Time management

Read one article, very nice. It's a Taiwanese article, very enlightening.

「時間」重要，還是「金錢」重要？

這個老問題常常被許多文章拿出來問，會問出這個問題，最後答案一定是「時間」，但，你真的有碰過任何一個視「時間」比「金錢」還重要的人嗎？所有的促銷活動，有95%是幫人省錢，只有5%幫人省時間（譬如你現在先買，以後可以不必再過來買）；如果你要搭飛機、火車、船……只要價錢差非常多，那麼大部份的人一定是選便宜的交通工具，怎麼可能去選貴的呢？最重要的是，你絕對不能讓「皮包」丟掉，就算丟了五十元硬幣都會心疼要死，但下午偶爾偷懶睡個5小時的長覺，頂多是罪惡感，沒有「心疼」。

不過，「時間」的價值，往往讓人驚奇，最近有一篇報導指出，英國的經濟學教授已經整理出一條「公式」，可以計算出你的「時間成本」是多少，這條公式是：你的每小時時間價值=(你的時薪x ((100-稅率)/100))/每小時居住成本，譬如「自己煮一頓晚餐」這種事情，應該是「省錢」的，不過，如果加入了「時間」成本呢?對男性來說，一餐等於要花15.72美元，對女性來說等於一餐要花14.30美元！

這數字令人吃驚，因為英國人平常外食，男性平均消費只有7.31美元，而女性是7.24美元，換句話說，我們都以為，在家煮晚餐很「省」，沒錯，從我們荷包所出去的錢的確是變少了，但如果你計算入「時間成本」，在家煮飯所需「成本」，竟然是外食的「二倍」多！

這點讓很多人肯定無法茍同！畢竟自己煮晚餐，自然有自己煮晚餐的樂趣，不是嗎？此外自己煮晚餐，避免吃到不營養或受污染的食物，平均壽命可能也會比較長，不是嗎？另外，自己煮晚餐，那種「省錢」的快感，也會讓自己更快樂，不是嗎！

這公式所計算出的「二倍」結論，的確有一個漏洞，它是假設，如果你將煮晚餐的那個時間，不要煮晚餐，而到外面去花平常原料的二倍錢來快快吃個東西，然後將煮飯的時間省下來來「工作」。沒錯，來「工作」吧！這樣的假設實在不太對，但，仔細想想，這好像也是奮鬥的一種方法。

「金錢」重要，還是「時間」重要？

你真的有碰過任何一個視「時間」比「金錢」還重要的人嗎？

我覺得「我」就是耶。

而且，我完全支持那個「煮餐成本是外食二倍」的驚人公式，我的確是視時間如命的，的確是願意將煮飯的時間拿來工作的。上次與半生不熟的朋友聊天，談「時間管理」，突然不知為何聯想到小時候看故事書的一個「守財奴」的故事，這個守財奴，將自己的存款全部換成一大顆金塊，然後小心翼翼的藏起來，那付吝嗇的表情，畫在故事書上面栩栩如生，到現在都還記得，不過，守財奴至少有一點，肯定做得很好，那就是他一定是一個比一般人還要有錢的人。我不是守財奴，不過我對「時間」之吝嗇，已經到了「守時間奴」的地步，有人說我很會運用時間，其實是因為我視時間如生命，守時間為奴隸的緣故，我真的是一個視「時間」比「金錢」還重要的人！

這個「時間吝嗇守則」，影響了我的時間管理，哈佛大學最近有一篇研究，發現人類做的各種決定其實和他們「買東西」所做的決定，使用了腦中的同一條線路，我們的大腦的ventromedial prefrontal cortex區塊會計算「價值」，如果今天看到兩位乞丐，我們決定捐款給右邊的那一位，那是因為，右邊的那一位在我們腦中計算出來的「價值」較高。從這邊可以知道，為何許多人常常無法「把握時光」？那是因為，我們打從心理不相信「時間有價」，或是將時間的價值「誤算成太低」了，所以我們無法好好的抓住時光，讓它太快溜走。

