Monday, February 27, 2006

Medicine: A Calling

Ask most Malaysian parents what they want their children to become, a substantial majority will want them to become doctors. To quote a prominent Indian lawyer-politician in a forum which I attended last year, "every Indian wants a family of doctors".

However, wanting to be a doctor, having "rights" to pursue an education in medicine is absolutely different from being qualified to become a doctor. Sometimes, as reported in the Star, "students apply for medicine not because they truly want to join the profession, but due to parental pressure or the thought that doctors make pots of money."

As highlighted in my earlier posts, "What's Up Doc?" and "No Cure for Medical Schools?", I've been wanting to write about this topic for the longest time. My best friend and best man is a specialist pediatrician based in Singapore (who is a Malaysian from Johor Bahru, by the way). He has served more than his full term with the Ministry of Heath in Singapore and will be out in private practice starting next month. I am certain that after years and years of hardwork, it will finally pay off financially for him.

Having seen him perform his service with the amount of dedication, and the number of regular long and difficult hours, I can say with certainty that being a doctor is one mean task. Hence when I read in the papers that the number of doctor wannabes who went for the career talk on medicine at the Star Education Fair had increased four-fold, almost causing a pandemonium at the venue, I thought - do they really know what they were getting into?

The Star reported that more than 2,000 students and their parents turned up for the session, with hundreds queuing outside the conference hall an hour before the 4.30pm talk!

Top students, who have the right foundation and quality should be given every opportunity to pursue a career in medicine. However, I worry when many third and fourth rate students seek to pursue a career in medicine at all cost. The demand from such candidates is so strong and lucrative that there are many profit oriented agencies which were set up solely to help these less qualified candidates gain entry into any institution which will accept them as students. These institutions are usually located in Indonesia, Turkey, India and Russia.

To a certain extent, these overwhelming demand for an education in medicine has encouraged the mushrooming of private medical colleges in Malaysia in the late 1990s and early 2000s. Today, when the pioneering batches of students are graduating from these private institutions, we find that many of them are not qualified to become doctors - for they are either half-baked or have received a half-baked education!

To me, what the point? Why do students whose results for STPM don't cut it "die-die-also" want to be a doctor? Some of you might remember the controversy over the recognition of students from Crimea Medical State University (CMSU) whereby certain Arts students with average results and no foundation in Biology or other sciences have been accepted to pursue medicine. The fact that these students are accepted immediately tells you the probable quality (or lack of) in these "universities".

Do these students actually know how much medical officers are paid and how long it takes before one will finally have the opportunity to come out into private practice? Even in Singapore, I know that my friend was underpaid for years, earning income significantly below that of all our peers (particularly those from the legal profession, by the way). And I know that the situation is worse in Malaysia.

The same lawyer-politician I referred to earlier argued that every student should have a "right" to pursue a degree in medicine. I completely disagree. With obvious scarcity of resources to conduct the medicine course with sufficient quality, places must be reserved only to candidates with the necessary foundation for their secondary education as well as qualifications in terms of their performance. In fact I'd go so far as to argue a case that students who don't meet the minimum subject and performance requirements to pursue a degree in medicine should be "banned" from taking up the occupation, at least in Malaysia anyway. If not, are we not just taking a huge risk and endangering the future generation of Malaysian patients who may come under their care?

Being a doctor is an extremely honourable profession. But the same honour should apply when one should know the limits of one's own academic and intellectual capabilities. The same honour will be smeared, if one actually "qualifies" to be a doctor and is unable to carry out the job functions in a competent fashion - which in this case, may threaten the lives of individuals out there.

Hence, when it was raised by Datuk Dr Shafie Salleh, the previous Minister of Higher Education, that an additional "Medical School Admission Test" be conducted before students are admitted, I thought it was a good idea (given the circumstances). The test which was to include videos "on the life of a medical student and doctor", attitude tests as well as a written examination should hopefully act as a better filter on the right quality of students as well as the right motivations. To a certain extent it might resolve the annual controversy over the admission criteria for matriculation vs STPM students with the common entrance examination.

However, typical of the civil service response time, "the test has yet to be implemented due to a lack of time". I do hope that this test can be carried out soonest by the new administration for the next batch of graduates, in a fair and equitable manner. In addition, I hope that the examiners for these tests are not officials from the Ministry of Higher Education but practising doctors and academics in our hospitals.

