Medical degrees are still very popular and a doctor’s job is still the ambition of many a young starry-eyed student. In reality, the cost of a medical degree is now quite enormous, especially in private medical schools, ranging from a few hundred thousand ringgit upward to perhaps about a million ringgit in some overseas medical schools. There is also a strong possibility that there will be a surplus of doctors in Malaysia in the coming years, so housemanship posts will be a problem. There is yet to be a “freeze” in the setting up of private medical schools in Malaysia and this oversupply problem will not go away so soon.
So how good an investment is, spending say RM500,000 on a medical degree? Envisage a scenario where doctors are employed on a salary scale lower than other professionals (e.g. architects, engineers) and tied down to a long compulsory government service. This investor writes that perhaps it is a bad investment and it may be a Time to “short” Doctor Bhd

With an impending oversupply of doctors and a slower growth in demand, the natural market reaction would be for the prices to fall. If this happened, in the extreme scenario, our doctors may share their fate with doctors in China in which their average income would be lower than other professionals like engineers etc. In China, the low pay is not due to oversupply but due to the fact that all doctors works for the government sector as healthcare is monopolized by the government. If the income for doctors really decline that much, I doubt many parents would sent their kids to medical school. However, I don’t think that will happen, doctors would probably band together and set up standardize rate to artificially inflate prices and maintain a decent amount of margins. This is bad for the consumer but may be a healthy thing in the long run if you do not want another situation of doctor shortage because of the low profit margins. This is important because our relatively young population would have aged by then.
Recommendation? Short Doctors and Medical Degrees.

Bottom-line: Don’t do medicine for the money. The financial returns are poor. Do medicine only if you feel it is your calling and you genuinely want to help others.

Related posts:
A doctor too many
Mushrooming medical schools pose concern
Doctors make far less money than most people think

The MMR wishes all readers a Happy Merdeka!
I’d like to point out this great post by Dr. Alex Tang on Andrew’s Letter to his Son about Merdeka

As I watched you and your classmates today, and the kids from all the other kindergartens walk up on stage to receive their certificates, I was reminded that this country of ours, Malaysia, is as much yours as it is mine. God has allowed me and all the other adults in this country a time to take care of it for you. But the day will come when we will have to turn it over to you and your friends.
I hope we won’t have messed up. I pray that we will have the strength and the courage to do the right things, so that we will be able to pass on to you, son, and those of your generation, a country that is successful. Not just rich in the things that we have — the tall buildings, the big houses, the fancy shops. But rich also in our hearts. To share love with one and all, to be kind and decent to others, to be fair and just to everyone, to let anyone who wants to come and live here and do an honest day’s work the right to call this country home.

We share Andrew’s prayer. God bless Malaysia.

Death is a process, not an instantaneous event for many. Indeed for some it can be a long goodbye for friends and loved ones. How do we fare as a nation, caring for the dying?
The way a nation cares for its weakest and most vulnerable is the mark of its soul. How it cares for the dying is a measure of the society’s advancement and enlightenment.
~ Lee Poh Wah, CEO, Lien Foundation

Sian sent in this link to Life Before Death which can be played via a Flash compatible browser. This is a summary of the The Quality of Death report from the Economist Intelligence Unit commissioned by the Lien Foundation, a Singaporean philanthropic organisation. Ranking end-of-life care across the world, the report shows that the UK leads the world in quality of death, in view of its excellent hospice care network and statutory involvement in end-of-life care. Malaysia stands at 33/40 in overall ranking in the Quality of Death Index, which contains four categories: Basic End-of-Life Healthcare Environment; Availability of End-of-Life Care; Cost of End-of-Life Care; and Quality of End-of-Life Care. So it seems we have a long long way to go when it comes to caring for our dying. We have a Hospis “Malaysia” which is so resource strapped it can’t even serve all of the Klang Valley, let alone Malaysia. I suppose we are too busy fighting over sand and water, who pays who in corruption scandals, to worry about the soul of the nation?

In the Nutgraph today : Private healthcare: Too expensive?

Universiti Malaya political economist Associate Professor Dr Terence Gomez says declining standards in government sectors have led the middle class to look for ways to bypass the public system.
“The promotion of medical insurance has led to private healthcare being more affordable for the middle class,” he tells The Nut Graph in a phone interview. Rising private healthcare costs, however, have led to higher insurance premiums, coupled with lower coverage.
Gomez says escalating private healthcare costs is therefore a political issue as well as an economic one. “The government faces a potential backlash from the middle class who don’t want to pay huge insurance premiums and yet are not willing to return to the public health system,” he says.
“This is an issue of concern for the [Barisan Nasional] government, which is already facing declining middle-class support.”

It is interesting that there is little talk of capping hospital charges which are distinct from doctors’ professional fees. Will capping charges (as opposed to leaving it to market forces) in any case be counter-productive for all concerned? I doubt it will ever happen if you read between the lines.

To complicate matters further, Dr Quek says the government, in fact, owns some of the large corporations that have entered the private healthcare business. “Khazanah Nasional owns 60% of the Pantai-Gleneagles group, while KPJ is wholly owned by the Johor state government. Since they’ve entered the market, they’ve been aggressively pushing profit margins higher and higher,” he says.

