Challenges to medical students

Tan Sri Dato Seri Dr Hj Mohd Ismail Merican

President, Malaysian Medical Council & Director General of Health, Malaysia

I am here for 3 reasons:

Firstly, to fulfill the kind invitation by AIMST for me to visit this impressive campus and to see
for myself what AIMST can offer to aspiring students who wish to excel in Medicine.

Secondly, to remind faculty members here that what and how they teach these students will
have an impact on their aptitude, their approach towards the delivery of health care and the
future development of their career. In other words, to remind faculty members that they are
responsible for the quality of the medical students produced by AIMST. They have to ensure
that students from AIMST have not only the core knowledge of medical education that is
current and forward looking but also the values and moral strength for them to be transformed
into competent and safe carers; doctors we can all depend upon to take care of the sick and the
infirmed. In order to do this, we must not only teach them the science of Medicine but also the
Art of Medicine. There should be sufficient emphasis on soft skills , communication and people
skills, ethics, humility, empathy , compassion and the desire to help others in need. The medical
profession is regarded as “the noble profession” because the saving of lives and relieving of
suffering are being undertaken by altruistic and compassionate professionals who have a high
degree of professional integrity, to act as their advocates and advisers. We have a duty to
propagate these highly desirable virtues and impress upon the doctors that we produce how so
important such virtues are. We must train doctors who are able to face the real-world
challenge of providing health that is safe, effective, appropriate, efficient and patient-centered.

Thirdly, to talk to you, the students of AMIST, many of whom are here this morning, to remind
all of you that you should consider yourselves fortunate and blessed to have been given this
opportunity to do Medicine. Some of you are here because you want to; some because you
have to and yet others because someone else has decided that you should be here regardless
of your own inclinations. I am a little worried about the latter two groups.

Be that as it may, you are all here and you must persevere, do well and pass the final
examinations and be ready to take up the huge challenge of becoming a member of the
medical profession.

But before you reach that goal, there are just so many things you need to do, learn, reflect and
research upon.

Many of you will be excited and happy when you graduate as doctors. And of course you
deserve being happy. In fact I will be worried if you are not, for by then, you have achieved
what many other students can only dream of or wish for, but did not get the opportunity to
fulfill their dreams, for whatever reason.

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So when the time comes, rejoice and be merry. Be happy and be thrilled to bits. Jump as high
as you can in ecstasy and regale in your success.

But after the ecstasy, the excitement and the thrill comes the pain, the reality. You have to stop
jumping. You will then have to put your feet on the ground. You have to roll up your sleeves
and be ready to do what is expected of you. And that is to prepare yourself to start your life
journey as a good doctor. The road is long and arduous, filled with potholes, bumps and
obstacles. This is the moment of truth. Do you have what it takes to steer through these
challenges? Do you have the character and the determination to grapple with these
challenges? Will you learn the truth about yourself? Are you going to be a man or woman
made of glass or one who is made of steel, but with a heart?

I for one do not want you to become mediocre or run of the mill doctors. I also see little future
for weak, selfish, irresponsible and insensitive doctors. I want you all to become excellent
doctors; doctors who have only one goal: and that is, to do his or her best to heal the sick, to
put a smile on the patients’ face, to make the pain that they are suffering from more bearable,
to reduce their disabilities, to tell them that life is still worthwhile even if you are sick, to gain
their trust and confidence and most of all, to show them that you care.

Some of us have what it takes to be just that. Others need role models and I wonder whether
we have enough role models in the medical profession. Or are they considered endangered
species?

Current status of doctors in Malaysia

In 2009 there were 30, 536 doctors in Malaysia with the doctor to population of 1: 927,
compared with the year 2000 where the ratio was 1:1,490. Out of these, 66 % of the doctors
were serving in the public sector. In line with Vision 2020, where it has been targeted that
Malaysia attains the status of a “high-income country”, our current target ratio of 1: 600 will be
revised to 1: 400, in line with the Honourable Prime Minister’s target for 2020. In addition to
improving the doctor: population ratio, we will still have to fully address the perennial issue of
inequitable distribution of doctors between rural and urban areas, where some clinics in Sabah
and Sarawak are still manned by assistant medical officers. Thus, the numbers alone, which
indicate that we are nearing “saturation”, may not be accurate without considering the
distribution factor. In addition, the doctor: population ratio does not take into account the
increasing sophistication of Medicine, with its many specialties and sub-specialties. In reality,
there is still a shortage in almost all specialties and sub-specialties.

Malaysian citizens must have access to high quality and affordable healthcare and to realize
this, our doctors must be prepared to serve in areas where they are most needed, in the spirit
of service and altruism i.e. putting the greater good above one’s own self-interest. Thus, a
career in medicine is most fulfilling if our intentions are to be of service to humanity, which
means that our young doctors must be willing to be posted to rural areas instead of just the
major urban areas.

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The English writer and dramatist, Douglas Noel Adams once said “To give real service you must
add something which cannot be bought or measured with money, and that is sincerity and
integrity”.

Ten Golden Rules of Good Medical Practice

Allow me to remind you of the 10 Golden Rules of Good Medical Practice (Source: Duties of a
Doctor, Malaysian Medical Council) and they are as follows:

1. Practice with kindness, ethics and honesty.

2. Upgrade professional knowledge and clinical skills.
3. Maintain good patient records.
4. Maintain good communication with patients and relatives.
5. Maintain doctor-patient confidentiality.
6. Allow second opinion and referral to colleagues.
7. Maintain good working relationship with colleagues.
8. Be conscious of the cost of health care.
9. Avoid publicity, self-promotion and abuse of position.
10. Be a partner in promoting global health.

Medicine is indeed a very challenging and demanding career. However, many young doctors
today have embarked on it without knowing what it entails. For those you who believe that this
is the right profession for you, you must transform yourself : be caring and compassionate and
of course, knowledgeable and competent. To others who find the going tough and are unable
to cope with the stress and the challenges and demands, it is not too late to look elsewhere for
inspiration.

The American inventor, Charles Kettering once said “We should all be concerned about the
future because we will have to spend the rest of our lives there”.

You must know what is in store for you when they pass out. What are your role and
responsibilities? What are the challenges you may face? It is not all about getting the word DR.
appearing before your name. That word ‘doctor’ itself carries some connotation. It gives you a
sense of responsibility and respect but respect has to be earned. Society will grant you the
respect for as long as you deserve the respect. Once you abdicate the novel virtues of the
profession, you will no longer be accorded the respect by society and the word ‘Dr’ becomes
meaningless. Your conduct in public is also very important.

Upon becoming a doctor, what you really have to ask yourself is: How best can I serve the
rakyat, society, the medical profession, the country and later on, the world at large? We do not
want to be just a jaguh kampong. We want to be world leaders and shakers and innovators. We
want to be the best that we can be. We must strive for excellence and the time to nurture
those hopes, ambitions and aspirations is NOW. Now is the time, when you are still students;

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when you have the capacity to think, learn, accommodate and equip yourselves with the
necessary knowledge, skills and attributes to be an outstanding doctor.

That is my challenge to you. I wish you all the best and hope you will do well in your studies and
look forward to welcoming you into the Ministry of Health and the health sector.

Address at AIMST University, Semiling, Kedah on 18 December 2010

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