Medical Snippets


Culture shock

After a couple of months working, I still have culture shock. Firstly is everything has to be written down, secondly, if you can’t manage it, always refer, refer and refer. A patient with poorly controlled BP in surgical ward must not be managed by surgical MOs, they have to be managed by medical MOs.

Even when refering (calling to the MO), HOs must record in patient’s file. Sometimes, if the medical MO doesn’t answer, we have to write down “called Dr. Siti Medical MO three times, went to voicemail” or something like “Dr. Abu said COAD is not medical’s case, he refused to see, must refer to IPR (Institut Perubatan Respiratori)”. Sometimes the patient’s file becomes a gossip documentation anyway, but better save our ass first because in Malaysia everything has to be done in writing.

MOs are sometimes stupid lazy asses, they’re not keen on seeing patients. Maybe it’s just the place where I work. I did call MOs of the other hospitals to refer or transfer out patients for further management, they’re much nicer and willing to see the patients.

 

Competent or not

Then comes the question whether HOs nowadays are competent or not. It’s a known fact that HOs nowadays are not as tough as HOs of the past. I have to honestly say that Russian/Ukrainian are the most incompetent ones as the first posters, but once they went thru several postings, they become skilled and competent.

Once we start work as HO, we start from zero, be it local, Russian/Ukrainian or Indonesian graduates. But knowledge and skills will develop with experience as we go thru postings, only ATTITUDE that matters now.

 

The MOs

Compared to the West, our MOs are more skilled and independent. Malaysian MOs do more appendectomies and amputations than the specialists in countries like Australia, UK and Singapore. That is why those countries are really eyeing on Malaysian young docs, because our torturous training force us to learn to be independent thus we become highly skilled. Even the Masters program in Malaysia are far more difficult than MRCS, FRCS and whatnots.

The gazettement for specialists who did their Masters program in Malaysia is only 6 months compared to those who did overseas (2 years). The overseas specialists claim that they are trained in prestigious institutions and become specialists at very very young age, but are they as skilled? Probably all they got to do over there is assist to hold retractors only while their counterparts in Malaysia are already cutting limbs off. Probably they got to assist to do CVP Line when HOs in Malaysia are doing every week. How prestigious indeed!🙂

8 thoughts on “Medical Snippets

  1. I have been following your blog for quite some time. There’s something that I have to comment on for this one regarding your post on the “MO”:

    FYI, master program in malaysia passing rate is approaching 100% due to the pressure from JPA and government, and it’s training is going downhill as most experienced teachers are now retired / went on for private.

    Malaysians MO doing more appendectomies/amputations than a specialist/consultant overseas? For me I think thats quite bullshit cause in order to be a specialist one has to get “signed off” for all the Ops they do, and it’s not as simple as you think, and for the fact that there’re less mortality and morbidity in OT in OECD countries (compared to malaysia) also showed that they are the OECD consultants for a reason.

    The fact that MO are allowed to do appendectomies (not sure if it is with or without supervision but i’ll assume that it is not) is not something to be proud of, lacking of supervision means that MO would not learn the right way to operate and needless to say how to manage surgical complications.

    And btw, there is a reason why people move on the singapore/UK/AUS/US for their medical treatment.

    There is a blog you might be interested in:
    http://pagalavan.com/
    Please read the posts in this blog, particularly “for future doctors: general misconception of being doctors”.

  2. there are two ways of looking at it:

    1. Doing with supervision means knowing how to do it the right way, less complication rate. But at the same time, also means trainees are less independent and cant manage on his/her own.

    2. Doing without supervision means learning how to be independent in managing patient, but higher complication rates (higher M&M). With malaysia having busy supervisors/specialists all the time, this is our current practice.

    It’s good that you are disappointed in our healthcare and healthcare training. But you’re not making a good case here. Yes some MOs are signed off to do appendectomies, some are not (almost all MOs in the surgical dept in my hospital are Master trainees). The fact that our local MOs are allowed to do independent appendectomies and only specialists are allowed to do appendectomies in other countries already proves that altho master training going downhill, we are still more independent than they are.

    If you think that Master trainee MOs shouldnt do independent appendectomies and amputations, by all means complain to the government.

  3. faiz,
    russian/ukrainian grads are the most incompetent as a first poster? is this really the case..
    ah, so scared for next year..how to improve our knowledge and better prepare for HO other than reading more?

