Sunday 19 April 2009

Why specialise

Before I begin, just want to say that the answer for my post last Friday “The fate of 4 slaves” is slave 1 & 3. The truth can be cruel. Why promote people whom willingly sell their soul for the company?

Whenever I talk to a doctor friend or meet a doctor on non-consultation occasion, I always ask them whether they are going to specialise. Some of them already are doing their Masters with cardiology topping the list. For some, they are still deciding on which “logy” to take. For the others, they have tried but couldn’t make it due to some unforeseen circumstances.

Generally, all doctors I’ve met told me they want to specialise… except for 1.

He is the brother of a friend of mine. When I asked my friend whether his brother will specialise, the answer was…

“No, he is not. He doesn’t want to be driven by money”.

He went to explain that his brother wants to help everyone as his brother is of the opinion that being a specialist will limit the scope of his patients. And of course, there is also the noble intention of not being money driven. What do you think of him?

There is no doubt that many perceived specialists as blood suckers. Most of you will know that I spent a lot of time in a few specialist clinics last year. Indeed, their charges are expensive. A 15 minutes conversation may cost you RM100 or more. But certainly, the level of service given to you is quite different.

There are quite a number of doctors who read AZAIG and I am sure they will agree with me when I say specialists will surely want to recuperate the money they spent for getting the qualification. But many will also agree that the line between recuperating money and “sucking blood” can be rather thin.

We are not here to judge, but I think it is important to examine what is the original reason for one to become a specialist.

“Oh man, when you go to SJMC… you see the specialists carpark, it’s filled with sports car and bimmer and all the cars you can dream of! I should have studied medicine!”

That was a comment made by a colleague of mine just last week. Now, if he was to be a doctor and then went on to become a specialist… surely, it is just money. But what about the rest?

If you are a doctor pursuing your masters, are you doing it so that you can really focus on helping specific patients?… or is the monetary reward sitting very significantly at the back of your head?

Jun, Xabi, doc… what say you?

1 year ago…
Songs re-engineered

2 years go… A trap on both sideAn accent mystery


day-dreamer said...

Hmm. But imagine the sweat, pain and tears down the road of medicine... BEFORE you get to be one. It's not easy and not everyone can make it. That's why they deserve the high pay?

Just my 2 cents...

gina said...

With all due respect, I think doctors spent their entire youth pursuing their studies and profession and they earn our utmost respect.

On the other hand, being greedy has clouded the profession when money comes first before life of others. It's sad to see people being turned away because they do not have insurance.

3POINT8 said...

I think most doctors are noble souls who wants to help humanity. Then as they go along with life, reality kicks in, and out of the sudden, the glamour of having heaps of money start to overwrite the initial reason to why they are into this profession.

littlepolaris said...

What I always wanted to do in my life is to be there for other people who needed a helping hand. I dunno why I chose medicine but perhaps because I think it's somewhat closer to my dream I guess not knowing dat the future path that I'm taking is very difficult especially in malaysia with the bias system.

I will definitely specialise in something of course. My first choice was to be a paediatrician. I love children and besides dat when I was young, the adults always bully me giving me a bad impression about most adults, so it gives me that kind of desire that I want grow up to be someone who have the capability to protect other children and make every child happy. Every child deserve to love and to be loved.

And then I had cancer. I saw something that usually the doctor tend to overlook. Most of the people in my uni, when mentioned about cancer they will only say negative things about it, to them all cancer patients will only end with death. No one ever thought of being an oncologist because the patients gonna die anyway so why waste time treating dying people? Or those who thought of being an oncologist... they say bcos cancer patients are rich, and since they will die anyway so let me earn their money first. But then I saw something different. I saw cancer patients craving for the support and encouragement to live on and they need a supportive and compassionate oncologist. One of the most wonderful thing that ever happened in my life is meeting my oncologist. Though people say SJMC doctors are blood suckers but my doctor is very nice. She changed my life.

Now I'm considering to take the path that no one take, to be an oncologist and overcome death with other cancer patients. But I'm not sure if I could make it there though bcos nothing is fair in our country including the chances to get into post-grad programme.

