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…

 

20 Comments (+add yours?)

  1. A true Malaysian
    Apr 03, 2009 @ 18:07:27

    Dr. Hsu,

    Today, Friday, 3 April 2009 is a terrible day for me for apparent reason that we know best.

    Then, this writing of yours troubled me further, not because it carries no truth, but it signifies how bad the situation we are facing now. This is only on medical health care which each of us need to face as we getting older and weaker day by day.

    Honestly, I don’t know which direct I am heading or should I direct myself to, but I am sure who should I vote in future General Election.

    We have given too many chances to Umno / BN to prove their worth and now is the time we give this chance to PR. I guess PR cannot be worse than Umno / BN.

    To Gerakan, you can close shop. No point wasting time trying this and that.

    Like

  2. khensthoth
    Apr 03, 2009 @ 18:17:51

    Sadly, there are too many parents out there who think otherwise. I personally know of a friend who is currently studying in medicine because firstly her parents forced her to, and subsequently she doesn’t want to disappoint her parents. Four years into her course, I don’t see she is any more receptive to studying medicine than she previously was. Her parents even said it’s a waste for me not to study Medicine because of my good results.

    Another friend of mine wanted to study Dentistry. Her father was a dentist. They forbade her to study Dentistry because “it would be a waste based on her results”. That is what’s wrong with the current mentality of certain parents.

    To make matters worse, some of their coursemates are involved in things that are contrary to any healthy lifestyle – drinking, clubbing, partying, smoking and taking drugs. And yes, this happens in Malaysia, in a semi-local private medical college.

    Like

  3. asiseesit
    Apr 03, 2009 @ 20:53:35

    funny you should write about this issue. something strike a chord in me this morning when a colleague related her visit to the dentist last weekend. the dentist simply was pushing a lot of dentistry products for her to buy like toothpaste, toothbrush, mouthwash, etc, etc.

    and i recalled one sign in a hospital near gatwick, UK many many years ago when i was with my sister to visit her neighbour that says “admit everyone, reject no one”.

    Like

  4. serendipity hopeful
    Apr 03, 2009 @ 21:06:01

    In our ‘instant gratification’ culture, most young people nowadays take up medicine to have their gratifications satisified immediately.

    Your pointers are timely reminders for those wishing to take up medicine as their lives’ profession. Medicine used to be a calling, it is hope many who go into it now will do so because it is a calling.

    Like

  5. Disgusted
    Apr 03, 2009 @ 21:49:02

    Dr,

    You are quite an exception because you belong to the old school of being “educated” in LIFE university more than you were “schooled” in medical school.

    As a compliment, you are a museum piece, very rare. Having said this, I have a privilege and honor of meeting and getting to know two other exemplary doctors too.

    One is a former president of your doctors’ association Krishnamoorthy in the late 90s and another, a founder of the St John Ambulance Dato Dr Low Bin Teck, a skin specialist.

    They are caring, kind hearted, dedicated and excellent professional doctors in their own right. Both are disinterested in active politics but they show equal concern on national affairs. Both are in community welfare work.

    monk

    Like

  6. anon
    Apr 03, 2009 @ 22:09:31

    For our common enlightenment.

    Source…http://www.thetruthseeker.co.uk/article.asp?ID=10450

    ———————————————————-
    Only Obama can save Iran from Israeli bombs
    Richard Beeston – Times Online April 3, 2009

    An Israeli colleague was sent on an assignment so secret and sensitive that it was years before he would share the full story with friends.

    He was dispatched by Menachem Begin, then the Prime Minister, to European capitals with orders to meet editors, politicians and opinion makers to spread the word that Israel was increasingly concerned about Iraq’s nuclear programme and would do anything to stop Saddam Hussein building the bomb. The warnings, intended to prepare Western public opinion, were largely dismissed as sabre-rattling (one editor insisted on discussing a new lavatory system designed on a kibbutz) – until June 1981, when Israeli Air Force F16s bombed the plant to rubble.

    A few days ago a chill went down my spine when an articulate and intelligent senior Israeli official made exactly the same argument about Iran’s nuclear programme at a briefing in London. He described an Iranian nuclear weapon as an existential threat to the Jewish state, which would defend itself whatever the consequences. These warnings are not new but the political and military circumstances are conspiring to make an Israeli attack on Iran a probability, unless the Middle East experiences dramatic changes in the coming weeks and months.