反之，如果視時間如命，認為時間的價值比金錢還高？那應該就能「把握時光」！問題是，為何我們大部份都無法接受，在家煮飯所需的成本，真的是比外食還要整整多出一倍呢？

是因為，以下４點：

一、大部份的人類並不是處於「隨時有任務」的狀態：大部份的人是為別人做事的，自動自發的意願不高，所以，當我們突然多出一個小時，我們並不是立刻就有事情在手邊可做！就是因為這樣，當我們真的外食，來省下一小時的煮餐時間，我們也不會去珍惜那多出來的一個小時，我們會寧可搭老半天的車，慢慢、慢慢的多花三小時回家，沒關係，「反正這段時間早點回家，也沒事做！」

二、大部份的人類並不是「隨處」都可以做事：就算第一點不正確，大部份的人依然只有在限定某些地方才能「工作」，當我們不在工作崗位時，我們就無法做出真的有意義的事情，如果現在因為飛機延遲而待在機場，大部份的人是「沒事可做」的；如果今天因為車子拋錨而必須走路回家，大部份的人是「一邊走一邊放空」的，大部份的人是無法在非工作場合以外的地方還在利用自己的時間來做一些事情，於是，反正現在也無法回到辦公室或書桌前，這段時間怎麼浪費都沒關係了，也造成時間的大量揮霍。

三、大部份人類在「今天」的時間，對「未來」沒有明確的投資效應：倘若今天存了500元，明天就多500元可花，非常清楚，但時間呢？大部份的人，今天多了5小時，並不會覺得因為今天善用它，明天也會跟著多出了5小時甚至更多！由於我們對今天「多出來」的時間幾乎「沒感覺」，不認為多出來的這段時間，可以拿來做某些事，對未來直接產生好處，所以我們大量的揮霍現在的時間，大量的大量的用掉他們。

四、大部份人類缺乏「短期目標」，因此對於「花時間」沒有疼痛感：每個人都有夢想，但很少人有「短期目標」，老闆叫我明天要交報告，是大家唯一的短期目標，一般人是不會自己設短期目標的，由於沒有短期目標，因此當我們在「花時間」的時候就好像穿著厚鞋子走碎石路，完全不會感覺到磨擦、損耗的「疼痛感」，我們完全沒有感覺我們在「花時間」，不會感覺到時間一分一秒的被消費，於是，我們的時間就會以百分百秒的時間、不知不覺的被消費掉了。

看完以上四點，或許你可以去follow很棒的時間管理方法，這我不懂，但，如果你也和我一樣，變成一個「時間吝嗇鬼」，或「時間守財奴」，那麼，你自然的可以將時間運用得很好！注意，那不會是「最好」，但比起很多號稱很會時間管理、但做的事卻沒有我們多的人來說，時間的運用是很重要的。

而想要當一個超強的時間吝嗇鬼，也很簡單，只要將以上四點都翻成「正」的就好了，這也是我的方法：

一、確定自己處於「隨時有任務」的狀態：時時都有任務，而這些任務絕不只是「瑣事」譬如要買什麼東西、要回哪些人電話……這些事通通都記得零零落落也沒關係，它們不甚重要。但我隨時都給自己一些任務做，譬如早期的時候我天天背單字，當時一有時間就來背單字，現在的目標是調配人力、想創意行銷、想創意方向，所以只要一有時間，就馬上開始做這些事情。

二、確定自己「隨處」都可以做事：我的任務天天有好幾樣，最近每天開始慢跑，慢跑之前一定先「上傳」到自己暫存記憶體，一邊跑一邊想某件事，然後跑完再「下載」，我記得當年早安打卡機的點子就是在去年某一次跑步的題目，跑完之後也想出來了。現在有了3G手機，隨處上網，如果真沒任務，也可以隨處給自己一個任務，讓自己「隨處」可以做事，就會開始發現自己的時間每分每秒都在產生價值。

