How to be A Doctor in Malaysia: Are you a real doctor?

When we talk about doctor, not many knew about how someone eventually can hold that title. For most people, to be a medical doctor, you need to enter medical school and miraculously be a doctor 5-6 years later.

I was called to write on the career pathway of a doctor. As any other professional career, I can assure you that it is not easy to be a doctor, a real doctor. You can be a bogus one but what's the point on that? This will be a multiple post entry, and for the first part of my story of a doctor's journey, I will call it: 

On The Beginning Of A Young Doctor

Everyone is correct, to be a doctor, the first step is to step into a medical school. To be accepted into a medical school, a person or a student must excel in his or her A-level exam, matriculation, or anything similar to that. In Malaysia, there are quite a lot of medical school however we need to understand that not all medical school were acknowledge or accredited to teach real medicine. Most public University in Malaysia are safe as all have gone through a strict quality assessment and accreditation process before they can produce a medical graduates. Some private college however, does not comply with the standard, thus choosing a medical school is an important step to do. One must not simply enter any medical school and be a doctor. 

I will not discussed on details on how a medical school being assessed in its quality, although all medical school that are acknowledge usually will have enough teacher, facilities, and a well structured programmed to learn medicine. 

Medical school usually offered 5 or 6 years program consist of theory and practical aspect of medicine. During this 5 years of study, student will be 'forced' to memorised all the anatomy of a human body (dissect a cadaver while doing that), understand the physiology of human body, the chemical aspect of of bodily function, pathology of disease and pharmacology. Practical aspect usually comes during third year and onwards and usually were called clinical years of study. During this three years of clinical years, student will be exposed to real patient in the ward, practice simple procedure and brush up their interviewing skills. From what I remember, medical school study is all about interviewing a patient to get the diagnosis and after that discussed on how to treat that diagnosis. 

This is why, medical student need to be in a hospital most of the time. I heard that some medical student graduated without going to the ward and meet up with patient, I do not know whether that can be counted as a medical graduates or not. During my years of study, my job everyday was to 'hunt' patient to get as many diagnosis as I can (not just for the case write up / case report that need to be sent). That's why some patient complain in social media that medical student irritate them and annoyed them. Some patient even refuse and rudely ask medical student to stay away from them. They did not understand that medical student is actually trying their best to learn from experience and if they look not that professional, yes, they are medical student for god sake! Professionalism does not happen at birth. It is acquired to knowledge and experience. 

Student also will be taught on soft skill, how to approach and talk nicely to patient, medical ethics, how to do a good clinical research, and even sent to district to study villagers aspect of health. I still remember my district posting where my group was chased by villagers' dogs as we enter the village. Some even suspect us on selling them some products so we were not welcome all the time. 

After an intensive 5 years of study, medical student need to undergo professional exams. This is the final exam to determine whether you are capable to be called a doctor or not. Professional exam will consist of theory paper on everything we have learn during that 5 years course, and clinical exam where each student will be given 1 patient to be interviewed and then the examiner will ask all sort of question regarding the diagnosis and how to treat them. There will also be a short case where each student need to examine around 10 patient (10 minutes for each patient) and come up with a diagnosis and treatment. As you can imagine, for long cases, plus short cases, there will be around 11 patient on that exams, and a student need to study 100 if not thousands diseases to prepare for that. The cases will be totally random, to be safe is to study the common one, but do not hope too much for a common cases. I get Friedreich's ataxia in one of my short cases, and my long case was Varicose Veins. I was memorizing all the hypertension, diabetes, heart disease, and all the disease in the wards, and one of them came out..varicose veins. 

After medical school, a medical graduates will receive the approval and a piece of paper called degree, and from that moment, he or she can called himself or herself a doctor. I will call them medical graduates as for now because to be a doctor is not merely to get that degree. That degree will not allowed a medical graduates to open up clinic or simply treat people. The degree is not the license to do what doctors do even though most our our lecturer said it is. It was not. 

House officer in the House

I will be honest here. After medical school, me myself felt that I am already a doctor. I can put that title in front of my name and I have a license to practice what I learn. Unfortunately, it does not goes like that. 

Medical graduates have to enter a 2 years program called housemenship. Officially and to make it sound less sexist, it was called House Officer Training Program. Some called it HO-ship. This program is the nightmare for every medical graduates. Half of medical graduates will be fallen during this 2 years period. I, myself feel like I will not be through during my HO-ship but I kept telling myself that I already spend 5 years in medical school, 2 more years would not be so bad. It was horrible. 