  4. @quansoh: from the sound of your comment, you definitely are not working as a doctor in Malaysia. I assure you, we do a lot of surgeries, especially emergency ones, independently. I’ve been an MO at HKL since 2006, and I do craniotomies, craniectomies, VP shunt insertion, EVD insertion, and excision of lumps and bumps on my own. From the logged records, we do almost 200 surgeries on our own within 6 months.

    I’ve been lucky in the sense that I’m posted at HKL. There are Neurosurgical trainees working there, and they guided us when we started off the first few months or so.

    Sure, Malaysian public hospitals may lack comfort. But where else can you get complete and proper healthcare for RM1 registration fee, or RM5 clinic fee, or up to RM500 for hospitalization fee regardless if you stay in for over a year?

    Please do a proper research and refrain from talking nonsense.

    @efenem: true, ever since e first batch graduated, Ukranian grads do have competency issues. However, I’ve worked with some of the better ones, too. Wherever you graduate from, it all comes down to your personal work ethics and attitude.

    About lazy MOs, well, when a House Officer starts working, we can generally tell whether he’ll be a good MO later on, or not. Again, personal work ethics. Our pay scale is low compared to this working in 1st world countries. Only if we think about helping others without expecting even a pat on the back, can we wake up in the morning and be motivated to go to work.

  5. To efenem,

    Yes i dont work in Malaysia. I have been following your blog because I found your blog aspiring and i enjoy reading your blog. I dont mean to ridicule anyone / any system in anyway, and i apologise if i made u feel that way. All I want to point out is that people are consultants/ specialists for a reason, and they got admitted to fellowship (ie FRCP FRACP FRCS FRACS) because they have completed their training to be competent (and obviously they have to clear their exams). I dont think it is appropriate for you to “imply” that overseas specialists are “not so good” while they have done a hundreds of Hartmann’s procedure with 2 years fellowship in colorectal surgery.

    I am not disappointed with Malaysian Healthcare system because that is the way it is, and in order for it to be reformed everything has to change and it’d probably take a long time.

    Perhaps I have not said that, as a Russian graduate I found you (in ur blog) you are highly competent and highly motivated as a med student/ doctor. (and i wish all doctors are like u)

    To Fadz,

    Thank you for giving me an insight about what is going on in HKL. It is indeed a new news for me for MO to be doing cranectomies /craniotomies independently, mind if I ask you how senior those MOs are? MO could be a PGY3 or he could be a PGY8 (equivalent to almost a consultant).

    What nonsense did I talk about? All i want to imply is that it is at best not to ridicule other doctors overseas because they are specialists for a reason.

    Sorry, what nonsense did I talk about?

  6. malaysian medical master programme is not 100% passing rate..
    it is stirict and has very low passing rate..!
    despite pressure from the JPA/goverment , it is stricly controlled by the local university and the colleges.

  7. Quansoh:
    “FYI, master program in malaysia passing rate is approaching 100% due to the pressure from JPA and government, and it’s training is going downhill as most experienced teachers are now retired / went on for private.

    Malaysians MO doing more appendectomies/amputations than a specialist/consultant overseas? For me I think thats quite bullshit cause in order to be a specialist one has to get “signed off” for all the Ops they do, and it’s not as simple as you think, and for the fact that there’re less mortality and morbidity in OT in OECD countries (compared to malaysia) also showed that they are the OECD consultants for a reason.

    The fact that MO are allowed to do appendectomies (not sure if it is with or without supervision but i’ll assume that it is not) is not something to be proud of, lacking of supervision means that MO would not learn the right way to operate and needless to say how to manage surgical complications.

    And btw, there is a reason why people move on the singapore/UK/AUS/US for their medical treatment.”

    Passing rate for Masters program is definitely NOT 100%. Who told you that? Certain disciplines, like Anesthesiology, have less than 50% passing rate each year. The aim is still to produce safe doctors and specialists, pressure or not.

    A lot of specialists quit Malaysian public service due to several problems, which I won’t get into here. Not only that, not all public hospitals here are specialist centers. With the high rate of road traffic accidents, Malaysian MOs do a lot more trauma surgeries than those working at Western countries. And that’s no bullshit.

    We do surgeries under supervision before doing them on out own. So we learn proper techniques first. Remember, safe doctors.

    Yes, there are reasons why people go elsewhere to seek treatment, but not because the doctors are bad or unsafe. Our public hospitals are overcrowded, with limited budgets from the government, and the pay really sucks. However, healthcare services have improved so much these past 10 years, with newer equipment and techniques. Unfortunately, the public still has this negative mentality toward public healthcare providers.

    So, quansoh, the your first comment, in its entirety, is nonsense. Sorry, but I find it irksome when people talk/comment without researching first.

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