(Not exactly) Newsflash: KKM Semakin Tenat.

Seriously guys… it wasn’t exactly a newsflash that MOH is understaffed, under-budget, over-worked and basically functioning sub-optimally due to all of those reasons. The same issues have been plaguing MOH since I started working in 2011 (and also long before that, I am sure). And naturally, with the way our economy is doing, the state of hospitals and health facilities in MOH has been progressively worsening since then.

And what a surprise (NOT!) that THIS time, it isn’t the mengada-mengada, manjalitis Millennials who are saying these things. These things come from the professional opinion of our country’s National Audit Department! When they say it, they have credibilities. People started sharing the news (which is not exactly news) all over the social media, flooding my newsfeed with their own take and opinions on the news. But when the junior doctors say it…. well, we can brush them off as manja dan mengada-ngada, kan? (Okay, I better stop the direction in which my composition is currently heading. Haha. I have promised myself that I am done championing the issue of junior doctors. I am already a senior now and I have my own issues that I care about to fight for. But old habit dies hard, LOL! I have always believed that as a group, we are only as strong as the weakest link. And therefore, we must empower our junior doctors so that they can be as, ehem, great as us the seniors. But heck, the juniors can learn to fight their own issues especially if they believe they are right. I have my own stuff as a senior doctor that I am unsatisfied about! LOL.)

If you look at the comments section, you will notice some of the commentators saying something to the effect of “Dahlah memang tak cukup staff. Yang ada pun, bukan semua functioning! Ada yang bermasalah… asyik EL, MIA dan ada yang mempunyai masalah peribadi hutang dengan Along sampai Along mai cari kat tempat kerja and mengamuk kat sana. Exit policy buat perhiasan agaknya!” (Love your comment, there!)

Another LOVELY comment:

“Aku tak tau la susah mana sangat exit policy tu tapi yg aku tau ada ex-staff klinik aku ada kes polis pun masih kekal lagi kerja dekat PKD aku tapi dibayar gaji hari. Depa sanggup buat laporan berjela2 utk tatatertib and bayar gaji hari tapi tak sanggup nak buat laporan utk pecat org. depa punya “busy” tu macam tiap2 bulan ada kes pecat org“

Another comment which I personally LOVE :

“Bukan saja masalah tak cukup pekerja… tapi ada yg tak function. Ada yg kerja cincai, salai-balai, tak bersungguh buat kerja, lembap…. dan ada yg jahat terhadap pesakit!Kalau aku jadi org admin dah lama aku buang dan terminate org2 bermasalah mcm ni. Kalau nak kerja, buat cara nak kerja. Berdisiplin mai kerja, dress appropriately pakai uniform kerja, professional layan pesakit dan PAP! Jgn sampai benda basic routine pun nak kena ketuk every day and nak kena cakap byk2 kali. Org2 yg baloq liat macam ni memang tak layak kerja dgn KKM. Ramai lagi menunggu masuk kerja. Inilah waktunya yg paling sesuai untuk kita terminate pekerja2 lembab dan membebankan jabatan. Sebab berlungguk lagi menunggu nak dapat kerja!”

Soooo many of my friends had the same view as above! We REALLY vented out while sharing the news in the social media.(Seriously, we cannot stop millennial doctors using social media anymore! One day the millennials will become the leaders and saying things in social media will no longer be taboo! Instead, it will become the mainstream. Trust me… you can see the trend already.)

We are FED UP of the admin people not doing something concrete to these toxic, cancerous, pathetic excuse of a human being who are degrading the morale of the rest of our MOH staff by their despicable (sometimes criminal) behaviour! Not just to their own colleagues but sometimes even to the patients! (I won’t say much if  you are bad to your colleagues. Kawan-kawan sekerja kau tu memang deserve your bad behaviour sebab depa tak pandai nak defend diri sendiri dan lawan kau balik sedangkan diorang mampu nak buat kalau diorang betul-betul nak! They deserve the headache of dealing with your problematic behaviour and your unnecessary EL/MIA/laziness if they do not have the spine and are TOO MUCH OF A COWARD to report against you. But if you are UNJUST to my vulnerable, defenceless, involuntarily warded patients, I will personally make it my life mission to deliver your punishment even if I have to charge you through the legal channel. I swear it! I have even warned my own staff that if I EVER see them using ‘ubat kampung’ on my patients, I will go after them myself! Because my patients are vulnerable and they are MY responsibility. I WILL GO AGAINST YOU if I see your unethical or criminal behaviour WITH MY OWN EYES. The responsibility is mine to report on you if I see your ‘ubat kampung’ with my own eyes! If I can’t get you through the admin channel, I will get you through the legal channel! I don’t care whether the charge will stick or not… but police report WILL be done against you if any form of punishment failed to be delivered using the hospital admin channel. Whether or not the charge will stick… is the job of the police and the DPP. But making the report is MY responsibility and MY prerogative and IT WILL BE DONE if the admin people fail to give a suitable reprimand and punishment against you.) 

So the admin people, please listen to the plight and woes of your clinical colleagues. Please take action against the person who has had multiple, repetitive complaints being lodged against him. (one complaint may be due to personal issues! But if multiple behavioural issues with multiple complaints?? Takkan nak brush off lagi?) Because even if we may not say things in front of you, we will certainly vent in the social media by hiding behind the sharing of ‘current issues’. Hahah. And the public will come to know all about it.

***

COURTESY STIGMA

One week ago, again my Facebook newsfeed was exploded by the scandalous news that a private psychiatrist had allegedly sexually harassed his own patient. To be fair, we need  to know both sides of the story before we come to any sort of judgment.

But, I was disheartened by some of the comments that I read in Facebook regarding this case.

Even doctors had said something to the effect of “Psychiatrists pun sama macam pesakit depa.” And another one had said “Psychiatrists pun ada mental health issues,” (What? You think Cardiologist cannot get heart disease? Oncologists cannot get cancer? Wake up to the real world, genius!)

Have you guys heard of the term ‘courtesy stigma’, first defined by the sociologist Erving Goffman in 1963?

Courtesy stigma is basically ‘stigma by association’ in which the stigma is extended to the people who are close to the stigmatized group. For example, family members of mentally ill patients are often affected by courtesy stigma. “Kakak dia ada Schizophrenia. Tak payah lah kawan dengan dia.” or “Padanlah dia suka marah-marah. Ayah dia pun bipolar. Like father, like son.” (even if the person has an absolutely valid reason to be angry at you, you will somehow relate it to the person’s mentally ill family member.)

And courtesy stigma also affects psychiatry doctors. Trust me, we in psychiatry know this VERY WELL. Some of our own doctor-friends will say things like, “Psychiatrist boleh faham patient mental sebab depa pun mental.” and disguised their offensive sentence as a joke.

Well, I am having none of that! None of my friends will ever dare say things like that to me because I call out on it STAT! Right there and then I will challenge their statement and shred their reasoning to pieces. And they learn to behave well with me next time. See? I am a staunch believer and practitioner of behaviour modification. Your bad behaviour will be called out and punished stat! I don’t put up with crap. Welll… not for long, at least!

So, I wrote my own comment in the Facebook thread by saying:

When a prominent ortho surgeon was accused of multiple counts of sexual harrassment, we do not generalize all ortho surgeons “gatal” the lot of them.

Anyone can behave unethically and despicably. And we shouldn’t overgeneralize a group over any misdeed done by a few in that group.

