They are the ones who should be grilled and the HOs can learn by hearing the MO’s answers. For the HOs, I would teach them how to work, and what is the right attitude, and how to be safe, how to interpret the vital signs for red flags.

          I am not saying that HOs shouldn’t be taught anatomy or physiology….I am saying that I won’t make them feel like crap if they don’t know. (But I will give my MOs craps if they don’t know because for someone who has decided to specialize in surgery, they SHOULD know) .

          When they don’t know something, I will simply ask the HO to read because they will still be having assessment at the end of their posting regarding their knowledge.
          However, on a day to day basis, I put my priorities in making them safe and and making sure they know how to work fast and efficiently. I will teach them how to present each case the way we should be presenting it at work. I will tell them that medical school is over…you present the most important findings and the related investigation results that will enable me to get my diagnosis as fast as possible. Most first posters don’t know how to present….they are still grappling with the transition from medical school to working environment. Again, at the end of their first posting, they should already know the art of ‘economically’ presenting a case without going on and on beating about the bush.

          How many specialists actually taught and re-enforced these practical points at work for their first posters? Scolding them is easier but they won’t learn that way! Trust me!

          So you mentioned that the attitude of UK and Germany doctors are different than our junior doctors. But did you notice how the superior doctors at UK and Germany treat their junior doctors? That’s the point I am making! Things are rarely one sided.

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          1. MR VASU, Surgeon

            Thank you for allowing my comments in your blog.
            Firstly, I don’t think you understand the main objective of the talk which talked about current status healthcare in Malaysia. The current system and its disadvantages are not created by MMA but the policy makers. If in the first place you are in the group that doesn’t realize the current system is ‘doomed’ (which our health ministry itself has admitted) then I’ll be wasting my time elaborating anything else.
            Regards to your comments and other readers misunderstanding on MMA, I hope the MMA President’s explanation will clarify them (it will be uploaded in Kedah MMA website) and hopefully in this blog as well.

            Regarding UK, as I said the attitude of the doctors are different. They have realised the limited practising hours has affected their experience, so they do come beyond their time table to at least gain experience without being paid. As, even consultant Hepatobiliary surgeon can be jobless as they compete for their posts, experience makes a lot of difference. Even many specialists, get attachment without salary to gain experience before actually taking up the post. Whereas, in Germany it was very simple. Only the competent stays, you want to follow working hours strictly, then fine, the HOD won’t extend your ccontrac the following year, that particular person will be jobless. Its same in UK, the job is not guaranteed, especially for incompetent doctors and specialist. In Malaysia, at the moment the job is guaranteed. So, many sitting in district hospitals treating patients without even knowing the group of patient need to be referred urgently due to lack of knowledge.
            If only attitute needed, why we need medical schools then? They are many paramedics has better attitude, might as well train them practically to become doctors, as per your interpretation only 30% of knowledge is needed.
            If a HO doesn’t know alimentary tract after studying medicine for 5 years, do I expect him to perform better in next few years – my answer will be – NO. Even secondary school students are taught regarding alimentary tract nowadays. When upper GI bleed comes, If the doctor only need to know how to identify shock and inform MO for further action, that absolutely can be done by trained paramedics. Why we need to call this group of staff ‘doctors’ then? How do you expect to take history, if you don’t even know your basic anatomy and physiology?
            If we really want to extend HOs who are having trouble, then we will be having real shortage of doctors in this country. I hope the time will come where, doctors has to compete for the post just like in Australia and European countries, and then only the competent will be retained in the system in Malaysia, till then no solution to this issue. The one suffer forever will be the people as patients including me I suppose. Thanks, and I’ll not comment further.

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          2. Thank you for replying, Mr Vasu.

            I am not saying that ONLY attitude is needed. I am saying that when we started working as a HO, we forgot most of the things we learned at med school. This is common. When the assessment comes, we will study and remember everything all over again.

            I am just saying that to become a good HO with a good attitude, you rarely need to become a walking encyclopedia. The focus is not yet knowledge at the HO level, because the fact is, you really become master of your craft once you start enrolling in Master/postgrad program. Even MOs are not as good as 5th year medical students when it comes to medical facts…because 5th year medical students are studying for their finals. The job of 5th year medical student is to learn only….it is their full time job. Whereas The MOs and HOs are working to get their daily tasks done and sometimes do not have the luxury of focusing on their studies.
            Having said that, of course it is BETTER to have a HO who has a good attitude AND excellent knowledge. By all means, we should encourage that.