And another thing is, not all doctors are good and smart like most people thought. Nowadays the quality of a doctor is like... erhmm very disappointing. I can tell you this bcos I know what kind of students I'm studying with and right now there is this issue with local grad doctor hating russian grad doctor. So being a specialist somehow can prove to the other doctors that look down on us that we are really good doctors.

littlepolaris said...

Oh yea, and money factor is important to me too. Before going out to help other people, I have to help my own family and kids first. I have to make sure my kids at home are well fed and well educated. And there are a lot of people who couldn't afford to buy food, buy medicine out there. If I'm a little richer, I can do more things to help other people. I could buy medicine and give free treatment to poor families at rural area. Sometimes you can't say money is not important. People who say money is not important, they are either faking it or their family is very very rich that their father provide them everything that they never have to worry about money issue. But of course, as a doctor we should treat everyone equally, earn only what we suppose to earn and when needed, give as much as we could afford.

Purple~MushRooM said...

Yes, they are irresponsible blood suckers who are geared towards earning money and do not care whether you are dead or alive after the operation which they performed on you, the operation which you agreed to let them perform immediately after they say words that scare the hell out of you, like you will die and blood veins will burst if you do not operate immediately, stuffs like that! Blardy hell these suckers!!

Fi-sha said...

Dear Zewt

p.s. i knew it so well that Slave 1 and 3 will be promoted..seen that too often im going to puke now.. heheheh...

how timely you write about specialist. My uncle, a neurologist came over to my house yesterday. He became one because of his beloved mother, who was so much affected by migraine they (his brother and him) always got whacked when she got the attacks. He is one of the God's gift to mankinds who treats his patients with care, dignity and understanding like they are his family members.

Nowadays, MO wanted to specialise purely on money, rarely one does that for serving the mankinds. Thats so sad...whats the value of those sportcars and bimmers when you are not doing your responsibility?

Take care Zewt!

Xabi said...

think that there is no such thing as as non specialist in medicine anymore. even gps are specialists of family health. this hasnt happened yet in malaysia (as far as i know), but i think it's moving in that direction. other than the obvious, ie to help ppl, passion etc. another point usually overlooked is that when youre a specialist consultant, you have full responsibility of your patients. unfortunately (or fortunately depending how you look at it), practising medicine has it's foundations built on the hierachy system. from houseman, to medical officer, to registar, you have to take orders from your consultant. you dont have a sense of full responsibility for the patient at all. so by becoming a specialist consultant, you make the decisions of what you think is best for the patient based on your expertise.

and the high costs of specialist consultations are also in part due to defensive medicine. over ordering investigations in fear of missing a fatal diagnosis. no one is perfect, and i dont think any doctor would purposely want to miss a diagnosis. if it was so simple, a robot could do our jobs, but it's been said that that will never happen because of 2 factors, 1) false negatives, 2) false positives. nothing is so absolute.

in my specialty of emergency medicine, i do it because i love the job. i dont earn on the number of patients i see unlike most of the other specialists. but i dont know a single colleague who has taken up a particular specialist training for monetary gains. those that want to earn money, quit medicine. i cannot imagine doing a job that you hate just to earn a fat income, especially in medicine. dermatologists and opthalmos are stereotyped to be the biggest earners, but i cannot tahan to see skin or eyes every damn day. if you have no passion for the job, patients will suffer.

i dont deny that money is important, and i dont deny that medicine does pay fairly well. im thankful im earning a fair wage for doing something i like. =)

shit, this is getting way too long. had to get a few things off my chest. my 2 cents worth. haha! =)

mistipurple said...

there are noble GPs. i stay away from the blood suckers. they can be smelt a mile away.
er, ya, GPs are specialists in my opinion too. not all, but one has to walk a couple of miles to find a good one, and then, stay the mile with him.

Elizebeth D.L. said...

