Most Eventful Ramadhan & Eid

Assalamualaikum, guys. I hope it is not too late for me to wish all my blog readers Eid Mubarak and Taqabbalallahu Minna Waminkum. May Allah accept all the good deeds from you and from me. Amin.

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I have always loved the month of Ramadhan since I was a child. This year’s Ramadhan, however, was quite eventful for me. But I still treasure it, nonetheless.

In the middle of Ramadhan, I had to sit for my CASC exam and oh boy, it was like walking through a journey of a treacherously thorny path for me. At the end of the exam, I was drained and exhausted with a heavy feeling in my chest about all the possible (imagined or otherwise) mistakes I might have committed. My apprehension was made worse by the post-exam discussion session that we had self-torturously embarked on among ourselves. (Worst idea ever to have a post-exam discussion! Only worsen my fear) During that discussion, I came to realize that some of them had done this CASC a few times in the past… one candidate had even done it for 5 times. And they were so good and so experienced but they still failed… and I am just a newbie. I knew my chance of passing was very slim. But I didn’t want to lose hope just yet.

After I got back from CASC exam, my mind was perhaps too preoccupied… I missed a step and fell down the stairs at my parents house, spraining my left foot. But because I had only just returned from exam leave, I didn’t feel like I could get an extended MC just for a sprained left foot even though this felt like the worst sprain I have ever experienced in my life. So I went for my first post-exam on-call with a crutch. It was a terrible on-call, not just because of the amount of the on-call cases, but mainly because I noticed how everyone was staring at me when I walked with a crutch along the hospital corridor. Not exactly the best feeling ever.

I felt so self-conscious that I decided to not use the crutch anymore the day after. Luckily, by my next on-call, the pain got much better and I could weight-bear already, albeit with a funny gait. It wasn’t the most fun experience I have ever had.  Adeh. I ended up spending the rest of the Ramadhan at my parents’ house instead of returning to my own place because my left foot was still too painful for me and therefore any help I could get with free meals preparation would be much appreciated. (Muchas gracias, mamita and papito! Your ever loving daughter loves you) The good thing was, I got to spend a lot of time with my parents in Ramadhan and buka puasa meals tasted much better (And it’s also great because it’s been a long time since I last feel like an only child. LOL.)

I went through the middle part of Ramadhan feeling like I was going to have to start collecting more money for my next CASC attempt. At one point, I decided to stop worrying about the result and just focus on getting the best out of Ramadhan first. Priority must be set straight, I had to firmly tell myself.

I had a good Raya celebration on the 1st and 2nd day of Raya with my family and friends.  As usual I had a ‘beraya & bermaafan’ session with my parents, my sisters and their husbands (This year, tak cukup korum. Two of my siblings celebrate raya at their in-laws’ houses.)

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And we also had our annual outdoor #OOTD Raya pose. Haha. There were a lot of ridiculous pictures of us acting like cheaply-paid models, displaying  baju kurung in an outdoor photoshoot session. 😛 I will only be showing you a few here here. The rest look too ridiculous for public consumption. *facepalm*

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On the 2nd day and 3rd day of Raya, I went out with two of my good friends. Because these two don’t know each other, I had to arrange to meet them separately.  These two are among the ‘wajib jumpa time raya’ people for me, despite the fact that I do meet them quite frequently throughout the year, anyway. I also attended a few open-houses organized by colleagues and friends. All in all, I really kept my promise to socialize more after exam. I did it! Haha.

 

But on my 3rd day of Raya, the anxiety about exam came back because it was the day my exam result was going to come out. I placed all my tawakkal in Allah because I knew I didn’t do as good as I hoped to do in the exam. I told myself that I would accept whatever result that I would be getting.

***

Dear readers,

I was quite disappointed that I did not pass my CASC exam. In order to pass the CASC exam, there are TWO criterias that must be met:

1)you must reach the passing mark

AND

2) you must not fail more than 4 stations out of 16 stations.

The passing mark is 62.7. My mark is 63.3%. So, I did reach the passing mark but I failed more stations than I should. That happened to a few of us. And there were also some of us who only failed 2-3 stations but unfortunately did not reach the passing mark. It was the most disappointing thing that could ever happen to a candidate… when you made it in one criteria but did not make it in the other. Gosh, so disappointing. Overall, around 47% of the candidates had passed. The rest, including yours truly, will have to prepare for another CASC attempt.

I was disappointed. But I accepted it (because what else can I do right? LOL)

I gave myself 24 hours to grieve properly. And then I told myself that I must get over it, stop feeling sorry for myself and start to DO SOMETHING (as in, study again, of course! What else, right? Gosh… so exhausting! But the truth is, the most exhausting part is remembering the money I had burned for this exam. Ouch! The pain is real! A lot of us MRCPsych candidates are struggling financially. That is one major stressor for all of us.)

But I couldn’t even grieve properly because I had relatives to entertain and my mom needed my help in the kitchen. Actually, come to think of it, that’s a good thing because it stopped me from ruminating over my result. Because my result had come out during the festive season, I had to be less self-absorbed and focus on helping my mother to entertain the guests.

I still remember how I had reacted when I failed my Add Maths as a Form 4 student back then. That was the first time I had ever failed at anything. It was such a HORRIBLE feeling back then. I was so self-absorbed, refused to talk and just ruminated for a few days straight LOL. But maybe it is a sign of maturity now that I could simply put aside my disappointment and responded to my environment properly, be sociable and just entertained guests like nothing really disappointing had recently happened to me. If I were still my old self, I would probably just shut myself in my room and ignore everyone after announcing to my family that I want to be by myself. I would  then pick up some fiction and simply escape reality by reading the story of another person’s life hahha. Yup… that was me as a teenager! (But I am so much better now, ehem, I think. Perhaps because as I grew older, I have come to realize that most things that I used to care about was not as important as I made it out to be. It is nice when things go your way. It’s good when things are calm and rosy. But when things don’t go your way, you are going to have to deal with it, respond accordingly and persevere. But, this is easier said than done. Because first of all, you have to calm the tumultuous turmoil in your chest. And that is HARD, my dear readers. But again, you have to do what you have to do!)

It is no use to deny that the weight of disappointment is always gonna feel heavy in your chest. But the point is not to let it overwhelm you. Keep your balance.

The day after I got my result, I felt like cancelling the plan I had made with another good friend of mine to meet up with her. I haven’t caught up with her for 2 years though we always keep in touch through whatsapp messages. She is one of my best friends during housemanship and now she is already a Paediatrician. But I just didn’t feel like going out the day after my disappointing exam result. Just wasn’t really in the mood. But then…  I told myself, “Afiza, you had wanted to meet up with her for so long. Just because you fail an exam, why should you change your plan? It doesn’t make it right for you to cancel a plan that you had committed to. Both of you had set aside a specific time to meet up and she had probably cleared her schedule for this reunion…. is it okay to break a promise just because you are disappointed? Buck up, girl! You are better than this!” 

I know it is not okay to cancel a plan that we had SO CAREFULLY laid out with each other many days prior. (Because both of us were always so busy to meet up properly, before. We doctors are not really spontaneous people and every get-together is NEVER a spur-of-the-moment thing.) And really, I also wanted to meet her. I knew she was going to be a breath of fresh air that I was going to need. So, I decided to go and see her in Sungai Petani as we had planned.

 

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And I am really glad I did that. The force of her insightful wisdom was what I really needed at that time. She is one of the wisest person I have had the fortune to know. She shared with me her own struggle when she was studying to become a Paediatrician and now she’s already doing her gazettement. She really did lift up my spirit in that 3 hours I had spent talking to her. I am so lucky that I am surrounded by inspiring people like her. It makes it easier for me to emulate their spunk.

So, can you see now why I feel like I’ve had such an eventful (or stressful) Ramadhan and Eid? Haha. It was like I was thrown into a roller coaster whirlwind of feelings and emotions in this particular year of Ramadhan and Eid. Feeling blissful and happy about Ramadhan and Eid in one moment, and then feeling anxious about results in the next moment. In one moment, I would feel thankful that I get to experience Ramadhan and Eid one more time this year, and then in the next moment I would feel sad about not passing the exam. I couldn’t even cry properly because even though emotionally I feel sad but intellectually I knew that I have so much more to be thankful for that it wouldn’t make sense for me to complain about anything. I would be an ungrateful slave if I complain about petty stuff when He had given me so much throughout my life. How He had guided me in the past when I was lost  by throwing me into the midst of the kind and wise people I had met in Australia! How He had blessed me with comfort and love from the people surrounding me. How He protected me even when I didn’t deseve it!

Even now, I can feel the wave of love coming from family and friends when I am feeling disappointed and defeated. That is indeed a blessing.

 

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Alhamdulillah for great family support and friends with positive outlooks. Anything more that He decides to give me would only be a bonus and I realize that. Passing an exam should not be anyone’s main focus in life, right? (But oh, it would be so nice to have passed. Really, I cannot deny that. But I am putting stuff into proper perspective in order to bounce back and fight another day. I am gonna beat  the crap out of you, CASC! Haha. Insya Allah).

Now, it’s time to resume my studying and prepare for the next CASC exam.

Wish me luck and please pray that I will have the strength and fortitude to go through the exam again.

Until next time, my dear readers. Much love and may Allah bless all of us.

 

 

 

Truly Non-Partisan

Last year, while I was working as a PACA for PH, one of my batch-mates had jokingly said, “Afiza, kau ni kalau Tok Det kentut pun kau cakap merdu.” in our batch’s Whatsapp’s group.

I laughed inwardly. I admit, that I was pro-Mahathir ever since I was in primary school. Everybody who knows me, know that! I read books about him “Mahathir Di Sebalik Tabir” when I was only 12 years old. I have since read many versions of his biography. And I have also read his autobiography “Doctor In The House”.  I haven’t read the book “Dr. Mahathir’s Selected Letters To World Leaders” yet, but I am planning to. I have a lot of other books about him at my bedside, waiting to be read. And Insya Allah, I will get to it, now that the exam is over.  So, yes, I freely admit that I am his fan.

But I am not blind to all his faults. I just happen to think that he is the smartest leader Malaysia has ever had, and if I am to take any chances, I am gonna root for Dr. M rather than Najib, UMNO and PAS.

That’s all.

And believe me, even if Dr. M was never in the picture during GE14, I would have voted for PH rather than Najib. Dr. M had NOTHING to do with me supporting PH. I hated Najib long before Bersatu was formed. To me, Najib was an evil kleptocrat who had abused his power shamelessly and openly. Nothing would ever induce me to support BN at that time, with or without Dr. M opposing Najib.

But the involvement of Dr. M in PH just strengthened my resolve to work harder for PH to win.

That’s all.

And after reading the book Billion Dollar Whale excellently written by the journalists Tom Wright and Bradley Hope, I am even more convinced that I had made the right choice in GE 14. May 9 2018 is still gonna be one of Malaysian’s greatest success story, just like The Dawn Raid saga.

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***

When I just got back from Australia, my father had registered my name into Puteri UMNO. I wasn’t keen to be a member of any political party. After going to Australia, I had developed more critical thinking in how I think about politics and I had stopped supporting UMNO or any particular political party. Instead, I prefer to look at issues and debate them in my mind, looking at the merits of the issue itself…. and not from which party the issue comes from. But as a, ehem, filial daughter I obeyed his wish and registered myself into Puteri UMNO. In fact, all my sisters did. (But we managed to avoid attending meetings and such even as my father sometimes wanted us to. Hahha. I have perfect excuses because as a house officer, I was too busy to attend political meeting anyway.)

My father has always been very “bersemangat” about politics, about patriotism and about fighting to increase the socioeconomic status of the Malays. Talks about politics and economy is our small talk in the family, (believe it or not) because my father has his own business and my brother-in-law is an entrepreneur. So, in the business world, people talk about politics a lot! They know stuff about government deals that had gone wrong and fishy things that ordinary people like us don’t really know. We also like to talk about education because my elder sister is a lecturer and my two younger sisters are passionate teachers. (So you bet that I have very strong opinions about our education system. In this blog I wrote about education quite a bit!) Otherwise, we will talk about medicine and health because I am a doctor, my youngest sister is a dentist and my own beloved mother is a retired staff nurse. Or else, my siblings and I will talk about the latest fiction we had read. (This explains why I am not good at small talk. Even my small talk is serious. Hahha. This is why I have a blog. I have a lot of opinions. And my opinions are strong ones too… not exactly suitable for a nice, relaxing dinner conversation in a social setting. So, my blog is where I write them all. And yes, I write them on Facebook as well. Because I believe, social media is a good place to advocate for causes we believe in. And I use Facebook a lot when it comes to political advocacy. I used to want to become a journalist, and writing in blog or on Facebook feels natural to me when I feel strongly about something.)

After my father got fed up with the blatant corruption in UMNO, he quitted UMNO and joined Parti Peribumi Bersatu. Again, he encouraged all of us to join the party. But this time, none of us did.

My father is the sort of person who believes that we must belong in some ‘society’ or ‘party’ in order to fight for issues we believe in. “Kalau tak, kita fight pun tak ke mana sebab kita tak kuat.”

Well, he has a point.

But, I still don’t want to belong to any party. I stuck by my decision to ONLY support anything or anyone based on the merits of their arguments rather than because “aku ahli parti tu. So aku kena setia pada parti.” 

Look, I am a loyal person. But I am loyal to the truth. I don’t want any kind of ‘artificial’ sense of obligation that ties my hands from saying what I really think.

So, these days, when I started to post in Facebook about certain government policies I disagree with, some people started to say, “Tu la… dulu kau undi PH sangat. Siap jadi PACA lagi. Sekarang, baru tau yang UMNO tu lebih banyak memberi manfaat kepada orang Melayu.”

Ugh! Gosh, penat cakap dengan orang macam ni sebenarnya. They just didn’t get it! They fail basic critical thinking.

I worked for PH during GE 14 (even when I was NOT a member of any of their party components) because I was ANGRY at Najib and at those spineless, coward UMNO politicians who did not dare to throw Najib out of leadership when his corruption was so obvious! I cannot condone that kind of evil kleptocracy to continue indefinitely in Malaysia. To me, regardless of the perceived incompetence of the current government at the moment, I would not do it any other way even if I could turn back time. UMNO must lose the election in order to uproot all the corruptions in the government and clean the system. In the next GE 15, if PH did not govern well, we can vote for BN again. In fact, I would rather we change government every single term so that any kind of corruption would be quickly uprooted every 5 years. When one party becomes too arrogant  for having been in power for too long, the rakyats will suffer. Monopoly in ANY sector is a fertile breeding for corruption and abuse of power. If we change people in power often, and there is no monopoly in who gets to be the government, they would know that their position is NOT secure and they will be more careful about making unjust policies and bullying the rakyats in the future. Because they know Malaysians now vote not based on political party and races, but based on the merit of the issues and policies. So, they will work harder to come up with good policies if they want to stay relevant!

