JUST TO SHARE (Lau Tai Onn): Interesting Discussions on Medical Doctors’ Plight

The blogger’s note: Lately there are some amusing and informative ‘cross-fire’ email exchanges between the blogger’s two most-learned e-buddies, i.e. ‘the Great Sifu’ Dr. Lim Ju Boo and ‘the Chief High Priest of the Evolution Temple”’ Ir. Tan Seng Khoon (who are close and old-time friends to each other), on whether medical doctors are well paid or not, following a newspaper report of “Doctors hurting, want to charge patients 30% more in fees” published on August 18, 2013. The original report and the said emails are reproduced below for the reading pleasure of the readers of this blog.

The Report:

Doctors are being paid less than plumbers, electricians and hairstylists, are finding it hard to survive rising costs and want to see a 30% increase in consultation fees.

Their fees have remained unchanged for three decades, The Star quoted Malaysian Medical Association (MMA) president Datuk Dr N.K.S. Tharmaseelan as saying.

He said some doctors are barely making a living because of rising utility, rent and salary costs. Some have given up practising medicine altogether.

Presently, general practitioners charge between RM30 and RM50 per consultation while the rate for specialists is between RM50 and RM80.

Dr Tharmaseelan said it is a misconception that doctors are rich and greedy, and that it costs a general practitioner about RM20,000 a month to run a clinic in Kuala Lumpur.

"The 30% rise is necessary for doctors to cover their basic costs, especially in light of mandatory rulings such as paying the minimum wage," he was reported as saying by The Star.

"We are required by law to have medical indemnity insurance, hire radiographers and engage waste disposal contractors at our clinics."

Dr Tharmaseelan said the MMA submitted a new fee schedule to the Health Ministry two years ago but the proposal was rejected because the government felt it was too steep.

"The government's proposal last year to increase our fees by 14% was unacceptable as it would have resulted in a bleak future for our members," he added.

This was echoed by his MMA colleague and senior medical practitioner Dr Milton Lum who said a plumber charged between RM50 and RM100 just to check the pipes in his house.

"That is way more than what a general practitioner charges for a consultation," Dr Lum was quoted as saying by The Star.

"Although medical bills can be astronomical, but doctors only receive a fraction of the sum as the majority goes to the hospital and managed healthcare organisations."

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On Mon, Aug 19, 2013 at 9:32 AM, Tan Seng KhOOn wrote:

Ju Boo,

Are you also in this group of doctors asking for increase in consultation fees?

I feel it is very bad.

Because you give FREE consultation fees to VIP, but now you want to squeeze from the Hoi polloi.

If you don’t know what this expression means, just click for the definition.

It means the common people.

The masses.

Like CHM, Perry, Baron, Lau and me.

We are the common, trodden, god-forsaken creatures in this miserable planet.

Rgds

khoon

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From: lim juboo

Sent: Monday, August 19, 2013 8:04 PM

Dear Learned Professor Khoon,

Just to inform you doctors are not well off either. A lot of people think that doctors, especially those in private practice are very rich. This is not true at all. Many of them are struggling to float. A number of my own colleagues who were then in the Government Service left before retirement to go into private practice thinking they could earn more. But years later when I met them, they regretted their decision. Doctors in government service during my time were notoriously very low paid with long hours, too many patients, on-call all the time, and get bullied by consultants and senior doctors.

So many of them left the government to go into private practice only to find the opposite – too little patients, cannot charge too much, else the patients will go away to the next clinic, must please the patients according to what they want (examples: the type of medication, the dosage, the type of tests they demand, or don’t want, must give them MC for how many days, must give them kickbacks if they recommend their friends and relatives to them, etc, etc).

Besides, they also start arguing with the doctor by bringing in information from the Internet and telling the doctor why the Internet tell them something else, or if they don’t get the type of medication they demand, they will go off and get them from the pharmacy. These are some of the problems some of my doctor friends and former colleagues told me.

But if they remain with the government, they have better control of the patients, but they must be satisfied with the long, long hours, and very low pay. It is either “the devil or the deep blue sea” Don’t think the job is glamorous either.

Doctors get stressed out especially with ungrateful patients (most of them are) who abuse and get angry with them instead because of the long wait at government hospitals. The doctor gets angry himself as he too has no time or the mood to smile at you. They just have time for 5 – 10 minutes for each patient in an overcrowded OPD (outpatient dept), and long, long next appointment after that for just the same old medication month after month till you are dead. Both the patients and the doctors are angry with each other. None are grateful to the other.