            Basic anatomy and physiology does help in history taking; the key word here is ‘basic’. I won’t scold them if they don’t know/have forgotten any more than that. But trust me, I can take good history and perform good physical examination without recalling all the stomach parts and the three layers of the Muscularis Externa. After all, hematemesis is hematemesis and malaeana is malaena, regardless of where the ulcer is in the stomach. So no worries about history taking.
            But If I were the one who has to do the OGDS as a surgeon, then of course it makes a difference to know in great details about the anatomy. But as I said, we should scold the MO who doesn’t know this rather than the HO who doesn’t. At the HO level, we focus on attitude and making them know how to recognize the red flags. We focus on telling them practical points…. because knowledge that you have forgotten can be recalled easily if you’ve already learned it previously. It is only a matter of restrengthening the synaptic connections when it comes to relearning knowledge that you have already learned in the past. Once they pursue their master, they will get it!

            But at the HO level, we should tell the HO how to work. What do you want the HO to mention in presenting UGIB. What important history do you want the HO to mention when it comes to Pancreatitis. WHat is unacceptable if they don’t present certain things in certain cases. Teach them calmly.
            When you scold them, they will only remember the scolding…not the knowledge.

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  2. Aneesa

    I agree. I am training to be a specialist. And I hate the system ( it doesnt stop at HOship). But, there will be one or two individuals that you’ll adore and aspire to be like them.
    Let the bad apples be. They usually have issues.

    The good ones will push you to be better and take your positive attitude to the younger generation.

    Dont be that MMA rep. We can do better

    All the best.
    Irish trained

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  3. John Teo

    Dear Afiza, I am truly impressed by your comments and indeed a lot of issues you brought up are very relevant. It is very rare indeed to hear from Drs like you from the current generation and I am very pleased that you have spoken up. I just wish there are more Drs like you who are willing to speak up and voice your concerns and only then can something concrete be done.
    I too graduated from Australia way back in 1992 and yes one tends to compare the system we are trained in and the system we are working back home in Malaysia and I too felt the stark differences even way back in 92. The truth as I perceive it why the current scenario is happening is that all concerned regardless of generation contributed to this present dilemma and that the root cause is Disunity among Drs. Each will just worry about his or her predicament and are only interested to speak up when things affect them or even worse, play the usual ” hide and seek game ” to evade and wriggle themselves out of uncomfortable predicament by whatever means available to them. It is very rare for Drs to speak up for what is right and those individuals are far and few in between.
    The answer to the current predicament and the “doom and Gloom ” picture is of course unity among Drs, so that we can speak with one voice and I have been advocating that since I came back till today and at times honestly, i feel it’s a losing battle although on and off we do get a few sparkle of hope from a few individuals.
    if there are more Drs like you, I am sure something can be done and it’s not a generation gap thing in my opinion , rather a disunity we need to tackle across the fraternity.
    by letting you know my year of Graduation, I guess you can work out how old I am, but that okay as hopefully we can speak with one voice rather than put each other down.Fully agree with you.
    kind regards,
    Dr John Teo

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  4. wan

    Nicely written. I also did my medical degree in Australia and you are right. I really hope our doctors in Malaysia can adopted their culture. But based on my HOship here I noticed most new and coming doctors are kind and very good as a teacher. Most ‘older’ generations are being phased out.
    With that being said, what MMA has really done to help us? I remember there was a time where one of the MMA higher ups said “If you don’t like working in Malaysia than feel free to work overseas.” With attitude like that it will be hard to improve our future medical care.

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  5. sop

    I thoroughly enjoyed reading this.
    In reality, even senior HOs compare and look down on junior HOs. “Dulu aku kene buat macam ni, sekarang kau buat macam ni je.” It’s everywhere.
    I’m lucky to have passed my HOship before the ‘doom and gloom’ wave hit. I try to help the current HOs survive the wave but it’s ultimately their effort that determines how far they’re going.
    BTW, Pagalavan should learn to write from you.