Please understand that just because I was a PH PACA that doesn’t mean I am going to support PH no matter what the issue is! So there is no need for you to say annoying things like, “Tu la…. sokong lagi PH.” What the heck? Why is it so hard for them to understand? In politics, we choose the lesser of two evils by evaluating the information that we possess at THAT PARTICULAR POINT IN TIME. Susah sangat ke nak faham? When the election is over, there will always be issues and we continue to use our GOD-GIVEN BRAIN to evaluate those issues and come up with our own opinion. Get it?

I am not the sort of person who would stick to one party. I am non-partisan. Tolonglah merdekakan fikiran dari politik kepartian. Free your mind and use your intellect to evaluate on any issue instead of blindly supporting people just because they come from your own race or your own party.

***

The truth is, lately I have been quite disappointed with Dr. M and ALSO with Dr. Maszlee in particular. And with Dr. Mujahid… Gosh the kekanda is not even worth mentioning! And let’s not even mention Kesavan Subramaniam, the Sungai Siput MP, who is now facing the accusation of having sexually harassed one of his political aide. This is so sick!

Let me enumerate below what are the issues I have been feeling upset about for the past few weeks.

1)Dr. M labelled Dr. MAZA as ‘pekak’

I was upset when Dr. M labelled Dr. MAZA as ‘pekak’ just because Dr. MAZA had said that Islam is being threatened under PH. Look, whether or not it is true that Islam is being threatened under PH, there is absolutely no call for you to label someone as ‘pekak’. If you disagree with someone, you rebut their points one by one! Simply labelling people when you disagree with them is a form of cheating…. it shows that you are too lazy to come up with a counter-argument and simply take an easy way out! I hate that in anyone! And to think that Dr. M did this, I was so disappointed.

If you listen to the clip above, Dr. MAZA came up with a lot of reasonable arguments regarding the unjust treatment subjected to Ustaz Zamri Vinoth. Therefore, if Dr. M disagrees with Dr. MAZA, he should have just answered on the issue without resorting to labelling Dr. MAZA as pekak! I expect more from Dr. M than this!

Below is my frustrated Facebook rants against Tun M.

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2) A DAP Senator  suggested for Malaysia to open an embassy in Israel. 

Nga Hock Cheh, a DAP senator, had – out of the blue – suggested that Malaysia should open an embassy in Israel, knowing full well that we don’t have ANY diplomatic relation with Israel.

What a stupid political move! Do you really want to be ‘kerajaan satu penggal, oh wahai PH? Malay Muslims will never vote PH again if you say something like this multiple times. Our patience has been stretched thin already! Prioritize your agenda! How does opening an embassy in Israel would advance you, politically? Are you so eager to alienate your Malay supporters? Do so at your own peril, I tell you.

GE 14 has shown that the rakyats can topple down the government that has overstep their boundaries. The Israel issue is a clear, indisputable boundary!

Nasib baik kau cepat sedar dan tarik balik kenyataan tu! Perhaps, you are trying to test the water, hmm? Don’t bother. When it comes to the issue of Israel and Palestine, our stand is CLEAR and it will NOT budge!

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3) There was also another nonsense suggestion to erase the status of religion in our IC. (For WHAT?!)

Some factions in DAP believe that stating your religion in IC is the cause of disunity in the country! Hahaha. What a joke.

You want to know what cause disunity in this country? YOUR insistence to maintain the existence of vernacular school is the MAIN reason Malaysians are not united. It is the main reason Chinese patients always request for Chinese doctors… because they can’t speak in Malay or English despite being born in this country! It is the main reason why some insensitive Chinese can have the audacity and the temerity to speak in their mother tongue when there are Indians and Malays in the group too. It is the main reason why Malay and Indian HOs in Penang had complained that their rude consultant had spoken in Chinese and effectively alienating HOs of other races in teaching rounds! This is why a lot of doctors in Penang GH had said that Chinese doctors (not all) in Penang are mostly racists!

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4)Questionable move by Youth And Sport Ministry to bring BTS into the country.

This is something I just cannot understand. Previously, mere days after winning the GE 14, Nurul Izzah had said that she wanted to bring Radiohead into Malaysia. (I don’t even know who is Radiohead, by the way). And now, Syed Saddiq wants to bring BTS (a Korean group) for a concert in Malaysia in an effort to promote the country.

Look, I am the sort of person who are not into anything Korean. Never really into their dramas or their songs or their culture in general. I seriously don’t know ONE SINGLE name of their actors or actresses.

Until the BTS issue came up in the social media.

I wrote a very lengthy Facebook post about this too. My stand is clear. I don’t think government should be seen to be so eager in supporting trivial, ‘picisan’ stuff! As a government, we should be seen to be focussing on serious stuff! Let the commercial people and the free market decide whether or not BTS should come to Malaysia. Kerajaan tak payah nak beriya-iya support. Doing that is such a stupid political move… the conservative Malays would not vote you anymore! Get it?

You shouldn’t make any statement supporting ‘lagha’ stuff happening in the country because it just looks, oh, so BAD when a politician is seen to be behaving like a fanatic enthusiast of foreign artists! Just be neutral and let the entertainment people bring them in if there is market for it! BUT YOU! MUST! STAY! CLEAR! OF TRIVIAL, PICISAN STUFF! Think about your credibility as a leader, PLEASE!

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5)The Education Ministry Is Just Not Doing A Good Job! 

I am not Dr. Maszlee’s biggest fan. I feel like he had failed to do something that is so critical and vital in education. He failed to be a strong, firm leader. From the very beginning, I had expected him to ABOLISH vernacular schools, reform the education system and gradually phase out the Bumiputera quota once vernacular schools are abolished. We need our future generation to be UNITED by one similar common background before we can talk about stopping the quota system.

Instead, among the first crazy thing we heard upon winning GE 14 was for the government to recognize a Taiwan-based UEC qualification! This is like throwing more confusion into an already chaotic education system!

I also had my own opinion about the move that Tahap 1 students not having to take exams because apparently, it is better to focus on manners and akhlak first. As though they cannot be learned simultaneously! But that’s just me. Maybe a lot of people out there prefer for their kids not to have exams. But I am the sort of person who wants some sort of benchmark to gauge the students’ understanding of the syllabus. So, I basically disapprove of this backward move because I don’t think learning manners and akhlak cannot be done simultaneously with academic learning. But I am not going to hold this against him because I know how polarized the opinions on this are.

But to my dismay, from the very beginning he was seen to be focussing on ridiculous, trivial stuff. Like the wearing of black socks and shoes. Like the implementation of cashless business interaction at school. WHY???? Por que?? Aku tak faham! Why do the kids need to be cashless in school when outside the school, they NEED TO LEARN TO USE MONEY anyway! Where is the rationale in this action? (And my cynical brain is also asking, whose company benefits from this system? Who is the company who will be installing the machine necessary for cashless business interaction at schools? Seriously cashless system in school ni… aku tak boleh nak hadam. Tak boleh brain kenapa Maszlee comes up with something so PICISAN!) 

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Step up, YB! Your portfolio is an important one. Grow a spine and be firm.

Nowadays, you have received criticism right, left and centre! You have nothing to lose if you just say “We will abolish vernacular schools. The standard 1 batch who first enters the new education system will no longer be subjected to any quota system when they are applying for matriculation, 10-11 years from now.” 

Two things will happen when you say that:

1)The kiasu Chinese (baca elok-elok. Aku cakap pasal Chinese yang kiasu sahaja. Bukan semua Chinese, ok? But kiasu Chinese.) will no longer dare to ask for quota to be abolished because THEY ARE NOT READY TO GIVE UP THEIR VERNACULAR SCHOOLS either.

2) You put yourself in a strong position to bargain for a quid pro quo. You come across as someone who is interested in the unity of the people and willing to sacrifice the quota pula tu! You seem reasonable and smart and willing to compromise for the future good of the nation! And when THEY insist not to abolish vernacular schools but at the same time still demanding for abolishment of the quota system, they would seem selfish and uninterested in national unity!

But what did you do instead? You said  something to the effect of “Quota should be there because even job openings are discriminatory. Private companies only hire mandarin-speaking candidates.” Gosh! Are you saying that one act of discrimination justifies the use of another act of discrimination?! “Oh sebab hangpa discriminate kami dalam pekerjaan, so kami discriminate korang dengan quota lah.” Is that WHAT you are saying? OMG…. no wise politician will say something like that! Ni dah level Ahmad Maslan kot!

Any debater can crucify you and make you look foolish!  Politicians should have basic debating skills, in my opinion.  Rather than comparing quota with job discrimination, you should compare quota with vernacular schools…. because the existence of quota is part of Hak Bumiputera. And if Bumiputera have to sacrifice their rights, then the non-bumiputera must also sacrifice their vernacular schools. Barulah comparable kat situ, faham tak? Barulah kau tak kena bash! Dan kalau kau kena bash pun, at least it will be for a WORTHY statement and a WORTHY move!

Now people are bashing him so badly in the comments section in Facebook and most of them are Chinese. See, YB? You are already unpopular as it is. Alang-alang dah tak popular dan masih asyik kena bash, might as well you simply take the most unpopular action of all by abolishing vernacular schools. Tak perlu nak jaga hati sesiapa… kau memang dah tetap tak popular. Hahha.

In fact, being unpopular now is a form of freedom for you. You can do what you believe as right because you know that catering and pandering to people is useless anyway. They still won’t like you. So chin up, and be firm! Just execute!

 

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Haih…. I just don’t know lah kenapa politician PH ni macam entah apa-apa. Especially the Malays (Belum lagi aku sebut Mujahid with the kakanda-dinda crap! Picisan! Picisan! Picisan!).

***

If I had become a journalist, I am sure I will be the kind hated by politicians in BOTH the opposition and the government. Because I am TRULY NON-PARTISAN.

I will applaud your good move. But I will also scrutinize all your mistakes and crucify you in my article. It’s a good thing that I am not a journalist. It makes for a more peaceful life.

As a doctor, I am exactly the same. There are times when I will keep my opinion to myself because it’s just not worth it to argue over something trivial. But I do have my red buttons. Push them at your own peril! Most of the time, aku tak ada masa nak gaduh dengan orang. I have fictions to read, book reviews to write, studying to do, housechores to complete and I have a blog to update and articles to pen. And I also have to socialize and catch up with friends, reply Whatsapp messages and emails… so that they don’t think that I have forgotten them. Aku banyak kerja… tak ada masa nak cari gaduh.

But I have pet peeves. Okay?

And I have certain issues I am not willing to compromise. I don’t like discrimination within medical field. If you discriminate certain groups with your snide ‘budget bagus’ remarks, I will retaliate on their behalves or on my own behalf. I don’t like it if you try to discriminate my psychiatry department by sending us staff of questionable calibre, hiding behind ridiculous easily shredded reasoning! If you try to justify the bullying of HOs, I will get back at you and break your arguments point by point. If you try to ‘sound alim’ by telling people to ‘redha’ in order to cover up your own cowardice to fight on issues, I will make sure you know exactly what I think about it! Sebab aku paling pantang orang budget alim dan bagi bad impression tentang agama, padahal kau pengecut dan kau tak reti langsung nak berbahas secara ilmiah! If you are unjust in your statement (like Dr. M was towards Dr. MAZA), I will give you a taste of your own medicine so that in the future, you will think twice before giving out such statements.

And another of my pet peeves…. is of course, politicians and their crappy statements!

And my favourite topics are books, comparative religion, philosophy, cats, education, psychiatry practice and the health system.

So any issue that touch on any of these things, I will be really outspoken and I will write about them. If I had touched someone’s nerves when I talk or write about any of these topics…. well, oops, sorry! Lain kali kalau nak cakap, fikir dulu yang ada orang macam aku yang boleh membalas dan menjawab. Jangan ingat semua orang malu-malu kucing nak face you off.

Otherwise, I am content to mind my own business and just read a book! So please, give a wise comment when you talk about things like these with me. For your own well-being, please use a bit of your own critical thinking when talking about politics to anyone. Because if you happen to talk to me, I will scrutinize, rebut and shred your argument point by point if I think your stand is wrong. If you cannot have a free mind, then you can NEVER understand people who DO HAVE a free mind and do not support any particular party just because it comes from any particular race. We generally avoid people like you. But if you are the ones who come to us criticizing our political stand… that’s ok, you can do that. But expect my rebuttals because I don’t keep my silence.

I leave you guys with a video by Dr. MAZA regarding how a Muslim must make a stand in their lives. We are committed to what is true and what is just. Anything less than that is not acceptable if we are a Muslim.

 

P/S: Alhamdulillah I fulfilled my promise to come up with 2 blog posts in May. Haha. 😉

Playing Verbal Fluency Game With My Nephew (And I Lost)

Salam Ramadhan guys,

I hope it is not too late for me to wish everyone a blessed and productive Ramadhan. Just hang on for a moment while I wipe away and clear out all these dust and cobwebs in my website. 😛 Been awhile since I last clean up around here. Adeh!

Gosh…. it’s been quite some time since I last update my blog. I have been super busy with studying. I always promise myself that I will write in my blog AT LEAST once a month. Just because writing is therapeutic for me. And because I want to prevent Alzheimer’s Disease by exercising my mind in a mental gymnasium of creative written expression. Haha. But obviously, I have failed to write anything in the month of April. So here I am… planning to make it up by promising myself to write 2 entries in the month of May. Hopefully, I won’t break this promise too. (Gosh, I need to step up!)