Please don’t say nonsensical things like “psychiatrist are also like their patients” or that “some psychiatrist have mental health issues”.

A lot of doctors have mental health issues across all fields. Some have anger management issues as well, making life hell for their subordinates. Some were depressed while undergoing their master programs. We in psychiatry have seen all of them. We know mental health issues are prevalent in any field.

Some of the other doctors have spouses or children who are affected by mental health issues…. because their parents are only concerned about being good doctors rather than being a good parent/daughter/son/sister and they delegate the job of caring for their own family to others.

Anaesthetists also have a higher rate of suicide. What funny jokes can we crack about that? Access to lethal means of suicide is a known risk factor for anyone who is depressed. But depression or other mental health illness can happen to anyone.

Stop this stigmatization and overgeneralization. Cognitive errors are so unpalatable when they come from doctors who are supposed to have an enlightened mind.

I was gratified to see that many had liked my comment even though I wasn’t expecting them to. Having a lot of people read this comment of mine and liking it means that people understood and supported what I had written. So at that particular time, I have at least educated some people into not stigmatizing us. Small steps… but everything big starts with something small, right? I have done my part. I have spoken up.  In some other place and some other time, another person will speak up over the same issue and do their own part in reducing courtesy stigma. Slowly and surely the stigma will be reduced by these collective small steps. In fact, it is already reducing! The number of junior doctors queuing up in the waiting list to become Psychiatry MO is quite high, these days!

In fact, I was informed by one of my readers that my blog is one of their point of reference when they are trying to research on psychiatry career pathways! So, if my blog has done nothing else, it has at least promoted the field of psychiatry to some junior doctors. The popular campaign by RCPSYCH to #ChoosePsychiatry is also gaining momentum in the other side of the world.

The number of junior doctors choosing to train in psychiatry is at an all-time high, according to the latest statistics.

New figures from Health Education England reveal a 92 per cent uptake in England, Scotland and Wales, with 446 of 483 available places taken by junior doctors wanting to specialise in mental health.

This compares with a 69 per cent fill rate in 2017, when only 337 accepted one of the 491 places on offer.

The dramatic increase follows the Royal College of Psychiatrists’ #ChoosePsychiatry campaign, which launched in 2017, and has worked to increase the number of junior doctors choosing psychiatry as their speciality.

The figures also reveal a significant improvement since 2018, when 480 junior doctors accepted one of the 613 places on offer – a 78 per cent fill rate.

Record levels of investment in mental health services by the government and the NHS has helped increased public awareness to unprecedented levels, making psychiatry a more attractive career path.

Dr Kate Lovett, dean of the Royal College of Psychiatrists, said: “Psychiatry is an incredibly rewarding career and these figures are exciting news for patients as well as the specialism.

“The College’s #ChoosePsychiatry campaign has helped drive this dramatic rise in junior doctors choosing psychiatry as their career path. 

ETHICS & LEGALITY IN PSYCHIATRY

As psychiatry doctors, ethics is one of our core subjects and is supposed to be our strength and our specialty! It is REALLY sad if we are the ones who cannot practice it properly. When ethical issues involving psychiatrists appear in the social media, it is especially disillusioning and disappointing.

We used to think that doctors are generally kind, helpful and ethical. But these days, that impression can no longer be taken for granted. Remember the case of the prominent Ortho surgeon who had sexually harassed his housemen? We all had wondered regarding how his criminal behaviour could be ongoing for so long? Aren’t MOST DOCTORS ethical? So, why do MOST OF THEM become the ENABLERS of criminal behaviour? We started to wonder and cast blame when the shit hit the fan.

“Kenapa specialists lain pun tak bersuara?” 

“Kenapa tak ada siapa buat police report?”

“Kenapa Pengarah Hospital tak buat apa-apa sedangkan dah banyak complaints?” 

I am sure, AT THAT TIME, they would answer things like, “Nak ambil tindakan kena cukup bukti.”  OR, “He is too powerful. Dah buat report police pun tak boleh nak buat apa.” OR “HOs sendiri and victims pun tak berani nak ke depan buat laporan kat dia. Budak-budak Master pun bawah dia juga… nanti depa takut tak pass master.” 

They justified their inactions and silenced their conscience!

Suddenly, ONE FINE DAY, it took only ONE PERSON to decide to contact the mainstream media (THE STAR) to give her side of the story. Maybe she was thinking, “To the hell cukup bukti ka dak! Yang pasti, aku nak benda ni keluar juga!” Sebab once dah keluar, barulah siasatan akan berjalan untuk cukupkan bukti! Masalahnya bila benda dok hushed up tak keluar-keluar sampai ke sudah… sampai bila bukti nak cukup?

So things that used to be swept under the carpet (BERTAHUN-TAHUN berlalu tapi TAK PERNAH CUKUP BUKTI sebab tak pernah siapa pun teringin nak siasat habis-habisan dan ambil tindakan) tiba–tiba senang ja terbongkar dan siasatan boleh berjalan.

Bila keluar berita yang “pakar-pakar Orthopaedic di hospital tersebut akan dipindahkan” (mungkin sebab pakar-pakar tersebut dilihat seperti membenarkan dan membiarkan penganiyaan berlaku) tiba-tiba ada yang mahu complain pula! “Kenapa kami kena pindah? Sedangkan kami tak terlibat! Kami tak bersalah! Kami tak tau pun kejadian sexual harassment tu semua!”

Amazing! Orang di hospital lain pun boleh tau pasal your notorious HOD…. macam mana kau di hospital tu boleh tak tau? What wilful ignorance is this?

You deserve the punishment of being transferred out! When you are neutral and not taking sides in the face of oppression, you are actually a co-conspirator to the act! Your silence in a situation of injustice means you are siding with the side of the oppressor! To quote Finaz Yunus, (the host of Analisis in TV Al–Hijrah) we have to “BE TRUTHFUL! Not Neutral!” and this is ESPECIALLY important in the case of human rights!

So, in my opinion, you deserve to be punished (mobilized and transferred out of the hospital) if you had known what had happened and yet you had silenced your own conscience and let the heinous crime persist indefinitely!

So the take home message is: Bukti memang takkan cukup AT FIRST. Tapi, tugas siapa untuk cari bukti once orang dah complain? Tugas KITA lah! Tugas admin! Tugas polis! Tugas DPP!

Kalau admin malas buat kerja dan nak brush off complaints by saying things like “Ada cukup bukti tak? Dia ni dah counselling belum? Korang dah pernah minta explanation letter kat dia ke belum? Dah pernah bagi warning letter ke belum? Dah pernah pergi kursus-kursus untuk pekerja bermasalah ke belum? Bla bla bla..Dia ni dah lalui this procedure and that procedure ke? Kalau benda2 ni tak buat lagi, tak boleh ambil tindakan lagi!” Aduh! Sampai menyusahkan pula pakar-pakar yang dah lodge complaints…. and the problematic worker will continue his problematic behaviour till kingdom come! Well, orang lain mungkin akan give up or just internalize learned helplessness in dealing with problematic staff. Tapi kalau aku kat tempat orang yang complain, aku takkan diam! Orang yang setakat ada problem EL/MIA bolehlah nak suruh counselling ke and whatnots…. tapi kalau kesalahan menyalahi undang-undang dan ada kes polis dan sebagainya (like being accused of sexual harrassment/rape/assault)… aku akan laksanakan gantung kerja dulu sementara siasatan penuh dijalankan! Once you are cleared, you can come back  to work! But this is a HEAVY accusation, and you should be suspended until you are cleared!