So for students aspiring to be doctors out there - think twice, think thrice, think very very hard. And if your grades just don't cut it (anything less than 2 or 3 'A's for your STPM with the required subjects), seek out a new career which you might excel better in. Medicine is not the end of the world.


Anonymous said...

I totally agree. I'm a second year medical student myself pursuing a degree from a local public university, and it really breaks my heart to see that some, if not most of the medical students here, can't even communicate a single sentence in English correctly. And I've seen scores of students who fail the first and second years repeat, at the expense of the govt ( = taxpayers' money). One wonders what patient in their sound mind would want to consult doctors given the knowledge that our institutions of higher education are being infested with such sub-class wannabe's.

And honestly speaking, I don't think the university entrance interview would make much difference, unless, of course, it's conducted by an independent board of practicing medical professionals. Otherwise it'll just be the same old practice of politics and biased acceptance conditons and denials based on the excuse that "your interview just didn't work out", as what happens every year to aspiring PSD scholars.

Anonymous said...

I think many out there still carry a believe that the medical profession is "the" ultimate profession to be in. It was yrs ago and similarly lawyers, engineers,accountants etc. all had their hey days.Today the scenario is very different.

If you're just a GP, forget it. Specialisation is the only way to go and even then some doctors are given "star-status" while others are merely one of them. It's probably the same, you got famous lawyers vs the run-of the mill type.

In most profession, generally if you work those kind of hrs like a doctor, you'll probably smell some of the $ like a doctor as well.

Maybe that's why medicine is a post-grad qualification in the US..they probably think and act better after their under-grad.

Anonymous said...

When some relatives of mine learnt that I wasn't interested in pursuing a degree in medicine after scoring 10As in my SPM some 10 years ago, they were dismayed and flabbergasted.

My reasons were that I wasn't interested in biology or medicine-related fields, was much more interested in mathematics, and didn't think that I have the physical and mental strength to handle a doctor's responsibilities. To which they said "rubbish!! those are not important!!" (Huh?)

They chided me and my parents, even going to the point of accusing my parents of "not pointing and guiding me in the correct direction". Luckily for me, my parents didn't get pressurised into pressurising me to go into medicine.

Well, I've never regretted my decision to study computer science... All's well that ends well, I suppose.

Golf Afflicted said...

Hey Anon 09:16

You looking for a job yet? I have some vacancies :-)

Anyway, it's great that you ignored the rubbish comments given by the "relatives".

I think I would have done decent as a biology student but I never took the subject because I can't ever get myself to dissect a frog, and I'll probably faint having to cut up dead bodies in class. And with my absent-mindedness, I'll probably leave kitchen utensils in the patient after surgery. :-)

No, top students are needed everywhere else as well based on their interests and talent, not just in the medical faculties :-)

Anonymous said...

I recall 2 years ago that I used to dissect 2 white rats just to discover what's inside their body and then drew out the diagram (cruel isn't it :-))Just imagine 2 innocent lives..ahem...rat I mean, had been sacrificed for the sake of bio experiments...
But those were the days during my Form Six and I enjoyed it very much!
Unfortunately, my love for biology means nothing more to my current pursued degree program-computer science. THose were the days...

Kian Ming said...

I remember telling my parents that I would study medicine if they wanted me to. Thankfully, they let me go down my own path. I studied economics because I wanted to make a lot of money then. I wouldn't have thought that I would end up doing a PhD in Political Science 5 years after I graduated with a Master degree in Economics. I am firmly in the camp that you should study what you're passionate about even if it is something which is out of the mainstream e.g. pottery making, opera or landscaping. Definitely research the field first before going into it but don't be discouraged by those naysayers out there who tell you that you won't be able to get a decent job if you study marine biology.

Anonymous said...

I think this is caused by the misconception that doctors earn megabucks. A fresh medical doctor actually earns around RM1400 - 1500 for his/her first few years in bolehland.

I myself know that I possess no medicinal plans in the future. Hence, upon knowing that my then school doesnt allow us to take Bio and Accounts together for SPM, I immediately dropped the former. Would I have done well? I stubornly think so. :$. Dont get me wrong - Its not that I like accounts, but I just dislike the way Biology was taught here personally. Hence, it lead me to self study, for the sake of knowledge, not exams.

As anon @Tue Feb 28, 08:55:58 AM says,

Maybe that's why medicine is a post-grad qualification in the US..they probably think and act better after their under-grad.