三、確定今天的時間，對未來有明確的投資效果：一開始我以為大量的「記錄」，除了寫部落格，天天也有寫日記的習慣，因此今天的任何空閒的時間都可以被「儲存」，「轉換」成一篇文章，文章也東抓西抓的將當下一些學習全都記錄，到三年後的未來，這些文章還會繼續吸引其他網友來認識我。但後來才知道，以上皆是，但只是「基本」，當我們天天在網路上要在限時內饑渴的搜尋網路的最新發展、最新案例，搜了四年之後，就會知道今天努力的饑渴的的大量閱讀，全部都可以百分百的換成明天可用的知識。

四、設立多重嚴苛的「短期目標」：我們都有夢想，但達成夢想之前，你相信必須完成Ａ、Ｂ、Ｃ、Ｄ、Ｅ…嗎？那麼，就定下Ａ必須在下周一就弄出來，Ｂ必須在下周三就弄出來，Ｃ必須在下下周就弄出來。我給自己設立的目標從來不會超過2個星期，有的時候為了符合這「二周定律」，把自己累得要死，但也就是這樣，每分每秒的時間變得很寶貴。你說，幹嘛這麼急，急什麼？沒有急什麼，只是我是時間的吝嗇鬼罷了，這是一個循環，當你設下大量的短期目標，就會想辦法完成它們，也會更吝嗇自己的時間，更吝嗇自己的時間，你的目標也會跟著「愈設愈短期」，最後變成一個超級有生產力的傢伙。

外食真的很貴，但，假設找到一間不錯的餐館，真的乾淨的、有營養的，一天其實可以省下你昂貴的時間成本，每個人活著一生，最大的資源不是金錢，而是「時間」，時間有不一樣的過法，但願您花了一分鐘閱讀此文，至少了解到一件事──

時間正在一分一秒的流失中，頭也不回。

Why Malaysia Gov Can't Retain His Doctors

Just read this from TheStar online, a doctor who served the country for 2 decades but left the system finally. I totally agree with him though I just serve the country for merely 5 years. Read it after the jump.

http://blog.thestar.com.my/permalink.asp?cat=1&id=30376

Why we left and why we will continue to leave...

Posted by: MS Mohamad

I read an interesting article today about a few prominent figures addressing their concern over the increasing UKM and UM medical graduates who have left the country to continue their medical practice overseas.

After reading the news for 3 times, I called a very close friend, an MD (UKM) graduate to ask his opinion on how the news might have affected him. He has been working in Singapore for more than a decade as a Consultant Surgeon with a certain sub-specialty

"Why be a slave in your own country, when you are a king in another?" He replied.

Indeed, if anybody would want to find a reason why all of us left, either after housemanship, after being a specialist, or even after sub specializing, and now, even prior to doing housemanship, they need not look at our payslip, or the wealth that we have gained overseas, but only to the Medical System that has been rotting in the ignorance and politic-based stupidity that Malaysia has been well-known for (in the medical field).

I have served the system for nearly 2 decades of my career, waiting for it to improve for so long, and only finding myself in despair, quitting with a 24-hour notice and serving abroad. The system is, in my opinion, keeping doctors, since the beginning of their career as House Officers to the end of it, in the lowermost priority. When I was working there, doctors are so ill-treated, while the nurses and the medical assistants are overpowering us.

I still remember the days when I was doing seeing patients and rounds as an MO, while the staff nurses would mind their own business, having breakfast in the pantry, or having gossip chats at their own leisure. My House Officers would then have to do merely all the labour-work, up to the extent of setting intravenous drips, and serving medications. If I am to expect the nurses, my patients would have been dead, or the work would have been too slowly or incompletely done.

