Doctors in Malaysia: Direct Selling Doctor?

I will continue with another topic for my series of post regarding medical doctor in Malaysia. Please go through my previous post on this series:

The purpose of my writing on this series are due to my urge to inform to those who want to become a doctor and for those who do not, to understand on how a life a doctor really is. There are thousand of article, blog post, even books out there showing the painful life of a doctor, how noble the job is, everything seems to be talking on one side of the fence. I want to talk on both side of the territory. The ugly side, and also the pretty side of medicine. A soldier won't admit their work just doing nothing waiting for enemy to attack. A teacher won't admit that their job is less stressful than those soldier. Same for doctor, always picturing themselves as the only person lifting the whole world. I want to talk on what really is medical life. Using example for soldier and teacher, I would say that a soldier won't admit his work is less stressful, teacher also won't admit that, even doctors won't admit. 

If a person who work under the hot sun, lifting load of concrete and iron, compare to those three people, they should be thankful for their job. 

This is my intention. I want people to understand that life as a doctor is a bless, same for soldier and teacher or whatever you do. Everything have their pros and cons. We should not be always bias towards each other. Everyone need everyone as a unit to keep this country running. With that, I should salute all those who are working today, no matter what you do. Without further ado, I would like to talk on the ugly side of the doctor... when doctor is doing business. 

Patient is customer - Customer means money. Here comes the money

(That was an awkward title..I may need to change it later)

So, as all those house officer now fully trained, confident, full with skills and knowledge, they will received a certificate of full registration. Now, they can do whatever they want. Basically, they are now can work anywhere they want. Does not matter it is a government hospital, private hospital, private clinic, company, or they can just sit at home doing nothing. Just to make sure that they are not bonded with JPA or government scholarship. Perhaps I will talk more on that bond later in the future. 

So most of the doctors will continue working in government. The pay was enough, not much, but enough. They have their own house officer to help them now. Nurses have more respect towards them, specialist now feel more like a friend compare to before, life is good. So they stay. Some of them (however now seems that more doctor are choosing this pathway) left government and start working in private sector. Life there is much better, less patient so they can practice medicine with more passion, the pay is superb, and everything else was the same as in the government hospital. One cannot denied that the pay is the major factor to be involved in private sector. Another group will join private clinic as a general practitioner. The pay is higher, and they now can just run a clinic treating common cold, simple cases, and chronic cases which are stable, the rest of cases will be referred to hospital. Life is good here, and this group of doctor engage more to society compare to those in Hospital. 

Another atypical place to work is a company. A lot of company are hiring medical officer to look after sick worker in their facilities. Pay is good but this company usually want some credential along with that doctor they are hiring. You need to have some speciality, an extra credit in your CV before you can join a company. I heard that an oil company (I do not want to mention which one), are hiring medical officer with just ALS certified (Advance life support). That ALS can be obtain in a 3-4 days (if not one week) course then you got your job there. No need to become specialist. But some company like to hire a doctor with specialty, for example Occupational Health Specialist. My friend keep trying to pass this entrance exam to enter Master Program in Occupational Health (OSHA they call it). He never pass. It was difficult compare to ALS. Anyone want to work in private and thinking of a specialty, OSHA could be a good choice. 

More atypical doctor will join Aesthetic.. a beauty clinic they say. This is an 'easy' way to become some kind of expert. You need to enter a short program, or diploma, or master program (I doubt people will take it), and become a aesthetition. I do not know how to pronounce or spell that. Let just call it aesthetic doctor. A lot of people confused on this kind of doctor. Are they specialist? Are they dermatologist? Are they plastic surgeon? I also sometime confused. But my question would be where do they get their certification? Do not get me wrong, Aesthetic doctor is a real doctor, they are medical officer who took some courses and work as an aesthetic doctor. They are not dermatologist. They are not plastic surgeon. They are just medical officer who are interested on that field. It is an area of interest. 

Aesthetic is a part of dermatologist master program. So a dermatologist, can be an aesthetic doctor by default. Their counterpart is plastic surgeon which are doctors who take master in surgery and specialise in plastic surgery. To become dermatologist and plastic surgeon, is hard way to do it. Becoming an aesthetic is much easier. I am very sorry to say, but I don't think aesthetic is real expertise. Some of my friend who are doing aesthetic now would be so mad and angry, they would challenge me to become aesthetic to try how hard their life is.... As I mentioned in my introduction, no one going to admit their job is the least to be having a headache and no one going to admit they defeat. It's a natural human reaction. 