In psychiatry, every single thing we do from patient admission, to medication, chemical restraint, physical restraint and seclusion/isolation are governed by the Mental Health Act! We are bound by the law in our clinical practice.

One of the shameful anecdotes in the Malaysian Psychiatry history! When a mentally ill patient dies in custody, the pounding headache is real!

 

But it is no secret that mentally ill patients are very vulnerable to being abused by our own staff or by the police officers who had made the arrest. Sometimes they are abused to their deaths as in the case of the article above. And this can happen anywhere, especially in the third world countries where patients’ rights are not that well-advocated.

It is our responsibility as a psychiatry doctor to make sure that our staffs are ethical and follow the law in how they handle our patients. Mentally ill patients have their own rights. If they cannot speak up for themselves, we must look out for them!

One of my friends had said that she had heard some talks of how “ada staff masuk cell dalam wad purposefully untuk pukul patient.” in one of the hospitals she used to work at. I won’t be at all surprised if some of our staff might have unnecessarily roughened up or abused our patients.

But, that is CRIMINAL BEHAVIOUR, okay! And if I see such a behaviour with my own eyes, I will give them hell!

I personally had sternly warned my own staff, “Kalau saya nampak siapa-siapa pukul pesakit tak pasal-pasal, saya akan report! Saya akan siasat! Saya akan ambil tindakan undang-undang kalau admin tak nak buat tindakan tatatertib dan orang lain tak nak buat apa-apa! Kalau pesakit unmanageable, inform saya. Kita boleh bagi ubat, atau sedation, boleh chemical restraint atau physical restraint. Tak perlu nak kasar dengan diorang pun! Tapi macam mana kita nak bagi sedation kalau korang tak report? Dan macam mana korang nak report kalau korang tak monitor patient betul-betul? So kalau patient buat perangai, jangan nak lepas geram kat diorang kalau korang yang tak buat kerja monitor patient. Kalau korang monitor betul-betul dan inform MOs betul-betul, dah lama doctors bagi intervention tanpa perlu nak kasar-kasar! Kalau pesakit aggressive sekali pun, pergi mana breakaway technique yang dah belajar tu? Pesakit aggressive sebab dia sakit. Yang kita tak sakit ni, apa alasan kita nak aggressive?” 

I make myself clear and my stand is rock-solid, unshakeable! If things happen behind my back, I might not be able to punish you because I do not know about it. But if I, myself, is a witness to your criminal behaviour against my patient, I will go all out to make sure you get your just dessert by the admin. And if the admin brushes off my concerns, I will use a legal channel to punish you! I will do it because I have the freedom and the means to do it! And most importantly, I have the WILLPOWER to do it!

Some people think that, it is necessary to hush things up untuk ‘jaga nama hospital’. Silap besar! What happened to Hospital Sungai Buloh once the conduct of the notorious Ortho surgeon became well-known, huh?!

The truth has a way of coming out! Instead of being known as “the admin who had done nothing when multiple complaints had been lodged”, be the admin who had done something worthy of your position by lodging your own complaints against him to the DG and MMC! Say to the DG and MMC “I have concerns about this specialist. I receive reports from HOs that he has been sexually harrassing them.” You MUST do your part. The outcome of your complaint is a secondary consideration! But you must do your part, first!

My principle is clear: I don’t owe my loyalty or my allegiance to any department, hospital or ministry. I owe my loyalty and my allegiance to the truth only. I owe my obedience to God, religion and my own personal principles, FIRST! Anything else is always secondary! Kalau kau salah, kau salah! My report against you had nothing to do with where I work at! I want my department and my hospital to be known as “jabatan/hospital yang akan jaga etika terhadap pesakit dan sanggup report staff sendiri kalau staff memang salah” rather than being known for lack of ethics or under the carpet dirt-sweeper! Because I believe that IN THE END, the truth will come out someday, somehow, someway… because the sunnahtullah is like that! And my lacking in action today will be the shame of me one day. I am accountable for what I see, what I hear and what I do about it. Even if the outcome might not be what I want and the perpetrator might go free, I have done what I should in my own capacity within my own limitations and that’s all that matters! 

THE LEGAL CHANNEL IS ALWAYS THE RIGHT CHANNEL

We always tell our staffs not to use the social media and we encourage them to complain using the right channel (which is usually incompetent and slow and broken). Kalau admin tak buat tindakan sepatutnya through the right channel, then we should go through the legal channel! (The legal channel is ALWAYS the right channel, anyway). Imagine what will happen once the legal channel is taken? Well, of course media akan hidu and things will become viral anyway. So remember, the legal channel is always an option! It is YOUR RIGHTS as a Malaysian citizen. And your job does not bind you from taking legal actions against anyone who had broken the law. The hospital admin CANNOT punish you for taking a legal action when they themselves fail to deliver a fair outcome out of your complaints.

And the bonus is, the legal channel can also be the viral channel. Imagine the headlines, “Houseman lodged a police report against nightmare specialist” Haha!

Remember this incident, guys? It was only last year! The HO took a legal channel (which is always the right channel, as a Malaysian citizen) and the issue became viral!

So, my recommendation to any victim of injustice is this: It’s okay if you cannot use the social media since it is not allowed for you to do it. If you are asked to use the right channel, go ahead and use it as your first line action. But if your admin FAILS to give you justice, you must go through the legal channel. And trust me, the legal channel will be the viral channel, anyway! Because the media will pick it up! So, yup… you get what you want at last!

Unfortunately, most people will not want to go through the hassle of taking any legal action, especially if the criminal behaviour is directed towards others rather than themselves. Well luckily, I am not most people. Once I am angry enough, I will fight to the end. If my warning is not heeded by my staff, I will strike on my own if the admin is too slow in doing their job. I will take a legal action. I am not used to learned helplessness and I will never make myself get used to it when it comes to dealing with dysfunctional staff with criminal-like behaviour.

***

THE STANDARD

Before I end this post, I want to ask my dear readers to ponder the concept of justice and redha. Because trust me, even so-called religious people get confused at times!

My dear readers,

In our daily interactions with others in the society, the standard that is outlined by Allah for us is JUSTICE! That’s why in Islam we have judges and the justice system (Syariah: Hudud, Kisas, Takzir etc). It is not the place of ANYONE to tell you “Redha sajalah anak you kena bunuh. Kalau  you marah pun, bukan boleh dapat balik anak you. Tak payah nak siasat, panjang-panjang cerita! Maafkan saja pembunuh tu. Redha kan dapat pahala! Redha kan Islamik.”

NO! NO! NO!

Instead, in our daily interaction with OTHERS – with our fellow human beings – we must always be mindful of justice because that is THE STANDARD that Allah had DEMANDED of us! You should instead say, “Allah had enjoined us to be just! Allah will punish us for failing to do justice! It is our responsibility to see it delivered no matter what!”

However, in our relationship with Allah, the STANDARD is redha! You should not question Allah, “Why are You not fair to me? Why do You let my son be murdered! Is this fair of You to allow him to be killed when my son is a religious Muslim and a good person?”

No! No! No!

Instead, in our relationship with Allah, we must always be mindful of redha! “Ya Allah, apa saja yang terjadi, aku redha! I submit to your wisdom.”