    It is a widely held conclusion among nuclear experts that Iran now possesses enough enriched uranium to build a nuclear bomb. It would still have to be enriched to weapons grade at the centre in Natanz before being made into a warhead. But Iran has mastered the technology and has the raw materials. Building a nuclear bomb is now only a matter of time.

    Iran’s presidential elections are in June. President Ahmadinejad is expected to be re-elected. Indeed, a Western diplomat in Tehran said that he had not met a single Iranian – even opponents of the Government – who did not believe that he would be returned with a healthy majority. He has vowed repeatedly to press ahead with Iran’s nuclear programme and appears to have the full support of Ali Khamenei, Iran’s Supreme Leader.

    The combination of the two events is seen in Israel as crossing a red line. Mr Ahmadinejad has threatened to wipe Israel off the map, has hosted a Holocaust-denying conference, and has stepped up arming and funding Hezbollah and Hamas, the two militant groups responsible for rocket attacks against Israel. If he is re-elected for another term with the prospect of building a bomb, Israel would do anything to stop him.

    This bleak outlook is made even more sombre by the formation this week of a new Israeli Government under the leadership of Binyamin Netanyahu with Ehud Barak, the Labour leader and junior coalition partner, as the Defence Minister. What is significant is not their political affiliations but their military background. Mr Barak, the most decorated soldier in the Israeli army, once headed Sayeret Matkal, Israel’s equivalent of the SAS before becoming the army chief. One soldier serving under him was Mr Netanyahu. Another veteran of this elite unit was Moshe Yaalon, also in the Cabinet. These men have taken part in assassination operations against Palestinian leaders and commanded daring raids deep inside enemy territory. In short, they have the experience and the confidence to plan and execute an attack on Iran. (Emphasis added)

    Indeed, Mr Barak was Defence Minister in the previous Government when Israel carried out its latest secret raid in January – on a weapons convoy in Sudan. According to details released this week, Israeli F16 bombers, protected by F15 fighters, attacked targets in Sudan. Pilotless drones then filmed the wreckage, relaying back images which revealed that some vehicles were undamaged. The jets then flew a second sortie. The aircraft, which were refuelled in mid-air, flew 1,750 miles from Israel to Sudan and back. The distance from Israel to Natanz, the uranium enrichment centre in Iran, is 900 miles one way.

    A factor in any Israeli calculation will be Iran’s air defences, which are far more daunting than Sudan’s. Here too there is good reason to believe that Israel may act sooner rather than later. Russia has sold Iran the sophisticated S300 surface-to-air system. Israel would want to launch an attack before these missiles are in place.

    These military imperatives might make sense to soldiers, but surely the political cost of a pre-emptive raid – not to mention the risk of plunging the Middle East into another big war – would rule out an attack.

    This argument might make sense from Europe but in the Middle East quite another logic is at work. Many Arab states, particularly in the Gulf, are more afraid of a nuclear-armed Iran than Israel is. A military strike that delayed that threat would be welcomed in some Arab capitals. The Israelis know that they would face a huge international outcry. But that happened after the raid on Iraq and many countries later thanked them privately. More recently they were widely attacked after the offensive against Gaza in January, but over time that criticism has died down.

    Today the only serious obstacle to this battle is Barack Obama. He has launched a diplomatic offensive aimed at repairing ties with Iran and re-engaging with the regime after 30 years of hostility. There are some signs that Tehran is interested. An Iranian envoy attended a recent meeting on Afghanistan alongside a US delegation. Similar talks have also taken place on Iraq.

    But these gestures are largely futile unless Washington can persuade Tehran that it is in its own best interests to shelve its nuclear programme, rejoin the community of nations and co-operate with America. That is a big step for a regime that came to power promising an Islamic revolution and continual struggle with America and Israel.

    When Mr Netanyahu travels to Washington next month, Iran is expected to dominate talks. Israel will not attack Iran without tacit approval from America. But time is running out. This could become Mr Obama’s biggest challenge.
    http://www.timesonline.co.uk/tol/comment/columnists/guest_contributors/article6024654.ece

    Comment

    The above is disinformation of the most insidious sort with its own hidden subtext. For it sets Obama up to take the blame should war erupt between Israel and Iran.

    It sets him up in another way too. For by being seen as the “one man” who could prevent war and it would only take a single assassin’s bullet to turn America’s first “Black” president into another Archduke Ferdinand. Ed.

    Like

  7. Disgusted
    Apr 03, 2009 @ 22:40:56

    Dr,

    You mentioned so many medical schools….how many doctors are being churned out yearly?

    Why is our ratio-doctor:population not improved?