Put that aside, for me medicine is a about treating diseases. I took pathology because I love medicine. I want to study on the disease. I want to help clinician to make a correct diagnosis thus supplying a correct medication. This is real medicine for me. As medicine developed, we start to think that maybe prevention is the best cure. So, with that another branch of medicine developed. A public health medicine, community medicine, family medicine... this group of medicine focus on targeting healthy individuals to prevent them from falling sick. Pathology do have a role here as we understand that diseases does not happen in one day, so we need to tackle it before it become a diseases. This is a beautiful way of medicine. 

Aesthetic by the way, is doing something out of this. They are in the line in between prevention, treating, and I do not know what. I am not saying they are fake doctor, they are real one. But their patient will be consist of those who are pretty who want to be prettier, or those who want to grow hair, and those who want to shape their stomach by not doing exercise, or those who want to make their skin more fair...and it goes on. It give me a headache. This is not a real disease. There are no pathology on that. Some of you will argue saying that hair loss is a disease and we all should focus our energy to solve them. I would say, those the hair loss have the potential to turn into a cancer? Or is it a predisposing factor for hypertension? It may be a sign of diseases, and if it is, then you will refer them to rheumatologist, dermatologist, immunologist... the real doctor. 

So sorry guys, I still not believing aesthetic until maybe one day later, when you step out from that grey line. 

So what is the deal on becoming aesthetic? Why lot and lot of doctors want to be come aesthetic. Read the topic above.... here comes the money. There are now aesthetic department in a government hospital, if there is one, usually it will be under dermatology. Aesthetic will always ask payment from their customer. The treatment won't be subsidised by government, I too will not subsidised them if I am the government. Those customer they treat are those who have nothing better to do with their money. They should be called only as customer, not patient. Do not get me wrong here, I don't blame people who go to spa and medispa and whatever you call it to become thin, beautiful or white, it's their choices. But I do think that a doctor is actually not necessary to be there too. Give that place to a beautician, does not make any different. Doctors is infiltrating anywhere like leeches, to suck money from everywhere they could.. 

I am too harsh here. It could lead to misunderstanding. Let me get this straight, I am partly wrong in my last statement, doctor is needed there. Why? Because only this people has the licensed to give certain type of medication and procedure. To make sure it is safe. That's their job. Anyway, they can become a business person to, selling product to their customer. It's a double edge sword and I do not like it. 

Worse than that is when a doctor still working in a REAL MEDICINE field but start selling products. 

Let me quote:

"The practitioner is the trustee for the patient and accordingly must avoid any situation in which there is a conflict of interest with the patient." 

A general ethical principle is that a practitioner should not associate himself with commerce in such a way as to let it influence, or appear to influence, his attitude towards the treatment of his patients.

 The association of a practitioner with any commercial enterprise engaged in the manufacture or sale of any substance which is claimed to be of value in the prevention or treatment of disease but is unproven or of an undisclosed nature or composition will be considered as infamous conduct in a professional respect.

A practitioner has a duty to declare an interest before participating in discussion which could lead to the purchase by a public authority of goods or services in which he, or a member of his immediate family, has a direct or indirect pecuniary interest. Non-disclosure of such information may, under certain circumstances, amount to infamous conduct in a professional respect.

Where the practitioner has a financial interest in any facility to which he refers patients for diagnostics tests, for procedures or for inpatient care, it is ethically necessary for him to disclose his interest in the institution to the patient." 
                             - 3.4: The practitioner and Commercial Undertakings. Taken from Malaysian Medical council Code of Professional Conduct

End quote. 

Lawyer know this. Doctor

I do not need to elaborate more here. As stated in that code of conduct, any doctor who sell stuff that claimed to be in the value of prevention of treatment of disease but is unproven or of an undisclosed nature or composition will be considered as infamous conduct in a professional respect... I am just repeating what it ways. Doctor's cannot sell product that can cause conflict of interest. 

To make it easy, I will choose a chef for an example of this situation. A chef, highly regarded for his master skill and cuisine, work in a top restaurant. His dishes were all good. You can't deny it. You go and ask him why is that his dishes were so good. He then will say, because he is using a good ingredients and he is cooking it with the amount of spices until its perfect. You were amazed. You went home and try what he told you, it turn out that he is right. That is his secret. 