Redha and justice are NOT contradictory concept! You can be “redha anak dah tak ada kena bunuh” even as you demand that justice be done for your murdered son. Your demand for the justice system to deliver justice for you has NOTHING to do with how redha you are with what God has fated for you.

Justice is your standard with fellow human beings and with the administrative system in this dunya! Redha is your standard in your personal relationship with Allah! They are two separate (but related) concepts!

(Not delivering justice is BELOW standard. Demanding justice is THE STANDARD… and it is THE MINIMUM STANDARD expected of us by God. Choosing to forgive your oppressor is ABOVE standard. But you cannot make any inference regarding level of redha, faham tak? You might choose to forgive your oppressor, but deep inside, you are still NOT redha about what Allah has fated for you! Yes… that can happen, ok? You can trick other non-educated civilians into forgiving crime by manipulating the concept of Redha while ignoring the concept of Justice, but you cannot trick me! Because when I tak puas hati, I read up! I know my stuff! Manipulate me at your own peril.)

Please be clear about this. And try to lead your life according to THE STANDARD (of Justice and Redha). Even as you may not do it perfectly hundred percent of the time. At least, TRY!

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

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.

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.)

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. The rest look too ridiculous for public consumption. *facepalm*

 

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.

 

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.

 

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, knows 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.

***

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.

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!

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!

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!

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

From the very beginning, I had expected the Education Ministry 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 Education Ministry because I know how polarized the opinions on this are.

But to my dismay, from the very beginning the Education Ministry was seen to be focussing on 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?) 

Nowadays, Dr. Maszlee has received criticism right, left and centre! He has nothing to lose if he just says “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 he says 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) He puts himself in a strong position to bargain for a quid pro quo. He comes across as someone who is interested in the unity of the people and willing to sacrifice the quota pula tu! He would 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 he do instead? He said  something to the effect of “Quota should be there because even job openings are discriminatory. Private companies only hire mandarin-speaking candidates.” Gosh! Is he 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.” OMG…. no wise politician will say something like that!

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 di kalangan kiasu Chinese.

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!

 

***

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 talk or 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 and rebut 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. 😉

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. 

 

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.

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.

 

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.

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. 

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.

 

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!

***

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.

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. 

My Problem With Anything Vague

The question I always have in psychiatry relates to the psychodynamic area of psychiatry.

“If something is unconscious to the patient, then how can you be reasonably sure that THAT is the reason for how she is feeling at the moment? You are just the therapist. If it is unconscious EVEN to the patient who had experienced it herself, then how do you know that you are right when you point out, oh, the childhood experience of this and that are the reasons for what the patient is feeling now?”

I kind of feel unsettled by the vagueness of it all.

****

I think many people who are involved in psychiatry DO have similar questions about psychodynamic stuff like this. But perhaps, unlike me, they don’t really feel the need to vocalize their confusions (or maybe they are not confused about it. Maybe I am alone in this bothersome affliction. Oh well…). 

I never get a satisfactory answer.

Or maybe… my benchmark for what is a satisfactory answer is higher than most. I was like that since I was a child. I would ask the same question to my parents repeatedly until I was satisfied. Of course, as I grew into adulthood, I learned to suppress my questions and pretend that I am satisfied with an answer… just to cut the interaction short. I suppressed my dissatisfaction at the answer that I received so that I could simply leave the discussion. And then I went back home, forever googling. Hahaha.

There are times, when I wonder, why should I bother being so open about my dissatisfaction? Orang lain belajar, jawab exam dan lupakan! Tak payah nak ruminate or question something that is already in the syllabus!

But questioning is how I learn! Debate, discourse, arguments… that’s how I learn. I need to know. Not with ABSOLUTE certainty; just with reasonable certainty that are backed up by scientific evidence.

I have to admit that my arguments can be very tiresome. Don’t take it personally, ok. That’s just my learning style. Convince me! Break my argument! Then, I will learn where I went wrong. If you cannot rebut me, then I will go away believing I am right.

When I was a teenager, I even questioned the so-called religious stories that were fed to me and my friends. And trust me, among traditional Malay community, questioning anything that sounds religious is taboo. They can jump to conclusion “Your faith is weak! Questioning something religious… you should make taubah and say astaghfirullah. It is the Satan whispering evil doubts to you.”

Kesian kat syaitan. Tak pasal-pasal dapat nama! When it is actually THEIR respresentation of religion that is faulty!

I had asked my naqibah, “Is that religious for her to ‘cungkil’ her eyes just because a man was attracted to her eyes? She had covered her aurat, even wore a purdah. But just because a man, who could not control his own self, was attracted to her eyes, she was supposed to ‘cungkil’ them out to demonstrate to us of her piety? Aku tak faham! How is that religious?”

In one narration, this woman ended being dead! And this story has been propagated as the story of a pious woman that all women must aspire to become! And only MUCH later did I find out that, it’s a fake story!! And this story is still circulating in dubious blogs and among ustaz/ustazah who could not be bothered to check their references.

I was 18 at that time, doing my IB studies in KMB. I was just a teenager; albeit a curious one. When adults (like ustazah who endorsed the content of the ‘talk’) do not even question the ‘religious’ story, what authority did I have to even question it?

But question it, I did. 

I couldn’t help myself. It was deeply ingrained in my psyche to express my discontent at things that do not make sense.

I was SURE many students MUST have had similar thoughts, but they didn’t feel the need to voice them out. Kita dengar, kita balik, kita lupakan. That was the maxim!

And I used to be like that too. Religion was a mere ritual, separated from any logical understanding whatsoever. I prayed, I fasted… I was good enough, I thought. That was enough, surely! I would have been just like other teenagers….EXCEPT…. at that time, I was dealing with the death of my ex-classmate. I was interested to know – more than I ever did before – about religion, about philosophy, about life after death.

And they fed me these illogical stories?! (I knew it was not intentional on their part. They believed the story themselves! To them they were speaking the truth. But shouldn’t they have cross-checked their references before they gave talks to others. If I were the one being asked to include such a nonsensical story in my religious talk, I would probably ask about the authenticity of the story and investigate the sources until I was satisfied enough! You nak bagi talk, you prepare betul-betullah, kan!!)

If  they had known, how MUCH such fake stories would SHAKE!!! the foundation of someone’s faith, especially in the context of someone who was grieving and was searching for the TRUTH, they would NEVER think that their fake Israilyat stories were harmless and were just for  “Pengajaran saja. Bukan maksudnya kena cungkil mata. Kita nak tunjukkan potret seorang wanita yang berakhlak mulia.” Ugh!!

I was incredulous and very upset when I heard such an answer! What the hell, berakhlak mulia pi cungkil mata tak pasal-pasal? (In psychiatry, that is like deliberate self-harm! And we use the term deliberate self harm even for someone who simply cut their wrists. But this is cungkil mata, okay! Imagine if we have a non-muslim psychiatrist hearing this story, he would NEVER be interested in Islam kan! He would say Islam endorses deliberate self-harm! This is why the Prophet (PBUH) made it so CLEAR, that ‘sesiapa yang berdusta atas namaku, dia telah menempah tempatnya di neraka’. That is a huge warning, you know! Some people could not imagine how stories like this can turn intelligent people away from the religion! They could not imagine that …because in the first place, they were not deep thinkers! So why would they ever question anything, right? They assume everyone is as simple minded as them! And anyone who question them is just not religious enough!)

****

Let’s create a made-up scenario here to demonstrate how easily we can be wrong in our assumptions.

