When the Health Ministry fails, blame the doctors!

Discussion in 'Adrian Wong' started by Adrian Wong, Dec 4, 2007.

  1. Adrian Wong

    Adrian Wong Da Boss Staff Member

    Many of you know by now that our Health Ministry has decided to extend housemanship for new doctors by 1 year, starting from 2008. Their reason? Poor performance by new doctors. Longer training will give them more experience and make them better doctors.

    Sounds good, doesn't it? In fact, V. K. Chin of The Star even gushed about how great this would be. If anyone has any doubt of his position as a government spin-doctor, his article should put those doubts to rest.

    I had intended to write in much earlier, but better late than never. I drafted off this e-mail and sent it to The Star and The Sun. Let's see who dares to post it. :thumb:

    Note : Updated it when I noticed I missed a salient point.
    Last edited: Dec 11, 2007
  2. plasma

    plasma Newbie

    This seem to be a spin from the recent mishaps involving a little baby, some actions needed to be taken.

    But aren't housemans the ones doing most of the work in the hospitals?
  3. rusty

    rusty Newbie

    IMHO, it's isn't truly a bad thing. How else would there be enough workforce in the government hospital? Both my grandmas was admitted into government hospitals, and their care is top notch (one in Universiti Hospital, the other in Melacca General Hospital). Furthermore my mother was treated extremely well in Selayang Hospital to diagnose her gastric problem. How about lately my girlfriend was warded for dengue fever who was also treated with great care at UH. If it's not the sufficient supply (through forced employment) of doctors medical service by government hospitals wouldn't be this good.

    Just because of one blotch up by a government staff, the public cry for blood. And the government have to find ways to fix it. At least they are doing something which is fixing the issue of inexperience doctors. What about other government department which doesn't seems to be doing anything at all? the department of environment? the prime minister department (totally ignoring the recent demonstrations)? Works minister?

    Yes, i'm very defensive of our government run health care system simply put the general misconception they are inefficient. Before my mom went for endoscopy at Selayang, she first went to a private specialist at taman tun. Not only was she forced to wait (popular tactic in ALL hospitals), her appointment was delayed at last moment notice. Mind you that endoscopy requires the patient to fast for at least 12 hours. so imagine what pain it must have been not eating for more then 12 hours and having gastric at the same time. My gf too was put into similar situation at Megah specialist center. waited for almost an hour for the doctor who lived at taman tun which is just a stones throw. and failed to diagnose it as dengue. plus we had to pay a hefty bill almost Rm200 for a bunch of unneeded medication. her treatment at UH was RM350 for 3 days stay (5 meals a day) and many other lab test (checking blood count). and the best part is it's subsidized by the government when it's confirmed dengue case (full cash refund on the spot).

    So, has the government health care wrong it's citizens? especially now with an extra year of service for doctors to make sure the rakyat gets the best medical attention.
  4. Adrian Wong

    Adrian Wong Da Boss Staff Member

    Actually, I don't think the houseman was at fault. There is supposed to be an MO covering him. But if the MO is too lazy/tired, then he/she will be sleeping the shift off, leaving the houseman to handle everything.

    It is partially (at least) the specialist's fault because he asked the houseman to inject the antibiotic over the phone, without making sure he knows how to do it... or whether he's supervised.

    IMHO, if any action needs to be taken, it has to be proper training of housemen. Right now, they are being used to do menial work. When I started off as a houseman, I was ridiculed and scolded for ASKING how to do certain things. The idea seems to be, you are expected to know how everything is done.

    Unfortunately, even the most brilliant houseman will not know the hospital protocols and practices. Refusing to teach them is how you get to such problems as housemen wrongly administering drugs. Refusing to give them enough rest is how you get housemen to confuse similarly-sounding drugs.

    FYI, even nurses are given the day off after an overnight shift. Doctors have to CONTINUE working their day shift after an overnight shift, and some are asked to do back-to-back calls... sometimes more than 3 days. :nuts:
    Last edited: Dec 7, 2007
  5. Adrian Wong

    Adrian Wong Da Boss Staff Member

    Actually, getting the workforce is NOT difficult. For a small country, we have a really large number of colleges churning out doctors every year. My college alone produces about 300 doctors a year, and it's on the increase.

    The issue of workforce is really about 'retention'. Right now, the government is relying solely on threat to force doctors to serve. Other countries only have a mandatory 1 year housemanship. We tacked on a 3 year government service on top of that, and now add an additional year. If you do not complete all 5 years, you CANNOT practice privately in Malaysia.

    Private practice isn't as lucrative as it is made out to be. Yes, private hospitals charge a lot, but doctors overall do not earn that much. If they do, it's generally because they work like crazy. I know a surgeon who is doing very well but that's because he works 7 days a week and rarely goes home until late at night.