My exam is next week, peeps!  I have come to the stage of tawakkal already. I have accepted that I will never be able to cover everything and I am gonna forget stuff. I am just human, after all. I accept that we can only try our best and the rest is in Allah’s hands. I will try not to be so neurotic towards the end of my exam preparation, ehem! Just ‘enjoy’ the exam , right? (Yeah, right. Haha. I am not THAT positive, yet. I can NEVER enjoy exams, darn it! ) 

Please pray for me, folks. I need all the prayers and good wishes I can get. And the best part of this is, we are in the blessed month of Ramadhan…so hopefully, all of our prayers will be granted by Allah. I remember how I took my final high school exam (SPM, of course) in the month of Ramadhan too. And Alhamdulillah, me and most of my friends got straight As for it. So, I hope I can repeat the same feat for my final specialist CASC exam in this Ramadhan too. (But I have come to know that the passing rate for CASC exam is only 50%. So, there is only 1 in 2 chance that I can make it. Oh, is there a glimmer of light at the end of the tunnel? LOL.)

Well, we have to do what we have to do, don’t we?

But whatever the outcome is, I will accept it, move on and act accordingly. I can always take it another time if I can’t make it this time. That takes the pressure off my shoulder somewhat. (But, ah… if only money grow out of trees, I will be one heck of an avid gardener. LOL. This exam cost me almost RM11,000 in exam fees and preparation course. And that is excluding my flight ticket and accommodation. *sigh*)

Such is life, folks. Not everything is a bed of roses. Even roses have thorns. We take risks, face the consequence, move on and persevere. Well, life is like that. Like riding a bicycle, people say. You can’t keep your balance if you don’t keep moving (well, unless it is an exercise bike… which is stationary anyway. In which case, the purpose of moving is to lose weight rather than to keep your balance. Which reminds me, that I haven’t exercised for awhile now. *sigh*)

And that is why, ready or not, I must take this exam. Keep on moving. Maintain my balance.

 

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While revising my academic materials, I was reminded of how I had played ‘verbal fluency’ game with my nephew one year ago. (To those who don’t know, verbal fluency is one of the cognitive test administered for frontal lobe assessment in the clinic). I laughed in the middle of studying this part of cognitive exam because I remember how I had lost to my 6 year old nephew in this verbal fluency game.

Guys, ageing is real! I lost to my 6 year old nephew that day, you know! God, the horror of it! Of course, to Eshan, I had said, “I only pretend to lose to make you happy,”

Of course, he didn’t believe me. Haha .

So please play this game with your family members as a form of mental exercise to prevent Alzheimer’s, ok! This is one of my favourite games to play with my nephews and nieces (because I am too afraid to play Scrabble or Chess with them… the shame will be too great if they defeat me in those too. Haha. Eshan and Aayra are making me feel my age so acutely. Seriously, guys… not even kidding.)

 

 

In that video, all of us were wearing purple for the wedding of my younger sister. We were all exhausted after entertaining all the guests and the kids were bored, so we decided to play this game while waiting for our Asar prayer. Yup, we left our parents in the ceremony hall to entertain the guests themselves. *walk of shame* #IKNowIamBad 

My parents were pseudo-cool about it…. they didn’t mind me and my siblings’ disappearance act a’la Houdini in the middle of a wedding. LOL. They are so used to it and have become habituated to their children’s lack of social skills. We always avoid socializing more than the absolute necessary amount. Haha. (But they did say, “Nanti korang juga tak kenal saudara-mara. Asyik tak mau sembang dengan orang.” Hahha. But then… I blame my father’s genetic. He is even worse than me when it comes to small talk. My mom is the only one who is good at it in our family.)  I didn’t even know most of the guests anyway. And making small talk with people I don’t know is one of the things that I dread. Not that I have social phobia or anything like that… hahah. I just don’t like crowds and noise too much.

And verbal fluency game is more fun anyway! LOL.

 

Notice how I went blank a couple of times and Eshan just couldn’t wait to count to ten as fast as possible so that he could win. Hahah. He is more competitive than my Kak Long ever was.

In the second video, even Aayra (my 5 year old niece) was helping me. Oh, the shame. (What was wrong with my frontal lobe, guys?!)

I swear, after exam is over, I am going to time myself for 1 minute and practice coming up with as much words as possible so that I can beat them in the next battle. Practice makes perfect, right? Raya is coming soon and they are gonna ‘balik kampung’ to my parents’ house…. so we can have the next battle during Raya. We will call it Aidilfitri Verbal Fluency Contest, si? #AndJustWaitEshan #MakNgahWillMakeAComeback #MakNgahWillDefeatYou 

For the record, I know what bison and walrus are (I know how they look like in the kids dictionary hahha), I just don’t know what they are called in Malay (excuses, excuses LOL) But ah… I have such a smart nephew and niece. I have to step up my game and be careful not to lose to them in the future. Adeh!

One day, I am gonna organize a verbal fluency test in Malay….. Eshan and Aayra will not defeat me in that one. Because my Malay is better than theirs (I hope!)

***

I leave you guys with a reminder (especially for myself) to enjoy this Ramadhan and make the best of this month with prayers and excellent good deeds (exams not withstanding). May Allah strengthen our faith and make us among the righteous in the hereafter. Amin.

Until next time. Much love and May Allah bless all of us.

Heartbreaking News In New Zealand

NZ

When I first found out that there was an ACT OF TERRORISM being committed at two mosques in Christchurch New Zealand on Friday resulting in 49 Muslims killed and many others injured, I was devastated.

I had  to stop my studying for awhile and just devoured the news that were spreading like bushfire in my Facebook newsfeed. I wanted to cry. But I couldn’t. My eyes just refused to cooperate to tear up. So, I was left with deep heaviness in my chest instead. I know that the heaviness will go away if I just cry. (This is my problem. It is always difficult for me to cry. I think if I could just cry, I can relieve this ache in my chest.)

I have been to Christchurch when I was a medical student. I went there  with my housemates for a holiday during the first semester break of my 4th year of medical school. We enjoyed our New Zealand trip very much because New Zealand is just such a beautiful country. I never thought that this tragedy could happen in New Zealand because my impression was New Zealanders were much more tolerant towards ‘other’ people compared to their Australian counterparts. They are more progressive in terms of giving their indigenous people (the Maoris) their rights and privileges. The rights of the Maoris in New Zealand are better preserved and protected than the rights of the Aboriginals in Australia.

So when something heartbreaking like this happened in Christchurch, I just could not process it!

And then I found out that the evil perpetrator behind this massacre was an Australian who has a Neo-Nazi political leaning.

Well…. I love Australian people. Most of them are lovely and kind. But some of them can be such racist rednecks! Five years in Australia taught me all I need to know about white supremacy and racism. My experience in Australia shaped me into the kind of person I have become now. I am a person who is super-sensitive to any form of racism or supremacy or ‘budget bagus’ group. You can judge anyone as an individual if you are so inclined. But don’t overgeneralize the whole group because of any mistake done by some individuals in that group. I COULD NOT tolerate that EVER. Muslims living in the West post 9/11 would understand the kind of suffering we had to endure when we were all painted with the same brush. To them, either we were evil terrorists or oppressed Muslim women! Either way, we were treated with suspicions and being looked at as inferior just because we wore the hijab outside the house.

I remember how I felt like I had to prove myself as a Muslim medical student in Australia. I had to do MORE to get the same kind of respect or esteem that the Australians effortlessly enjoyed. As an introvert, it took some adjustment for me to push myself to be extra-friendly, to be outspoken in tutorials, to join group discussions, to mingle with people (now doing these things is much easier for me these days… especially the outspoken part. Haha)  I had to do all these extra efforts in an attempt to contradict the degrading narrative of what being a Muslim woman was perceived to be (when actually, I really preferred to keep quiet and just went home and read my books). Whenever I couldn’t answer any question in the tutorial group, I felt so embarrassed (more embarrassed than I would have been if I were in Malaysia) because I felt like I was feeding the stereotype that Muslim women are stupid by my inability to come up with a sensible answer. I felt like I had to say something (anything!) in the tutorial even when I had nothing to say. I felt like I had to fill up my speech quota of the day in order to appear fully switched on and involved in the tutorial discussion. I felt that way after finding out that some tutors had complained to the admin that “the Malaysian students are too quiet and not participating in the tutorial discussion”. So during each tutorial session, I doubled my effort to appear extrovert because apparently, the more you talk, the more intelligent people think you are. *rolled eyes* (And yes, Australians are very extrovert! And so, people who are too quiet would be thought of as less intelligent or less capable) So, I strove harder in order to contradict the stereotyped image of what being a Muslim woman was. My sweetest moment was when my assignment on Health Equity Selective was being put up on my uni website (in our students blackboard page) as an example to the juniors in the batch below mine on how to write a Health Equity Selective project in the category of Psychiatry.  Me, an International student whose English is only a second language, got the opportunity to display my assignment as a guidance for the juniors to emulate when doing their psychiatry Health Equity Selective… I was over the moon! (Yup, I had chosen Psychiatry for my Health Equity Selective project. I have been interested in Psychiatry since I was a medical student and had chosen that field for my elective.) I was over the moon because I felt like I had proven a point. It was like, I was saying “See… a Muslim student is not that stupid. If we don’t talk as much in our tutorial session, it is because some of the things are obvious already… that it is not even worth mentioning. And English is our second language… it takes more energy for us to come up with any sort of conversation compared to you guys. If we are a bit slow in articulating our thoughts, that is only to be expected, isn’t it? Besides, we just don’t feel the need to stand out all the time.”

My Malaysian juniors were like “Kami bangga sangat tengok Health Equity Selective Kak Afiza masuk dalam blackboard. Malaysia boleh gitu!”

I laughed.

I am proud of my juniors too. I was proud whenever I see my Malaysian juniors were more well-adjusted and had assimilated better with other Australian students compared to us, the seniors. The juniors learned from our own mistakes and put more effort in making Australian friends. They experienced less criticism that “the Malaysian students do not mingle with people. They like  to keep  to themselves and don’t put in any effort to assimilate with the whole batch”.  As the years progressed and we started getting more Malaysian students among our junior batches, I thought, we were doing such a good job of portraying that Muslims were not as bad as what were shown in the media. Slowly but surely, I felt like the stereotype against Malaysian students were eroding. My heart burst out with pride when I saw how Malaysians were very heavily involved in our university Islamic Society (I myself was the treasurer of University of Newcastle Islamic Society at one time) and we were always the front-liners when it came to interacting with non-Muslims at the Islamic booth during Islamic Awareness Week. Compared to the Saudi or other Middle Eastern Muslims, Malaysian leadership shone bright in the Islamic Society. (Perhaps because our command in English was better than them). We could answer controversial questions about Islam quite well while guarding the booth. All in all, we were making pretty good progress.

But it could get pretty tiring. Always having to prove yourself over and over again is tiring. Whenever there were new incidents of terrorism and bombings in the Western world, I felt like all our hard work to prove that Muslims are good people were completely undone. And we had to do it all over again. Prove ourselves all over again. It was exhausting. Mentally and physically draining.

But I never regret any of it! Because the struggle that I had gone through made me who I am today. There is beauty in the struggle that we have to face in order to live up to our Muslim identity and Muslim ideals when we are living in a non-Muslim country. Looking back, I was my best self in spirituality when I was a medical student in Australia. Because of the struggle I had to face in Australia, I was more conscious of God and more connected to my religion than I ever was in Malaysia. I invested more time to learn about Islam properly (partly because I had to prepare answers for the questions that non-Muslims liked to ask). I was my most patient self when I was in Australia… because I was carrying the image of a Muslim and I did not want my bad behaviour to tarnish the name of my religion. In Australia, I had a purpose GREATER than my own self because I had to be a small ambassador to my religion! So despite all the struggles and the difficulties, I was very motivated. Our social support were the usrah-attending seniors who kept reminding us to be good, to do good, to strive for the hereafter and not just the dunya. (This is the part of myself that I miss the most, now that I am in Malaysia. I miss the Afiza who was nice. Because the current Afiza is not so nice! Hahah. Somehow, after coming back from Australia, I have retained my outspokenness but have not retained being nice. Perhaps because Malaysians are not always nice too….they are not always ethical…they don’t have values of respect or punctuality or cleanliness or efficiency…. they can be lazy…  they can trample on your rights… and if I am too nice and not outspoken enough, I will be oppressed. And I don’t want that.)

***

Allah had planned my life so beautifully, Alhamdulillah.

At 18 years old, I was grieving the death of my friend. Looking back, maybe I had an existential crisis at that time because I was so shocked by the fragility of life. That my friend could die at such a young age! I wondered, what was this life all about? For two years, I was wondering to myself about existential stuff, but afraid to vocalize them out for fear that they would label me “tak kuat iman”. And then Allah sent me to Australia where I met religious people who could answer all my questions. Alhamdulillah, my existential crisis resolved then. I became a firm believer. I came across someone in Melbourne who answered my questions patiently, systematically… scientifically, even! Suddenly, I felt a sense of spiritual awakening that I had never experienced before that summer, which was my first summer in Australia. I knew then that Islam is logical; that it makes sense! If things do not make sense, you must double-check whether it is truly religious in the first place. I was ecstatic and grateful for all that I had learned that summer.  It is nice to have real faith!  (I was so relieved! Finally, the horror of the Israilyat stories I had to swallow in KMB can be vomited out once and for all without feeling any guilt. That’s why I will always love Australia, the place where I had experienced an exponential growth, mentally and spiritually! There would never be a time when I think of Australia without a sense of nostalgia. It’s just not possible. Some of the things I had learned in Australia STILL influence my behaviour until now!)

I believe, some Muslims would have an existential crisis after witnessing this current heartbreaking incident. Some of the family members of the deceased might experience what I had experienced during the period of grieving. They would start questioning… why are there so many dreadfulness in this world? Why do people do evil things? Why didn’t God do something about it? Why didn’t He intervene? Why is this world so unfair? Why was I even created? What am I supposed to do in this life? Is Islam really the right religion? How do I know that? What if I am in the wrong faith… what will happen to me when I die, then?

They might have all these questions as they deal with the death of their loved ones. And hopefully, they will go through the cognitive process of finding the answers… and finally be at peace in their faith. You cannot bury these questions and silence your conscience. Repressing your doubts will not help you find peace. You must actively engage with your intellect and answer the questions that you have about the religion, about faith, about life after death. Otherwise, you will always be in doubt. And it won’t be real iman. You will not experience true peace that comes with firm belief. You will not feel confident to take any action, to speak up, to do what you believe is right… because you are not even REALLY sure if God is real and that He will help you out of any trouble.

So, don’t bury your internal existential crisis or your philosophical conflict. Answer them! Seek and you shall find! And believe me, what you find will be beautiful and priceless!