Let’s say… an imaginary psychiatrist, who is not well-trained in psychodynamic, finds out that when I was 11 years old, Ustazah S at my primary school was upset at me for secretly reading the school magazine in her class while she was teaching. This imaginary psychiatrist also finds out that Ustazah S had scolded me fiercely and took my magazine away from me and then she hurled the magazine out of the classroom door until it fell all the way to the ground floor of the building. (I was just flipping through that school magazine in her class because I couldn’t wait to find out whether my short story was placed in the ‘karya murid’ section.  Hahha. My fault for being unable to delay my gratification, I admit. But she didn’t have to throw my magazine down the building, right? Marah aku sudah cukupkan?! Tak payah lah nak rosakkan majalah sekolah aku, right? Hahha. I was ready to admit my mistake for reading the school magazine in her class. But when she threw my magazine all the way from the 3rd floor down to the school garden, I could feel my anger flare almost instantaneously. Instead of looking downward to demonstrate my remorse, I looked up and stared back into her eyes and refused to look away. It was a staring match I was determined to win. Hahah. She became upset and scolded me even more. “Kenapa jegil mata kat Ustazah? Tak puas hati!?” I remained silent but I held her gaze still. In my heart, I went “Memanglah aku tak puas hati! Kau baling buku aku kot! Kalau rosak, kau nak ganti ke?!” Haha. Seriously, I loved all my books! At that age, I had to collect my school money to buy myself any book and magazine that took my fancy. Every single book was precious to me at that time. So, of course I was angry! Ustazah S decided that I should stand at the corner of the class for the rest of the period because of my insolence for staring at her eyes. I defiantly held her gaze while walking to the corner of the classroom. In the end,  I won the staring match. LOL. Until now, my hilarious siblings who knew the story would take one look at me and said, “Weh…mata kak ngah dah mencerlang tu. Dia dah marah tu. Lariiii!” hahah.)

 

Hahah. I am not this bad. I don’t think I have a sinister smile.  LOL

The psychiatrist who finds out of my history with Ustazah S would probably say, thinking that he is applying his psychodynamic skill, “Hmm…maybe this is why you are hypercritical towards religious figures? Because of this ustazah? Maybe this is why you always like to question religious stories? Maybe this is why you don’t like anyone who speaks  like ustaz or ustazah? Because of what happened to you in your childhood with this ustazah….”

I would probably go…. “This psychiatrist is so ridiculous. He just didn’t get it! Such a faulty psychoanalysis!”

This imaginary psychiatrist is ignoring every other thing that was relevant to my behaviour in KMB when I questioned that ‘cungkil mata’ story. He is ignoring the fact that in the first place, the religious story was fake! When I questioned it, my question was right. I did not question it because the speaker reminded me of my childhood Ustazah S! I questioned it because I wanted to know whether the story was valid… because it sounded so dodgy, okay?! He is also ignoring the fact that, there ARE religious figures that I actually like especially those who are logical and sensible. So how does my terrible childhood experience with Ustazah S can explain my ability to like certain type of religious figures? Surely my sentiment and my dislike towards anyone is more logical than just being solely influenced by my brief childhood experience with Ustazah S. Human beings – when they are not psychotic, at least – are logical creatures!

This psychiatrist, if he jumps to such conclusion, is not being thorough in his assessment! For example, he might also be ignoring the fact that as teenagers, our formal operational stage was on the way to its peak! (Google Piaget Theory of Cognitive Development, guys!) Our logical sense was at its peak when we are at the teenage stage, especially when all our lives, we are surrounded by intelligent cohort from our previous school and all of them study science! Of course, we would question something as stupid as the ‘cungkil mata’! And do not forget the context of me dealing with the death of my friend. The urgency of me wanting to know existential, philosophical stuff like this was at its most passionate at that time. 

Piaget Theory of Cognitive Development

 

When you put all those into context, the childhood Ustazah S really is not that significant to explain my abrasive manner in questioning religious authority, is it? 

So, my point is, not everything is about your terrible childhood, right? Childhood experience cannot explain everything that you are feeling or going through now! People who you have met and disliked in the past do not necessarily have such power over you that you would illogically and instantly dislike anyone who you meet in the future that reminds you of them!

I don’t believe that psychodynamic is that simple!

Oversimplifying things like this is an error in judgment!  We would be underestimating the power of our brain to learn from other non-childhood experiences. Our brains are always continuously learning, adapting, and assimilating our mental schemas (Piaget’s theory again) until we reach a cognitive equilibrium! And this process goes on for the rest of our lives.

You are not defined by your childhood alone. You don’t stop learning and adapting and accommodating… and you don’t always get stuck in a rut just because of your terrible childhood experiences. Our brain is so much better than that when it comes to adaptation!

Give our brains some credit!

I created that ‘imaginary psychiatrist scenario’ simply as an example of how easy it is to jump to conclusion and construct a connection which is NEVER actually there. And trust me, in those who practice psychiatry, sometimes they DO have the tendency to make assumptions, thinking that they are applying their psychodynamic theory that they learned VERY superficially during their Master days.

Heck, one case protocol….does NOT a psychodynamic expert make!

And yes, sometimes making assumption is necessary to help you direct your thoughts in formulating your case… but you MUST verify it! Otherwise, your assumption is pointless in the general scheme of things; your assumption would be worthless to the case and at worse, it only makes you come across as judgmental to the patient. 

If you have learned psychodynamic and you think assumption and interpretation can be made lightly, you don’t understand it enough! You don’t respect its grey complexity enough! And therefore, you should not be applying it haphazardly! I don’t like psychodynamic, but I have a lot of respect for it sampai aku tak berani pun nak guna that approach and pandai-pandai buat assumption pasal orang. Because I understood how very easy it is for me to be wrong when something is as vague and as unscientific as this! Psyhodynamic is an art…. more than it is a science. Some people are good and talented at this art… but for those who are not good at it, they shouldn’t even bother to make assumptions ‘tak semena-mena’, thinking that they are simply applying their psychodyanamic, ehem, ‘skill’.

I prefer the straightforward approach. If I observe something about the patient that I do not find the real origin for, I will clarify it with the patient. The patient deserves the chance to either confirm your assumption or deny it! You owe your patient that much. You owe it to your patient to make an effort to come to a correct understanding of their position!

“Afiza, for those who are well-trained in psychodynamic, I am sure they won’t simply jump to conclusion based on flimsy observation.  Psychiatrists who are trained in psychodynamic would take everything into context lah! Macam yang you nak dan macam yang you cakap tu!”said a friend of mine with whom I discussed the matter over. 

“Okay, kalau macam tu, we as psychiatry doctors should be trained very well first in psychodynamic.We should first KNOW which type of cases and which type of patient warrant psychodynamic approach. Kalau kita just psychiatry doctors biasa yang tak expert in psychodynamic, kita tak boleh pandai-pandai buat assumption kan? Some patients are intelligent, you know! And they might take it personally when we cannot connect the dots properly and simply repeatedly go back to her childhood yang mungkin langsung tak signifikan! Lepas tu bila dia annoyed dengan kita, kita cakap dia ada transference dengan kita pula! Padahal mungkin dia memang ada valid reason nak annoyed dengan kita!”

My problem is: I don’t like vague things! And psychodynamic feels vague to me. I will never be good at it, I humbly admit. And that’s why I just bought a book on psychodynamic. I want to settle these doubts in my mind once and for all. 

