I was on my way back from university, stuck in my car at a traffic light . I heard a loud ambulance siren from the back. As I glanced at my side mirrors, I could see cars next to mine parting to either side, trying to give way to the ambulance. That made me think: Were the cars, me included, moving away because of the siren that required them to do so by law, or were they moving away because of a true sense of concern about the emergency that might have required this ambulance’s service? This question highlighted a seemingly significant negative in society today: the lack of altruism.
What is altruism? Well to the layman, it would mean putting someone else’s benefit above yours. A simple example would be a gesture of giving your seat to an old lady on the bus when all the other seats are taken. There are obviously more elaborate interpretations of altruism, but for the sake of brevity this example shall suffice. Altruism is an important part of any society, and arguably more so in the case of healthcare practitioners. Doctors often need to sacrifice a lot in order to ensure the significant progress of each and every one of their patients. With that sacrifice comes tremendous stress and agony, which we future medical professionals should learn to handle.
In recent times, the level and standard of healthcare in Malaysia has dropped, and this is worsened by the increased influx of medical officers that has caused a ‘bottle neck’ in our healthcare system. Put simply, the number of specialists in each department is too small to sustain the number of graduating doctors/medical officers. Matters are made worse by the huge number of private institutions that offer medical courses for more better and affordable prices. Medicine has unfortunately become a business, and this jeopardizes almost everything a healthcare professional should stand for.
Principles that businesses adhere too do not run parallel with the healthcare ethics. Companies often compete with one another, to gain more profit and generate more wealth. This leads to them being more short-term minded, to gain large amounts of profit in short amounts of time. The pursuit of self-interest triumphs everything else. When the market values are applied to healthcare, patients are burdened to be at the receiving end of this spectrum. Furthermore, doctors are also victim to this system. Private hospitals offer more lucrative job opportunities than government facilities, causing large numbers of more senior specialist to shift to the private sector.
So the question is: why do these more lucrative jobs seem to attract better specialists? The answer is pretty obvious: the medical practice itself has become somewhat a competition. Good/skilled doctors fear the rise of other good doctors, and tend to hope for the downfall of their peers, hoping that they make mistakes so that there is less competition out there, not to mention having different approaches to treatment and not sharing those approaches with their peers in the fear of an increase in competition. Less qualified doctors are not looked as threats, and hence don’t fall under this category and end up working in government facilities. Private hospitals house more ‘credible’ doctors, and government hospitals are left with the “not-so-credible ones.” By credible, I obviously mean the more qualified ones; the ones who have worked longer years , gotten better educations, and the ones with better repertoire. Its not to say that there are not any ‘credible’ doctors in the government healthcare scene, it’s just that the numbers are scarce.
This business-motivated healthcare system is very well a part of Malaysia. The implications of this on patients are far greater than we could imagine, and they’re not changing things for the better either. Moderate to low class citizens will go to government facilities, where more often than not (unfortunately), mistakes and misdiagnoses are made. Patients get ill, damaged, scarred permanently, physically and emotionally.
The worst part is, those responsible are not held accountable, and can get off easily. Why? The legal process would be too much of a burden to handle for those patients. Medico-legal trials in Malaysia , can last for more than 6 months. During this period legal fees have to be covered by the complainants, and legal fees isn’t cheap. Not to mention the reward that courts do offer to those who do come up victorious in such trials are neither great nor sufficient to cover most legal fees. The cost of one blind eye is 60 thousand ringgit , and the value of a full blown court proceeding would probably exceed this. The next question would be, how is justice then served? The fact is, it’s not. Most doctors with powerful lawyers tend to win, albeit their reputations are affected in the process.
Upper class citizens and a minority of middle class citizens are also affected in the private sector. Doctors in private hospitals compete with one another and as mentioned above, there will be repercussions. Two doctors from the same sub-specialty can have two different approaches to the same treatment regime, eventually getting different results. Hence, doctors perform differently: one succeeding more than the other. Patients are left with different prognoses as a matter of circumstance. Matters are made worse when patients don’t know who the best specialists are to consult and to get the best form of treatment. Doctors also don’t share their new modifications and updates to specific practices or techniques so that they can get above others in the competitive market place of healthcare. Sadly, patients from every single income bracket are affected in one way or another.
Medicine is a beautiful science; but we as future medical practitioners should be aware of the flaws of the medical system that exists in Malaysia.
At this point, I should perhaps kindly tell the reader that this piece isn’t intended to drive anyone away from studying medicine. Medicine is a beautiful science; but we as future medical practitioners should be aware of the flaws of the medical system that exists in Malaysia. Often, this issue seems to be glossed over and there is not enough said about it. I can’t speak for medical practices overseas, as I’ve yet to have any experience with healthcare systems abroad. But for those who intend to practice here in Malaysia , these issues should surely not be ignored. Altruism and the business culture don’t go hand-in-hand. Maybe one day, when we grow up and become successful doctors and specialists, we could know better.
If anything, this is what I ask for: One fine day, when you receive your lucrative job offer from a private sector, perhaps due to your distinguished first-class honors degree and a place on the dean’s list, take a step back for a moment and consider that your personal career gain is part of a larger flawed system where the less fortunate are exploited and treated unfairly. That’s nothing personal against you, nor is there anything wrong with you gaining success in your career; you’ve probably worked your socks off and certainly deserve the best that you can get. But an awareness of the problems that we face might help change it for the better in the future.
Arjun Gopal a/l Subramaniam (ME114)