When I was a House Officer, I had to run down 4-5 floors just to review a blood investigation of a dying dengue patient. The ward staff would either be nowhere around, or will say that he is busy (busier than the doctor?) or the answer I got at that time:

"Doktor nak cepat, doktor turun sendirilah, gaji doktor lagi banyak dari saya"

Even when I was a Specialist, the staff nurses had to be called again and again just to make sure the management plan for the patient would be done. I was already used to answers from them:

“I’m busy with something else"

“My shift is already over"

...it was routine for me.

The Medical Assistants were worse. They would hide behind their so-called boss, the Head of Medical Assistant. They feel hiding behind him would make them not under our jurisdiction, that we have no power to instruct them in managing the patient, that they have power to manage own their own. I've seen them giving medications not as we prescribed, performing procedures without our knowledge, as if they are the actual "Doctors". They are in their own world, and we have to do their job, taking blood, labelling samples, and even cleaning gadgets from the procedures that we have done.

Oh, but the ministry loves this group. They even let them run a clinic now, instead of upgrading the clinics already run by doctors. The government feels that the MAs are very important and should never be ill-treated by those big bad doctors. One time when I was a District Hospital Medical Officer, I was conducting a delivery of a baby. An MA insisted that I remove my car which was block-parking his car. I answered through the phone that I was busy.

He came to the labor room and yelled "Semua orang pun sibuk jugak, macamlah doktor seorang yang sibuk!”

It is insulting that an MA or a staff nurse claims that they are BUSY, as busy as a doctor? As a Malaysian Doctor, I have even worked for 72 hours straight. I have experienced working until my 6 month old daughter did not recognize me at the end of the week.

Is that how busy they are? I am very sure that they are so busy, that they can only spend 2 hours at the nearby Mamak stall, or can only leave at 5:10 PM instead of 5, or can only have 1 hour of lunch.

The management staffs are worse. I have to beg and plead so that I can get my on-call claims, of RM25 per 48 hours of work. While sitting in an air-conditioned office, they will at their own leisure, process my call claims so that I will receive them by the next decade.

The state health or Hospital Director would just give another inspirational talk (of bollocks) on team effort and beauty of teamwork.

That is how Malaysian doctors are treated in the government sector: without respect, without dignity and without significance. Why?

It is because we are bound by ethics to try our best to save lives, despite how ill-treated we are. We hardly have time to complaint because we are too busy or tired, and we would rather spend the precious time resting or seeing our loved ones. The burden of trying to save lives is on our shoulders alone. No MAs or Staff nurses would shoulder it with us. They have their own bosses: the Sisters, Matrons, or Head of MAs, which job description is to ensure that the big bad doctors will not ask their underlings to do extra work.

This is how the Malaysian Ministry of Health have treated their doctors. I am very sure that in each and every doctor, there is a slowly-burning patience in serving the Malaysian people, which will eventually fade and cause them to surrender to serving a place that treats them better.

A few colleagues who graduated from UK choose to serve there:

"The pay is more, and we get the respect we deserve"

Another works in Brunei:

“Here the staff nurses respect Malaysian doctors, and they are very co-operative" (He ended up marrying one)

A few are consultants in Singapore (working with me):

"Here we are treated well, we spearhead the management, and every else do their work to the best of their capabilities".

A few even enjoys working in Indonesia:

“The work-load is horrible since there are a lot of patients, but we are well respected by every hospital personnel" (They have migrated there for nearly a decade)

I am sure that people will see doctors as power-hungry individuals who want to be the boss in the hospital. Trust me, after having graduated 6-7 years of medical school, earning a DEGREE, and subsequently MASTERS, and SUBSPECIALITY, you would expect a degree of respect and being considered important. We are trying our best to improve patient's quality of life, or making sure he lives another day. Is it too much to ask from the system that we are important?

I find that Malaysia is the only country that is making doctors' lives miserable and treated like rubbish. It was never about the pay in the first place. It is about the treatment we are getting and the false political-based promises. Do you know that the so-called circular about doctors can have the day off after working 24 hours straight released JULY 2009 is not yet implemented? Do you know that the raise of UD 41 to 44 does not involve every doctor in the government service?