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  6. I am a medical lecturer. I used to work in IPTA and currently in IPTS. The medical schools are strictly regulated by MMC. MMC has produced guidelines for running a medical programme. There is no difference or double standards in ensuring that the medical schools abide with the guidelines. All medical schools will have to undergo accreditation process whether IPTA’s or IPTS’s. In the guidelines, it’s clearly stated the minimum entry requirements for admission to a medical school. I can vouch that the minimum entry requirements are not as what the speaker implied.

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  7. ROBIN

    It is natural to have an inflammatory reaction like this person above. However, there are true facts from the speaker’s point of view.
    I can confidently say that the overall experience, exposure, resilience and therefore knowledge and quality may have taken a dip. There is no source and there is no need for source. It is common sense.It is not difficult to estimate these things based on number of doctors/patient ratio. Of course a hardworking doctor could overcome this by being proactive but if you look at the overall picture there has been a decline.
    However, this is not the fault of junior doctors, but society and government. For not recognising the upcoming surge of doctors, not minding the colleges the students were sent, not monitoring the progress and quality of institutions and all that. These young doctors are victims of circumstances. You can see by the sound if it.Society was only interested in making doctors not bothering about the consequences of oversupply, sadly speaking.
    Now what to do.Junior doctors like this lad needs to listen and act on the statements, Listen to the facts and reality behind the statements.
    No question about the validity, they are all very close to facts. Please think on how to overcome this predicament.
    We ned to diversify medical practice, introduce research, and perhaps rethink career options if deemed unsuitable. You can be good certainly but how? think.. Spend more time with patients, incorporate research, make smart choices, reach out for new heights in education by presenting audits, widen the horizon of medical practice, research, make appointment with a supervisors to follow on your progress etc, You are good breed but you will have to live it.
    Working under pressure is one of the attributes of a good doctor, in fact it is a condition.Being criticised is one of them. Show your strength by changing them into challenges and you will be successful.Thats all.
    This is what ‘current generation’ could think about. Otherwise lamenting and trying to dispute wisdon- ‘ain’t gonna take yer nowhere’.
    Stop starting this ‘new school’ dogma which is shallow and lame. Do not be in denial as most of the above has truths in it, but remain strong and prove it wrong if you can.

    Like

    1. MR VASU, Surgeon

      Robin ‘s comments reflects many Clinicians views. When we learn to accept our shortcomings and learn to progress, definitely we can progress and excel, mostly can be a good and safe doctor.

      Like

      1. And I agree with you and Robin.

        Everybody – regardless of their generation – should have the right attitude at work to excel and become safe doctors.
        But good attitude is not exclusive to ONLY the previous generation.
        Junior doctors are always lambasted right, left and center without highlighting the point that the problem is at the individual level and their attitude. NOT the working hours and certainly NOT how many bombastic procedures he/she has done as a HO.

        Like

  8. Nabila Anuar

    *applaus*
    Well said.

    I attended the MMA talk in SP, and to his (d speaker) defense, he was not solely blaming or condeming the new generation. He was telling us bout the future health care system that no one wants to stay put. Like specialists that will quit working with the gov and work with the private instead due to relatively small paycheck with work overload, and d neverending complaints. He did mention that specialist (including himself) have to be like “fireextinguisher” to put out/answers to all letters, complaints, medicolegal cases which is no fun at all and they cant be “real doctors”. And blablabla so on…

    And conclusion of the talk was to invite we all to join MMA and be a BIG organisation (like the teachers organisation – mcm dia ada masalah je ngn cikgu2, keep comparing us to teachers. Huhuhuh) so that we can voice out opinions (to d gov/ MoH/MoE etc) to make a better future health care system. So u shud join. ☺️

    (Or maybe i attended other mma talk? Or i dozed off? Huhuhuhuh)

    Nway well done kak afiza. Ahaks =p

    Like

  9. MMA KEDAH

    REPLY FROM MMA PRESIDENT – DR KRISHNA KUMAR

    I apologise if you did not have the time to ask questions but my email address was in the first and last slides for any queries. There are members of the MMA Kedah in HSB and they would have gladly pointed to the direction as to where your queries could be answered.

