Big mistake (syndrome) = small mistake (cause) + small mistake (risk factor) + small mistake (symptom)
Mistake can be divided into reversible and irreversible

1st Small mistake = JPA choose the wrong guy to study medicine (irreversible cause)
2nd Small mistake = Study environment and wrong doctor’s perception (reversible risk factor)
3rd Small mistake = Writer’s attitude of becoming a doctor (symptom that maybe reversible but can be irreversible as it is chronic)

We need to breakdown the problem and treat:

Solutions (treatment) are as follows:

1. To educate JPA people in choosing the right candidate (PRIMARY prevention – detect the cause, kill it before the epidemic start) from the beginning

2a. Can transfer him to India/Indonesia/Bangladesh/Egypt/3rd world country NOW and get the respective 3rd world university degree.
2b. Raised the penalty from 160K to 1000K

Since his intention is to get enough exposure – you got plenty chance to know the diseases. If he agree, JPA please transfer him and just recognize his degree :so no recognition issue – SECONDARY prevention (to treat before the ‘disease’ / complication affect him)

3. Send him back to Malaysia and ‘treat’ him first in Malaysia (TERTIARY PREVENTION – complication set in and need treatment)

I guess JPA is doing the tertiary prevention as well as secondary prevention (raising the penalty from 160k to 1000k).

Ha, we doctors treat our patient like that and we need to treat this ‘patient’ before the plaque swallow him.

Rationale : My 2 cents of feedback, I wish to correct your opinion that Malaysian do not think malaysian medicine is better and we are NOT solely implementing what is RESEARCHED and PIONEERED by others at the very first place. Please attend some of the Malaysian Cardiology Conference (or others) and listen to the country best brain of how they criticising the lastest research together with their experience. See how are they extracting the conspiracy behind each trail and how they prove the trial is bias. Please be informed that most trails are funded by drug company to advertise their expensive drugs. (example, the best 1st line drug to treat hypertension is diuretic instead of CCB, ACEI, ARB in term of cost and mortality)

You haven just ‘seen’ the condition of both countries. In fact your are not part of the either health systems yet. Everybody can give commend of what they think but when you are really practise as a doctor and bearing the responsibility as health personal, you perception will change.

I believe sending student to overseas is not a waste BUT I do believe that sending a student overseas that who is not coming back or if coming back only complete the compulsary service and leave to the private later is a ‘waste’ to the tax player money. How many of the JPA scholarship oversea students manage to complete the 10 years bond service with the government? I afraid I don’t have any in my mind at the moment.

Pls come back to work in Malaysia and give commend later. Are you planning to stay to complete 10 years bond? I afraid later the excuses are bad health system, how come other lazy one get promoted and I don’t, I have been placed to the place that I don’t want, a lot of on call, low salary and so on when you plan to leave later.

To commend Russia graduate as ‘incompetent’ is not solely from what we think. It is from what we see and how they all perform when they are doing attachment in Malaysia. We as senior doctor don’t see only the knowledge but importantly the way and idea of how to look for the important patient history, come to the provisional diagnosis, ordering necessary tests and your approach later to solve the patient problem.

Knowledge you can learn from the books as we all don’t expect you know top to toe of each diseases. We senior doctor sometime have to read back our undergraduate book as well. So, the thinking and the approach of how you search and prioritise the patient problem when you see each patient is my utmost concern.

Sorry to say that the russia graduates that I seen so far is not up to the respective standard. They’re more concern of how to do T&S, dialysis and procedure but neglected the basic science and the correct approach to the disease. Skill can learn later but when you have wrong approach from the first place, it is very very hard for you to change later.

Adaptation from one health care system to the other health care system is no problem as if your approach is right in the first place. You can survive in both places. For example, russia student that I saw couldn’tt tolerate the synonym that used in Malaysia. Example CXR and chest x ray, AXR and abdominal x ray, Rx and treatment, Ix and investigation. I don’t know why they are so insist of using the full sentence. It is just a media for us to communicate with our college. What we concern is your approach, approach and approach.