We are waiting for improvement. We have waited a long time when we were working in the system. Somewhere along the line we decided to leave and wait outside the system. Until the system changes, we will continue to work overseas, in countries which are appreciative of us. Trust me, Malaysian-graduate doctors are considered highly skilful and competent in neighbouring countries, and the 15 % brain drain is more significant than you think.

We will return when the system prioritize us and gives us the quality of life we deserve.

If it stays the same, Malaysian Hospitals would end up having Staff nurses and Medical Assistants as "Doctors", and we would have to send patients to Indonesia for an appendicectomy.

Hear our voice. We hardly speak, but will usually fade away from conflict (and fly to another place).

Doctor too many....to be continued by Part 3 & 4

Same author, Dr Hsu, who wrote again regarding "Extraordinary Amount of New Doctors in Malaysia", worth reading.

http://hsudarren.wordpress.com/2010/05/04/a-doctor-too-many-iii/

http://hsudarren.wordpress.com/2010/05/06/a-doctor-too-many-iv/

Part 3

This is the number of house officers as of end of April 2010 in HKL , the biggest hospital in our country:

Unit	Number of housemen in the unit
Orthopaedic Department	52
O & G Unit	50
Medical Department	72
Surgical Department	57
Paediatric Department	62

Just as an illustration, the orthopedic unit mentioned in the table above has 182 beds. With 52 house officers, it amounts to 1 houseman to slightly more than 3 patients.. A ratio you would not be able to find anywhere else in the world, believe me! Not even in the most advanced country!

Gone were the days when we had only 2 or 3 house officers in a unit. I remember during my time, when I was doing housemanship in Penang GH, I was for 2 weeks the only houseman in the orthopedic unit. Now I heard they too had 60 housemen in the unit (Jan 2010 figure).

Just imagine, if you have 60 house officers following a consultant doing the ward round, how are those at the back going to learn? I do not think there are even enough standing room for all of them. How are they going to examine a textbook case ( a case with classical signs and symptoms), since to do so would have subjected the patient to examinations 60 times– if the patient does not die from his illness, he might die from too much handling from these housemen!!!

The figures I quoted are real figures. I am sure those of you reading now would agree with me that there are now simply too many doctors being produced, and since there are not enough hospitals to place them in, there is no choice but to place them in the same units…

No wonder i received emails after my last posts saying that many house officrs are seen spending most of their time in the canteens, since they just have nowhere to go…

And in no time, these same people will be treating you and me, including the politicians. Perhaps I should warn them here that Healthcare is different from education. In education, if our schools are no good, they can still send their children overseas to study. But when these politicians get a stroke or heart attack, it would be too late for them to fly out to even Singapore to seek treatment. They would be treated by the same local doctors that they help in mass production.

Our healthcare standard is going to deteriorate with this sort of training of our doctors..Just like almost everything else.

I am now in the process of writing a memorandum to be submitted to the Ministry on this problem and I hope my writings can bring some sense to this madness of indiscriminate issuing of licenses to set up medical schools.

Part 4

At the end of 2008, Malaysia has about 23000 doctors, almost half in private sector.

Our Ministry is trying to achieve a ratio of 1:400 as existed in most OECD countries.

In the haste to achieve this number game, they have forgone quality.

It does not mean the more the better. Look at some of the communist countries like Bulgaria. They have a ratio of 1:200 doctor:population ratio. That does not mean that they have a better healthcare than Britain which has a ratio of 1:450. Another example is Kazakhstan which has a ration of 1:280 , as compared to Australia which has a ratio of 1:400. Does that means that Kazakhstan has better healthcare than Australia?

Our officials stress too much on achieving numbers. They stress too much on ‘form’ rather than substance.

If we have well trained doctor which are productive, a ratio of 1:1100, will mean that we are on par with those 1;400 countries with doctors which have low productivity.