    The idea of the talk was not ‘doom and gloom’ but to show all the facts that exists. Studies mentioned were from the Ministry of Health and the information given was from press reports and from existing junior doctors. It was meant to provoke the junior doctors to think and to come out and make changes to their future rather than letting others determine their future.

    Entry qualification to premier local government and private universities are high but remember that there are over 300 universities abroad that may not consider local standards when taking students. They only require a no objection certificate from the Education Ministry. Furthermore, there are no students going overseas to pursue a teaching career hence these graduates do not suffer similar problems.

    If you had listened to my talk carefully, I had clearly stated that the younger generation determines the future of the generation to come. This was meant for the current generation to get off their bottoms and to do something and not just wait for others to act. MMA has made changes with my contribution when I was the SCHOMOS chairman so that the current generation did not have to work as I had to. Some of the changes that I have contributed personally together with many others before and after me especially through SCHOMOS is to improve the conditions of doctors in the government service.

    Till today, I continue to strive to contribute to the mankind in general rather than just talking or writing about it. Action speaks louder than words but improvements become norms and the younger generation continue to complain about it. The critical allowance, increase in basic pay, call allowance and the reduced working hours are some of the achievements of my generation and contributes to the current generation.

    This generation gap occurs throughout time. Our forefathers used to say that our generation did not value the independence fought by their generation. Rather than looking at the gloom and doom, get up and do something about it yourself.

    Please note that I never stated that we were completely successful. If you had listened, I had also stated that I continue to fail to train the junior doctors adequately due to the limited time for training and exposure and by the sheer numbers we have currently. Previously, I would know every house officer that worked with me but now, my interaction with them is curtailed due to the limited time, not giving me a chance to develop a teacher trainee relationship.

    The problems were not created by us but the parents of your generation who pressurised the politicians to continue opening more universities locally and accepting more universities overseas so that their children can become doctors.
    Doctors of my generation do not determine the number of Medical universities built or the number of postings allocated for Houseofficers , medical officers or specialists.
    I have not singled out any particular university but was quoting facts from the MOH study, one which did not involve me. These facts can be easily obtained if one chooses to look for them.

    Therefore, before you accuse any generation, ask yourself if you are willing to make the changes necessary?Wake up and make the changes you want to see. Don’t be defensive. Why are you expecting others to find the solutions? Why can’t you also look for the solutions? Are you interested enough or bothered enough?

    When you commented on your experience in Australia , you had forgotten what you had said earlier. The requirements here are very different than in Australia. You should be grateful that you have been given opportunities to do procedures while under training.

    Imagine , if you were to be posted to the rural areas in Sabah and Sarawak . Every aspect of your local training would be useful as you would be required to do everything on your own, to stabilise the patient, before transporting the patient to a higher centre. Would you then appreciate your training here, I wonder, or would you rather be an overqualified clerk doing rounds before being posted out.

    If you want to know the differences between training and working conditions in the UK versus in Malaysia, please look at my articles in Berita over the last 20 years. Working at every level in both countries, I was able to compare them. I am sure the system in the UK is similar to that in Australia. They are not always necessarily the best and the patients are not always served better, either. You can also look at these articles for suggestions to improve working conditions, training and other issues pertaining to both doctors and patients holistically.

    I believe that my generation are no angels but we have dramatically improved from previous generations. You no longer see scalpels being thrown by surgeons in the operating theatre. Junior doctors are no longer kicked or physically abused in the wards as before as my generation do not condone such behaviour that we were subjected to.
    However, in some, the mental pressures remain probably due to poor coping skills and some vent their own frustrationson their subordinates. But that does not reflect my generation, in general. The mental stresses working in the health sector has been further aggravated by the increased expectation of patients, the level of education of the patients, complaints, administrative issues, medico-legal and others. Therefore, we all continue to work under different evolving conditions.

    Change is the only thing constant in life. It is up to each individual to take it up and try to improve the conditions we are in. If each person can move a grain of sand a day, in no time we could build mountains and mould our lives towards a brighter future.