Yea I strongly agree. 3 / 4 years in university will change your views a lot. However, i think this cannot be implemented in bolehland, becauseee..... lots of people will not be qualified after graduation, based on their grades, directly leading to further discrimination, double standards, grade inflation.. etc...
and hey, we dont have enough doctors around too.

So, for those aspiring doctors who thinks its the road to El Dorado, think again. Stop that bs about wanting to save/help people, face it man - you're living off peoples miseries. Think again.

Anonymous said...

Tony, more often than not application selectivity isbased on the prestige of the university - not the university's academic quality. On CSMU taking in STPM Arts students, they obviously don't consider what learnt in STPM all that important.

Eastern Europeans have this aversion to rote learning and like it or not, STPM is the perfect example of it. You are not required to know all the concepts properly to score in STPM, you are except for the matter of your practical exam, required to be able to answer exam questions properly with answers examiners want to read.

And if you have taken STPM you would see that a large sum of questions are delibrately worded to trick or confuse the candidate. In other words, while a all-A student may not *understand* concepts he is supposed to learn, but the very least he is a good riddle-solver.

Why is STPM like that? To keep non-Malays out of prime university spots, of course.

And BTW, most Indian university with medical programs are difficult to get in. May be less so than local universities, but none the less difficult. Most, if not all, Indonesian universities are government-owned and aren't seeking profits, particularly by lowering standards for foreign students. In Universitas Gadjah Mada, for example, out of the nearly 45,000 undergraduates and postgraduates, only 605 are foreign students in 2004.

Other than perceived lax admission criteria, how can you justify taking a swipe against a whole lot of universities in Russia (and Ukraine), India, Turkey and Indonesia? A personal anecdote, my cousin went to study medicine in Dublin because she couldn't get into any reputable Indian universities (i.e. the ones recognized by the Ministry of Health). Yet Irish doctors don't seem to be half-baked. Odd.

On your minimum qualification; 2-3A's, it far more than enough to pursue medicine in the UK, Ireland, etc. Convert those 2-3A's into CGPA and you would get a GCPA higher than 3.0 - more than sufficient to get into pre-med undergraduate courses in the United States (nevermind than STPM is significantly harder than the average American High School Diploma).

When was the last time you heard of American or British doctors being largely half-baked and incompetent?

But so you know, Tony, getting an A in STPM is extremely difficult. It is much easier getting an A in A-Level's instead. Most A-Level students in Taylors, for example, got straight-A's. How many schools can claim the same feat with STPM students? Having such high demands is quite irrational; after all STPM does not measure how well a student would do as a doctor, or even test how well student would do in a university course.

Anonymous said...

To anon @ 02:26

well..I agree with you. Take a glimpse at prospectuses of UK medical school, an average of B's in A-Levels is required to do medicine.

Unfortunately in Malayisa, 3A's is even not enough to secure a place in medics. Some end up in dentistry or pharmacy.

As a person whom has sat STPM before, I share the pain when our 128 perfect top scorers cannot even get their preference in our local IPTAs.

From humanistic point of view, this is the biggest mockery of education system. We have a group of most potential medical students with good basic sciences, but we ask them to do their course in private uni (one of them is a newly established twinning program with university in Sumatra)

Can you believe that?

Our nation's best bio-maths students are being treated that way!

Kiss good-bye to stem cell research and whatever medical breakthroughs we dream in 2020.

It's exciting age we live in right now with the codification of human genome, stem cell research, etc.

You may argue that having a perfect 3A's or more is not a measure that these young people will end up to be good doctors.

But again, this is mere conjecture.

I would say their good results foretell that they would end up to be better medical students.(as they have strong basics in sciences).

Not to ridicule those existing students whom enter with dubious
pre-u qualification, take a walk to the local campus and see how those medic students with weak foundations have done after one year.

Yes, they have made it to the course. But just have a look at their 1st year results after they enter the course.

In sciences and mathematics, learning is cumulative.

Scoring perfect scores is not act of whim, but is the result of persistent effort, learning, and right mental attitude that push them along.

I wished AAB government would have shown more appreciation to this group of 128 special achievers (at that time)!

We desperately need them for 2020!

it is not necesary to ha

Anonymous said...

In Singapore, 4As is insufficient to get into medicine because competition is just too high. Probably need additional papers such as S-papers or an excellent GP grade.