1771957-Yasmin-Mogahed-Quote-Your-life-is-nothing-more-than-a-love-story

 

***

Screenshot 2019-03-16 22.45.22
My Facebook status on the act of terrorism at the two mosques in Christchurch.

I have been busy preparing for my CASC exam these days. As usual, I am at my most neurotic self while preparing for exams, LOL. I would start thinking about how much money will be lost if I fail my exam. I would start thinking about “ah, aku dah tak larat nak study! I just want to be a chronic MO.” Hahha.

Sometimes, I mourn my lack of time for fiction reading. It is ridiculous how much I sweat the small stuff.

I forgot that there are other more important things in life other than being a nerd and passing your exam. I forgot that my fiction-reading are trivial, picisan stuff! Stuff of amusements and ‘main-main’.

Siapa yang melaksanakan kewajiban, mereka diberi PAHALA, dan bag

In other parts of the world, people are fighting for their lives!

On the same day that the mosques in  Christchurch were attacked, Israel had also launched series of airstrikes across Gaza! We have thousands, if not millions, of our Muslim brothers and sisters in various parts of the world undergoing physical and mental suffering… all at the same time! And I am worried about exams? And about reading fiction? Gosh, Afiza… you are preposterous!

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Sometimes, I have to admit, I can be really stupidly ridiculous. I am done worrying about trivial stuff! Because there’s more to life.

For as long as I can remember… everytime I was overwhelmed by my study, some sort of tragedy would be breaking news and made me realize that my struggle was not significant at all in the general scheme of things. For example, in 2010, while I was preparing for my final General Medicine exam, the Turkish ship Mavi Marmara, which was a civilian ship bringing aid to the Palestinians, was attacked by the Israel Navy in May 2010. The attack by the Israel Navy was bravely resisted by the civilians on the ship; nine activists died and many were wounded. I was worried sick about my exam at that time. But after reading about what had befallen the Mavi Marmara ship, I had felt similarly ridiculous as I am feeling now for being too worried over small stuff when people are fighting for something greater than even their own lives!

I composed a poem for Mavi Marmara at that time entitled FORGIVE MY SCOWL which I had uploaded into the poetry section in this blog. I composed that poem after taking a pause from studying my General Medicine notes in order to clear my muddled head and to lift up the overwhelming heaviness in my chest.

This is also why I am taking a pause from my CASC studying and writing this post today. To clear my head. To lift up the heaviness in my chest. Because I just couldn’t cry. Because to compose a poem, it would take a much greater mental strength than I possess. Because I am too mentally exhausted by all the bloodshed.

I pray, that all Muslims would unite together and peacefully respond to this sad calamity in a positive way. I hope, there will be no revenge bombing by Muslims because it would only make matters worse for our brothers and sisters in the West. Trust me, I had enough experience of how terrible it is to be in the West when so-called Muslims commit an act of terrorism somewhere. (Nak masuk lecture hall keesokan hari pun rasa nervous! Rasa malu! Belum lagi rasa takut kena attack bila terpaksa jalan berseorangan.) Please, no revenge bombing targeting innocent people, be it Muslims or non-Muslims. Please, no more bloodshed.

***

I leave all my readers with a reminder to live in this world like a traveler or a stranger. Because, really… isn’t that what we are? Until we reach our final destination, we are only a traveler along the path of life. Hopefully, we will find something precious and beautiful along the way.

stranger

Values For A Balanced And Well-Ordered Life

When I was an IB student in KMB, part of the World Literature component that we had to study was the novel The Great Gastby, authored by an American novelist, F. Scott Fitzgerald.

Though at that time as a teenager I was not that enamoured with this magnum opus of F. Scott Fitzgerald, the FIRST TWO SENTENCES of this novel had stayed with me until now.

In my younger and more vulnerable years my father gave me some advice that I’ve been turning over in my mind ever since. 

“Whenever you feel like criticizing any one,” he told me, “just remember that all the people in this world haven’t had the advantages that you’ve had.”

We had to analyze the novel as a student. And I just kind of wrote in my literature analysis that we shouldn’t be judgmental towards other people because we don’t know what other people have gone through in their lives to cause them to behave a certain way now. By the way, I got an A for my literature analysis of The Great Gatsby at that time. But all I wrote in my essay was some wishy-washy namby-pamby crap that I feel embarrassed to be recalling now.

Trust me, I have changed my mind. I think the longer I am in psychiatry, the more objective I become about things that I read and what I should tolerate and not tolerate. Or maybe it is just the effect of me being older and wiser.

I believe that what happened to you in your past DO affect your life now…. but only up to a point. Whether or not you let the past haunt you, it is ON YOU. It is YOUR DECISION.

If I could go back in time and do the literature analysis all over again, I would probably change  the tune of my essay and write something like this instead: “We all have different life story. OF COURSE none of us will have the same kind of advantages and disadvantages. That’s just life. It doesn’t mean you can excuse yourself when you do something bad or maladaptive. Instead of wallowing in your disadvantages in life and comparing how other people’s lives are much more advantageous than yours, you should move forward and think about how you could make your life better, isn’t it? Mr. Gatsby deserved what he got in the end! He should have moved on a long time ago and stop pining for a married woman.”

Trust me, I have no sympathy for the great Mr. Gatsby.

***

As a psychiatry MO, I am going to be honest and admit that I have favourite cases and favourite patients. I mean, that is only natural. That’s why we have subspecialty, right? Because we don’t always like all types of cases even though we DO see and manage them all to the best of our ability.

And, let’s face it. We do have favourite patients, don’t we? We don’t discriminate our patients in terms of treatment and resources but there are certain patients we like to see MORE than others. That’s just human.

So, what sort of patients do I like? Well, I like patients who help themselves because it makes it all worthwhile. Because without the patients helping themselves, there is nothing much I can do to help them that would work long term. We can psychoeducate till kingdom come, or do daily home visits, or call them every day to update on their progress, or we can repeatedly give them compliant therapy…. over and over again…. but nothing will stick long term until they accept their illness, and make THAT VITAL DECISION to take the meds and perform all the non-pharmacological measures we tell them to do. My whole investment in effort and time to make  their mental health better depends LARGELY on the fact of whether or not they themselves will do what I have told them to do! I can do my best… but it won’t work if THEY don’t do their best. We are not going to be there for them 24/7. And we shouldn’t have to. Part of the responsibility should be shouldered by the patients themselves and their family members.

So yup… I do have favourite patient’s family members too. The more cooperative the family members are, the bigger the smile that I bestow towards them as a form of greeting at the start of the conversation. LOL.

It is kind of disheartening sometimes. When the reward for our hard work (seeing the progress of our patients is a reward) depends on the patients themselves taking that leap of change…. it can be disheartening because some of them just refuse to take that leap.

So when patients (or their family members) ask me about their prognosis or if they will ever get better, I said truthfully “You will get better. Not all conditions can be cured… but they do get better. But how much better you get depends on YOU.”

And that’s the problem. And that’s also the solution.

YOU are the solution. Regardless of your background! Regardless of your advantages and disadvantages in your past! Regardless of what had happened to you in the past and the present, YOU are the solution to your own problems. Make that decision to take your medication. Make that decision to not let your past determine your future. Make that decision to put some effort in doing all those lifestyle changes! Make that decision to do your CBT homework! Make that decision to feed your thoughts with positive self-affirmations as you were taught to do in your CBT sessions. Make that decision to practice that deep breathing exercise and the relaxation techniques taught to you. Do it for you!

Because I cannot do it for you.

***

What are the values you must internalize in order to move forward DESPITE your past and  your disadvantages?

Because trust me, if everyone can behave badly by citing random disappointing things that had happened in their lives as the cause of their depression/borderline personality/ antisocial personality/addiction, then everyone can get away with crimes because “oh, it is not my fault. I had a deprived and disadvantageous childhood, you know”.

“Oh, I murdered that guy because he reminded me of an ustaz in a Maahad Tahfiz who had sexually abused and sodomized me when I was younger! It’s not my fault. Don’t judge me if you don’t know my past.”

But when you are arrested by the police and subsequently sent to be evaluated in Hospital Bahagia Ulu Kinta, we will only determine whether or not you were of sound mind when you had committed that murder and whether or not you are fit to plead! Regardless of whatever bad past experiences you had, we are only going to be interested in the soundness of your mind! We are only interested to know whether you knew what you did was wrong and contrary to the law! That’s it! We might be interested in your past… but only up to a point. The court may take note that you used to have a disadvantageous childhood… but you will STILL be punished. It is only right for you to be punished. Your bad past will not suffice in the court of law to justify your crime!

Facts! Reality!

Regardless of whatever childhood adversities you have experienced, by the age of 18 you will be treated like an adult in the court of law! You would be assumed to have had the maturity of an adult and you are accountable for your own action. You cannot turn around and blame your parents when you are addicted to drugs… because your siblings who are NOT addicted to drugs ALSO have the same parents as you! The judge in court will not entertain wishy-washy, sappy sob story of an excuse like that! Even in Islam, we are accountable for our sins at the age of puberty! The reality should not be distorted to adjust to YOUR subjective experience! Instead, regardless of whatever bad experiences you have had, you must make the effort to adjust to the reality. If anyone can be excused based on ‘subjective’ experiences of childhood disadvantages, then that’s it! There should be no law and order. Everything must be grey and blurry, then!

Likewise, the reality is such that when you behave in a counter-productive manner or in a socially inappropriate manner, most people will reject you. Regardless of your past! People who are going to deal with you day in and day out are not going to care about how difficult your past was after a certain point! Their sympathy can only go so far. So the onus is on YOU to rise above your past and change your behaviour if you want to lead a fulfilling life. And we are here to help you do that. But you must be willing to put in some effort without always blaming others for every single thing that goes wrong in your life.

In Psychiatry, we also learn that there are certain risk factors that predispose someone to having depression or other mental illness. But some people do cope well with life despite having those risk factors! How come?

So my take home message is  this: Your past DO affect you… but ONLY up to a point! You are not totally helpless against your past! Because the rest of your life is determined by what you are going to do now in moving forward.

And you can turn over a new leaf by internalizing certain values in your life that I am going to enumerate below. Please take note that I am not disregarding or invalidating all your past experiences and all the injustices that had happened towards you. I am just giving you a way to move forward.

Effort

“Doktor, ingat senang ke nak usaha? Pesakit depressed memanglah tak larat nak exercise, nak buat behaviour activation semua. Bila doktor cakap kena usaha… macam stigmatizing. Ada doktor suruh pesakit kencing manis usaha supaya pancreas diorang keluarkan insulin? Tak kan…”

“No, I won’t tell type 1 diabetic patients to put in an effort to force their pancreas to produce insulin. However, I do tell them to put in an effort to take their insulin, to control  their diet, to exercise and keep a healthy lifestyle. And this is what I am telling you to do too. It is not stigmatizing. It is factual.” This was my answer to the patient (who also had some component of personality on top of her depression). Very matter-of-fact, very reality-based.

To be honest, I NEVER like the ‘mental illness stigma’ poster that compared depression with diabetes. It is so inaccurate, and we should stop saying “Jangan stigmatize pesakit depression. They cannot help their behaviour. They lack serotonin. Just like pancreas orang yang ada diabetes tak boleh keluarkan insulin, orang depressed pun tak boleh keluarkan serotonin. When you tell depressed people to put an effort, it is a stigma! You don’t tell diabetic patients to produce insulin, do you?”

Ugh! Gosh! I cringe inwardly whenever I hear misleading things like that.

I agree that we should not stigmatize mental illness! But I disagree about depressed patients not having to put in any effort in dealing with their depression! Asking people to put in some effort should not be construed as stigmatizing! In ANYTHING we do in life, effort is vital! In ANYTHING!  Stop trying to tie our hands from telling our patients to put in some effort! What do you want me to say then…. tak payah usaha langsung?

As a Muslim, Allah will not help us without us putting in our effort! To Muslims, that’s a fact! I am not going to distort reality just to align myself with the content of a bad poster. I am not going to distort facts just to appear FALSELY empathetic and sympathetic when the reality is different! If we cannot tell them to put in some effort, then how about asking them to go to occupational therapy? Doesn’t that require some effort? How about asking them to attend their CBT sessions or their psychotherapy? Doesn’t that require effort for them to do their homework?! How about asking them to practice deep breathing exercise and do some physical activities? Doesn’t that require effort?

The only condition that doesn’t require your effort is when you are in a state of coma! You don’t tell ICU patients to put in any effort, sure! But for the rest of us, the requirement for a good, healthy and balanced living is our effort. The faster you internalize this idea, the faster you will improve your life, Insya Allah.

So, please! Please stop promoting mental health awareness by comparing depression with diabetes! That’s like comparing apples and eggs. They are not even in the same category! (at least, comparing apples and oranges can fall under the category of fruits! But apples and eggs are two different categories altogether, get it?). For one thing, there is no component of the ‘mind’ in the Pancreas! There is no intertwining interpersonal conflicts and ongoing social stressors in the development of Type 1 Diabetes! So Type 1 Diabetes patients really cannot change anything much in the way they behave to help their condition. But this is not the case in depression! So, how is this a good and fair comparison? Neither the diabetic patients nor the depressed patients are treated fairly by this comparison.

And Wallahi, this comparison should cease to exist! (Adoi, penat! Too much emotion has been invested in writing about this alone, LOL. Pheww!) 

To quote Kevin MD: 

Diabetes is a disorder of insulin metabolism. Insulin is produced in the pancreas. The (depression-diabetes) analogies disregard the intimate intertwining of brain and mind. For the pancreas, there is no corresponding “mind” that exists in the realm of feelings and relationships.