    Your post as a reaction to my talk, shows that the message I wanted to disperse had reached the target group albeit a bit skewed. It has given me a chance to expose the problems to you. Remember, no single person can solve all the problems in the world. In my capacity as the President of MMA with the support from all the members, we are doing our best to improve the conditions for doctors of all generations. Your generation is our future and our hope. I sincerely hope you contribute to the changes towards a better future for doctors.

    You can contact me at drhkrishna@yahoo.co.uk

    Thank you again

    Like

    1. Thank you for your response on my post.

      My post was not an attack towards MMA or you, personally. Even before the talk, the junior doctors have been at the receiving end of negative criticism since the onset of the shift system. When I talk about arrogant, self-satisfied previous generation, I am talking about it in general. Not you or the MMA in particular.

      And as I have mentioned, this sort of tendency for comparison happen in all aspects of mundane daily lives and in all working fields. Even paddy planters and rubber tappers talk about how things were done or should be done. Your talk only serves as an impetus for me to write again something that I have already written about when I was a HO 2 years ago.

      My post is highlighting the fact that we don’t feel the criticism is fair, seeing that we are at the bottom of a large heap and did not determine the course of events in our health care system. Yet, we are the one who is suffering from the results of the previous generation’s policies.

      I am saying that we don’t like the alleged lack-of-training that is going on, either. Of course I am grateful that I get to learn to do procedures as housemen (the only postings where I had the experience of working in the shift system was in paeds and casualty), but that’s not the point of my post.

      The point is, junior doctors have been under-trained everywhere in the western countries yet they get to become good specialist at the end. So, how did they do it? So we should take steps to emulate and integrate their system into ours and slowly prepare our system to accommodate the changing circumstances.

      As you said, your generation has improved. No more scalpel throwing in the OT. In a way you are saying that, even though some are still very malignant, but they do not reflect your generation.

      I agree.

      And I am telling you that the poor attitude of some of our junior doctors (some taking ELs and MIA every now and then) is NOT a reflection of my generation, either. They are plenty who are good and competent…maybe not as good as your generation who do all sorts of bombastic procedures, but this is not a good time to compare between you and them. At the end of the day, they are being doctors in a different circumstance and environment than you.

      I think, though our views differ, our objective is the same. We want better future for doctors and for patients. Our paths may diverge now but later it will converge eventually because our destination is the same – towards a better future.

      If you think I am just writing and not doing enough, that’s because as a nobody in KKM, that’s all I can do. I speak about it, highlight the issues that junior doctors feel and hopefully someone take notice. It’s a heck of a lot more than other junior doctors are doing. I do this knowing that I may get harsh criticisms from more powerful specialist in KKM..against me who is a nobody. But we all do whatever we can in our limited capacities – you and I both.

      Thank you. It is an honour to have received your personal response in my humble blog.

      Like

  10. John Teo

    “If you think I am just writing and not doing enough, that’s because as a nobody in KKM, that’s all I can do. I speak about it, highlight the issues that junior doctors feel and hopefully someone take notice. It’s a heck of a lot more than other junior doctors are doing. I do this knowing that I may get harsh criticisms from more powerful specialist in KKM..against me who is a nobody. But we all do whatever we can in our limited capacities – you and I both.”

    May I just add, No Dr is a nobody, regardless of him or her being Junior or Senior, private or KKM, Specialists or non specialists, powerful or not… Each Dr is entitled to his or own opinion and yes, definitely yes, we can highlight the issue and we can do even more by joining MMA as it’s the single Largest Organisation that represents Drs and we can speak up for our colleagues when injustice perceived or real is being thrown our way and we can organise Junior Drs together so that we speak with one voice , remember a finger alone is powerless but 5 fingers clenched into a fist is a powerful force indeed and we can contribute and campaign for what is right so that our current generation and future generation are In a better position and have a more rewarding career and we can be an architect of what we are to be and what the future will be , only if and only if we shed the notion that we are nobody and powerless.
    History have proven time and time again that Great changes comes from the efforts and voices of only a few who are true believers of change.
    Always believe in the infinite power to change and always aim for the moon and even if we fail, at least we have tried.
    Pls ignore all the negative things that come your way as it not worth the effort.
    I hope you can agree on some of the points made.
    best wishes,
    John Teo

    Like

    1. Ditto on the fact that one is entitled to one’s opinion. It is the one principle I staunchly believe in.
      I bow in respect to all specialist in their respected field. But when it comes to general principle of things, everyone should be able to have their say and openly discuss what they believe in regardless of one’s position in any organization.