    Yet many other doctors are faltering in private practice, merely because there is excess supply of some specialists in the market. We are churning out a LOT of doctors, and that's a fact. The issue the government should be asking is WHY can't they retain them?

    I don't think money is the only reason why doctors leave government service. Many are leaving for Australia where the pay is essentially the same. I asked them why, and the answer certainly was not money. In fact, they have to invest a lot of their money to migrate to a job that pays essentially the same.

    The big issue here is working condition. Many doctors are leaving for better working conditions. I personally believe most doctors join the profession to serve the people. But I don't think even the most altruistic person can accept functioning at less than 100% mental capacity just to "fill a slot".

    I believe what most doctors are asking is a reasonable working condition, where they get enough rest. Countries like the US, UK, Australia already enforce work time restrictions and this has resulted in better healthcare. Why can't we do the same?

    If we can do the same, I'm pretty sure many doctors would remain. But I doubt it will happen, because it has been our government's policy to flood to market with doctors... so at least some will have no choice but to stick in public service. IMHO, that's a BAD policy. It's cheap for the government but expensive (health-wise) for the people.

    Well, the government isn't really interested in fixing things. It takes too much effort. What they are doing now is blaming it on "inexperienced housemen" and using that excuse to extend government service.

    If countries like the US and the UK can train their housemen in ONE YEAR, why can't we do it? The truth is the LENGTH of training has little effect on the QUALITY of training. With bad training (as a result of overwork, no training, etc.), you can train a houseman for 10 years and still get a lousy doctor.

    Actually, our healthcare system itself is GOOD. I'm not saying that we have bad healthcare. But it is on a slide downhill. If we do not reform the system, we will end up with a bad healthcare system. DYKT corruption is also snarling its way through our healthcare system? Doctors and nurses are being "rewarded" for recommending certain drugs, prostheses and other medical products over their competitors? It is the beginning of the end IMHO.

    TBH, government hospitals generally have the best equipment. They also have very good doctors running them. I personally do not like some of them (for their attitudes), but I can't help respecting them for their knowledge and dedication to the service. But I would not generalize and say that one is better than the other.

    IMHO, there are pros and cons to both private and government hospitals. You may have several bad experiences in private hospitals, but I have recently (just days ago) seen how efficient one was. I have also heard and seen my fair share of problems in government hospitals.

    Ahhh.. That is where I would most strongly disagree with you. An extra year of service will not get you the BEST medical attention. It just reduces the cost of our health programme because having more local doctors would mean our government can do without expensive "imports" from Pakistan and elsewhere.

    It is all about the money and nothing about better healthcare. I have not heard A WORD about proper housemen training programmes, or better working conditions, or even enforced rest for our government doctors. It is really all about the money. :hand:
    Last edited: Dec 7, 2007
  6. rusty

    rusty Newbie

    point taken, as for doctors migrating to the UK and Australia, it's most probably due to the strong labor laws. hence the good working condition. I do have to agree that we are somewhat lacking in this part.

    however as for the part of doctors performing better overseas, other then the more humane working conditions, it's also due to a supporting industry, lawyers, and insurance. civil rights are tightly uphold in those countries, hence the ease of getting a lawyer to fight for patients right/compensation whenever there's a blotch up. this can be a contributing factor for doctors to be more thorough with their work, hence, more professional. so, other then working conditions alone, the sense of responsibility is equally as important.
    as for us, either we close one eye, or the government compensate. i'm not sure what will happen to the doctor/medical staff that's responsible.

    anyways, as for corruption in the medical line, it's rather inevertable looking at the state how the government is run. depending on which hospitals, some have influential medical staff which demands for their choice of medical supplies. while there is still a small portion where the store keeper plays boss and decide what to buy depending on which salesman service him best (most of my customers/distributors service store keepers since the result is immediate). IMHO, having a store keeper which buys without medical knowledge more damaging then medical staff that's been rewarded for taking a competitor brand. anyways, that's going way out of topic since there are bad apples in every field regardless position in work/social strata.
  7. peaz

    peaz ARP Webmaster Staff Member

    imho, if you want dedicated staffs, you have to treat them well. Otherwise, you'd just get disgruntled staffs which would not work their 100% or maybe even 50% no matter that kind of restrains you implement.

    seriously, to quote an example, if you want your car to be fixed well, pay the mechanic reasonably and don't undercut and bargain too much. Happy mechanic = good service. Of course, a sly one will always be sly no matter what you do. So do choose a trustable one too. haha
  8. Adrian Wong

    Adrian Wong Da Boss Staff Member

    Actually, the legal fraternity is killing the medical profession in litigious countries like the US.