I prefer to compare depression with having a fractured lower limb in terms of how effort would improve your outcome. “Katakanlah awak mengalami kemalangan jalan raya dan kepatahan kaki lalu tidak boleh berjalan.  Lalu, saya pun beri kepada awak tongkat untuk bantu awak jalan. Sudah tentu berjalan dengan tongkat dengan kaki yang patah lebih susah berbanding sebelum kaki awak patah. Tetapi tongkat itu serves its purpose untuk bantu awak bergerak walaupun memerlukan lebih banyak tenaga. Tapi jika awak masih duduk di kerusi dan tidak mahu berjalan walaupun sudah diberikan tongkat, maka tongkat itu langsung tak berguna! Bila awak duduk dan baring sahaja, ini akan membawa risiko mendapat bedsores dan secondary infection yang lebih teruk lagi. Apabila saya berikan awak tongkat dan suruh awak berusaha untuk berjalan, tak bermakna saya menidakkan kemalangan yang berlaku dan kesakitan yang awak alami kerana patah kaki. Tetapi saya bantu awak untuk move forward WALAUPUN ya, saya akui awak kemalangan dan ya, saya akui awak memang sakit dan patah kaki. But the tongkat is here, isn’t it? Are you gonna take it and walk or are you going to just sit down, not using the tongkat and instead repeatedly go back and forth questioning why the accident had happened to you? And why aku patah kaki dan orang lain tak patah kaki? Because think about it….How is that going to help you? Now… let’s get back to your depression. I am giving you your medication and I have scheduled CBT sessions for you with our clinical psychologist… will you take it? When I told you to put in some effort to do all these measures, to try to go to work… I am not denying your depression and I am not saying it is going to be easy! It is hard! Of course going to work while being depressed is ALWAYS going to be much harder than going to work without any depression… that goes without saying! However, now I have given you some medication, and you will be seeing our clinical psychologist for CBT sessions….these things are the tongkat! Yes, it is still harder to go to work compared to when you were not depressed… but now, going to work is becoming more achievable, isn’t it? Compared to when your depression was not treated at all, now even though it is STILL hard… it can be achieved right? Just like it is still painful for a man with a broken leg to walk with a crutch, but at least with the crutch, the man with a broken leg can now walk, isn’t it? Will you at least try first?”

Most patients who already have some spark of optimism inside them can relate with the ‘patah kaki’ analogy FAR BETTER than the diabetes analogy, in my experience.

Really… I am not a vague, wishy-washy person. I am always the ‘bottom line’ kind of person! I want to know the truth, the reality, the actions that I need to do and what is the possible outcome I can expect. And therefore, I don’t like to comfort people with half-truths. I do adjust my style of giving away the real truths to my patients depending on their personality and the appropriate context…. but I am not gonna give them empty words of comfort. I am not gonna tell them it is okay when it is NOT okay. I am gonna tell them, “What happened is not ideal but what are you gonna do about it? Let’s face it and deal with it! It will be hard but it can be done. I will help you… but again, it will only work if you help yourself because a lot of things require effort on your part!”

And most patients recognized the truth and they gravitate towards it! The sunnahtullah is such that deep inside, all of us want to know the truth. And when we give the truth to them, it builds trust because they know that this doctor is not lying and pretending to care about them! Sure, some of them don’t like to hear the truth and they might hate us for awhile. But the seed of doubts regarding their actions has been planted in their minds…. and eventually they will think and evaluate the matter again.

But patients who STILL persisted in playing the victim card (usually a personality component is involved here), will continue to deteriorate. And my heart sinks.

As a psychiatry doctor or a therapist, among the first thing we should do (after allowing them to ventilate and express their distress), is to get them to internalize the value of effort! We will not get anywhere if they still persist that they are victims of their past and therefore they will always be ill and flawed because their past can never be changed and therefore there is no use for them to put in any effort.

That is really such a tragic way to think about life. We must pull them out of that mindset before anything can ever change. But unfortunately, it is STILL their decision to change their mindset! At the end of the day, we can only do so much to help them. The ultimate outcome lies in their decision. 

 

Having A Growth Mindset

The opposite of having a growth mindset is having a fixed mindset. The worst thing that can happen to anyone is to have a fixed mindset. Having a fixed mindset would wreak havoc in your life because you have basically internalized learned helplessness. Learned helplessness is bad, folks! With learned helplessness, people can be driven to suicide because they believe nothing they do will ever change the situation and there is just no hope left. 

 

ext

Biologically, we learned about brain plasticity which is the ability of our brain to change through life with our experiences and our training! It correlates perfectly with the value of having a growth mindset.

From the psychological point of view, Piaget’s theory of cognitive development talks about how our mind and our mental schemas are always adapting and accommodating…. for the rest of our lives. So we are not always stuck in our bad childhood memories. Provided you put in some effort, you can overcome your disadvantages! 

While I do think that me hearing out your feelings and allowing you to ventilate your problems do help to de-stress you while you are facing your crisis, I am more interested to know what you are going to do about overcoming your limitations in life? That’s the BOTTOM LINE always.

With a growth mindset, you will have a positive and optimistic outlook in life because YOU JUST KNOW that whatever it is that is happening to you, you can master the steps that you need to take to overcome the challenges! You just need to grow your mind by expanding your horizon with new skills, new set of positive thoughts and new set of behaviours. When you have a growth mindset, you know you can learn and re-learn and un-learn your way into a better coping mechanism. 

You won’t say things like “Dah aku memang macam ni. Family aku dulu ajar aku macam ni. Memang dah tabiat aku. Memang aku tak boleh nak ubah… nak buat macam mana?”

I am not saying that it is easy to change your habits! A person with a growth mindset ALSO might be resistant to change because they are already comfortable with their own habits and personality. But when it is important for them to change and adapt (perhaps, there is something at work that they have to be in-charge of that requires a new set of behaviours and habits), they will make themselves change their habits and behaviours because they know that the only constant in life is change! And if they have to do it, then they have to do it!

So, will you continue to practice? Will you continue to study and acquire knowledge and skills for the betterment of your future? Will you be willing to put in some time and effort (goes back to effort, doesn’t it?) to do what has been taught to you during your CBT sessions so that your new skills slowly become second nature and would be automatically activated in the future with much less effort than what you have to put in now?

You will do it, when you have a growth mindset.

If you have a fixed mindset… don’t worry. This is the beauty of the concept of having a growth mindset. You can unlearn that fixed mindset NOW, and start to learn to have a growth mindset.

Having An Internal Locus Of Control

In psychiatry/psychology, locus of control is defined as the degree to which people believe that they have control over the outcome of events in their lives, as opposed to external forces beyond their control.

locus of control

If you have an internal locus of control, you believe that events that happen to you is the result of your own doing rather than the external forces outside your control. For example, when you have an internal locus of control, you would believe that you had passed your exam because you had studied hard and went to all the lectures and tutorials that were given at the uni and because you had prepared accordingly. You did not think it was the external factors beyond your control that had made you pass. You did not think that it was just luck or because other people were doing even worse than you or because the teachers like you better than your other classmates. You are less likely to conform to your surroundings when you have an internal locus of control.

If you have an external locus of control, you believe that you had no control over the events that had happened to you and there was nothing you could do to influence the turn of events. For example, you believe that you would never pass the exam because the subject was too hard and the lecturer did not like you. So there was nothing you could do to pass your exam. You believe that the result of your exam somehow depends on all other external factors except your own effort. Having an external locus of control makes you more likely to conform to expectations and environments because you want your life to progress smoothly.

In general, when it comes to motivation and drive, having an internal locus of control is much healthier than an external locus of control. 

However, having too much of anything is never good. Having a much too internal locus of control can also cause you to blame yourself and will make you feel unnecessarily responsible for something that you could never help. And that can also predispose you to depression. See the diagram below to see what I mean regarding imbalanced locus of control and why it would be bad to have too much of either.

locus

 

The key word here is balance and reality check! I have mentioned before that I like the truth! I like reality check! Those are the two words I use a lot with my patients. You are entitled to your feelings and you have a right to them because it is YOUR feelings…go ahead and have them. But at the end of the day, your feelings do not necessarily reflect the reality. And if adjustments need to be done, your feelings must be compromised to give way to the truth or the reality! You must start learning to feel the right thing! (yes it can be done!) Because your feelings, even though you have a right to them, are subjective. But the truth and the reality are the objective facts! It will make your life much easier and less turbulent if you can learn to feel the right thing. 

As Muslims, we know that things that happen to us are decreed by Allah. But because we don’t know the decrees of Allah yet (I don’t know whether I will pass my exam or not, for example) we are ORDERED by God to put in some effort to attain what we desire. So the locus of control is balanced here. You are neither too sad nor too happy about things that happen to you in this life. Because you know that whatever bad or good things that happen to you have already been decreed by God and eventually anything bad and good will simply run its course! It will pass! There will be a next challenge to conquer and then the next, and the next…. until you breathe your last air! Bad events hurt… but give it time. Put in some effort, work at it again! Continue! Persevere! Feed that internal locus of control.

And when a disappointing outcome arrives… recognize that some things are out of your own control but it does not nullify your effort at all. It’s just life!

For example, someone passing their viva is a combination of effort, studying and doa (internal locus of control) and examiner factor, your health issues during the time of exam, and the type of case  you get (external locus of control). That is the reality! Nothing in life is TOTALLY in your control. And nothing in life is TOTALLY under the control of the external forces. Perhaps, when you realize this fact, your feelings about anything will be in moderation.

324472-My-Heart-Is-At-Ease-Knowing-That-What-Was-Meant-For-Me-Will-Never-Miss-Me-And-That-Which-Misses-Me-Was-Never-Meant-For-Me

Read Up

I suggest that people take up reading as a hobby. Not because it is my hobby and I am very much in favour of that habit (haha… mungkin ada juga komponen biased sikit. Because I will always think that reading is superior to any other hobby hahah… so yup, ada biased sikit) but because it is the one good hobby that will benefit anyone regardless of gender, social status, and whatever past experiences you have had.

Even if you read commercial fiction like Harry Potter, you will feel like “Wow…. this kid could fight the evil Lord Voldemort by the virtue of his effort and perseverance. Setakat kena marah dengan consultant, that is nothing to be scared about. I will turn up to work and finish my housemanship regardless of how bad I kena marah. I can overcome this!” Hahha. Okay… that is an extreme example. After all, Harry Potter is a fictional character and most people don’t try to relate their lives with fictional characters to sooth their feelings. So, you might not think that reading Harry Potter can ever motivate a disillusioned houseman (though actually it works with a lot of ardent readers out there! It certainly works with me!)

But you can also read biography/autobiography of really inspiring people. Autobiography books are real-life events! In my last blog post, I talked about the biography of Muhammad Ali and how inspiring he was. If you are a Muslim, you can read the seerah of our Prophet and his companions (I have mentioned before that Umar Al-Khattab is my favourite superhero). Read about the history of Jerusalem and the oppression committed by Israel towards the Palestinian people who are still persevering and fighting for justice and freedom (Netanyahu is worse than Lord Voldemort, okay!). Read the biography of Mahatma Gandhi and Nelson Mandela and the sort of sacrifices they had to make for the sake of freedom and social justice.

I am not saying that reading protects you from depression or neuroticism. But it broadens your horizons, knowing that people are always struggling sometime, somewhere. You get to live the lives of many people through reading, and you get to find out how all these various people cope with their own mistakes and  their own troubles (After all, the best way to learn is to learn from other people’s mistakes and troubles…. rather than making the mistakes and having the troubles yourself, right?).

If you just read (the right material), you will have a better coping mechanism. It improves your logical thinking and your abstract reasoning which will make it easier for your therapist to work with you. Some of your CBT homework require some reading too. You are more likely to do it if you already love reading.

If you don’t like reading, don’t worry. Focus on getting a growth mindset, first… and then you will know that you can adapt your brain into loving to read… and it WILL benefit you.

For Muslims, it is no coincidence that the first verse that is revealed by Allah to our beloved Prophet Muhammad (PBUH) is to read! Iqra’, remember? Get some knowledge! Internalize the values that you read and use it as your guidance in making any decision! Our parents can only teach us so much… because they have only their own experiences to tell you about. Their way of doing things and their experiences may not be applicable to you. And so, we read in order to experience the lives of many people so that we can have a big arsenal of weapons to choose from whenever life strikes us hard. 

iqra
This is the first verse of the Quran that was revealed to our beloved Prophet Muhammad (PBUH)!

***

And as a therapist, sometimes we need to set up boundaries with our patients. We have to let them experience the consequences of their own behaviour. We should not be enabling and reenforcing their bad behaviour by always giving in to their demands for attention and validation when what they are doing are obviously wrong and maladaptive.

They have to stick to their appointments and learn to deal with the consequences of being late to their  CBT/Psychodynamic session. When they throw a tantrum, we should ignore them until they are willing to behave well and until they can state exactly what sort of problems they want to discuss with us in a rational and calm manner. Behave like an adult and we will treat you like an adult.

Some patients will manipulate their counsellors or their therapists or their doctors. It is important that we recognize that behaviour and not accidentally rewarding them.

A few years ago, I myself had terminated a therapeutic relationship with one patient when he had thrown a tantrum at the nursing counter in order to see me. My late HOD, Dato’ R, happened to be at the counter at that time and managed the situation by telling him that I was covering addiction clinic and he must see other doctors. The patient should have come during his allocated appointment time but he didn’t.  He had come earlier than his scheduled appointments so many times in the past and I had told him not to do it. I told him that he had to learn to deal with his feelings by the techniques that had been taught to him. And I told him that he should go to the ED for any emergency that crops up in between appointments. I was hoping that by making myself less accessible, he would learn to deal with his distress by himself using the techniques that had been taught. But he still didn’t.  A few days later, he came to  the clinic again (again, without an appointment) and I decided to see the patient one last time to terminate the therapeutic relationship. I told the patient that what he did at the nursing counter a few days ago was unacceptable and I think he should see other doctors. I was very firm. You must follow the rules, or bear the consequences. After I terminated the therapuetic relationship, he did not see any specific doctor since then and was placed in the general pool for any doctor to see. As far as I know, there is no issue since then.

One day, I happened to bump into him at the supermarket. He was polite and did not try to detain me when I said that I need to excuse myself to finish shopping. That was a huge improvement! A few weeks later he came to the clinic, and he had requested to see the doctors in room 2 (happened to be my consultation room on that day). The clerk at the counter was firm and said “But you didn’t follow appointment. Pergi bilik 5. Lepas ni kalau nak request doctor mana, datang on time.” And he abided by that instruction without insisting to see me in Room 2. Very good behaviour that he had displayed there! So, I have made a decision that if he ever comes on time later on and requests to see me, I will grant him his wish as a reward for his much improved behaviour.

I am very particular about time and sticking to agreed rules and negotiated terms. That is one of the ways I know that the therapy is working. I have an aversion to being manipulated and controlled. I don’t like it and I won’t allow it in my therapeutic relationship with my patients. On this, I am very firm. I don’t think it is healthy to be there for your patient 24/7.

