Tuesday, April 19, 2011


Dr Iskandar Firzada Osman

Kali ni kita alihkan sedikit pandangan kepada isu yang berbeza tetapi masih ada kena mengena dengan stigma.

Ada macam-macam jenis stigma dalam dunia ni. Aku tertarik untuk berkongsi pandangan yang Doctor Iskandar tulis ini sebagai renungan bersama. Aku kekalkan artikel asal tanpa sebarang terjemahan untuk menghormati originality penulisan beliau.

Pandangan beliau bermula daripada isu berikut:


EVERYONE knew she was a mediocre student, yet Lina (not her real name) was bent on pursuing a career in medicine.

Armed with her not so spectacular Sijil Pelajaran Malaysia results of weak credits in Biology, Chemistry, and a pass in Physics and Additional Maths, she applied to do medicine in several of the local public and private universities.

Her applications were rejected. But Lina was determined to be a doctor.
On her insistence, her family enrolled her at a local medical college which offered preparatory courses to do medicine in several South Asian and East Asian countries.

Despite acknowledging that her results were not up to the mark, the college took her in as a student and made her re-sit her SPM science subjects.

Within seven months, she completed her pre-medical course and Lina is now pursuing her first year of medical studies in a relatively unknown university in Bangladesh.

Stories like Lina's are not isolated. The pathway to that "elusive" medical degree seems to be getting easier, even for those who don't meet the standards.

Over the last 10 years, Malaysia has seen a mushrooming of private medical colleges to meet the increasing number of high-achieving school leavers who fail to secure the limited medical seats available in our public universities.

At last count, there were 26 public and private universities and colleges offering medical degrees.

While the majority of these universities and colleges impose strict entry requirements, including having distinctions or strong credits in Science subjects at A-Levels, some are a little more accommodating in their pre-entry qualifications.

Many of the smaller colleges offer foundation courses in medicine for those who do not have the minimum entry requirement of strong credits in Science subjects and Mathematics. Students from these colleges go on to pursue a medical degree in lesser known foreign universities, usually in Asia and eastern Europe.

What worries the medical fraternity, and Malaysians in general, is the quality of doctors the less established medical colleges are churning out.

As Malaysian Medical Association (MMA) president Dr David Quek pointed out in the December issue of the MMA Bulletin "it's not just the medical degree from 'any' university, but the prestige and the quality of the medical university or college that truly matters".

The MMA has reason to be concerned as recent reports have indicated that many housemen, including those from local universities and colleges, are so inept that they cannot perform even simple procedures that medical aides, such as nurses, can do.

Dr Quek stresses that the government's goal of trying to achieve a doctor-patient ratio of 1:400 by 2020 is "way too fast and too soon", cautioning that it won't be long before the country faces not just a glut of doctors "but also a possible erosion of standards", due to the insufficient infrastructure and training and supervising personnel to cater to the influx of medical graduates.

A doctor who has been practising for more than 20 years concurs that standards have dropped quite drastically.

"Now, some of these housemen do not even know how to insert an intravenous drip or take a patient's blood pressure or take a proper case history... and these are basics every medical student needs to know."

He adds that when pre-entry requirement standards are lowered, then the industry would eventually churn out sub-standard doctors.

He says even when he was studying in India in the 80's, he knew of students who did not make the grade but were offered seats in some lesser known medical colleges after paying huge capitation fees.

"Some of these students who entered the university a few years before me, had still not completed their studies when I graduated. Some took up to 10 years to complete their medical degree which most of us did within seven years. One wonders how competent a doctor they would be."

He says because of the large number of medical graduates and limited number of teaching hospitals, many were not gaining enough experience during their housemanship.

"As housemen, we used to work 15 to 20 hours daily and if we were on call, it could even be 36 hours. But I am all the better for it as I was able to serve in various hospitals in Kuala Lumpur, Sabah and Terengganu and gained wide clinical experience as we were expected to do everything," he adds.

Pandangan Doctor Iskandar:


I'M writing in response to the report "Mediocre students becoming doctors" (New Sunday Times, Feb 20).

Nineteen years ago, when I did my housemanship at Ipoh Hospital, I had the opportunity to work with people who graduated from various medical colleges all over the world.

At that time, there were not as many house officers as today. The majority of us graduated from India (both from recognised as well as unrecognised medical colleges), from the three medical faculties in Malaysia (including my wife and I), Pakistan, Indonesia, the United Kingdom, Australia, New Zealand, Iraq and Belgium (who brought reference books in Flemish).

Initially, I could sense "favouritism" among the medical officers, clinical specialists and consultants towards house officers who graduated from certain universities.

As my wife and I graduated from the youngest local medical faculty from among the three, word went around that we were not as good as graduates from the other two faculties.

However, our attitude, dedication, commitment, accountability and passion during our housemanship earned us their respect.

I have had a colleague, who graduated from a prestigious medical college in the UK, asking me how to take blood from a patient because in the UK, she never had to do that (it was done by a phlebotomist).

She learnt and became an expert.

On the contrary, I also had a colleague who graduated from a well-known medical college in Australia who could not cope with the workload. It came to a stage where, during ward rounds, the consultant would prefer to ask the nurse about the patients' progress because the consultant did not trust the doctor's judgement.

On the second day after reporting for duty, a colleague took me aside. She was my senior in that department and had graduated from a recognised medical college in India.

She told me that she was assigned to teach me how to do an insertion into a central venous line.

She mentioned that she had performed many such procedures during her college days as well as during her posting at the department.

But I found that she was not doing it right. She, however, insisted that her method was correct.

In the end, the patient ended up with no central venous line but surgical emphysema and bilateral pneumothorax. The medical officer had to intervene and the patient had to have bilateral chest tubes inserted.

What I'm trying to say is that we should not prejudge our medical graduates based on where they graduated from. As graduates, they would have attained similar basic knowledge where medicine is concerned. What is lacking in some of them are the skills they should have acquired during their housemanship.

To those who have graduated from so-called low-ranking medical colleges, please do not feel disheartened. I challenge you to prove the critics wrong.

With the right attitude, dedication, commitment, accountability and passion to learn, you are not far from the quest to become a good doctor.

To the rest of you who have graduated from recognised medical colleges, discard the arrogance and be humble because without the right attitude, dedication, commitment, accountability and passion to learn, you are nowhere near to being a good doctor.


AHP:  Siapa pun kita dan walau apa pun yang kita lakukan, mari kita lakukan yang terbaik dengan penuh keikhlasan. Insya-Allah ianya akan melahirkan impak positif dan berkekalan.