    DYKT : Due to insane insurance rates, many O&G practitioners are forced to either quit.. or only practice Gynaecology in the US? This does NOT improve the quality of healthcare. Instead, it reduces the number of available practitioners, drives prices up and increases the burden and risk on those who practising.

    IMHO, doctors are like everyone else. They are human. Making mistakes is a GIVEN. Even when they don't make mistakes, FAILURE is a certainty in some cases. They are not Gods. To punish them for being human is really excessive. You don't see the same treatment being applied to other professions.

    What excessive overwatch and litigation do is force doctors to keep thinking about risk and liability. DYKT there have been many cases where doctors refuse to help dying patients merely because by helping them, they would be exposed to litigation? DYKT there have also been cases where doctors helped people in life-threatening situations and yet were successfully sued by those they helped for inane things like not getting their consent before helping them? :nuts:

    At the end of the day, such practices result in a bunch of doctors who are more worried about their licenses than real doctors who are interested in helping people in trouble. But what can we do? This is the system that the people asked for. :haha:

    Regarding corruption, our government has to do something about it. If there are options, ALL those available options must be presented to the patient for him/her to choose. Otherwise, the drugs and other equipment must be purchased based on their merits and cost, not how pretty and sexy their sales reps are... or how much commission the Head of Department gets for the sale.

    Also, the government MUST pay a salary that commensurates with the sacrifice of these doctors and the risks they accept each and every day. Otherwise, our public healthcare system will run itself into the ground. Right now, the only way the government can retain staff is by FORCING them legally. Are disgruntled doctors what we want in our hospitals?

    IMHO, do away with stupid projects like our Angkasawan, North, South, East, West "Economic Corridors", Port Klang Free Zone and we will have BILLIONS of ringgit to pay our doctors AND other government servants.
    Last edited: Dec 22, 2007
  9. Adrian Wong

    Adrian Wong Da Boss Staff Member

    Ooops.. Just forgot I sent The Star an updated comment (see above). I just updated it above. Missed a salient point earlier.
  10. Adrian Wong

    Adrian Wong Da Boss Staff Member

    BTW, my comments came out in The Star two days ago but it was HEAVILY sanitised. No mention of the SLAB programme or our own Masters programme. What's the point of printing my comments if they skip the salient points?

    I didn't even bother to cut out the piece of trash. :hand:
    Last edited: Dec 11, 2007
  11. ZuePhok

    ZuePhok Just Started

    told ya, it's printed for morning market.
  12. Adrian Wong

    Adrian Wong Da Boss Staff Member

    LOL!!! Very true. :haha: :haha:

    Now I don't even buy it unless there's something important, or I need to check what movies have been freelisted. :haha: :haha:
  13. ZuePhok

    ZuePhok Just Started

    also, nasi lemak, mee goreng, chicken rice and BBQ!
  14. Chai

    Chai Administrator Staff Member

    Nah, I carry some with me when I walk the dog. :thumb:
  15. Dashken

    Dashken Administrator!

    I use it when I want to wrap up something, present maybe just to make it thicker... :mrgreen: Or to clean some glass or my car's windshield... hard to find nowadays because we don't buy it at all already. It's quite cheap considering RM1.20 for so many pieces of paper, especially Saturday's and ESPECIALLY KL Saturday's version... thick until dunno what.. :faint:
  16. Adrian Wong

    Adrian Wong Da Boss Staff Member

    Didn't they raise the cost of the weekend issues? :think:
  17. Adrian Wong

    Adrian Wong Da Boss Staff Member

    Anyway, I shot off an e-mail to The Star today :

  18. rusty

    rusty Newbie

    That's very civic minded of you. My dad does the same too (since i'm too lazy to walk the dog).

    I've written to the editorial once, but it was to flame comment on someone who ranted about the difficulties in getting a scholarship for a degree for his child. the person who wrote in is a teacher for government run school. other then a few grammatical fix, the content was not changed.

    but it was sooooooooooooooo long ago.
  19. Adrian Wong

    Adrian Wong Da Boss Staff Member

    Well, you probably did not talk about anything taboo like the SLAB programme I mentioned above, or even the way our government is covertly forcing doctors to remain in Malaysia.

    I'm sure the people would not take too kindly to such programmes. But with government newspapers like The Star censoring everything sensitive or controversial (to the government), how will people ever know what's REALLY going on?

    Hence, I hope everyone who reads my post will forward it to their friends and relatives. I'm really tired of our government pussyfooting around the real issues and lying to the people to further their own agendas.
  20. rusty

    rusty Newbie

    There's always malaysiakini ;)

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