Another satisfied customer came and ask the same question, but then now the chef said, its because I am using this $100 pan. The customer bought that pan from him, went home and use a good ingredients and spices to cook and it turn out the chef was right. 

And another customer came asking the same question. The chef became greedy and sell another $100 pan. The customer went home and cook with cheap ingredients and wrong spices. It turn out bad. The customer said the chef is lying. He went back to the chef asking for refund, the chef said that the second customer testimony saying that he was right. The third customer must be wrong. He did not get his refund. 

Now, is that chef a good person or not? Do not say he is a good businessman, or he still a good chef. I want you give me honest opinion, is he is a trustworthy? Certainly not. 

Same as doctor, who sold all this kind of product. You take his or her words thinking that this doctor must be real because he is a doctor (like the chef working in top restaurant and the food is good). This doctor must not be wrong, if not he must be in jailed. You will take this doctor word as it is. You are wrong, this doctor is business person first and not doctor first. It is very unfair for patient. 

I have met a lot of this type of doctor. I always call them "apostatic" doctor. Medicine is kind of religion for me. So those who did not follow the real medicine would be apostate. Some of them who I met selling Vitamin C injection. Rm100+ for one injection. As you all know, Vitamin C will be excreted into your urine no matter how much you take it. It's a micronutrient. Eating one lemon perweek will prevent you from vitamin C deficiency. Why in heaven you need to take thousand upon thousand of miligrams into your body? Thinking that it will prevent viral infection - a theory not proven. Thinking that it will cause your skin to be beautiful - it may but you need a microgram dose a day for that and it does not directly connected to beautiful skin. have you ever heard of people with vitamin deficiency in our country? Unless they have a syndrome..or diseases, or vegetarian (in case of vitamin B12). Some doctor I met selling virgin coconut oil. Telling that this oil is good in preventing 101 diseases. Common, coconut oil? Its a good food sources but do you need to sell that in your clinic? Was it supposed to be in supermarket or grocery store? 

See, if that oil sell in grocery store, with that kind of price (expensive), people won't buy it. If you put it inside your clinic, along with all those antihypertensive medication, diabetic medication, antibiotic, and other real medication, then there will be something going on there. People will believe this coconut oil will have the same effect like those antihypertensive medication and so on... They will buy it. They will be cheated. The doctors will smile and - here comes the money...

I do not say doctor cannot become a businessman. Well, many doctor successfully do so. They can. Unfortunately, they have to choose. Like the aesthetic doctor I mentioned before, they have to choose which pathway they want to take. Why I respect my aesthetic doctor friends is because they did not shy and they are proudly claimed themselves aesthetic doctor. They choose to do that and they are targeting customer based on their area of interest. Although, most of the aesthetic doctor is the one selling product like this. sigh. 

The worst is those who still work in real medicine but sell product like they are some kind of aesthetic doctor or something (oops, sorry). As I said, they have to choose. The recommendation for a doctor that want to sell health related product it to quit their practice and start focusing in their product. They can use their title-whatever- as long as they did not practice clinical medicine anymore. It's very confusing when a robber also work as police officer at the same time right? Thus choose one. 

Some people will start attacking me for saying this. They will say that we all will grow old and broke if we did not start doing some kind of business nowadays. Well, you have to understand here, I am saying about those who sell health related products. Those doctor who sell headscarf, cake, nasi lemak, gold, stock market, cars, houses, and any other thing, they are not doing anything wrong. They can do that. What they should not sell is those coconut oil, vitamin c, supplements... because all of this are conflicting with their current job. I mean they have to treat, yet they want to prevent by selling stuff. Why don't give that stuff for free if it really preventing diseases? They must answer, because they will not have any income from that then. Now you realise, those doctor selling product put money first, patient later. No matter how they say it, their interest is conflicting. 

So, everytime you went to see a doctor and he start promoting you product.. quote those code of conduct I just shared above. You might give that doctor a chill a bit. ;)

Don't sue them by the way, yes you can do that. Just tell them the truth if you really love that doctor or maybe you a good person. You can report them to MMC and they license will be taken and maybe they will become a full time salesman or salesgirl. 

I would really like to remind all my doctors friends on this law...but, they hate me for that. It does not matter how much people hate it, its the truth. 

Truth is like poetry, and most people hate poetry. 
                    (From the movie :The Big Short [2015])


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