    Why are we running short of specialists? Brain-drain is one factor. What about other reasons?

    Why are Malaysians need to obtain second source of professional opinion about their ailments? While in the past, perhaps, one opinion was considered trustworthy.

    monk

    Like

  8. Justin Choo
    Apr 04, 2009 @ 00:23:27

    Dr Hsu,

    From my “encounter” with doctors, The answers to all your questions are all “No’s” for most of them.

    They charge exhorbitantly, most are not polite and are impatient, all are in the “Business” of “Healthcare”.

    Your patients are fortunate to have you as their doctor.

    Like

  9. klm
    Apr 04, 2009 @ 00:34:25

    Dr. Hsu . Brovo. You must be pissed with some of your fellow medical doctors.

    We are a nation of quacks. Not least of all many of the doctors. I refused to see any doctor below certain age.

    We have quacks in lawyers, who bribes and subvert the judicials – looks like me, quack like me, but may not be me crap.

    We have quack in the ipoh mari judicial commissioner who interpret the law wrongly.

    So what else is new.

    Like

  10. clearwater
    Apr 04, 2009 @ 05:49:23

    We have a culture of mediocrity, thanks to you know what policy, and an embedded crutch mentality alongside with ‘instant gratification’ expectations among the young. No one wants to miss out on fun. Forbearance and patience are no longer virtues but liabilities. Honor is a forgotten word. What’s important are the material and physical rewards, the more the better, not a balanced outlook and value system in life. The young do not believe toil builds character. They think it’s dumb. Stupid. You have put it correctly, being a medical doctor is not all glamorous and fun, society looking up to you saving lives and curing grateful patients like in all those TV doctor soaps. You also do mundane and distasteful tasks as well.

    Misguided parents who compel their children to achieve their own frustrated ambitions are also to blame. They drive the poor kids to be disinterested doctors, engineers, lawyers etc. instead of another ‘lesser’ vocation of their choice where they will be happier and fulfilled. I know you allow your children to lead their lives, Dr. Hsu, but if they had chosen to be, say a chef or a fashion designer, will you have given them all your support? Or will you try to change their minds? Education for children were my greatest expenditure [some prefer to think it’s an investment ] and while I don’t regret it, there are times when you can’t help but feel some of that money could have been better employed. Yes, put the kids on a shoestring budget like you were as a student. Work every summer for survival money, no vacation; after graduation support your sibling for his education. Do you think this kind of hardship builds better character for your kids? Or make them resent a useless parent who cannot provide adequately? Excuse my rambling, I could not sleep.

    Like

  11. Tpg2sg
    Apr 04, 2009 @ 08:07:35

  12. Dr Hsu
    Apr 04, 2009 @ 11:36:28

    I let my children choose their careers. I never pester them to do medicine. They probably do it because they are proud of me…….At home , I do tell them from young that doctors must be compassionate, and it is a field where you can really help people… Probably that has influenced them.

    It would be less of a burden for me if they have chosen some other fields.

    As for why our doctors patient ration does not improve, in fact it is improving but many new hospitals are being built.

    In KL, we have the Selayan Hospital, Sg Buloh Hospital, Serdang Hospital, Ampang hospitals and so on.. These need doctors.. also each department has much more doctors than our time. The work load is much less… Whether productivity has gone up, I leave it to you to judge.

    Why the public sector is so short of doctors? You are right to say that brain drain is the main reason.

    There are a few thosuand Malaysian doctors working in UK alone. If all malaysian doctors come back at the same time, UK health sytem will face big big problems.

    My daughter is now working in Adelaide Hospital. In her batch of 41 house officers, more than half are Malaysians.. So there is a joke that the hospital is a Malaysian hospital, since most of the medical officers ( senior house officer) are also malaysians…

    There are many more working in Singapore, new Zealand, Hong Kong, and these are mainly overseas graduates where the standard of medicne is high, and they have to be competet to be employed there…

    I have written about Brain drain. All fields included, there are at least a few hundred thousand competent Malaysians working overseas, not including those in Singapore…

    These people includes professors, engineers, accountants , lawyers, actuarists, entrepreneurs, businessmen, doctors , nurses, dentists… These people alone would have propelled any country to a developed status in no time..

    Surprisingly, they include Malay Malaysians too, and many of the JPA students in UK refused to come back to work as doctors… That is a fact…

    Many more JPA students are taking it easy to do their course in countries like NZ. My daughter batch of JPA students, more than 10,( all go there direct without twinning), only one graduated with her, the rest of them repeating their course , at our tax payers expenses….

