Wednesday, February 11, 2015

The Rise of the Gen-Y Doctors: Stop Scaring Us Off!

Since I have been working in the hospital for the past one year, I can’t help to notice the burgeoning number of medical students exhibiting these non-purposeful movements inside the wards. There could be up to 50 medical students in the ward at one time, from various universities, private and public alike. While to some of my colleagues, these students are a nuisance and just slow down our work, I actually don’t mind having them around, because not too long ago I was like them too. I understand how it feels to be there to get your cases for teachings, to fill in log-books, to be eager to learn or do something, do some real doctoring. But I can’t help to think “wow, all these people will become doctors? There are 2 to 3-fold more of them in the ward compared to patients!”The glut of new medical school graduates is obviously not breaking news. I brought up this issue back when I was the President of the MMA Medical Student Society in 2011. Although I am still worried about the glut of new doctors coming in, I do not agree that scaring these doctors-to-be into quitting medicine and find something else to do is the way to go. I don’t think it helps those whose parents has invested a lot in sending their children to medical school, using all their savings, and having high hopes for their children to be the first doctor in the family.

We should stop scaring future doctors that there will be no more jobs for them in the future. If we limit ourselves to the thinking of medicine involves only being in the mainstream specialties like being a cardiologist, neurologist, surgeon, paediatrician and the likes, yes there will be not enough places for all of us. But the new generation of doctors must see medicine as a much wider field, much of it unexplored, and any of our innate talents can be incorporated to advance this discipline of saving lives. Let's face it. Everyone is a genius in their own fields of interest. Even though you are erupting enthusiastic about doing hard-core clinical medicine, there must be certain departments in the hospital that brings you down to the level that made you think twice about being a full-fledged doctor. Forcing someone to be an outstanding doctor in a department that he or she is not interested in is like forcing Stephen Hawking to paint and Picasso to explain about the beginnings of the universe.

We are aspiring to be a first-world country, but we are still having the third-world way of seeing things. We still look at the less-mainstream specialty as ‘second-class’: the pathologists, basic medical scientists, pharmacologists, haematologists, public health specialists, family medicine specialists, etc. When one of my friends aspires to become a haematologist, my colleagues automatically thought that he just wants to be lazy and sit around answering the phone from house officers who need MO code for their blood investigations. Truth is, haematology is a far more challenging field, and I had witnessed it myself when I met with Dr Noryati Abu Amin when I worked for the WHO. She is a dedicated and highly respected Malaysian haematologist that has served the World Health Organization HQ in Geneva for more than 10 years, creating guidelines and protocols for safe blood transfusion that is strictly followed around the world. She is currently the head of National Blood Bank Malaysia. You see, some good students with good memories are born to become protocol-memorizers. Some that are not that good memorizers but are greater on the innovation side are born to become protocol-developers.

In the first world countries, many ‘less-mainstream’ specialty doctors, the researchers especially, achieve great things in the field of medicine, winning the Nobel Prize in Medicine. In some first world countries, you need to have a degree in something else before you can enroll into a medical school. They are very supportive of inter-disciplinary application of knowledge. Every medical student knows David Netter. He took a degree in arts before doing medicine. As a result, he incorporated art into anatomy, and hence produced one of the main references for anatomy that all medical students around the world use. In Malaysia, when you are interested in something different from the mainstream, people label you as ‘not a real doctor’. When one of my MO was transferred department to join the CRC (Clinical Research Centre), the other specialist and MOs looked to him as ‘too weak for the department’, ‘not doing a true doctor’s job’, because he is more interested in doing research. For me, medicine has to incorporate 2 main values: service and academic. Service is important, but if everyone’s doing service, who is going to develop medicine further? As we move on to become a developed nation, our health care must evolve to become that of a developed country, where research comes hand in hand with service. Maybe we need more doctors to study Tropical Medicine and learn ways to stop the epidemic of dengue instead of adding more beds to the hospital, maybe we need more doctors to research the antimicrobial resistance in the hospitals, maybe we need another doctor to even take up politics and revive the old days where Malaysia moves forward at a fast rate, lead by a medical doctor. Smart people are smart enough not to do medicine if we scare them off. If we keep scaring them off, the only ones left to do medicine are the dumb ones who don’t care about their future.

When we see the medical field as a vast, largely unexplored area of knowledge, we will see its job opportunities in abundance. So medical students, or all those aspiring to be doctors, come, come from where ever you are. No matter where you graduate from: Indonesia, India, Czech, Russia, everyone has their own talent that can be incorporated into the field of medicine. Only if we open our minds and see medicine as a wider field. We are the Generation-Y doctors. Maybe a Nobel Prize is within the reach of our generation. In the words of the Irish singer Damien Rice in his song ‘Trusty and True’:

“Come, let yourself be wrongCome, it's already begunCome, come aloneCome with fear, come with loveCome however you areJust come, come aloneCome with friends, come with foesCome however you areJust come, come aloneCome with me, then let goCome however you areJust come, come aloneCome so carefully closedCome however you areJust come…”

Sunday, February 1, 2015

Another Year

Scrolling through photos of Malaysian delegates at this year's WHO Executive Board Meeting, I only realized it has been a year since I was there. Time flies, life has been so much busier, life in the hospital is so much different. But I guess Allah has the best laid plans, everything has a reason. 

One instance is that I was involved in helping to draft a framework for WHO's Roll-back Malaria program in Geneva. I thought my ideas were good, but now I am back in my own country seeing how Malaria really looks like, I had to think twice. It's funny that we prescribe mosquito nets, and the mother tells me the mosquitoes are INSIDE the net, nets are too old and torn, some are even not used and are modified to become fishing nets! (the family originated from Indonesia, and they were back in their hometown at that time).

In terms of my country's own public health threat, the past few months has been exhausting with the non-stop cases of dengue coming in. I did not work on something about dengue when I was in the WHO, and wished I had. The dengue epidemic in Malaysia has totally went out of hand, and it is frustrating to have the same child coming in with recurrent dengue, which he had a few years ago. I could get angry assuming that the parents did not do enough to protect the child, but on further questioning, the parents in fact had done their best to make their house aedes-free. But the problem is, what's the use if you are the only one working to eradicate aedes. The neighbours are still ignorant, the community does not care when a container with stagnant water is outside of their house compound. The community is still malaise about dengue when nobody in their family has died of dengue. They still wish for a miracle vaccine and the government to provide these to solve the problem. They haven't seen a mother crying in regret, asking for forgiveness in front of her daughter's dead body that has died of dengue.

I did not experience this before, and never had a burning desire to solve this at a global level. I guess it is really helpful to be in contact with patients, knowing how they live, eat, sleep, how their socio-economic conditions are. As the words that is stuck at my supervisor's door at the WHO HQ: "Is it sufficient to treat patients and send them back to the conditions that makes them sick in the first place?". That is the thing that kept me going, what gets me through the long hours, sleepless nights, and all the unnecessary yelling and scolding. Another year to go. I'll be back

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