I just bought this book via Book Depository. It cost me RM232. I wanna cry!

***

I am just an MO. So if I said something or expressed my criticism towards a certain concept or worldview in psychiatry, I am just not credible enough, right? Not everyone is like INTP/INTJ who respects someone NOT based on position, but based on what you have to say. Some people need the stamp of titles and authority to push them to reevaluate their thoughts.

Kalau HO/MO cakap tak betul atau tak dipersetujui oleh orang atasan, mesti akan dikritik. Kalau specialist cakap, tak betul pun kita akan senyap. That kind of ‘yes boss’ attitude is prevalent everywhere and I have kind of adapted to that and have stopped expecting Malaysians to be less of a coward who can actually be honest with what they really think and just speak them out. (There is a lot of psychodynamic in this paragraph, and if you are the psychodynamic type you might be able to see it… But rather than going back to my non-existent childhood trauma, you can just go back to my first posting as a HO. Haha. See? Not everything is about childhood! My attitude towards authority began slowly as part of my INTP/INTJ personality but it escalated to this point after my first posting. Our brain is not so weak that they are stuck in childhood forever. Some people do get stuck with their unresolved childhood conflict… but some people get upset due to some recent things they genuinely and validly SHOULD be angry about. So, verify, verify and verify! Verify your assumptions with your patients!)

Imagine my delight when I read the book written by Jeffrey A. Lieberman (the former president of American Psychiatric Association) earlier this year, and he concurred with what I had always believed about psychodynamic. I don’t generally read a lot of non-fiction (I have been trying to increase my habit of reading them over the years) but this is one non-fiction book I actually enjoyed and I found it very relevant to my career.

Well, Dr. Lieberman who was also one of the people involved in constructing DSM III which was a MUCH more systematic DSM than the previous two DSM…. well, he criticized psychodynamic quite heavily himself in this book.

Dr. Lieberman went through the history of psychodynamic and psychoanalysis in his book. He explained the history of how it came all the way from Europe to be practiced in the US, and how it then affected the psychiatry practice in the US.  He said that, initially Freud’s psychodynamic had brought respect to the psychiatry field until they feel they owed a lot to Freud/psychodynamic in general…. but as the sciences became more influential, as biological and behavioural approach took center stage, others started being openly critical towards this approach, and slowly but surely they departed from this approach.

I love this book! I have been having the same thoughts about the imprecise and unscientific nature of psychodynamic approach for so long (since I got into the psychiatry department) that when I stumbled across this book, I felt like “Yes! Finally there is someone who call a spade a spade. Finally, someone influential had written a book that concurred with my thoughts.” (I am sure there are others who have probably written the same thing over the years, but none that I have personally read myself. So yeah, I was pleasantly surprised when I read this book. I was so impressed by Dr. Lieberman’s book, so much so, that after I returned this book to my friend who had lent it to me, I went online and purchased it for myself so that I could have the copy of the book for my own keeping. So this book flew all  the way across the vast seas for me. I recommend this book for everyone interested in psychiatry!)

One of the best feeling that a  reader can experience  is when we read the written thoughts of someone else we have never met and yet…we can feel… “You and I could have been good friends if we are not separated by time and space. You explain my thoughts so precisely in a way that I would never be able to do. I would love to meet you.” (I feel that way towards Charlotte Bronte, Anne Bronte, Jules Verne and Jane Austen. And many many more authors. I have had hopeless crushes on book characters for so many times that I have lost count on how many different ways my heart is divided. Haha.)

***

I am not saying that psychodynamic approach should not be practiced. Some of the theories are actually understandable (id, ego, superego is one example of psychodynamic aspect that I can understand…well, sort of. Fruedian slips do make sense in a way. Free associations can be useful in therapy, I suppose. The negative therapeutic reaction described in psychoanalysis is comprehensible enough.)

I am saying that when it comes to making assumption about our patients (or about other people in general), we have to keep in mind that psychodynamic is not precisely accurate. There is a high chance that we are wrong in connecting the dots especially when we are not trained! I repeat, “when we are not trained!”

If we want to practice it, we should do it properly.

Further your training in psychodynamic if you like it so much. Do it right. Don’t just make assumptions in every case you see thinking you are applying your psychodynamic approach, and at the same time you never even make the effort to actually verify what you assume about the patient. Because people who really know what psychodynamic is about would find our casual manner of doing it as quite haphazard and an insult to the REAL way psychoanalysis is supposed to be done.

I am sure that psychodynamic psychiatrist would inwardly cringe when they hear their colleagues jump to conclusion improperly and would feel “this people would give this approach a bad name; more bad name than it already has.”

Some assumptions are not psychodynamic. Some assumptions are just nonsensical baloney. And we in psychiatry should know that. If we want psychiatry to gain some semblance of elite status in medical field, we can start by being serious and methodical in how we come up with our thoughts about our patient.

My take home message is this: If you want to practice psychodynamic, you do it right and do it properly. Intelligent people can hear what you say and they can break your assumption to smithereens when they are annoyed by your jumping to conclusion and they will walk away thinking psychiatry is full of baloney. Is that what we want? For intelligent people to feel psychiatry is bogus? Just because we are psychiatry doctors and are ‘supposedly’ an expert in human behaviour and motivation, it does NOT mean that we are correct in our assumptions all the time. It does NOT mean that we can make assumptions based on flimsy anecdotes when we are not properly trained. And then, we go around giving excuses “oh, this is psychodynamic approach.” *shakes head* Aku rasa psychodynamic psychiatrist pun akan bengang! Be fair to the patient…. be fair to the reputation of psychiatry. Be fair to yourself! 

The Association of Time & Respect

My exam is in 5 months time. I am freaking out!

My mom was telling me how 5 months was plenty of time to get ready for ANY exam. “Tapi kalau asyik kalut baca buku cerita, kalau ada masa setahun pun takkan sempat, Kak Ngah,” LOL *sarcasm detected*  

It’s not like I don’t know how precious time really is. I do know it. Allah Himself had sworn by Time in Surah Al-Asr.

But knowing something is not enough to move me into acting on it. Because… how else can I explain my inability to stop wasting my oh-so-precious time and just study consistently from now on (and stop buying anymore fiction)?

Knowing something is just not enough prodding for me to resist the lure… especially when the temptation (in the form of book reviews by Goodreads/Amazon/BookDepository) proves too hot to resist? Once upon a time, when online shopping was unheard of, I could resist book reviews easily because there was just no other alternative. A Kedahan like me could only rely on Popular to supply me with new releases of books and what Popular didn’t sell, I wouldn’t be able to buy. Temptation was manageable then. (We don’t have MPH, Konokuniya or Borders in Alor Setar and thus Popular monopolizes the Alor Setar’s scenery of book selling industry until now. But alas, Popular has never been exactly great at updating their stocks of recent book releases.)

These days, temptation is impossible to brush off. I just bought myself a book by Mathew Reilly, The Three Secret Cities, via online shopping when I could not find the book in Popular despite the fact that it has been released since November. (I TOLD you Popular is SLOW!) So feeling exasperated by the long unfruitful waiting, I decided to go online-shopping to take care of the itch. Now, I am patiently waiting for the book to arrive on my doorstep.

Which means that when the book arrives, I won’t be studying, LOL. Yup, wasting my precious study time, I admit. But it’s not like I can concentrate on my studies anyway when I know the book is somewhere inside my house still awaiting my touch. Might as well I just get rid of the temptation and hopefully, I can then focus on my study… Amen.