Alas, we built 5 star hospitals with lobby bigger than Shangri La, but you dont need 5 star bed to treat diseases. You need clinical acumen , experience, and doctors who communicate with their patients.

As for the question asked by MKO in the last post (A doctor too many 3), it is still ok to get treatment from govt hospital NOW. In 5 to 10 years time, I am not sure. Unless they buck up, and set up a body to oversee the standard of doctors produced, I will not want to get treatment there in 10 years time.

I must stress that I am never against producing doctors. I am not in favour of producing too many INADEQUATELY TRAINED doctors. That would be like producing too many gun-carrying policemen without training them as to when to shoot and when not to shoot.

At the rate we are producing doctors, 4000 a year, we will soon be down to 1:100 ratio.

Let us assume that we have a population of 27 million. Let us assume that the population growth is 3%. So every year, we have an additional 800000 people. Divide 800000 by 400, you get 2000. That means once we achieve a ratio of 1:400, we need only to produce 2000 doctors a year to maintain the ratio found in most advanced country. But we will be producing 4000 local plus 1000 from overseas (India, Indonesia etc..many will be staying put in the place they study like my children). So there will be excess 3000 doctors a year… This will quickly bring our ratio down to perhaps 1:100, and you will find some o the hawkers and taxi drivers with MBBS degree hanging in their stalls or taxis.

Not joking…

And looking at the history of medicine at advanced countries, when their doctor:population ratio decreased, the charges went up, and so was the cost of medical treatment , even when taken into consideration of inflation. This is because those who are competent, will charge higher and do more investigations.

There will come a stage when we have too many doctors, too many lawyers(already happening since some junior lawyers have to pay the senior lawyers to do their chambering), too many nurses, too many hawkers, too many cars, too many motorcycles, too many politicians, too many parties, too many police, too many criminals and too many crooks….. I dread to think of such a day!

As for the suggestion by Stevent in the last post, yes, we can send them overseas to work and gain experience, but which country would take them in if their standard is low? I am sure there is a cutting point where even Singapore would not want to take them in, as is the case now.

So you can still send them, to tag with experience doctors. That would like starting their medical training again and you need to pay overseas doctors money to do that sort of things, and there is really no guarantee these people will come back, once they are competent enough to be able to find a working job overseas.

The whole system is rotten, and all the planners can think of is short term and they are all very short sighted… Ultimately they will suffer too if there is a drop in medical standard. Because health hits everyone equally, it does not mean that if you are wealthy and powerful, you would not get cancer or immune disorders.. Ultimately, like facing the creator, everyone will have to face health problems, and they will then realise that what a monster they have created in their haste to achieve certain figures… Because a healthcare system without good doctors will be like a monster released ..

Too many doctors in Malaysia

come across this blog, can't agree more.
Let's share after the jump

http://hsudarren.wordpress.com/2010/...r-too-many-ii/


Malaysia, a country with about 26 million populations, boosts of 24 medical schools now.

Just a few years ago, the number was less than 10. In fact, when my eldest son entered medical school 10 years back, i could count medical schools with my fingers. Now even with my toes and my fingers, I could not do so. Some of the names are so new that I, as a doctor, do not even know they exist until I did some research for this article.

The list is below:

Public universities:

• University of Malaya, Faculty of Medicine

•Universiti Kebangsaan Malaysia, Faculty of Medicine

• Universiti Sains Malaysia, School of Medical Sciences

• Universiti Putra Malaysia, Faculty of Medicine and Health Sciences

• Universiti Malaysia Sabah, School of Medicine

• Universiti Malaysia Sarawak, Faculty of Medicine and Health Sciences

• International Islamic University Malaysia, Kulliyyah of Medicine

• Universiti Teknologi MARA, Faculty of Medicine

• Universiti Sains Islam Malaysia, Faculty of Medicine & Health Sciences

• Universiti Darul Iman,Faculty of Medicine

Private Universities and Colleges’