During this 2 years program, all this doctor or they call it trainee doctors, will be forced to apply whatever they learn during medical school to a real life saving situation. They will be pushed to the limit, and they will be stressed, they will be depressed. This was necessary to make sure that every young doctors can cope with that stress. There are no such thing as stress free environment when you are dealing with life and death decision. You are basically trying to fight the death angel, you are challenging the death sentences that are already given to a patient by God. You must be over the limit to do that. 

You will have only a few hours sleep every night for the next 2 years in the program and even if you have more than 3 hours of sleep, you will be haunted with a nightmare. You will dream of your patient, your job, your boss, and every other staff in the hospital. I may exaggerated a bit but this is what you will feel. 

Nobody respect a house officer, that is the reality. Life is a bit confusing during house officer training as all these doctors are still not yet a real doctors, thus everyone will try to step them on the head. Nurses, sisters, matrons, PPK, janitor, patients, medical officer, specialist, and so on will never respect this human being bearing the title of house officer. This is why many drop out and left this program to pursuit something else. Most of them could not cope with such life. 

Put the dark story aside, a house officer is not that inferior after all. Try removing this group of people from the hospital, all patients will be dead for sure. These house officer is trained for 5-6 years in medicine (in case you forgot, duh!). They can make life saving decision, and if they don't, they'll be screwed by everyone mentioned above. So, it was a mistake to label these young doctors as inexperienced, no brain, tidak pandai, stupid, or whatver. They have passed their professional exams so they are knowledgeable, more than any other person who never went to medical school. 

House officer, not just a tool to write (a writer) in a case note. They are not robot who are programmed to only do work without thinking. Most of patient and the public misunderstand the role of house officer. They are not simply following orders, they are actually capable of making a decision. Most of the cases that are admitted to hospital will be clerked or interviewed by this house officer, they make diagnosis, they plan the treatment, and they wait for the medical officer or specialist approval whether to proceed with that decision or not. In a life saving situation, house officer can even administered life saving drugs and medication without waiting for specialist or medical officer to come and give the order. 

For example,in a case of symptomatic hypoglycaemia, a house officer will not wait to call his or her boss to ask on what to do, they will immediately order intravenous dextrose and keep on monitoring blood sugar level even without the knowledge or their superior. Same goes during any other life saving procedure, where basic life support need to be started. 

House officer are not called house officer for fun, they were in house doctors who keep their eyes 24 hours inside the ward. They will be the first one to noticed if someone having problem in the ward. Its like having a maid taking care of your house, would you hire a maid that only do what you asked them to do? You will prefer a maid that know what need to be done without you around. 

House officer  will be rotated every 4 months. They will cover medicine, surgery, obstetric, gynaecology, paediatrics, emergency medicine, and orthopaedics. Some of them will go to anaesthetic medicine instead of emergency. Now I heard that there are a few additional rotation that they need to do such as psychiatric and district posting. Each rotation will have its own assessment and logbook to be completed. Logbook is necessary to make sure that all house officers completed all the procedure to make sure they have enough experience on doing that procedure. 

After a harsh 2 years of training, young doctors will be called senior house officer and eventually, if they passed their assessment and completed their log books, become a medical officer. 

Only those who are tough enough to went to through that 2 years period of intensive training, will be crowned as a medical officers. Those who did not complete 2 years house officer training, can be a bogus doctor, or claimed themselves as a doctors and sell health products using that name. 

I am very sorry to say that, as many of my friend also did not completed their house officer training, some be a good citizen, some become teacher, some become a good businessmen and businesswomen, and some using their name to sell health related products, but I have to give the honour to those who completed the program. They eventually become a real doctors after that. 

From that moment of finishing housemen-ship, a doctors can claimed proudly themselves as a doctor. A real one. Trust me, most of them will not announced themselves loudly as doctors in public. Not because of they ashamed, not because of they were humble, but because the experienced given during that 2 years of house officer training will make them realised how heavy the responsibility of becoming a doctors. Becoming a doctors is not just simply calling yourselves a doctors but the responsibility that are given to you. Life of someone you barely knew will be put upon your shoulder, and you are capable of 'creating' a life, reviving the death, or even kill someone. 

For me, all doctors that have that full registration as a medical officer are damaged. Somehow, you can see in their face, they have been through a painful pathway of life. Salute to them, they are the real doctors, they deserved to have that Dr title in front of their name.



This post will be continued on:

• Becoming A medical Officer in Malaysia: Are you still a real doctor?