I can tell you, MOST doctors (at least from my eyes and heart, I can conclude this!) are just for money! So far, from last year experience, I can say that I have only felt 1 good heart doctor (when I say good heart, doesn't mean he give free treatment. sometimes you just have to have some sympathy on some patient who are dying, don't just give treat your patient like someone give prints you money only!) out of maybe 20-30!

I wish they can experience the difficulties of some sickness they diagnose EVERYDAY by themselves one day, then they know what it should take to be a real doctor. Those idiot bastard!

passing thru said...

Before bashing every doctor on earth stop and think a moment.

Who builts the hospital for patients to stay?
Who produces the bed for patients to sleep?
Who produces the medicines that patients take?
Who produces the equipments for operation?
Who produces your scan machines?

Is it the doctor?

Doctors are the least responsible for hospital charges and gets bashed the most just because they are at the frontline. Why nobody bashes the drug companies who sells drugs at exorbitant prices? Nobody bashes the developer who charges exorbitantly to build a hospital? Nobody bashes the company who sells scan machines at exorbitant prices?

These are the prices consumer ultimately pays.

GPs most of the time do not need these facilities and thus the charges are cheaper. When you need specialised treatments, you are paying for the above. I'm sure specialists' charges will be like a GP if you don't need any of the above too.

Ulquiorra said...

The oncology of the private hospital in melaka bluntly that my late brother should just get his leg amputated because this so called specialist thinks that my family could not afford alternative treatment. I will never forget the arrogant look on his face when he said that to my brother. So much for being a specialist.

weezer said...
This comment has been removed by the author.
Ulquiorra said...

the oncology of the private hospital in melaka bluntly told my late brother he should just get his leg amputated because this so called specialist thinks that my family could not afford alternative treatment. I will never forget the arrogant look on his face when he said that to my brother. So much for being a specialist.

Yvonne Foong said...

Hie Xewt

I am studying Psychology and not medicine., But after completing my bachelor's I would do my post graduate studies and specialize in a psychology specialty too. Because that is necessary and that's what society needs. Most students in my college don't intend to go on studying psychology. They are doing it now just to enhance their employment opportunities in the future.

In the U,S, every doctor has to specialize. Even Internists, doctors specializing in internal medicine. This is because students must first earn a bachelors degree in any liberal arts subject. After getting a four-year bachelor's degree, they go on to spend four years in medical school. Once they have gained their MD, they would specialize by doing another 2/3 years as a resident in hospitals and institutions to learn a specialty. If they want to learn another specialty, they can do so by taking up another residency program.

Students in America cannot jump right into medical school after completing high school. They need to have a first degree. This is how the system eliminates those who are less serious. Only those who truly want to become doctors will persevere and stay focused on their goals. So those who DO enter medical school have already come so far, there is little reason not to specialize.

But in countries with the MBBS system, doctors get in and out of medical school just like that.

zewt said...

day-dreamer - i appreciate the hard work... but the original intention?

gina - oh yeah, if patients are turned away becos of insurance, then it totally defeats the medical spirit. guess that's why they are called private hospital.

3POINT8 - that is true. however, doctors are also trained to see a patient as a case, not a person... that part is no good.

littlepolaris - closer to your dream... what is your dream? i agree on looking after family's welfare first. certainly, that's what our lives should be centred upon. you should become an oncologist. i believe you will be a good one after what you have gone through.

purple mushroom - hahahah... sounds like you had a very bad experience. well, certainly, there are a lot of bad fruits out there.

fi-sha - i have a colleague who has a cyst in his brain, perhaps i should ask him to see your uncle. seriously...

xabi - perhaps emergency medicine are where all the true docs are eh? :) like someone commented, i believe most docs started with a good heart and pure intention, but the way of the world just cloud their sight, just like any other profession. by the way, you dunno anyone who does things that they hate purely for living? go ask the accountants, i cannot believe people actually enjoy crunching numbers.

zewt said...

mistipurple - well, i personally know of 2 very good GPs who can make very good diagnosis. i guess it comes with experience. and they are generally very old already... the medical world will miss them.

elizebeth DL - to be fair to them, i think they became numb after a while. like how things happen in grey's anatomy... too close to the patients can be emotional draining for the doc.

passing thru - i agree. i know of someone who sells drugs and machine to hospitals, he said he is doing patients a favour... oh well.