• UCSI University, Faculty of Medical Sciences – School of Medicine

• Monash University Malaysia, School of Medicine and Health Sciences

• International Medical University, Faculty of Medicine

• AIMST University, Faculty of Medicine and Health Sciences

• Allianze College Of Medical Sciences, Faculty Of Medicine

• Management and Science University, Faculty of Medicine

• Cyberjaya University College of Medical Sciences, Faculty of Medicine

• Royal College of Medicine Perak, School of Medicine

• Melaka Manipal Medical College, School of Medicine

• Penang Medical College, School of Medicine

• MAHSA University College, Faculty Of Medicine

• Newcastle University Medicine Malaysia ( NuMED)

• Taylor’s University College, School of Medicine

• UTAR

These are the medical schools in Malaysia. These schools when fully functional will produce about 4000 doctors a year. There will be thousands more Malaysian doctors being produced overseas, since many Malaysians are studying medicine in UK, Australia, New Zealand, India, Indonesia, Russia, Taiwan and even Ukraine.

The sudden mushrooming of medical schools are apparently due to shortages of doctors in the public sectors. This is because most doctors in government service resign after their compulsory services and opt for the supposedly greener pasture in the private sector.

In most other countries, the logical thing to do to counter this brain drain of doctors to private sector is to find out why doctors are resigning from government service and then try to address the woes of the doctors , and hopefully keep them in service. I call this common logic.

The Malaysian solution , like in many other instances, does not take common logic into account but rather uses the sledgehammer approach. After all, we do have Malaysian logic which is different from common logic practiced in most other countries. For example, if we cannot have spacecraft of our own, we can still produce Astronauts by sending Malaysians into space hitchhiking on other countries’ spacecraft.

In most other countries, the common logic will be to try to improve the working conditions in public sector so that doctors will stay back. But Malaysian logic is sledgehammer logic, and is very different.

If the doctors do not want to stay in government service, then Malaysia shall flood the market with doctors, so goes the Malaysian logic. Never mind that setting up of medical schools and training doctors are expensive businesses. We have petroleum and huge amount of development funds. By building more buildings and buying expensive medical equipment to equip these medical schools, billions will have to be spent and of course, in the Malaysian context, everyone will be happy, down from the planners, the contractors, the parents and all others involved, since the perception is that projects in Malaysia inevitably will have some leakages and wastages and many people are very happy with these leakages and wastages. Never mind that we may have the hardware but we may not have enough qualified people to man these medical schools.

The Malaysian logic seems to be like this: If enough doctors are produced, the market will be saturated with doctors and thus doctors will have no where to go but to stay put in government service.

Well, the people may be clapping hands and rejoicing that with more doctors than are needed, medical costs will come down.

Unfortunately, things do not function like this in medical education. Experience in some countries tells us that some doctors in private practice , when faced with too few patients will charge higher and do more investigations, some of which may not be needed, so instead of medical cost going down , it will go up.

In any advanced nation, the setting of a medical school requires a lot of planning and not on ad hoc basis. Planning that must include where to source for experienced and qualified teachers, where to build new or source for existing teaching hospitals which are big enough for the placement of these medical students to do training. Planning such as facilities, equipments, classrooms, curriculum. In the west, it takes many years of planning for a medical school to be set up; whereas in Malaysia, we see more than 10 in the last 5 years.

In Malaysia, due to the sudden ‘exponential’ increase in medical schools, we have medical schools pinching staff from each other, even the mediocre ones, and with that number of qualified teachers only, it is unavoidable that many teachers may not have the experience and qualification to be medical lecturers.

The early birds (medical schools) are more fortunate. Their students are placed in bigger hospitals like the General Hospitals of Kuala Lumpur or Penang. Now, some of the medical schools just opened have to send their students to smaller district hospitals to do their training. The smaller hospitals are often manned by more junior doctors who are not qualified to be medical teachers, and these hospitals have only very basic facilities and equipment.