      However, one must be prepared to face the character defamation that would come one’s way.

      Like

  11. In other countries, they have the anti bullying policy. Read this as an example, from Ireland
    http://www.hse.ie/eng/staff/Resources/hrppg/Dignity_at_Work_2009_Policy.pdf
    Look at page 4 & 5 for what is and isn’t considered bullying over there.

    ” Examples of Bullying
    The following are some examples of the type of behaviour which may constitute
    bullying. These examples are illustrative but not exhaustive:
    – Constant humiliation, ridicule, belittling efforts – often in front of others
    – Verbal abuse, including shouting, use of obscene language and spreading
    malicious rumours
    – Showing hostility through sustained unfriendly contact or exclusion
    – Inappropriate overruling of a person’s authority, reducing a job to routine tasks well
    below the person’s skills and capabilities without prior discussion or explanation
    – Persistently and inappropriately finding fault with a person’s work and using this
    as an excuse to humiliate the person rather than trying to improve performance
    – Constantly picking on a person when things go wrong even when he/she is
    not responsible”

    I am sure all developed countries have similar policy in place to prevent this situation.
    Maybe we can introduce similar policy here in Malaysia.

    Like

  12. John Teo

    Thank you Afiza for your reply. the challenges in health care in Malaysia are myriads and we are on a slippery road towards obscurity if we do not reverses this trend. It is up to you and me and all of us to contribute to this change.
    There are always fear of retribution and character defamation and so on and so forth if one were to speak up but speak up we must, if we were able to have some hope of changing for the better.
    that is why I salute you for your bravery and hopefully you and all your colleagues will join force as one and with us and all other Drs to fight for a Better Malaysian healthcare . if one is right, have faith in your views and never waver.

    Like

    1. Ok, then, sir. Let’s all speak up.

      I am not brave. Really. I was told that I am too opinionated and too loud for my own good.

      There are times when I self-reflect and filled with doubt whether I was right. Whether later I will change my mind.
      However, I believe that as mere mortals our knowledge is limited within the boundaries of time and our own limitations.

      What matters is, during that time, with the information that we have at that time, we honestly and truly feel that we are saying the right thing. If it’s not the right thing, then in the future we will find that out, and we have the prerogative of changing our mind then. When that time comes, we cannot be obstinately stubborn to adhere to our old thoughts simply because we had spoken out loud those thoughts previously.

      In the future, I don’t know what my thoughts would be. But for now, this is what I believe.

      Like

      1. John Teo

        When I hear from Doctors like you, it give me hope that there may be a future for Malaysian Healthcare and for The Medical Fraternity in general… Those who tells you that you are too opinionated and too loud for your own good are unfortunately the sad ones who have an inferiority complex and responsible for the total mess we are in now….
        It takes a brave person to speak up and an even braver person to admit we are wrong when we are wrong… The culture of KKM and Drs in General whether in Public or Private , senior or Junior have been there for years and years and it takes a long time for things to change but change we must…
        That is why I applaud Drs like you who dare to take a stand and I am standing with you and all our colleagues…
        By the way, pls don’t address me as sir, as althought I graduated long time ago and yes I am a specialist, we are all the same and we are in the same rocking boat.. we must fight as one and voice as one..

        Like

  13. MMA dungu

    MMA is useless. My biggest complaint about being a doctor here is that KKM is too bloody pro-patient. Everything is about jaga hati patient. In this respect, MMA has been a bloody white elephant. What use is MMA besides providing courses and sucking membership fees?

    I commend KKM on their efforts in public healthcare, such as in dengue prevention, HIV education, and even in educating patient compliance to medication.

    But I see zero to little effort in advocating the rights of doctors to NOT be bullied by patients for MCs, to NOT cater to ridiculous demands to be seen quicker than the allotted time in the A&E unit, to defend themselves against endless complaints…the list goes on. Everything is about pleasing the patients.

    Are we running a bloody business or what here? Customer is always right, is it? Where is the high and mighty MMA in all this?