Don’t expect to change the recent health system overnight as I believe that our DG and superior are doing hard work in changing it. You just can’t expect that you only come back when everything is ready for you. You have to sail through the hard time of how the system change and witness it.

Rationale : I do undertand you unsatisfaction for the commend form the so called ‘superior’ regarding the feedback especially Russian graduate. I can feel your anger in your feedback. However I wish to tell you that the only way you can turn the situation is to show your future superior and senior doctor how reliable and capable you are. Me too have undergone the situation maybe a little similar with your situation.

During my housemanship, I have to undergone my hard time too as my worst time was needed to work for continuous 48 hours without sleep and on top of that have to remember all the 40 patients history, presentation, provisional diagnosis, lab investigation as the next plan for each patient. You need to present to the specialist all the above information 5 times a day WITHOUT looking into the files. Which patient discharge today, which one is new patient? Sounds impossible but it can be done.

“When we do electives in Malaysia we are shocked by how Malaysian doctors write diagnosis, without full information of stages, classification and complication. It’s like you need to search through the whole thick case report and while trying , to read the illegitimate handwriting, work out painfully what is exactly wrong with the patient.” – I agreed with you, but take into consideration that you are looking a note that is from a working doctor, he is not suppose to write every patient case like ‘text book’ format and you student just read and learn. It like what I mentioned to you the approach, if you know what you want, you extract the important information from the 2 inches thick note, NOT to read and copy everything from it, otherwise you have endless job to do.

Doctor try to discharge patient before weekend. I guess the situation is same as Malaysia as well. The reason behind is the hospital need more beds to accomodate weekend patient. Beside working as medical student, have you ever considered the work and stress of the staff nurse and others like doing all the dirty work (changing diaper, washing dirty patient & facing with difficult patient etc).

Russian doctor earning less than bus driver? Compare to my time, my oncall earning only earn RM25/call (till 2004 I suppose)- it was even lesser than those who working in McDonald and labour. I did’t even mentioned it to anyone (since you brought it up). My worst time was 14 calls in a month and only earn RM350 extra in a month. Houseman now is earning RM150/call. You can’t compare it with other profession. You are not going to work in Russia later.

Put away all your unsatisfaction and frustration. Concentrate of what you suppose to learn now. What I advise you further is the 2 year housemanship is utmost important to all the houseman. This are the time that your future characteristic as doctor are formed. If you ‘curi ayam’ and lazy in the training. You might able to pass the posting, but later when you go to the rural area or working alone later, if you know nothing or a little thing only, the loser still the patient. So be prepare to undergo the hell like training and ‘torture’ by the system. If you can sail through it, you’ll be very much satisfy later.

I don’t care where are you coming from (UKM, UM or from well known uni), but if your attitude is wrong, then sorry to say that, I’m worry for the patient treat by you. Better go sell drug.

Lastly, you earn the respect from the people for what you did. I really wish you can prove that I’m wrong and I’m looking toward it. I can see that people always complained about Malaysia Health System. But can you find any place in the world that you only pay RM1 for the emergency doctor treatment (including CT scan, CXR and treatment), outpatient clinic and others. Malaysia situation now is 30% total doctors in Malaysia are working in government and they’re seeing 70% total patient in malaysia.

Do you know that some rich people use to come to government hospital paying RM5 and leave with expensive medicine costing >RM1000 even they are afford to pay it. Why some terminal / bad prognosis patient always ended up in government hospital after their money has been ‘squeezed’ totally by the private hospital? Do you still think government hospital is bad, I don’t think so. Why nobody see this??????

There are positive and negative aspect of each health system in view of different country politic influence and situation. So we shouldn’t apply other country health system to a country. Russia don’t have majority of Malay, Chinese and Indian people and Malaysia don’t have a lot of Russian people.

Wish you all the best.