This is just the beginning of the problems. For a doctor, graduating from a medical school is the beginning of a life long journey, and the basic medical degree is more like a license to start to really learn how to manage and treat patients.

The most important year after a doctor graduated is the houseman-ship. If a doctor does not have proper houseman training, then he would face a lot of problems later on. He or she may know all the medical knowledge in the world (just for argument sake only since knowledge of medicine is so vast that no one can know everything), but without the proper houseman training, he or she will not get the hand-on experience so crucial and important to doctors. A doctor without proper houseman training is not unlike a person, who has played only racing in the arcade games, suddenly being asked to race in a real life race. He would not have the hands on experience to do well. A doctor without proper houseman training would be like a person given a license to kill and a disaster waiting to happen.

Now, with 4000 doctors being produced in a year, where do we find so many houseman positions for these young doctors? Even now, with some of the medical schools just starting and not yet producing doctors, and the number of doctors being produced is much less than the 4000 , the wards in some of the bigger hospitals are filled with so many housemen that in some wards, there are not enough patients for these housemen to learn management skills. About a year back, I was told, in HKL some of the units have more than 20 housemen. Recently one doctor told me that in some units, it may have even more than that. I was aghast. Since with that many housemen in a single unit, and so few senior officers to guide them and so few patients for them to learn from, how are they going to learn the skill of doctoring?

When there is not enough training for these housemen, what do you think our policy planners do? In the typical Malaysian style, they increase the length of houseman-ship from a year to 2, hoping that the longer time will help to give better exposure to these doctors. Compared to Australia, New Zealand, and United Kingdom, houseman-ship is still one year only. By increasing the length of the houseman-ship, it is a tacit admission that our one year houseman training is not as good as the above mentioned countries. A poorly trained houseman will become a not so good medical officer, and since now most of the specialists are trained internally, it will be a matter of time that future specialists may not be as well trained as present.

Many parents do not know about the actual situation and still encourage their children to take up medicine. They are not told of the actual situation. The day will come when there are simply so many doctors that none are adequately trained. There will come a day when a doctor graduating from a medical school cannot even be placed in a houseman position and that day is actually very near.

Blogging? Facebook? Twitter?

It's been a long while that i didn't update my blog. Well, I'm just lazy, frankly. But i think that the day i joined Facebook, i'm more involved and iterested in posting over Facebook and receive instant response from friends that i know. Rather than checking blog everyday and receive comments from unknown visitor. MAy be this is the END OF BLOG and the ERA of FACEBOOK and TWITTER? I wonder....

What a surprise!

Recently I found out that the area I stay got few stalls selling green bean soup (Chinese dessert) which is my favourite in Penang. Didn't ever think about finding some here as this is not that popular 'tong sui' compare to others. I tried out some, nothing great but good to know that I can have some in the future. Happiness is simple. Haha.

Busy, Busy, Busy x3

Still struggling with my subspecialty rotation. Time is not enough, too many patients (20-30 patients daily by me alone, the only medical officer)to cover and many paper work to do (Discharge summary of every patient, procedure note, referral letter, memo, etc.) Life is even worse when I'm on call that day and post call later. No post call off in my deparment as there is always not enough doctors in service. (Except Anesthetist MO can have a FULL DAY OFF after on call, SO ENVY!  :(  ) Seriously considering to go back hospital to settle my paper workk during weekend. But, how is my life? Where is the quality of life? Sigh.... Basically now working from 6.30am till 6.30pm now every day (12 hours x 5= 60 hours per week + 1-2 On call Per week ). I just realized that I become easily agitated and irritable. Sigh again. Lucky that my parents are still very healthy and can take care of themselves. Otherwise it would be very sad that I spend most of my time looking after others parents but neglect my own. Seriously don't think that this type of life is reasonable. Anyway, the good thing is, I really learn alot from this rotation, both theory and practical procedure and it does help me to become a better doctor. 

Well, another 6 weeks to go.......