    I met some of them, nice people, when i went down NZ last year.They spoke like gentlemen, very polite…Only thing because they are not on father’s scholarship, they do not study as hard… For those on father’s scholarship like my daughter, , they cannot affford to fail because if you fail, you have to repeat the year, and one year retention means lot of money. So all those who go on father’s scholarship all graduated…

    IN UK i was told there are also a lot of JPA scholars repeating, again at tax payers’ expenses, meaning you and I are footing their course plus their playful lifestyle there; at the same time we have to foot for our own children’s education.

    So those young people on their fathers’ scholarship will view all these as very unfair, since they are better students and their parents have to slog so hard to support them overseas, while these JPA scholars are playing around and still get free education at the expense of tax payers who are the former group’s parents… How to convince these young people to come back when they view the whoe system as so unfair?

    Like

  13. Dr Hsu
    Apr 04, 2009 @ 12:14:06

    clearwater,
    yor predicament is common among Malaysian Parents, because we dont have a fair and equal system .

    One friend who sent his child overeseas was asking me whether he should, instead of spending few hundred thousands to send his son overseas, just give the money to his son to start a business.

    I told him that it is important to teach them how to fish rather than to give fish to them… If the business fails what happens? AT least with a degree and skill, he can survive anywhere.

    I have written about the dilemma of Indian Malaysians and Chinese Malsyians parents , where children are all overseas, and they would not want to join their children because they are used to the lifestyle here.

    Many of them who slogged and send theri chidlren overseas know that they have slim chance of their children coming home. But if they do not send them to study, their children would probably lose the upward mobility if they choose to stay back here and could not get into the field that they want… Another dilemma there.

    Like

  14. klm
    Apr 04, 2009 @ 12:44:11

    Dr Hsu. Yes. Can pohwatchdog answer to this. He pisses me off.

    Like

  15. Disgusted
    Apr 04, 2009 @ 13:02:23

    kim,

    You’re right, me too. The problem with such dogs, they hardly think out of the box (some people refer it to the coffin box), meaning their brains are quite dead, no induction and deduction and just shallow.

    They deserve the government they get but tragically they also dragged the country (others) down to the longkang, many who don’t deserve and don’t support such a government.

    These are traitors to everybody’s conscience.

    Like

  16. Trackback: Are you prepared to be a doctor? « Wi’s crap
  17. sing
    Apr 06, 2009 @ 15:54:28

    Doctor,

    May your tribe increase not only in this land, but all throughout the world.

    How many so called doctors have prostituted their Hippocratic Oath!

    Like

  18. Disgusted
    Apr 06, 2009 @ 22:23:43

    Cilipadi,

    Powerful earthquake hit northeast Italy, 70 dead and 1,500 injured. Last hit year 2002.

    It’s coming this way, my friend, more coming….

    monk

    Like

  19. Henry Chew
    Apr 07, 2009 @ 11:59:36

    Dr,

    The world is flat & the best survive.

    Look at the big picture, in case of Australia.

    1st, The World is Flat. Human resources are commodities & in this case is Doctors. If there is demand of doctors in Australia & price offer (earning or standard of living) is right. Not only Malaysia doctors, but doctors from all over the world will be moving to Australia.

    Ask youself, do you want to provide a better standard of living (life style, condition or protection at work, education, safety, prospect – now & children)?

    In the situation of the World is Flat there is no needs for more Medical School, but attraction for the Doctors. Or we have the distraction?

    2nd, the best survive, protectionism kill.

    Do we want Quality or Quantity? In many of Malaysia government is to produce Quantity, thus everyone have a share of it in a questionable quality manner.

    Our neighbouring country is alway keen in attracting the best expat to work in their country. While we import foreign Doctors in bulk until certain quarters start questioning the reliability of them, i.e. language barrier with patients.

    The policy maker must make to understand, the World is Flat & The Best Survive.

    Like

  20. Dr Hsu
    Apr 07, 2009 @ 14:19:15

    Hi Henry,
    how are you?

    Certainly what you said has truth in it.

    Only thing most of the medical degrees from this country are not recognised overseas… MU used to be recognised but not now…

    Maybe this is one way of keeping doctors here.. Produce degrees that are not recognised . so the graduates will have to stay here and work.. As to attracting docotrs from other countries, yes, we do have doctors from Myanmar and Indonesia working here…

    These people cannot go elsewhere because their degrees are also not competitive overseas..

    Like

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