At what point is your patient going to be able to learn to think for themselves and  solve their own problems if you are always there to be depended on whenever they are in crisis? Once we have agreed on the negotiated rules and terms, we must stick to it. Early in the treatment, there might be some adjustments and hiccups along the way. But by the time the adjustment period is over and the patient is still crossing all sorts of boundaries… then a serious talk must be conducted to establish what is okay and what is not okay in this therapeutic relationship. Any more crossing of boundaries is no longer healthy for either party and perhaps we should pass the case over to our colleague.

And that’s what I did.

Maybe as I grow older and mature into the profession, I might learn differently about what to expect and what to tolerate with regards to therapeutic relationship with my patients, but being controlled and manipulated and being forced to give in to that kind of behaviour will not be something I will passively tolerate. I don’t think that will ever change about me.

On the other hand, another patient of mine who had successfully internalized the values of effort, and having a growth mindset and having an internal locus of control (unfortunately she STILL hasn’t internalized the values of reading, haha) had successfully managed all her crises in the 3 months when I was not around in the clinic (because I was doing my forensic attachment in HBUK at that time). When she saw me shortly after I returned from HBUK, she had said “Doktor tau tak dalam masa 3 bulan ni banyak sangat benda jadi kat saya. Tapi saya boleh handle sendiri, doktor. Doktor tau tak saya dah berhenti kerja yang dulu. Waktu tu saya sangat stressed dan nak sangat jumpa doktor… tapi nurse kata doktor pergi attachment. So saya pun pendam sajalah and handle sendiri. Alhamdulillah, sekarang saya dah dapat kerja baru. Dan gaji saya lagi bagus dari kerja saya yang dulu.”

I was overjoyed that she could handle things for herself. I said to her something along the lines of “Bagus! Memanglah semua masalah kena handle sendiri. Kalau saya ada pun, apa saya boleh buat? It’s your job, it’s your life… you have to make your decision and stick to it and then put in the hard work. And then, there will be another challenge… and you will handle it again just like you have handled it in the past. These things will continue for the rest of our lives.  Memang awak boleh buat pun. Congratulations! Lepas ni bolehlah bagi appointment 3 bulan sekali pula.” I teased.

“Dua bulan dulu lah, doktor!” 

I laughed. “Saya tak ada tiga bulan hari tu, awak okay jer! Pernah dengar tak, necessity is the mother of invention? Bila benda dah jadi dan kita terpaksa handle sendiri, waktu tu lah kita discover our real abilities. The situation NECESSITATES us to grow! We must start creating opportunities for you to handle crises yourself in between appointments. You can do it! In fact, you have done it when I wasn’t around!”

I cannot wait until I can give her a four monthly appointment. Hahah. Yes, she is one of my favourite patients. Because she internalized those values I had listed above, she is much better now. So, I like seeing her because I feel like all the time spent in my session with her was not in vain. Not wasted. But eventually, it is our responsibility to make sure our patients can be confident to let us go. One day, I might have to move elsewhere, work in another state. I am not going to be there for them 24/7. It is an unrealistic expectation to be placed on any doctor or any therapist! And I refuse to do it for any of my patients. It is kinder in the long run that we maintain boundaries and make them self-sufficient. It is the kindest thing you can do to anyone…. to provide them with a fishing rod instead of a limited supply of fish of uncertain duration. That kind of uncertainty will create unconscious distress in them because they will always be wondering “Can I survive without my therapist?”

So, I have told her that next time, we are going to try for a 3 monthly appointment regardless of whether or not she feels ready. She just smiled… because she knew I always do what I said I would. Or maybe it was a smile of someone who is confident enough not to worry too much any more.

Why worry when everything has been written and all you have to do is to go through it and do your best until you breathe your final breath.

I leave you guys with one of my favourite songs by Sami Yusuf. This song teaches us that when it comes to dependency, there is only ONE entity that we REALLY cannot live without… and that’s the way it should be in this life. That’s the reality. All the dramas in your life should take a pause to acknowledge this fact once and for all. And trust me, you will be happier for it.

 

The Gudjonsson Suggestibility Scale & The Legendary Muhammad Ali

Muhammad Ali Book
The biography of Muhammad Ali, written by Alan Goldstein

#BookReview  #GudjonssonScale  #MuhammadAli

Dear readers,

Last month, I had read  a biography of The Legendary Muhammad Ali written by Alan Goldstein and Masya-Allah, I was blown away. It was a truly absorbing read and I finished reading the book in 3 days. Muhammad Ali’s life was nothing short of inspiring.

I knew that Muhammad Ali was this great boxing legend who “floated like a butterfly and stung like a bee” but in my opinion, his greatest achievement was not made in the boxing ring. There was no specific arena… no particular moment while fighting in  the ring… in which I could say “Yup, that’s it! That’s when he was at his best.”

It was just the way he led his life… the way he stayed true to what he believed regardless of what other people said about him. The way he had stuck to his gun regardless of the risks of losing his money and  fame, and even regardless of going to prison. That was some heavy-duty powerful faith there! How many people would rather be in prison rather than sacrificing their principles? These days, I assure you, not many!

float and sting

When people persecuted him for his staunch principles, he stood firm and fought back with witty words that spoke volume of his wisdom. I didn’t know before what was the big deal with Muhammad Ali. I only knew him as this great boxer who also happened to be a Muslim. To me, ah… ok fine, just another famous Muslim celebrity.(What can I say? I was never into boxing and Muhammad Ali was famous way before my time. Now, I am acutely embarrassed of my previous ignorance of this legendary persona!)

But after reading his biography, I was in awe.

I remember, whilst reading the book, that Muhammad Ali would have no problem with the Gudjonsson Scale if the test was administered to him. He would stick to his gun and to hell with what other people say to the contrary.

Want to know what I mean? Read on!

***

So what is the Gudjonsson Suggestibility Scale?  Well, this is not a very well-known test in psychiatry. When they are used, they are usually used in the forensic setting. It has been used in court cases in several jurisdictions but has been the subject of various criticisms.

I am not sure whether this scale was ever used in Malaysia. I certainly never came across it when I was doing my forensic posting.

But I had to study this scale when I was doing my Part A MRCPsych exam. I remember feeling slightly troubled when I thought of how my performance would be if the scale were administered to me.

According to Wikipedia, this scale was created in 1983 by Icelandic psychologist Gísli Hannes Guðjónsson. The Gudjonsson Suggestibility Scale consists of reading a story aloud to participants, who are then asked to recall as much as they can remember. Subsequently, participants are probed with 20 questions pertaining to the story, 15 of which are misleading. When the 20 questions have been answered, the participants are clearly and firmly given a negative feedback on their performance. Specifically, they are told that they have made a number of errors and that it is therefore necessary to repeat the questions to obtain more accurate answers. On the basis of participants answers to the misleading items, a total suggestibility score can be calculated.

I remember thinking, would I ever change my mind, even as I know that I was right, if the pressure towards me was administered just hard enough? Would I break? Or Would I bend? Would I stand straight or would I fall in heaps and pieces?

Imagine someone administering the Gudjonnsson Suggestibility Scale to you.

Let me walk you through the simplified version of the scenario (you can read the actual details on how the scale is administered in Wikipedia)

So an examiner reads you a story and after hearing the story to its conclusion, you are initially reasonably sure that you have understood the story correctly. The examiner then proceeds with asking you a few questions to test your comprehension. You are confident with all the answers you have given the first time. Then, the examiner asks you some of the questions again and again… the examiner acts as though he thinks your answers are not quite correct…. so….would you slightly alter your answers to accommodate the expectation of the examiner? If the examiner asks you repeatedly “Are you sure that was how the story goes? Are you sure? Is that REALLY what happened? Could you perhaps be mistaken?Is that REALLY how you understood the story?”…. would you then doubt yourself?

Or would you stick to your gun and say “I know what I heard. That’s how I understood the story. I could be wrong. But that was what I heard and what I understood. And I am not going to change my answers no matter how many times you question me. Period!”

Seriously, in my own experience, MOST people would accommodate expectations (subtle or non-subtle) regardless of how wrong the expectations might be or how right their answers initially were.

Heck, it happens to our politicians all the time. It takes someone with strong conviction like Tun M to oust Najib out of his political throne because everyone else around him were as fickle as the weather when it comes to speaking up for the truth and fighting for justice.

It happened to me when I was a junior doctor. It happened to many other of my colleagues. It happened to even specialists and consultants when they were dealing with their own superiors.

It happens in our ward rounds and teaching sessions ALL THE TIME. For example, you might KNOW that you have given the right answer to your specialist’s question…. but when your specialist tests you by deliberately questioning your answer (or maybe the specialist himself also did not know that you were actually correct), you would change your answer to accommodate the expectation of your specialist. And even if you don’t change your answer, you will still start to doubt yourself even as you give the same answer… but this time, your answer comes in a less convincing manner.

One of my close friends had answered correctly regarding what are the anti-depressants licensed for OCD. She rattled off “Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline.” Her answer was correct and spot on! Of course she must have read it before doing her presentation and she should have been confident with her answer. But someone in the audience had questioned, “Are you sure Sertraline was licensed for OCD. I am not sure… but I think, Sertraline is not licensed for OCD, right?” And EVERYONE fell silent regardless of whether they are HOs, MOs, specialists or consultants. Maybe everyone was also not sure at that time and it was too easy to assume that someone who was brave enough to question the presenter must have been correct. 

But me and Dr. T…. we have this curiosity that is not easily satisfied. We used to read that Sertraline is licensed for OCD. Our Part A MRCPsych notes had a list of all meds and their licensed indication. And we kind of vaguely remembered that Sertraline is licensed for OCD but we were also not very sure when someone had questioned our friend’s answer.

By the time, me and Dr. T had finished extracting the information from the pdf version of Maudsley Guidelines and had confirmed that my friend’s list of answers were correct, the audience had moved on to a new topic of discussion.  And me and Dr. T didn’t feel like it was appropriate to point out to everyone that my friend’s answer was correct and the person who had questioned her was the one who was mistaken. I mean, people make mistakes and if we can let it go, we will let it go. But rest assured, if the CME gathering was still talking about the same topic, I would have offered the correct information for the benefit of everyone in the audience. My close friend deserves to have the credit of having given the correct answer. It is only fair for her to receive that recognition, in my opinion.

After my friend had finished her presentation, I went to her and said, “Mesti kau dah prepare sebelum present. Kau tahu kan jawapan kau betul. Just be firm and stick to your answers. Lepas ni, tak kisah siapa yang tanya…. specialist ke, consultant ke…. if we know what we know…. we stick to it!” (Bab mengajar orang suruh rebel, memang boleh bagi kat aku. Hahha)

She told me “Aku baca sekali lalu saja… takut aku tersalah.” This friend of mine is the nicest, the most humble and the least aggressive among my close circle. She is the angel to my devil. Hahha. So, I know she would willingly accept the appearance of being mistaken even when she was right. I am her exact opposite. And I think, Dr. T is also like me. When we believe we are right, we are going to question you regarding what made you question our facts in the first place? (As in, how dare you question me when you yourself are not sure! Now, face our wrath! Hahaha. Okay, just kidding.)

Look, it can happen to anyone. When an ‘authority’ questions you, you become uncertain of yourself. Most people are like that. As stubborn as I always am, even I used to be like that too when I was a HO or a junior MO.

Now, I am more certain and more confident of myself in general. Yes, I still doubt myself, but much less than I used to. If I don’t know, I will say I don’t know. BUT… If I know what I know, there is NOTHING you can say that will convince me that I was wrong. I accept only evidences and references. You must give me more than words before I will accept I was wrong. I had invested time and effort to read my academic materials to come to a conclusion of certain facts, and for you to say that I am wrong, you must give me enough reasoning and evidence for me to change my mind. I would love to learn the right thing…. but I am not suggestible. I might pretend to accept what you say just to keep the harmony… but I will not accept anybody’s dubious words at face value without doing my own research.  I will go back home and verify your answer until I am satisfied. 

But even I sometimes feel unsure whether or not I will ever be as staunch and resolute the way Muhammad Ali had been.

In his life, Muhammad Ali provoked his opponents with razor-sharp words that rhyme and comical one-liners that hurt. But what made him an iconic cultural figure was his quotes on achievement, social justice, religion and war. And what made him greatly impressive was his rock-solid stance in his principles.  

***

Why did I say Muhammad Ali would have passed the Gudjonsson Scale with flying colours?

Well, because he was the epitome of faith and belief in himself and in his religion that there is just no room for him to doubt himself on what was the right course of action. He knew what he knew and even if the whole country was against him, he would not budge.

muhammad-ali-motivational-message-and-quotes-4-638

He held firm to his principles and his belief NOT to fight in the Vietnam War waged by the Americans towards the Viet Cong. Because he was persistent in sticking to his belief, he was exiled from boxing, ostracized by his peers and fans, and stripped of his crown as the heavyweight champion of the world. He was pressured right, left and center. People called him as a coward for refusing to fight a war he did not believe in. He lost almost everything – money, fame and reputation – and he also had to face the risk of prison for refusing to go to war… but he remained firm in his decision.

Muhammad Ali had declared himself as a conscientious objector and refused induction into the U.S army, famously saying, “I ain’t got no quarrel with them Viet Cong,”. He also had said “No Viet Cong ever called me a nigger,”

vietnam war

 

He was also recorded to say, “Why should they ask me to put on a uniform and go ten thousand miles from home and drop bombs and bullets on brown people in Vietnam while so-called Negro people in Louisville are treated like dogs and denied simple human rights?”

I am free

I especially love Muhammad Ali’s beautiful words in defending his stance: “I believe in Allah and in peace. I know where I am going and I know the truth, and I don’t have to be what you want me to be. I am free to be what I want. You can’t condemn a man for wanting peace. If you do, you condemn peace itself. A rooster crows when he sees the light. I have seen the light and I’m crowing!”

Beautiful!

But his words had upset the US Government. So, the US government then tried to send him to prison. He was put on trial and sentenced to 5 years in jail and $10,000 fine.  He was also banned from travelling and was not allowed to participate in matches outside the US. To this, he had said, “They want to stop me working, not only in this country, but out of it”. He must have suffered greatly at that time but he pushed on. 

He was 3 years in exile from boxing. And he almost had to serve his prison sentences, but fortunately, the US Supreme Court later overturned his charges. Muhammad Ali praised God on hearing the news. “I’ve done my celebrating already. I said a prayer to Allah.” 

He added, “They did what they thought was right, and I did what I thought was right.” To him, it was as simple as that.