    Like

    1. I would not exactly say they are useless. I am sure they have contributed quite a lot in their own rights.
      However, the lambasting of junior doctors overshadow the whole efforts in many of their talks. We don’t wonder that most junior doctors don’t join MMA.

      Unless they change their tune just slightly – delivering the same point but in a different spirit – it would have come off a bit better.

      Ditto on doctors being bullied by MC seekers. Sometimes doctors being pressured by staff to cut queues in green zone so that we can see THEIR children earlier. In my opinion, A&E is the LAST place for anyone -VIP or not – to demand anything.

      The concept of triage is such that if your case is urgent, you will be placed in Red and YEllow,in which case you will be seen quickly without you even having to ask.
      While in green zone – where the MC seekers usually are – they can afford to wait.
      I pointed this out to someone in MMA, but he didn’t exactly agree. He said that he will always try to help staff whenever he could, which is of course a commendable attitude. We should always help staff….but not at the expense of cutting other people’s queue or at the expense of abusing the A&E service.

      In my opinion, staff should know better to go to KK for non-urgent cases rather than abusing the services of the A&E. As staff. we should educate our own family not to go to A&E for all cough and colds that can be seen at KK or private GPs. I always told my own family not to go to A&E for cough & cold or muscle sprain. Staff laa yang patut lebih tahu and ‘walk the talk’. How is it fair that you expect the public not to abuse A&E, but when it comes to your own family, suddenly it is ok…and wants to cut queue some more!

      Like you said, there aren’t enough people defending us against unfair accusation by the public. When the public demanded for ‘women doctors only’, doctors are defended by bloggers first, and by doctors in social media. Maybe it has escaped my notice, but not much publicity was given to any statement by MMA regarding this issue last year. Their voice is only loud enough when they are assuming the voice of ‘doom and gloom’ against junior doctors.
      *deep sigh*.

      Like

    2. John Teo

      Dear MMA Dungu, A lot of benefits and things that Drs have now are because of sacrifices of others before you.. You may not realise it but other Drs before you have put their sweats and toil and hardwork to get what we have today…
      Did you realise that Drs have been threatened by Jail term and arrest so that you may enjoy your on call allowance today? this is just one of the many examples of what others have done so that their colleagues may benefit from their actions.
      Who is MMA,,. I agree MMA is useless and MMA is a white elephant…. Why?
      it’s because MMA is only a name and a logo and an association’s name..
      What matters is you and I….. it is you and I that make up MMA and it is us who can do something and fight for a better conditions and better outlook.. when we call MMA useless, we are actually calling ourselves useless because again it is you and I and we who have done nothing….
      If we are not happy about things or conditions, bullying etc etc… we speak up like what Afiza did, we try to correct what is wrong into right so that we all are better off , we organise ourselves so that we are a force to be reckon with, We join MMA because the logo and the name allows us to channel our grouses officially….and we do a lot more…
      when we point fingers at others, the same fingers will point back at ourselves asking what we have done also?………

      Like

  14. Talk_kok

    Facts:
    1.diabetic patients in Malaysia in no.1 in the world(2.4 million diagnosed,2.6million un diagnosed)
    2.obesity in Malaysia is no.1 in Asia
    3.paediatric obesity in Malaysia in no.1 in SEA
    4.300% increase in dengue cases in Malaysia(apparently MoH/KKM released 10000 genetically engineered mosquitoes in 2010 to fight dengue which obviously backfired)
    5.MoH/KKM went over their jurisdiction by announcing Cadbury chocolate is ‘haram’
    6.Malaysian healthcare system have never won any internationally recognized awards/achievement/or whatever.

    I mean ,thats our problem, we talk so much without facts.this is what separates us from western civilization.

    Ps: that’s why I quit MoH/KKM. Just work hard and get accredited/acknowledge,them talk. Just my 2 kurang. Peace. #savegaza

    Like

    1. Trigger-happy

      Technically, they didn’t declare it to be haram or halal. All they did was announce that it had porcine elements.

      Having said that, however, they still should not have went ahead and confirmed what at that time were circulating rumours, knowing the kind of impact it would have had on society. They should have consulted JAKIM/MFK first. I agree that they jumped the gun in that case.

      Like

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