Today in the newspaper, the Director General of Health spoke on a few issues namely:
1. The exorbitant fees in private practice
2. The failure of medical curriculum
3. The loss of human touch
4. Mushrooming of medical schools
5. Quality of Housemans
Lets look at the issues which actually has been around for ages and yet the typical Malaysian attitude prevails that is to make noise and then forget about it as fast as it was brought up.
The issue of exorbitant private fees have been brought many times but what most of us fail to understand is that while the doctors charges are regulated by the MMA, the private hospital charges aren’t. Well, then again there are many aspects that this matter can be looked at. The doctors who do their job and charges according to the MMA schedule, well I guess that should not be an issue. However, there will always be the ugly ducking, where charges are made unethically, though bounding to the schedule – that is to say there are abusers of the schedule — people who will make multiple charges for a 10 minute procedure for instance. From the hospitals standpoint, medications, technology and utility charges are rising and therefore the need to increase the charges gradually but saying this some hospital managements are equal to that of hotels. I suppose that it is difficult to regulate the hospitals as many sitting on the top of these hospital managements are linked politically or another and thus are indispensable. So the best way – squeeze the doctors!
The failure of the medical curriculum and the mushrooming of medical faculties are issues that have been voiced for many years. The problem is that those who now enter universities are not mentally prepared to undertake the real university education which for the failure of our secondary education, the tertiary education has been modified. Many lectures and professors have been heard saying that students that enter universities nowadays are not mentally matured as what it was before. The students are less resilient and the need to “hold hand and guide” is so high that if the past system maintains there would be many more failures and mental breakdowns. This I believe is the failure of the primary and secondary education. Then we have the major migration of brains to overseas especially to our neighboring Singapore. Then we have so many medical schools that blooms faster than mushrooms that dilutes the brains further. This has caused many major medical faculties to fall to the support of younger inexperienced staff to teach. Many of these new medical faculties do not have enough staff to teach their medical students and are dependent on the support of government specialist to assist the teaching of their students. The remunerations in pay and the acknowledgment of the work of those who did this country proud has been forgotten and left unattended to the extent frustration would be the natural response. Now, in government service everybody is sitting on the same scale as long as you are a specialist regardless of seniority and experience which is paramount in medical fraternity. I regress. The curriculum has been modified over time to make medical education more fun and attractive at the price of the quality of education. The so called US-based system is adopted without taking into consideration the local health system. There are more assignments and projects which has overtaken the need of medical students to spend time with patients. So, one wonders why the loss of human touch? Medical students nowadays hardly spend anytime with patients unlike my time. I have seen this happening in UMMC,UITM and also USIM. I am sure it is across the board.
Then we have the new houseman. As it is with students entering universities, we now have fresh doctors who are not ready to work and fail to realize that they are in a job that deals with life. Our government has spent billions to send some “brains” to many ambiguous medical universities overseas where the curriculum is worse than that of our very own — where they hardly have exams and that these fresh doctors hardly know what the thyroid gland is or what hernia is all about. It irritates me that the DG says that the onus are on the specialist to train these fresh graduates when at the same moment protects these bunch of fresh doctors with various rules and regulations. These new doctors are so not ready for the job that in recent years, as the DG says, “There have been many instances where housemen experienced mental anguish, depression, anxiety, stress and suicidal tendencies while undergoing training and this is no laughing matter.” But the truth to the matter is not to then blame the specialist but to then go back to the crux of the issue – stop sending these students to such places. As a patient, would you be happy to be treated by somebody who know not where the thyroid gland is or know not how to ascertain your diagnosis because he has no clue what your complaint is about? Is it fair for the public to be treated by these generation of fresh doctors even though there are specialist supposedly overlooking their work? There are people you can train and teach and there are the ones you just can’t! To make things worse, the DG decides to enforce a promotion exercise where part of the assessment is from the housemen– “As such, he advocated a two-way assessment system where not only the specialist and doctors provide feedback, but the houseman would also be given an opportunity to provide feedback on their trainers. On the criteria for promotion of public service doctors, Ismail said it was based on five main aspects, namely service, training, research, one’s standing in the eyes of peers and the 360 degree perception” — ridiculous — it only encourages the system to get worse then any better as now those specialist who really care and are strict would be judged badly and those who have no regards for the future of the medical system would be promoted quickly – Bullocks!
This is just part of the matter but I have said enough for now!