Muhammad Ali had no higher education. He came from a poor family. But when he spoke, it was full with conviction in his faith and belief system. 

After 3 years in exile, he then resumed his boxing career after the Supreme Court had overturned the charges. Amazingly, he returned to the ring stronger than ever, winning match after match, strengthening his reputation in leaps and bounds.

History later had proven him right. Vietnam War was an embarrassing failure to the US. The US had lost the war and its veterans returned home to taunts and abuse by their own countrymen who were frustrated by the cost of the war to the US economy and to the morale of the country. Influential Hollywood celebrities started to protest the war which Muhammad Ali had condemned much earlier from the very beginning. University students had begun to protest the prolonged war with pickets and demonstrations, cementing the fact that Muhammad Ali was right not to be enlisted even at the risk of being imprisoned.

The truth had prevailed and Muhammad Ali’s wisdom had shone crystal clear and bright.

See?

As I had said, even though he was this great boxing legend of the world, his most impressive achievement was not made in the boxing ring. It was in the way he stood up for what he believed as right, no matter what!

Years later, Muhammad Ali’s name on the Walk of Fame was placed on the wall, instead of on  the ground as in the case of the rest of the other famous celebrities. I am sure, his name was supposed to be on the ground initially… but knowing Muhammad Ali, he must have insisted that his name should be placed on the wall… or NOT AT ALL. And his wish was accommodated since his name is so great that it would be preposterous and ridiculous to leave his name out of the Walk of Fame. So finally, when his name was placed on  the Walk of Fame…it was on the wall, as he had wished, instead of on the ground like the rest of the others!

 

When asked regarding why he wanted his name to be placed on the wall, he had said, “Because I don’t want the name of Muhammad to be stepped on.”

This, my dear readers, is the greatness of Muhammad Ali. May Allah be pleased with him.

Ali
May Allah be pleased with you. Amin.

MRCPSYCH, The Road Less Traveled

A few days ago, a couple of medical graduates who are currently waiting for their housemanship posting had asked me to brief them about the MRCPSYCH program and how it compares with the Master program.

In my conversation with them, I addressed a lot of issues regarding the specialty training in Malaysia and the issues surrounding our training. The stigma, the challenges, the difficulties, the hard work.

This post is inspired by my interaction with them.

***

The thing is, my behaviour has always been consistent. I have always spoken up about the same kind of issue, over and over again. 

I don’t agree for anyone to persecute a whole group just because they are ignorant or biased in their views. I don’t agree for anyone to persecute a whole group out of a mistake done by a few people in that group. I don’t agree for anyone to badmouth a whole group for incompetencies committed by some in that group. Because racism and Assobiyah is a sin in my religion!

If we are Muslims, we surely can relate. When Bali bombing happened in 2005, many Muslims in Australia felt the heat. Islamophobia and hate-related crimes increased. It was not surprising to encounter some rednecks shouting at us “Go back to your country, you turban-head!”

My experience in Australia shaped me so much, to the point that I have perfected a very sharp vision of how not to overgeneralize a whole group for some idiotic things committed by some of the people in that group.

***

When I was a HO, I felt so angry when I heard some of the consultants in the hospital talked badly about Russian grads or Indonesian grads or Ukraine grads. I was an Australian grad, and therefore I was spared the stigma. But even then, it was said “Overseas grad are not as good as local grads. They are not good at setting brannulas. They are not exposed to procedures as much!” Pffft! But one month into your first posting, ANY HO can set the brannula regardless of where they grad! One month into medical posting, ANYONE can do procedures for Peritoneal Dialysis and short lines and long lines. So, what exactly is the big deal here?

So when I was a junior MO, I wrote a long blog post defending the Russian grad. (It can be read H.E.R.E.) I wrote that, contrary to people’s belief about the Russian grads (that Russian grads had achieved bad SPM results and should not have been qualified to go to a medical school) those who were government-sponsored to Russia were actually the cream of the cream in our SPM batch. They went to Russia based on their trial results! It was the government policy AT THAT TIME, to send brilliant people to Russia. I went to Australia based on my SPM result… not my trial! So these government-sponsored Russian grads were actually excellent students.

A lot of the Russian grads (some of them my friends) had widely shared the post. It became viral in no time. I was quite surprised.

And now, we have had many specialists and even consultants in various fields who were Russian grads. In fact, there are still many MOs who are currently doing their master training who are Russian graduates and they are just as good as the local grads or the UK/Ireland/Australia/NZ grads.

See? All your skepticism and your ‘budget bagus’ statement and yes, your arrogance!! have been proven wrong! Any incompetency, attitude problem or lack-of-knowledge in a Russian grad, they are personal to that particular person! You are not being fair when you overgeneralize the whole group! Yes, you had PERSECUTED the whole group just because they were weak and disadvantaged

When there were so MUCH brouhaha about how HOs in the shift system would never be as good as us who were doing our housemanship in the on-call system, I had been very consistent in defending the HOs in the shift system! Even though I was a HO during the on-call system, I NEVER act like I have a crystal ball to see the future and automatically KNOW that none of them will be just as good as me.  I defended the shift system many times! Because I don’t,  and NEVER WILL condone anyone to persecute a whole group or a whole system for any mistake or attitude issues done by some people in that group or in that system! How can you be so small-minded and so certain that the whole group in that system will never be a good doctor just because they have a different training than you! I have many friends doing internship in Australia, UK, New Zealand and Ireland… all of them are good doctors now even though the shift system is implemented there. In fact, the irony is, we send our undergrads to learn to become a doctor in those countries who have been doing the shift system for decades! And then we have the cheek to bash the shift system?!

In my department now, we already have MOs who did their housemanship when the shift system was already implemented. And they are just as great a doctor like the rest of us seniors! In fact, banyak lagi senior yang baloq liat compared to them! Again, all your ‘budget bagus’ statement that this shift-system will produce bad MOs have been proven wrong! Any bad MOs prevalent in the environment stems from their own personal issue and again, it is ridiculous to persecute a whole group based on mistakes done by some in that group!

***

External Pathway Vs Master Pathway

There have even been a lot of ‘budget hebat, aku paling terer’ statement when it comes to bragging about systems in specialty training.

Nowadays, there are already many specialists and consultants who were the product of MRCP, and thus they received less criticism than us MRCPSYCH. But still, you can hear people saying things like “MRCP is not as good as master”.

But the reality is, there are NOW many consultants who are the products of MRCP, some of them are cardiologist, respiratory physician and gastroenterologist ALL OVER THE WORLD. When you say they are not as good as the physicians in the Master pathway, what exactly do you mean? On what basis do you say that? Is the Master qualification recognized all over the world outside Malaysia like MRCP? No! Do you have an objective scale in which to measure how better the Master pathway is compared to the MRCP? No! Or are you just giving an emotional statement just because you disagree with the MRCP physician’s management? Or maybe you have had an inter-departmental issue or disagreement that would have existed anyway regardless of whether the physician is an MRCP product or a Master product?

This is what is happening with MRCPSYCH too. Unlike MRCP, we are only just recognized in Malaysia around 2013/2014. So everyone is having an adjustment disorder about the whole thing. And of course the most logical thing to do – in their opinion – is to bash the MRCPSYCH system and comparing them with the master system in an unfavourable manner, despite the fact that the MRCPSYCH system is recognized the whole world over!

Now, my question is, how sure are you that MRCPSYCH system which is world-recognized will never produce good psychiatrist like the master system? Do you perhaps use a better and different book than us? Do you use special Malaysian-made books that cater specifically to Malaysians psychiatric diseases? (Or do you, in fact, use UK-based books and some of our MRCPSYCH notes too, hmm?) Do you perhaps have a larger amount of greater professors and lecturers compared to the rest of the world? Do you read different journals than us? Or do the people doing the master pathway are somehow less forgetful, more diligent, more up-to-date in anything compared to the MRCPSYCH students? I mean, WHAT?

Oh yeah… maybe the master students were more ehem, GUIDED by lecturers compared to us who were so-called ‘study sendiri-sendiri.’ But then I have checked with several master students too… not just in psychiatry but also in other fields…. they were always told “La ni kita adult learning ya. Bukan semua kena spoon feed. Kena belajar sendiri and tahu apa nak belajar.”

Hahah. So what is the difference, then? Kau belajar sendiri, aku pun belajar sendiri! And nowadays, how many percentage of your time are spent at the uni, especially if you are an out-campus student and also doing various rotations all over KKM facilities? The same KKM facilities that we the MRCPSYCH students use!

Oh yeah… master students have to do thesis! MRCPSYCH tak payah.

So what? I am not going to be a researcher. I am going to be a clinician! You choose master, you deal with YOUR requirement. I choose MRCPSYCH, I deal with MY requirement and the requirement set up by KKM. I pay using my own money to train in MRCPSYCH pathway. If you want MY requirement to be the same as YOURS, then maybe the amount of financial support by the government to MRCPSYCH candidates should be the same too. Everything should be the same then! Tak payah nak buat two different pathways if you guys are so KIASU to question why MRCPSYCH candidates don’t have to do any thesis. My question is, why didn’t you choose MRCPSYCH if you had cared so much regarding how we don’t have to do any thesis? Does doing the Master thesis help you being a better clinician? How much difference does it make? I want to know. And if you think doing this thesis makes you into a MUCH BETTER clinician than the MRCPSYCH candidates, then you shouldn’t feel so bad that you get to do it. Shouldn’t you want what is best for your adult learning despite what other people are doing in another pathway? 

One last point about doing thesis! It would be UNFAIR and VERY UNJUST for anyone to suggest that the MRCPSYCH candidates should do a thesis, just like the Master candidates. When you are doing a master program…. OF COURSE you have to do a thesis! All master students in OTHER FIELDS also have to do a thesis to be eligible to get a MASTER DEGREE! That’s why nama benda ni MASTER PROGRAM! Whereas, MRCPSYCH is a MEMBERSHIP program! We don’t get a MASTER degree despite the fact that our syllabus are the same with the master program. If we ever want to pursue a PhD in the future, we have to get a master degree first before we can do a Phd! But for you guys who are already doing the MASTER Degree, if ever one day you want to do a PhD, you can straight away do it because you already have a Master Degree! Get it? Faham tak beza Master dengan membership program? Semua Master degree kena buat thesis, regardless of their fields… faham tak? How is that FAIR and JUST for you to suggest for us to do a thesis when we are PAYING OUR OWN WAY for an exclusive world-recognized membership program and NOT for a master degree? Semua nak sama rata… tiba-tiba at the end of the day, korang dapat master degree tapi kami pula dapat membership of Royal College of Psychiatrist? Nak sama rata celah mana?? (Gosh, aku  tak faham how some people utilize their minds! So weird how they want everything to be fair … as long as in the end, it STILL favours them!)

So, if you are a smart person who JUST KNEW DEEP IN YOUR HEART that you don’t want to do a PhD in the future and you don’t want to become a lecturer or a researcher and you just want to be a CLINICIAN, you would have chosen the MRCPSYCH program! Simple decision making, isn’t it? Tapi kalau kau nak jadi CLINICIAN tapi nak juga ambil Master Degree, that’s YOUR choice! Mungkin kau rasa Master Degree lebih hebat, lebih seronok, lebih banyak pengalaman…. for whatever reason… that is YOUR choice! Jangan nak suruh kami pun nak kena buat thesis! Siapa suruh kau pilih Master?? Lepas tu nak jealous dengan kami pula? Kemudian at the end of the day kita sama-sama buat thesis, tapi kau dapat Master Degree, kami dapat Membership! Banyak cantik! Fair sangat lah tu? How biased is that!

In many parts of the world, most doctors only do a Membership program rather than a Master program because as a doctor and a clinician, that is already ENOUGH. Malaysia should have its own Membership Program for post-graduate training without having to go through the Master system. Maybe this is something we should start looking into! UK has it (RCPsych UK), Ireland has it (RCPsych Ireland). In Australia and New Zealand, they have a regional membership program called The Royal College Of Australia and New Zealand and their candidates also don’t have to do any thesis! Semua orang yang buat membership program, memang tak payah buat thesis! Faham tak? Please get this into your head.

If we have our own local membership program, only then it is fair for you to do some comparison between MRCPSYCH and the local membership program. Candidates can even decide to do BOTH the local membership program as well as the MRCPSYCH program just to get an extra international recognition. (Maybe we can set up a Royal College of Psychiatrist of Malaysia? Or maybe we can collaborate with regional countries and make it into an ASEAN College of Psychiatrist or something. Tak payah dah KKM nak bayar duit kepada universiti untuk train specialists! Besides, most of  the KKM facilities are being used for master training, anyway kan?) Let’s just keep the master program for those who want to become trainee lecturers. Of course trainee lecturers have to do a Master program (and therefore a thesis) if they want to become a lecturer or a researcher or an academician.

Look, at the end of the day, all of us have a choice! We choose according to our own views about what is beneficial for us and how it would fit our commitment and lifestyle. You had a choice too. Once you have made your choice, you really should stop questioning regarding how greener the other side is.

And before I forget, please remember that people who live in a glass house shouldn’t be too quick to cast stones.  The Master system is also very vulnerable to criticism. At least, I TRUST the integrity of the MRCPSYCH pathway. I mean, we NEVER heard any incidence of someone getting hold of leaked questions. We NEVER heard other candidates complaining about how they were disadvantaged because  they did not know about the leaked questions until after the exam… because that kind of thing just does not happen. There is a reason why MRCPSYCH is world-recognized. Because we adhere to a very strict exam guidelines standard and  procedures. Can we say the same about the Master system? Think about it before you say anything disparaging about another system. There are good and weak points in BOTH systems. You are welcome to point out the weakness in my system, but you too must be ready to hear your weakness being pointed out in return. Fair, ok?

***

Now, let me be very clear why I chose MRCPSYCH over Master.

It does not have much to do with the fact that MRCPSYCH is recognized all over the world, even though that is a really good aspect of doing MRCPSYCH! I don’t think that having a world-standard recognition automatically makes MRCPSYCH better than the master system (yup, unlike some people, I don’t feel the need to belittle other system. I think belittling others is a sign of insecurity! But if you belittle mine FIRST, I will certainly retaliate. So jangan nak jolok sarang tebuan unless you are prepared to be stung. Because I will sting you!) Like I said, we use the same books, the same syllabus, the same DSM-5 and the same ICD-10. MRCPSYCH is not better than the master system or vice versa. Please be CLEAR on this!

