Are you prepared to be a doctor?

A new medical university, IIUM,  has just been set up in Malaysia. I have lost count of the number of medical schools in this country. We have now too many medical schools. Yes, the demand is there , since everyone having 10 As wanted to do medicine, and Malaysia, been a boleh nation, has been producing ‘tons’ of 10 As students. ( now there is even 20 As…. ). Since the demand is there, medical education has turned out to be lucrative ‘business’ since medical schools can charge many times more than science or arts faculties.

Australia, with almost the same population but much bigger land area and much smaller doctor-population ratio, has only a handful medical schools, but all well known in the world..Yet, their healthcare is so much more advanced than us.

Well, firstly , I would like to tell parents and students out there, medicine is not suited to just anyone with straight As… Medicine is a field that requires a life-time commitment to the care of patients, not as a business to make money.

We call medicine a practice. Not as a business. When people ask me how is my business, I always tell them ‘ mine is a practice and not a business”.

In a business, you are out to make profits. In a practice , for the sake of livelihood, we do charge a fee for treating a patient.  But if the patient cannot pay, we still have to give the treatment..

That is why it is wrong for hospitals to be public-listed companies. Public listed companies are out to make profits for its shareholders, not for the welfare of its patients. Well, it will claim that it provide the best treatment and have the best facilities, as a marketing gimmick to attract patients customers… Once a hospital is listed, it will lose its human edge… It becomes a commercial entity.

I have always held the views that provision of good health and clean water should not be commercialised.

Even ordinary clinics cannot turn patients away if they cannot afford the treatment.

That is the basic medical ethics.

I charge a fee but i always let my patients collect their medicine even if they have no money or not enough to pay. There are of course not many such patients as society becomes more affluent… We did service quite a number of these in the eighties, and on one occasion, I remember I went for a housecall and didnt collect a single cent after seeing the condition of the family…Please note that patients have dignity and they would not ask for waiver or reduction of charges if they are able to afford.. They ask because they cannot afford… And doctors must give the same treatment regardless they can afford or not.

For those who are going into medicine, ask yourself:

Is it for money you are entering the field of medicine , or is it really for the love of helping people and alleviate sufferings?

Can you be patient enough to sit there for 60 minutes listening to an old lady telling the woes of her family ? Can you be human enough to comfort her,holding her,  even when she smells and stinks ?

Can you stand the chores of standing there for over 10 to 20 hours to do or assist in an operation without asking to be relieved, since chances are there would be no one to relieve you?

 Can you stand working from 8am in the morning on a Saturday and finish work at 4.30pm the next Monday (that was the weekend call I personally went through)?

Are you prepared to be on call for 24/7/365 a year , if you are the only doctor in town in some of the rural areas?

Are you prepared to face SARs or Ebola patients coming to your clinic to consult you without you scooting  off from the back door? (During the SARS scare, doctors carried on seeing  patients like normal, even though anyone with fever  could be a SARS patient and you would definitely be infected in the small confine of your consultation room if the patient that walked into your room was a SARS case)…

Are you prepared to handle excretions of patients such as stools, urine and vomitus, or physically handle a foul-smelling and maggot-infested wounds?Even if they cannot pay you?

Are you prepared to face a lifetime of learning since medical knowledge needs to be kept up to date ?

As a hypothetical question just to illustrate a point, are you prepared to treat someone who might have killed your loved ones?  Medical ethics demand that you do..

 

If any of the answer is no, then medicine is not for you.

For the government, it would be pointless mass producing doctors even if we want to have a balance of professions among the different ethnic groups. We have to remember that doctors handle lives, and incompetent doctors can turned out to be licensed killers…A doctor ‘s ethnic group is off no importance, what is important is that he treats all his patients competently without a slight thought of race , colour or religions.

We cannot be producing doctors for the sake of producing them. We cannot shift the passing curve to the left in order to make sure that bad students,  who would otherwise fail, pass exam and be doctors.