But if they leave the government and go on their own, it is the opposite. They look for patients, and must please them instead. They even give out calling cards to seek “business recommendations” or “by word-of-mouth” to spread the word round, especially from their patients and relatives in order to survive. I also know of doctors who have left their own private practice, or resigned from the government and gone into other business. Some don’t even want to go through the torture of being a houseman or a junior doctor right from the very beginning immediately after graduation.

My wife has met the parents of 4 of them who gave back their certificates to their parents immediately after graduations because their parents wanted them to become doctors. They went to find another job instead.

There was also another Malay lady who got a scholarship from the government to study medicine somewhere in Egypt or Ireland? This doctor lives in the same garden as us. She always “ponteng” going to work. Her mother told my wife that her daughter did not feel like going to the hospital to work every day. She said she is very tired. So she roamed the streets window shopping instead. But I do not know what happen if she refused to go to work – whether or not disciplinary action was taken against her or was sacked? We get all kinds of doctors with all kinds of attitudes and mind set.

There was another doctor with the same surname as me who graduated from the University of Cambridge (of all universities in the world, mind you!). He was introduced to me some years ago. He was so filthy rich – wealth inherited and given to him by father who owns land and property all over the Ampang area up to near Pudu area. But this newly graduated Cambridge doctor never practice medicine even for just one day immediately after returning from England. His father told him to go to Cambridge for medicine.

So he did just to please his parents. But he was not interested. Instead, on graduation he was so busy looking after all his father’s little empires. He told me when I went to his house “what for I earn that kind of salary from the government. I can’t even take care of my parent’s properties”

When I was in England, I read in the newspaper there – Daily Mirror (I think) of a British doctor who became a plumber. When asked by the tabloid the reason, he replied - as a plumber I get 5 times the income than being a doctor. It was just a matter of arithmetic he replied.

Just only two days ago my wife told me over breakfast that doctors are in the same category as lawyers and politicians, especially doctors in private hospitals. They all cheat others she told me. They are not honest at all. She told me these doctors ask you to undergo unnecessary treatment and surgery and ask you to undergo all sorts of unnecessary scans and imaging– MRI, PET, CT, US, mammograms, etc.

They (doctors in private hospitals) will then ask you if you have a medical insurance. If you have, they will add more “investigations” into their bill especially if they own these scanning machines (to get back their “investment”), and even send you to see a psychologist after that. She was telling me all that.

But of course I just kept quiet, because she is the Female Speaker of my house, and it was much safer for me to continue with my simple breakfast of just two slices of plain bread and a mug of Milo. But I was unsure whom she was referring because there are a dozen medical specialists among us in our extended family. So it is better for me to shut up!

Thankfully I don’t require all that to “cari makan”. Mind is not even “cari makan” Mind is just “window dressing gaji buta” that simply comes in smoothly every month without any struggle or going to work which of course is downright CHEATING!

You chaps think being a doctor is so lucrative. You must be an idiot. It is more blessed to be an engineer even if your boss tells you to mix more sand than cement to cut cost, and quickly sign the “certificate of fitness” even if it is unfit for even a dog to stay inside.

That’s what I call “the cheating professions” including mine - the gaji buta profession!

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On Tue, Aug 20, 2013 at 12:13 PM, Khoon Khoon wrote:

Ju Boo,

Is this the reason why Chua Soi Lek abandoned medicine to go into politics?

Doctors need to specialize to do well.

When they are in a group like in a specialist center or in private hospital, they do very very well.

Like your brother in Gleneagles.

Not so good as a lone ranger in a private clinic.

There they will rot to death treating the same old disease, cough, cold, fever, pain in joints, running nose etc .

If one injection does not bring in the money, then just give another one.

Rgds

Khoon

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From: lim juboo

Sent: Tuesday, August 20, 2013 1:46 PM

Learned Prof Khoon,

You need to be reincarnated into a doctor in the next life to understand the plight of doctors in this life. You think it is so easy to get patients just because you are a specialist?

First of all, patients don't straight away see a specialist because they do not know what exactly is wrong with them even if they search the Internet for self diagnosis till kingdom come. So they just do not know which specialist to go to in the first place. So they go to their regular GP or to a government hospital first. It is these GPs who swap all the patients first, and discourage their patients from going elsewhere. If all the GPs start referring all the cases to the specialists, then how to survive?