Personally, I see the conflict between current students and the will of the past generation for them to study medicine or some "respected" field as a clash between materialist and post-materialist values.

Our parents grew up in a materialist culture, in the sense of the word where they were the first generation of people after the war and independence in the region and went through the initial process of nation building. Economic indicators show that they lived through a period where hard times slowly became good and therefore have a greater priority of financial survival over other "intangibles".

We, generation x-ers and later, as we have lived in a an era of unprecedented wealth and technology, have different priorities on the intangibles as we think that we are no longer restricted financially and henc e free to pursue different things in life than not only a job, but a job that we enjoy.

ThoeY said...

Am not very sure if this is the right blogspot to say this... but anyway, it's not very irrelevant. I, a not Malaysian student, studying in Malaysia and had as much confusions about the line to major at... can't tell you how much... my problem is that I find myself interested in each and every field !!! don't ask how.. but i find all majors interesting in a way or another. Thankfully I know that I don't love physics related majors too much, but I do love biology and medical related majors, I do find it interesting... yet again, am not the very patient type of person who would sit for long hours trying to understand how to help another patient!.. in other words I don't have the guts for too much studying hours, even though, it is a dream to become a doctor? would anyone be able to consult me?

If I may, I do also have an opinion about doctors in Malaysia, particularly Malaysians ... living in that country for 19 months now, had me going to different hospitals for many purposes.. most of all was accompanying a sick friend! ... mmm... I for real have pitted the way doctors deal with patients, not all of them though, but to be more frank and specific... it was Malay doctors who usually lack some humanity and even moral values sometimes... I have many stories to start telling but let me tell you the one I find most interesting...

Two guys who weren't close friends of mine and who are actually brothers crashed in a major traffic accident, when one of them passed away and the other slept into a comma ... for days the guy didn't wake up but as soon as he did, he was very lucky to find his sweet doctor standing right in front of him saying "oh, you woke up, your brother died by the way" !!! now does a sane doctor ever do that?! the dude was lucky for he didn't get back to his comma...

Now after telling you the story, would you still want to consult me about my major?! :)

Anonymous said...

How ever bad the medical profession is, it's a good living compared to the globalisation-driven trials & tribulations in other vocations.

I know because possessing an impressive degree in Computer Science from a great internationally known university surely didn't protect me from poverty, long cycles of unemployment due to offshoring, and living on the streets or sleeping on couches at the relatives.

Be careful of what you choose to study at university. A lot of courses these days are a total waste of money and time. They are so nonsensical and trivial that you don't need to attend university to learn them. As such, many degrees are worthless and will not help secure employment whatsoever.

Dr. Rubz said...

I'am a medical doctor graduated from number one medical university in Ukraine,not CSMU.For many years, I heard about this issue regarding to less knowledgeable medical graduates.Let me tell some experiences of mine during my practicals in Malaysia. I met a senior doctor who was graduated from Ireland,who also was a JPA sponsored.She was a very low capable doctor where her knowledge was super bad even compare to a houseman!This statement was given by her own colleague who was a professor!So I wonder how a houseman could performed much better than a senior doctor! Another scenario, a MO(UM graduate) who works in a private clinics send off a patient(who came for abdominal pain) with a piece of a paper written "adhesive colon" and without any referral letter or recommendation. This patient came to me and I referred her to a HO(CSMU graduate)to assist her and she was diagnosed for recurrent hernia,just as I suspected!Another scenario,few of Russian,Ukrainian and China medical graduates volunteered in a medical camp where there were few MOs(graduates from UKM)from Ampang GH.On that medical camp,we opened few booths for medical consultation.Guess what, the queue for these oversea graduates were too long compare to the local MOs.You know why? Because these Mos refused to consult patients with normal blood test.How do you expect a patient to accept a statement "you are may go back home" from a nurse or ordinary volunteer? The proper way is,the Mos should entertain the patients and consult them in case they have any other medical problems. Here you may learn few things; One:Never jugde a book by the cover.Don't think that all Ireland/UK/US medical graduates are much smarter and capable than other graduates.It is depend on the individual. Second: Don't think that all Russian or Ukrainian medical graduates are not up to standard to any Malaysian local medical universities/colleges.Even UM graduates can act worst! Third:Smartness is not the only criteria to be a good doctor.An excellent doctor should be kind,humble,polite,understanding, caring,attentive, hardworking and always remember to improve himself!