Ulquiorra - sorry about your brother. yeah, those are the bad fruits out there. the arrogance, i really cannot stand them.

yvonne foong - well, things are even worse in our country isnt it? i have heard of cases where doctors cant even pronounce certain disease properly and in all honesty, dont exactly know what they are doing. we need the american system for this one.

Elizebeth D.L. said...

Zewt, if they can be so easily "emotional drained", then they are not a good doctor.

neno said...

money not easy to earn..even for specialist..

i rather face toilet bowls than some ppl..

but wat to do..

zewt said...

Elizebeth D.L - hmmm... u have a point there... sigh... hey, i actually wanna be a doc after watching patch adams.

neno - hahahaha... so that you can enter the gents right?

lynnx01 said...

I may be a little late to comment but anyway, I am a medical student. I agree that most people ask me what do I plan to specialise in. The general society looks down on normal doctors who do not specialise. I would sound like a not ambitious person if I tell people I do not mind not specialising. This is because, I find that being a GP is an entirely huge area that one can make a difference in. It is the first contact most patients get. GPs or family physicians are the ones who can make the early changes to prevent permanent damages and worse conditions. First contact care is very important too. We can send out a very important message to the general public. So, I really do not mind being a family physician. I may not have any superb title -ogist- to go by, but this is a little something I can contribute to the general public. Then again, there is such thing as family medicine specialist. Hehee.

neno said...

kekeke..this time not to go into gents..wakakaka..empty gents not much to see..

this time i rather clean toilet cos i rather see real shit than shitty ppl..

zewt said...

lynnx01 - sounds like being a family physician is the way to go if u really wanna help ppl then :)

neno - shitty ppl... bosses? hahahahahaha...

neno said...

wakakaka..worst..ppl who are not bosses but thinks tat they are..kekeke..not forgetting ppl on the other side of the counter..

doc said...

i specialised bcos, for me, it was the only way to go. shd i remain in govt service, the specilaist qualification would accord seniority in the dept, ie. less work, more pay & if i chose to go private, specialising is mandatory, as there are too many GPs already.

eventually, i went out to private practice bcos of the remuneration, pure & simple. but when i reach retirement in about ...hmm...15 years, i would like to go back to govt service on a contract basis. even now, sometimes i reminisce about how life would have been had i remained with the govt.

zewt said...

neno - yeah, one can never consider one as boss until he is the one paying salary.

doc - good to know doc. and i am glad you will be serving once again... i am sure it will be a fulfilling experience.

Sheena said...
This comment has been removed by the author.
Sheena said...

I resent the implied agenda on the part of the people you quoted that becoming a specialist is all about the money.

How about the other specialists who worked unbelievably hard to get where they were, and still remain in government service?
They're definitely not doing it for the money.

In fact, while I agree some rates charged by private specialists are astronomical, you get what you pay for.

They work in - surprise, surprise - a specialised branch of medicine, most of which would probably be incomprehensible to a non-specialist, even if he/she is a doctor, and - as much as I hate to sound patronising - probably incomprehensible to the general public, who haven't had to study the way specialists had to, or work the way specialists had to, or sacrifice as much as specialists had to, in terms of time, family-time, social-time, life, before they finally achieved their qualifications.

So, people, don't accuse all specialists of doing this for the money when you haven't had to do the same as they have. And you don't know the reasons why people do what they do.


Sorry, Zewt. A bit annoyed there - like you couldn't tell :) People who make generalised assumptions about things they don't know generally drive me up the wall.

Unknown said...

Btw, you do know I wasn't referring to you per se but the people you quoted, right?

And people who make assumptions in general.

OK, I'm sticking my foot in it. I stop now.

zewt said...

sheena - hahaha... got your point. i guess ppl jump into conclusion for a reason, bad experience perhaps. as for me, i just hope ppl who do specialise are clear of their intentions. dont do it purely for the money like my friend.