Then we also get GPs who work hand-in-glove with their specialist friends to get "kickback" for every case they refer. But if a GP refuse to refer, then the specialist themselves will be affected. This is because they also depend on the GPs as the first line doctors to refer the cases to them.

In other words, both GPs and the specialists depend on each other. But usually the GPs tell their patients they can treat them instead of going elsewhere. Everyone in this (un)reincarnated world is fighting for their own survival like your temple of evolution survival of the fittest. Now you can understand using your temple evolution theory.

Even if the patient goes to a specialist in private practice straight away without going to their GP first, they will also chose for themselves which one to go to. There are so many, many of them now in private practice, and also in the private hospitals they there is a competition among them even for the specialists.

Since the patients do not know which one to chose, they will like dinners looking for a 'good' restaurant to eat, see which specialist clinic (or even an ordinary GP clinic) is most crowded. If it is crowded like a restaurant or a coffee shop, then that specialists "must be damned good" This is just part of human behaviour. But they don't realize the more crowded it is, the less time that specialist has the time to listen to you. So instead they send you for all kinds of redundant blood tests and all kinds of scans and imaging to get back their investment.

I have patients in the past complaining to me about all the scans, imagining and all kinds of blood tests, and the collection of all the imaging films they have which weighs a ton and have depleted their entire life savings and even medical insurance, and yet their specialists told them there was nothing physically, radiologically wrong with them.

Yet these patients still complain there IS something CLINICALLY and SYMPTOMATICALLY wrong with them. So it only shows their specialists have NOT listen to them but just depend on all these scans and blood tests to add on the their bills. This is truth, nothing but the truth, and the whole truth. In other words, their doctors have not used their clinical acumen to make a definitive diagnosis, but just depend on all these lab report as an excuse to charge the patient.

I for instance listen very carefully what my patients tell me. I just allow them to talk and take their time. Then I will ask them questions bit-by-bit to come out with a differential diagnosis. Surprisingly using this very cheap method I have made over 90 % accuracy in the diagnosis without sending the patient to any invasive procedures. I used the lab support less than 2 %.

That's what I call a good diagnostician, and not a good doctor that depends on all these lab tests and scans. First, listen to the patient orally, if not sure by auscultation (use a stethoscope to listen to regurgitation, bruits, abnormal breath sounds, and classify, as well as to grade the various sounds you hear). If still not sure, palpate to feel for solid mass, abnormal findings. If still not sure, percuss to listen to the percussion notes ("music") to detect fluid and ascites or solid mass.

All these are traditional methods of diagnosis we have used for more than 200 years and they are almost 98 % accurate without even any lab support. What if a doctor has to work in a remote rural area without all these lab support? I was working in the Rural Health Dept at the Institute for Medical Research formerly, and we have to rely on just our ears, eyes and hands to make a health status assessment of hundreds of thousands of people staying in all those remote places across jungles, rivers and steep terrains, mud deep, deep inside where even bicycles could not be used. How do you expect us, an entire team of 20 -30 medical personnel to carry all those x-rays, lab equipments, heavy weighing machines across rivers and streams and through all those mud and drag them up to the slippery hills and steep slope?

Of course we use just our ears, eyes, and just fingers, and just light instruments like a BP set, a stethoscope, a skin-fold calliper, a light tape for measuring body heights and a small light weighing machine to measure body weights, and a haemoglobin meter to measure HP, and maybe some dip sticks as dry chemistry for various blood and urine tests. Maybe some sample collection tubes and vials, and syringes to collect blood or take some swaps for culture to bring back to the lab at IMR. We have been doing this for 25 years till I retired.

The rest we don't need.

What we need MOST IMPORTANTLY was our BRAINS, and not all those machines.

That hallmark - my dear Learned Professor - was what we have - our brains - as a first class researchers and as fantastic diagnosticians. Get that!

But we get no momentary gains of course as a government servant, but God has rewarded us much later with income unexpected from outside sources (not pension) after retirement. Get that also!

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Sent: Wednesday, 21 August 2013 5:52AM

FROM: Tan Seng KhOOn

Ju Boo,

If I have a choice over reincarnation, what for I want to be a doctor?