10 dedicated and competent doctors would be better than 500 doctors with ‘tidak apa’ attitude who never seem to have time for their patients. I have seen doctors not touching their patients, the famous case being mentioned by Dr M himself in the eighties, the doctor who touched her patient with a pencil and not a hand, for reasons that no one seemed to know…

With such a lot of medical schools being established within such a short span of time, where can we source quality teachers?How are we to ensure that acceptable  standard is kept, not only medically but more importantly, ethically ? How are we to ensure that we are not producing licensed ‘quacks”?

I leave all these for you out there to ponder…

 

Is this a new or the last chapter?

If Malaysia history is a book titled “RAHMAN”, today marks the end of the Chapter A, and we are now turning to the page titled “N”.

In a democracy, when there is a change of new leader, the people normally would have high expectations and hope for change.

On this occasion, however, I have a sense of foreboding. As I have mentioned in an earlier post, Deja Vu, that new leaders on assuming power would have lots of promises; but  as shown in the past, very often, these promises were mere rhetoric and what was promised seldom got carried out…

I have mentioned that I do not expect any real reforms , especially in the areas of more liberty and the fight against corruption, politics of patronage and money politics,  but I will be most gladto have myself proved wrong.

Since it is a fact that we are now turning into a new chapter N, as ordinary people, we could not do much to alter it until of course the next general election.. So we have to hope for the best, and  I have  hoped that this new leader can prove me wrong .

The most pressing thing to tackle — apart from the poor governance , the loss of excellence in all fields, the corruptions and  the crime situation– is of course the economy.

We are already into recession,  as I see it.. What we can do is to try to move out of it as rapidly as we can, and in the meantime try to alleviate the effects of the recession on the people..

This recession will probably result in the re-thinking of the concept of globalisation of the world… US is trying to spend its way out of the recession, and if it succeeds, it will have no choice but tackle the problem of its huge deficits, and the debts it incurs over the past decade. It would probably erect certain trade barriers to cut import, otherwise, we can also look forward to see the dollars slowly losing its strength against other currencies.

If US cuts import, the Asian economy that depends on export will be hit. These includes the tigers and the sang kancils.. We will all have to rethink of strategy to try to change our economic models… Probably from a centre of off-shoring manufacturing-based on cheaper labour, , to a higher tech and innovative based economy which has a niche in certain fields..

To move up to a higher tech and innovative economy, we need people that are  well educated, English competent, knowledge-based, analytical-minded and liberal . Are we producing enough of these? The answer, sadly, is no. Even if we can overhaul the education system and start producing these people, it would take at least another 2 decades before we can see real results.

Malaysia however has a ready pool of talented people. Unfortunately, these are now overseas , contributing to the economies of other countries.

 In fact if these people  who are now working overseas do come back, we will never be short of innovation, since many of those overseas are top-rated scientists, economists who are so much sought after and courted by the people overseas.

To have even 10% of these coming back would be a big plus to the country. But in order to attract these people, we must alter our whole concept of being Malaysians.  There cannot be 2 sets of rules anymore, one for the elites and one for the common people.

For the world economy, protectionism may rear its ugly head again, if US decides  on cutting deficits. And with that  , FDi can be expected to reduce… With the reducing FDI being courted by most of the developing countries, we need to have certain attractions to attract them, as in the case of attracting back the overseas Malaysians..

We must have policies that provide a fair and level field for everyone. We must have policies that are open and just. We must have policies that make all Malaysians feel wanted. We must have policies that do not discriminate any one , not on ethnicity, not on religious faith and not on social class.

So, adjustment to certain affirmative policies must be made… The only affirmative action that the whole world would accept   is to have it based on ‘needs”and nothing else. The hard core poor must be helped, but other than that, free market polices must be encouraged for us to be competitive and be attractive to FDI..There must be a level playing field for all people..

English as a subject must be re-emphasized.

There must be a fair and independent judiciary to protect and arbitrate fairly any dispute  that might arise from business agreement, without which,private sector, as well as foreign investors,  would think twice to put money here.

Can the new chapter bring us all these? or will this be the last chapter of the book and a new book would come out in the next GE?