It will be a never ending problem until there is a comprehensive National healthcare financing system, perhaps something like the Australian Medicare system. This will take a lot of effort and political will power. People’s health and indeed lives are at stake the longer politicians dilly dally on this extremely important matter.

Nice slide presentation by Dr. Chew. Best viewed Full screen size – just click on the Menu at the bottom left of the Slideshare window for this option.

So he was asked to demonstrate as ABG is needed for one patient.
He took the needle, inserted it to patient’s wrist at an obviously wrong site for radial artery, and obtained nothing but some air. (Specialist and MO frowned, thought he was going to withdraw and re-attempt).

Surprisingly, he pulled out the needle like ending a procedure, passing it to the nurse, “Go and analyze this in the ABG machine…”

Specialist stopped him, “What are you going to analyze there? It’s just air!”

And he said, “Ya, you asked me to take arterial blood GAS right? I got it!”

via Dr. Darren

There are now about 30 medical schools in this country. One wonders what the quality of the training is for some of them. While this incident has it’s funny side, it only goes to show how deficient in knowledge and understanding of basic medicine some of today’s HOs can be.

Now I thought this is a good idea – a bracelet which tells you when to re-apply your sunscreen by changing colour. Pretty useful in sunny Malaysia!
Read more in The Beading Gem

I want to give a shoutout for the Private Medical Practitioners Association of Selangor and KL who have been active in maintaining their website.
The recent change in secretarial duties has not impeded their posting updates. Kudos.

There’s an old joke which goes something like this:
Patient: Doctor, is it OK to have sex after my heart attack?
Doctor: It’s OK but no undue excitement, so only with the wife.

On a serious note, it is something which is probably under-discussed particularly in the Asian context where open talk about sex are relatively “taboo” and where both doctors and patients are rather reticent about discussing this issue.
Nevertheless, it is an important topic, particular for patients recovering from a heart attack, and it is timely that our cardiologist blogger has posted about Sex after a heart attack. HOTM’s wise words:

The lesson I learn is that sex is part of normal life and age is no barrier. Even following a heart attack, many still wish to have sex. However, because of lack of cardiac counselling, immediately follwoing the heart attack, many were cautious, did not know what to do, and so refrain from doing, just in case. After 1 year, the urge to have sex is strong and so they experiment and continue, and return to their normal habits.
For those who wish to know, it is OK to have sex following a heart attack, once your doctor allow you to return back to moderate activity. Basically, if you can climb 2 flights of stairs, sex should not be an issue. It may be wiser for the non-heart attack partner to take a more active role. It would be good to avoid viagra. These advice are eaier to give now that angioplasty has improved the outcomes following a heart attack, allowing aptients to return back to their normal life style faster, and that includes sex.
As for doctors, the take home message must be that we should spend more time counselling our patients following their heart attacks and that includes talking about their sex life.

Spotted in Vagus’ blog

• When oncall, eat when you can, sleep when you can. Never think it’s too early for bed, just because it’s 8 pm. You never know when that pager will go off, and if you’ll get to see the callroom again for the rest of the night
• You’re human. You’ll screw up (I still do). Learn from it. Forgive yourself for it
• If you have to, use the Hide-In-The-Bathroom-To-Cry trick. I’ve had to employ that several times in my internship. Remember, even the worst day ever will eventually end
• You’re going to be (almost) perpetually tired for the entire year. Life goes on outside the hospital, so have a balance. Have a social life, even if you don’t feel like it
• Never piss off the nurses. If you do you’ll never get a good night’s sleep. There is never an excuse to be rude or obnoxious
• Nurses may not have had the training you have, but they’ve had the experience. If they ask you to come to the floor because a patient doesn’t look well, come stat!
• The learning never stops. Having said that you’ll have way too many journals to read, and soon they’ll stack up and will only make you guilty. If you have a 3-month old medical journal you haven’t already read, you probably never will. Get rid of it. Pick and choose the type of journal and article you’ll read, get rid of the rest
• Lastly, never say no when a consultant offers free food or coffee (no, seriously)

Great tips, Vagus!

There’s a joke which goes like this.

Doctor to Patient: “I have good news and bad news for you. First the bad news. You have a rare, incurable and fatal disease. The good news? It’ll be named after you.”

Eponyms are widely used in medicine. They are so many and varied it can be hard to recall all of them. Some indeed are pretty obscure! Those of use who use PDAs would have heard of Dr. Andrew Yee’s Eponyms programme which helps you look up medical eponyms. There’s also a website whonamedit if you want to look them up on your browser.
Anyway I am reminded about this because of a recent CNN article The men behind famous diseases.

Are there any Malaysian named medical eponyms? None that I can recall, unfortunately. In whonamedit though, in the country listing, there’s mention of Prof TJ Danaraj in honour of his work in Takayasu arteritis.

Related post:
Blogrolled: We stand on the shoulders of giants

It’s BFM Radio’s Health awareness week and yours truly just got interviewed on the use of the Internet for diagnoses and health information. The interview was conducted over Skype and will be broadcast at noon today. The podcast should be out in a day or two. Check it out – BFM radio on 89.9