***

But my time is MINE to waste it in any way I like. If my time were to be wasted anyway, I might as well be the one who DECIDE what I am going to waste it on. And since I am going to waste it regardless, I might as well waste it doing something enjoyable, right? (like reading fiction, hahah) Logic, si?

However, I resent having my time wasted by others, especially in cases when I have no say nor control on how it should be wasted on. I am not gonna tolerate having my time wasted by ANYONE unless I absolutely have no choice about it for some obscure reason.

For example, I tolerate people wasting my time by being late when they first show me how to hike a new track. Because I need them at that point. But once I have mastered the track and have stopped depending on people to show me the way, I prefer to go hiking by myself. I find it troublesome to wait for them when they are late… and I am not going to. If you are late, I will go without you. Next time, I won’t go hiking with you anymore unless you can prove to me that you are not going to make me wait. The reason I always try to make myself independent and self-sufficient as soon as possible is because my time is precious and it is MINE to waste it in however way I choose. I am not gonna waste it WAITING on people. If I were to waste it, I wanna waste it reading fiction, ok?

And so it goes, that I almost always hike by myself. Occasionally, when my friends ask me whether they can join me hiking, I make it compulsory for them to be on time. I will wait for them up to 10 minutes if they are not on time, and then that’s it! I will go without them and I am okay with that. I am okay doing things alone. If you are not okay to hike alone like I am, you follow MY time.

All my close friends know this about me. If they are close to me, chances are they are a punctual person, themselves. Even when they are not naturally a punctual person… at least when they have planned an activity with me, they made themselves punctual for me if they are my friends. Because they know, I can do most activities myself and I have no problem doing things myself. They are the ones who usually feel awkward doing things alone and ask me for company, so they have to abide by my rules. I can eat alone, walk alone, shop alone, … I don’t mind it. What I do mind, is waiting on people when I could have done something else with that time. 

Does that sound cold-blooded and inconsiderate? “You must do things my way because you are the one who need me and I don’t need you as much. So you must follow my rule if you are going to depend on me in doing this activity.” Hahha. Yeah, when put it that way, it does sound cold-blooded, isn’t it? And so insensitive, right? But I am just being honest, here.

In my opinion, for you to keep me waiting when YOU KNOW I must have been waiting, you are PURPOSEFULLY disrespecting me. In MY view, YOU are the insensitive one, here! Not me. I made the effort to see you on time even though I don’t really need you… because I respect you and I honour my obligation and my promise that I have made towards you to arrive at a specific particular place at a specific particular time. But you didn’t make an effort to arrive on time to see me even though you were the one who were asking for my company? (In my mind, I will be like, “Damn… I could have read a few more chapters of my latest fiction in my comfortable bed rather than waiting for you. What makes you think you are more enjoyable than my novel that I will be willingly waiting for you without feeling angry when you fail to be on time? Don’t you know that there are not many people whose company I enjoy more than my books?”) When you fail to be on time (+/- 10 mins are still acceptable; I have learned to tolerate that much) in my opinion, I am no longer obligated to be sensitive towards you and I will make my displeasure known. My cold-bloodedness… well, you earned it. You will be lucky if I ever agree to make any plans with you again. 

One of my friends (the nicest one hahah), said, “Afiza, relationship requires compromise. You have to meet people half way. Not everything must be done your way.”

I was like, “Oh? You mean, if my way is the punctual way, which is the right way… and the other person’s way is the non-punctual way, which is the wrong way… I must compromise MY right way for HER wrong way?”

“Is there always a wrong way or right way of doing things…. that’s dichotomous, isn’t it? What I am saying is, you must meet people half-way.”

I laughed. “Half way? You mean, if I am punctual… and that person is always 2 hours late… we must meet each other half-way by being one hour late instead?” *sarcasm detected* (and to answer her question… yes in certain things, there ARE the right way and the wrong way of doing things. If you think your way is more right than mine, engage my intellect by debating the matter with me and make me see. I will change my view if I am convinced. I am willing to change to follow the right way. See? I am willing to learn… to do things the right way or the more efficient way. Not because it is YOUR way or MY way…. but because it is the right way. When it comes to time, being punctual is OBVIOUSLY the right way. Otherwise, why bother specifying the time in doing anything?!)

My friend shrugged after hearing my answer. She knew I have made up my mind and there was nothing she could say that would change it. Yes… when it comes to being punctual, my mind is made up! The debate is closed! 

In my opinion, unless you are facing an emergency situation, there is NO JUSTIFICATION for you to be non-punctual! There is NO JUSTIFICATION for you to keep people waiting especially WHEN YOU KNOW that person is waiting! And if it happens multiple times, well, I am not going to tolerate it and my mind will conclude that “Obviously, there are discrepancies in our habits and attitude towards time, and therefore we cannot be friends. I value my time more than I value any relationship with a disorganized person.”

***

So when do I tolerate people not being punctual?

Obviously, I will tolerate them when I STILL need them (like in the case of people showing me the right track for hiking). To me, that is just simple strategy on my part. Since I need you, I will have no choice but to tolerate your annoying habits. But once I have mastered the skills that you have and is fully able to be independent, I will no longer tolerate your bad habits. I am not being disloyal… trust me, I would have been really honest about my dissatisfaction regarding your bad habits… but if you persist in doing them despite my clear communication of dissatisfaction, what else am I supposed to do? Eventually, after my obvious dissatisfaction is being brushed off, I will take that as a sign of disrespect and I am just going to have to say “Look, it’s been nice learning things from you… Thank you so much. But for now, I am just going to say good bye and do my own things for awhile…. well, unless you are willing to be on time when we next go for a hike. Otherwise, I will see you around, yeah? No hard feelings, ok!”

That’s why I appreciate people who are on time! 

I don’t abandon my friends lightly. I do care about them. But the least they can do to show that they care about me in return…. is by being punctual. That’s all I ask (and of course, other than that, I also want them to have general good principles that align with mine. I am not going to be friends with murderers, thieves, psychopath, work-slackers…. well, you get the idea. Hahah) Luckily for me, my friends are mostly punctual. (Like I said, if they are not punctual as a habit, we would not have come to the stage of being friends in the first place. I would have abandoned them when we were at the stage of being acquaintances.). But even friends are allowed to have lapses and make mistakes. Tertidur, terlupa, unforeseeable emergency that crops up… those are understandable rare occurrences when my friends are late. I can tolerate that. These are the friends I keep… and they will enter my ‘inner circle’. To them, I will be loyal and supportive and transparent in my thoughts and my feelings. So, I am not that cold-blooded, am I? I do know how to be loyal and supportive and ehem, ‘nice’, but I am not like that for just anyone.

In fact, why should I?

And trust me, NO ONE should be loyal and supportive and nice to EVERYONE. Who got the time, man? Why do you want to waste your resources like that? Be selective in whom you should be loyal/supportive/ nice to! Be that way with family and real friends who respect your principles and your boundaries! Invest your time where it is most beneficial to you. We don’t know how much TIME we have left on this earth and we should spend them wisely with people that matter. And with the rest of the others, just be generally polite and professional, abiding by the rules of social conduct (which includes being punctual) and fairness (which includes being honest) but not more than that. Don’t drain yourself with unnecessary obligations that will take away your resources. And believe me, your time is your resources. 