The reason I chose MRCPSYCH is because I am already used to the freedom and the ‘adult learning’ in the western system! I am free to explore knowledge and form my own opinion without having to navigate politics in the uni. I don’t like those things! I am very outspoken too. I don’t think I can tolerate the Malaysian mentality that outspoken-ness is equal to arrogance (Not all Malaysians are like this, and not all workplace have mentality like this. Even my workplace is generally nice and supportive. I need to put this disclaimer so that no one ends up with their feelings unnecessarily hurt).

I avoid any type of environment that would try to regulate or institutionalize my thinking and my ability to speak up about anything that is wrong or unjust. That is THE ONLY REAL reason I chose MRCPSYCH over Master.

I have heard some disturbing stories about the master system (not necessarily in psychiatry but in other fields as well. I don’t think this is the norm in the master system… but it can and does happen). My friend had told me regarding one student who was quite outspoken regarding her dissatisfaction in the master system, and because of that, she was barred from taking an exam. I asked my friend “Perhaps, she has an attitude problem? Was she always late or did not perform her responsibility well? Was she MIA? Maybe she didn’t finish her assignment?”

My friend said, “No, she was just more vocal about what she found wrong about the master system. So she made a few enemies. She had no knowledge issues. When she takes her exam in the next sem, she passed with just one attempt… she is quite intelligent actually.”

I was bewildered by that story. How can you bar someone from taking an exam just because she speaks up against the system? How dare you! I told my friend “Kalau aku kat tempat kawan kau, I will sue the uni! And I will send complaint letters to many people in KKM! See me in court!”

My friend laughed, “Lagi teruk dia kena nanti. Kami semua ‘yes boss’ ja la,”

There was also another story regarding how ‘adult’ the learning really is. You just did everything and you had to pay for it too. “Kami yang organize kursus. Kami yang dok organize lecturer mana nak bagi talk. Kami yang kena jadi MC, kami yang kena jadi usher… tapi kami pun kena bayar RM500 untuk kursus tu, Padahal kami yang organize. Ramai orang tak puas hati… tapi senyap jalah.”

Wow… how, ehem, unique is that arrangement? In the Western country, the trainees would have raised hell if they are treated that way! Instead of barring the students from having exams, they would be scrambling around doing damage control to their reputation. When you pay for something, you are the service-user or the participant of that course! Somebody else should be organizing it! Not you… who had PAID for it! There is an emphasis for getting the value of your money when you are doing any transaction in the Western country! That is just a simple concept of fair dealing!

***

screenshot 2019-01-17 12.25.49
My Facebook Status on October 12, the day when  Dato’ Azman came to HSB for a session with MOs.

Another issue in the Master system is regarding what happens if you want to quit your master program. I had raised this issue myself when Dato Azman came to HSB even though this has nothing to do with me and more relevant to the master students (So jangan ingat aku asyik tulis saja. Bila ada peluang nak cakap dengan orang atasan, I do it, okay! I just need to feel annoyed enough and then I can REALLY speak.) And Dato Azman was quite nice in listening to all the issues I had raised. I applaud his patience in giving us, the MOs, a fair and transparent platform to speak up.

Another friend of mine who was doing a master program in another field had told me that if she wants to quit her master program, she has to pay RM250,000 to the government.  I was aghast!

“Takkan sampai RM 250,000 kau spend untuk belajar kat uni for these few years?!”

My friend told me, “Dia cakap sebab kita ambil tempat orang lain. So dia nak penalize kita dengan RM250,000 tu. Padahal satu semester RM 8000 saja. Kalau lapan semester baru 64,000.”

I shook my head in disbelief. RM64,000 vs RM 250,000. That is almost QUADRUPLE the amount that you actually used to do your master. How can they justify penalising people QUADRUPLE the actual amount of money used? In my head, I went “This is even worse than usury! Riba kot! Even worse than hutang dengan Along! Just because the master pathway had the MONOPOLY in the business of specialty training, it doesn’t make it right for them to impose unjust deals and rules!” (That is why monopoly is bad in any sector. It encourages unethical abuse of power and the consumers have no rooms for negotiations of their rights because they have NO OTHER ALTERNATIVE!)

So on the day of the meeting with Dato’ Azman, I went down to where the mic was and I said, “Many people are interested in  the master program. But you made it so unattractive to us with oppressive deals. When I am doing MRCPSYCH, I know what I would be getting for everything that I have paid. When I pay RM1300, I get the course notes. If I want to join online classes/tutorials, I can pay for it and I get classes/ tutorials. When I want to do mock exams, I pay for it and I get to do mock exams. When I want to do my actual exam, I pay for it and I get my exam. If I fail the exam, I just need to fork out MORE MONEY to pay for another attempt and I will get another attempt. There is no ‘penalty’ whatsoever. The system is so much more transparent, money-wise. I get what I pay for and I KNOW what I am paying for! No one feel cheated or short-changed! So…how can we justify QUADRUPLING the amount of the actual money used just for the sake of penalty?”

Seriously, I was quite outspoken in that meeting. I mean, think about it! Why don’t you penalize the person by asking her to pay another RM64,000 on top of what the person already owed the government? Which means, get the person to pay RM128,000 (RM 64,000 for her own study + RM 64,000 Penalty for the place of others that she had taken = RM 128,000)  That is more reasonable, isn’t it? (but still unfair. In contrast with the MRCPSYCH system, you only pay for what you want or for what you use. It is fair and transparent!)

We call ourselves as Muslims and Malaysia is a so-called Muslim country! And yet in ANY ‘urusan Muammalat’, the Western non-muslims are more fair and more just and more transparent in all their dealings and transactions! That is the truth! And that’s why when I see intelligent, fair-minded Muslims, my heart softens towards them because they remind me of Australia, the place where I had learned to become more mild-mannered after I was impressed by their intellect and their patience and their fair dealings. In their system, they are MUCH MORE Islamic than us! (Bila balik Malaysia, my disposition has suffered a relapse. Hahah. Hopefully, with the new PH government, the environment in our institutions will change accordingly and my manner will become mild again. LOL)

I told Dato Azman, “I am actually doing the external pathway… but I am just speaking up on behalf of my master student friends scattered all across the fields. What is the RM250,000 money for? They learned mostly by themselves just like us in the external pathway… what is the money paid for then?”

Dato Azman raised his eyebrows “They learned by themselves?” He sounded surprised. And Thank God, there were a few MOs (I didn’t know which of them in the audience) had shouted yes! (Hahha. Thanks guys, whoever you guys are, for the support! I needed it at that time! You guys rock!)

I went on to say, “When we were doing our undergrad study, RM250,000 might be a somewhat justified amount for us to pay back. We got a lot of lectures every week, we got tutorials, we got quizzes every month! We could roughly see where the huge amount of money was spent! But with ‘adult learning’, I do not understand what is the RM250,000 penalty for.”

Dato’ Azman had noted what I had said and he said he would think about it and look into it. I hope, he really does. He also gave his email address and he said we are welcome to write to him directly for any issue. He was quite nice actually despite having to hear a lot of issues and complaints by many MOs that afternoon. Some MRCP candidates had also spoken up and supported what I said regarding our issues in the external pathway. MRCP candidates and the MRCPSYCH candidates kind of conquered the mic that afternoon. Hahaha.  But Kudos to Dato’ Azman for remaining calm. (Actually there were so many other issues I had gone to the mic for but not all of them are relevant to this post. Aku antara orang yang paling kerap guna microphone on that day. And seriously, Dato’ Azman was very patient in handling my questions. Tabik spring!).

I think, this is what leadership is about. Listen and respond.

The era of autocracy is outdated and should have been long gone! Dialogue is in! When someone criticizes your system, you don’t bar them from exams! Instead, you engage them in an intellectual discourse and settle your differences. You remain objective and fair towards them. Be matured! We are all adults here! But once you use autocracy in a cruel and unjust manner, you will one day encounter a student who may fight you back and will never stop fighting until she/he wins against the system! The probability is such that when you use the same method over and over again ENOUGH TIMES, one day you will encounter an EXCEPTION to the norm. When that time comes, you would wish you have never used autocracy against the student and had used intellectual discourse instead. Because trust me, some students may have the courage to fight you all the way to the court. Just imagine the kind of damage it would do to the reputation of the system. It is already happening in housemanship  and now our housemanship training has gotten a terrrible name already. So, please use the method of engagement rather than autocracy in anything you do. Because in this generation, the current maxim is “Be fair or Beware”.

***

Some people had also said “Bila ada external pathway ni, kita tak boleh nak control who are the candidates that become our future psychiatrists. Who knows…orang tu ada attitude problem ke… mungkin diorang tak sesuai nak jadi psychiatrist. Kalau dalam master program, kita boleh stop dia jadi psychiatrist from the very beginning kalau kita rasa dia  tak sesuai.”

Wow…. this is SO Malaysian! Do you think NONE of the master graduates had ever had any attitude problem? I can name a few, too! But do I go around saying “See? What kind of bad psychiatrists the master program is producing? And look at the products of master program in other specialties! Some of them molested HOs. Wow… such a splendid ‘attitude screening system’ you have in the master program, huh?And with those who didn’t molest HOs, they simply remained silent out of sheer selfishness and cowardice! What kind of specialists are the master program producing!? Look at how institutionalized their thinking is that they would ignore any wrongdoing just because it comes from someone of a higher hierarchy than them… perhaps because they are so used to it in the master system. Asyik senyum and cakap, ‘yes boss’ or ‘yes, prof” all the time!” Did I say any of that? Ada ke aku keluarkan kata-kata overgeneralization macam tu? Ada aku generalize semua master products as cowards based on that notorious incident? Tak, kan?! Because I am fair in my thinking and my judgment! I don’t over generalize people. In psychiatry, over-generalization is a cognitive distortion, ok? 

Should there be any issues with the attitude of your future specialists, you deal with them when they come along! Just like in anything in the world, you intervene when there are issues! You shouldn’t PRE-EMPTIVELY discriminate the whole group with your snide remarks based on your bigoted, discriminatory unfounded fears! But now, what  we did was the EXACT OPPOSITE! (klasik perangai orang Malaysia! Suka buat benda tak logik!) When there are serious issues with your specialists, you remain quiet and silent because you “nak jaga nama jabatan!”. Bila specialist dah ada isu, kita pula pi buat senyap! Sampai HO pun boleh kena molest for MANY YEARS! (Tapi ada hati nak condemn the external pathway sebab kita tak boleh nak, ehem, ‘pre-emptively screen their attitude’! Wow! Amazing reasoning! Boleh tak kalau ada isu, deal with it then and there?! It is a more logical approach, isn’t it? Tak payah nak kalut risau pasal the future, sedangkan benda yang kita boleh intervene STAT, kita tergamak buat senyap for MANY YEARS! What is that?! How dodgy is our priority!)

If an MRCPSYCH candidate does not perform well in the department, you can talk directly to the candidate and tell the person to improve. The candidate’s particular issues should not be generalized to the whole system! If a specialist asks an MRCPSYCH candiate something that she/he doesn’t know… maybe it is the candidate’s personal lack-of-knowledge and incompetency issues. It doesn’t mean the whole MRCPSYCH candidates are not good. Likewise, I have seen quite a few Master candidates who are not that good… some of them are already a specialist and they can still be confused about certain aspects of patient management. To me, that is just human! I do not generalize that to the whole Master program, do I? We read, we take exams, and then we have a tendency to forget a large chunk of it! That’s why we have CMEs! So that we can refresh our knowledge, get it?

So, when you come up with a statement, please be fair! You might get away with it when your audience are not as out-spoken as me or if they always feel the need to kowtow to people and please the authority. But I am not like that. That is just my personality.

personality

I reiterate that I am not bashing the master system. I  think they produce very good psychiatrists, in general. But my personality, my principle against unjust contract, my aversion to oppression, and my personal inclination, had made me choose the external pathway, instead! It is MY personal choice. And you can openly judge me for it… don’t worry, I will just argue against your points. If you can openly judge my choice, I can openly judge your choice too! It will be fun! But if I speak and answer you back in a way that might hurt your feelings, don’t think I am arrogant. You had it coming. And I am the sort of person who fight ALL THE WAY once I am angry enough!

I have always spoken up against the persecution of any underdog. My behaviour is CONSISTENT. If MRCPSYCH is considered the underdog program, heck, I don’t mind speaking up about it. I have spoken up (written up) for others before… and so, believe me, I have no problems speaking up or writing up for myself.

I will continue to do it until MRCPSYCH is as established as MRCP and any issue will then become redundant background noise! 

***

“Don’t worry, Afiza. Kalau depa dok buat payah, kita pi ja la kat Singapore ke Brunei ke…UK pun boleh. Terus jadi orang sana. Gaji pun lagi banyak. System pun lagi bagus.” Said my friend.

That is true. But it will be sad for Malaysia isn’t it? I understand now how the ‘brain drain’ phenomena befalls Malaysia. People get upset by some bureaucratic red tape and they just pack up and leave! And Thank God, that option is always available for MRCPSYCH candidate

Yup…. with MRCPSYCH, I retain my freedom. Free to speak up. Free to move out. Free to address my concerns and the concerns of my colleagues. I will not exchange that freedom for anything in the world. And if people ask me why I choose MRCPSYCH, this is why!

If you have different values than me, you do you! Live and let live! But if you try to belittle my pathway in front of me just because we have different priorities in life and different lifestyles, get ready for my rebuttals. Because I will give them! This is my promise!

Disclaimer:

This is my personal blog and my personal opinion on Malaysian specialty training. It does not reflect the opinion of anyone in KKM or in my department. Please also refer to my blog disclaimer on the bottom right side of the page. My blog has been around since 2009 and it has always been dedicated to me recording about my life as a medical student then, and my life as a doctor now. I have always been very outspoken about things even when I was a houseman. My blog is a place for sharing of life experiences, life-philosophy, world-view and opinions as well as for advocacy of the causes I believe in. So, if you disagree with me, I encourage you to have your own blog and advocate for your own point of view. I also encourage you to leave a comment if you disagree with me and we can debate the matter. This is a free country that respects the rule-of-law since Pakatan Harapan won the General Election last year. Which means, everyone can have their own point of view and advocate for what they believe in. Any assumption, presumption, speculation or hurt feelings that result from what I had written are the responsibility of the readers themselves and they are accountable for it in its entirety.