Time is not just gold and money. Time is LIFE!

 

***

I also tolerate unpunctuality from superiors. Why? Because in order to complete our professional activities, subordinates need superiors. So, of course I will tolerate unpunctuality from them. Well, for awhile, at least. But again, eventually, I would make my dissatisfaction known.

When I was doing one of my clinical attachments in one particular hospital, I arrived to my first meeting with my supervisor 20 minutes late because in the letter I had received, I was told that I was supposed to report to Unit Sumber Manusia first. I didn’t know that it was customary to see the supervisor first before going to the Unit Sumber Manusia. How was I supposed to know the custom of a place I had never been to before? (Anyway, if that’s customary, it should be clearly communicated in the letter, shouldn’t it?). My supervisor told me “I am a punctual person, please try to be on time.” I was also quick to reply, “I came half an hour early and had reported to Unit Sumber Manusia as instructed by the letter given to me. I didn’t know I was supposed to see you first.” I hoped, I had made it clear that I was just as upset by the lack of proper planning and the bad communication that had taken place. I am always quite sorry when I am late… but NOT when I am late through no fault of mine! I am not willing to take a blame that is not mine to take.

I like structure, planned schedule, and having a timeline. To me, that’s professional work ethic. I can understand that sometimes the roster might be tight and superiors can be late in arriving on time especially if they have to cover multiple wards or workloads from their colleagues who are on leave. But if schedules are planned, and rosters are not that tight and many people are available, there is NO JUSTIFICATION for you to keep your subordinates waiting.

As an MO, I am in the middle position of being someone’s superior and also someone’s subordinate. So, I can totally identify with the difficulties of being either of them. Superiors have their own limitations and so do subordinates. But come on, having limitations when you are a subordinate is always going to be more difficult than having limitations when you are a superior. Because by the very definition of subordinate, he/she will always be dependent on his/her superior for decision making. The subordinate is always subject to the superior’s dictation and instruction. And that’s why I make it a point to not make my HOs wait without telling them what to expect. When I do think I might arrive late, I whatsapp them beforehand to let them know that I am going to be late and I will tell them what I want them to do in the mean time. Because I believe, it is MY responsibility to tell them what to do when I am not around for the activity that I should be doing with them. It is not their responsibility to have to check with me whether or not I will actually arrive especially when it involves an activity that has been routinely scheduled! When something is routine, there is already a tacit and implied understanding that I should be there. Any failure on my part to arrive to a routinely scheduled activity means that it is automatically my fault if I fail to inform them about it. I do NOT think that superiors have any rights to keep their subordinates waiting any more than it is okay for subordinates to keep their superiors waiting.

Respect is the key point here.

We should respect our subordinates just as we should respect our superiors. We should also respect our patient’s time waiting for us to come and review them! Should we not be available to conduct our professional activity in the clinic or in the ward, it is our obligation to passover the matter to our colleagues of the same rank. If rosters are tight and there is no one else in our own rank we could passover our obligation to, we can tell our subordinates to go ahead and run the activity on our behalves. Of course, it is not ideal but if circumstances cannot be helped and we trust our subordinates to run the activity on our behalves, that must be clearly communicated. It is not okay to let our subordinates to wonder to themselves about what to do and whether or not we will ever arrive and whether or not they should just go ahead and run it themselves. If we want them to start any activity first without us, tell that to them. If we want them to wait for us anyway even though we are going to be late, tell them clearly so that they can apologize to the waiting patients and persuade the patients to wait for our arrival.

It shows respect and decency. You don’t have to be someone’s close friends to respect his or her time. You just have to be an overall decent person.

And that explains why I will not tolerate people who are not punctual. I respect people’s time even when they are not my friends. So, for anyone not to respect my time or other people’s time, well, that is bewildering to me and I will take it personally. 

But I was told that “Afiza, hang kena baik sangka. We are a product of our environment and upbringing. Not everyone was raised to be obsessed about punctuality.”

Okay, I do give people chances to redeem themselves. I will tell them that I am not happy about them not being on time. But if they do it again despite my explicit communication of dissatisfaction (and trust me, most of my communication is explicit anyway), then I no longer have any obligation to ‘baik sangka’. My obligation to clarify the matter is done and whatever ‘sangkaan’ I have about you is accurate from that point onwards.

And that’s that.

***

My staff nurse told me one day “Dr. Afiza jalan laju sangat. Awat kalut sangat ni? Dok ligan apa?”

My colleague replied something like this, “Dr. Afiza hanya jalan lemah-lembut bila dia tengah tak sihat. So kena bagi dia tak sihat selalu kalau nak tengok dia ayu.” I was having URTI at that time and was feeling generally lethargic. So, they were teasing me about my slower walk and how I look more demure when my face was less expressive than usual. Haha.

Yes, I do walk fast. My nickname when I was in high school was Fifi Ferrari. (Created after the like of Maria Mercedes, a popular Mexican soap opera at that time. Haha. I had really creative friends, back then!). It’s because I value my time. I don’t know how people get bored because I always have things to do. Upon waking up, I have to pray, get ready to go to work. From the parking lot, I have to rush to punch in. And then, I have to go to my ward and review my patient. And then, I have to go to my clinic and start my clinic. The routine is already established. There are always THINGS to do that it doesn’t make any sense for people to walk sedately as  though they are aimlessly wondering what is their next task for the day. It always annoys me when I have to slow down my pace whenever the people in front of me are walking slowly. In my mind, I would be like “Ni nak berjalan ke nak jalan-jalan? Ni tempat orang kerja, bukan tempat melancong tengok permandangan nak jalan slow-slow.” Hahha. (Okay, I know this is just my personal pet peeve. Everyone is entitled to their own pace of doing things. If you want to walk slow, that’s your rights to do so. I am just venting out that I couldn’t stand walking behind someone who walk slowly and aimlessly.)

When would I be walking sedately? Well, maybe when I am walking at the beach….or when I am on a holiday and trying to soak in the beautiful scenery of a new place. Yes, I can walk slowly then. Because my PURPOSE at that time is to enjoy my holiday and learn a new culture and absorb the beauty of the new surrounding… and therefore I act accordingly and walk slowly to fit the PURPOSE of my activity.  Another time I would walk slowly is maybe when I am walking with friends who are slower than me. Or when I have just arrived at a new place and not yet sure where places are and need to stop and read the signs to know where I should be heading. But once I am familiar with the place and with the routine in that place, I like to get things done in the day as fast as possible.

At my clinic, my routine is established. From the moment I go out of my car in the parking lot to head to the punch card machine to punch in… until I punch out at 5.00 p.m, I always have things to do. Whether it is to see my patients in the ward, start the clinic, or go for lunch and start the p.m clinic or go for a departmental CME…Why should I dilly-dally, walking sedately and aimlessly when I already KNOW what things to do one after another?  Doesn’t it make more sense to get your task done as quickly as possible and settle everything one by one so that you get to relax as soon as possible?

Again… it’s about time. I cannot even tolerate wasting it by slow walking. That is the reason I always wear pants to work and very rarely do I wear baju kurung. I couldn’t walk fast in baju kurung. Lagi awal aku siap kerja, lagi awal aku boleh study, lagi awal aku boleh relax, lagi awal aku boleh baca buku cerita, get it? Hahha. As simple as that.

So you want to see me relaxed and not kalut? See me while I am reading my fiction or when I am sleeping. I am at my most relaxed then.