From Dr Leonard Goh
I’m sorry, I’m leaving . . . although, I had initially envisioned that I would spend my entire professional career as a government doctor in Malaysia.
However, the realities of life have caught up with the idealist in me and I have come to the inescapable conclusion that I have to leave.
Our healthcare system is too broken, especially when it comes to the issue of contract doctors. The more the government tries to fix the problems related to contract doctors, the more complicated the issues get.
This is the inevitable result of making such an important policy change on a whim, without prior stakeholder engagements or any hint of prospective planning. We desperately need a reset button, but will the government have the courage to admit that they were wrong and be willing to start over from scratch?
I still have a long career path ahead of me. I know that given the right opportunities, I have the potential to be a leader in the regional, or even global, stage.
Staying in government service would mean denying myself any hope of reaching for the stars. I’m done with running with all my might but getting nowhere, on the giant hamster wheel that is the health ministry.
The workplace conditions are ridiculously inhumane. My colleagues and I are working past the point of sanity to treat our patients to the best of our abilities, but the government has time and again failed to support us in this endeavour.
We have been shortchanged far too much for far too long. I refuse to allow my altruism and empathy to be exploited anymore.
It’s not my fault that I have been looking for options outside the government service, long before I finished my housemanship training. My hand was forced by the government when they insisted on hiring me on a mere three-year contract, even though my career progression is measured in decades.
Now, top that up with the still-ongoing series of administrative blunders and haphazard planning by the health ministry. Is it not logical, then, for me to bravely pursue the uncertain promise of greener pastures and success overseas, rather than meekly settle for the certain promise of a bleak future in the government service here?
I’m sorry, I am leaving, but it is not without a lack of trying, though. Believe me, I’ve tried. I’ve sacrificed most of my time to advocate for junior doctors and improvements in our healthcare system.
I was the first contract doctor to take up the position of SCHOMOS (Section Concerning House Officers, Medical Officers and Specialists) state representative, and thus far the only one to have held a SCHOMOS exco position at the national level.
I’d like to think that I made a difference, perhaps insufficient and rather insignificant in the grand scheme of things, but a difference, nevertheless. Despite that, it’s all too little, too late.
I’m sorry, I am leaving, but this doesn’t have to be goodbye forever. While many doctors have left, plenty are staying. I wish those remaining the very best in reigniting the engine of progress and getting the country back on track.
Meanwhile, I’ll be forging ahead with my own path in a foreign land. When the time comes, I’ll be waiting at the station ahead, ready to board the train again, armed with my accumulated years of experience abroad.
I’m sorry, I am leaving, and fingers crossed, we’ll cross paths again one day, tanah airku tercinta, tanah tumpahnya darahku.
Dr Leonard Goh served as a contract doctor in a government hospital from 2019 to 2022 and is an FMT reader.
From Dr Leonard Goh
I am humbled by the overwhelming support and love from within the fraternity and beyond in response to my previous letter, “I’m sorry, I’m leaving”.
I wrote the letter for a few reasons.
Firstly, I sought to give voice to the multitude of government doctors and other healthcare professionals who have worked hard to make it here, but ultimately found their efforts to be in vain, and are now leaving the country, weary and disappointed.
I also hoped to illustrate that while financial remuneration might be a factor in the decision to leave, there are other intangible aspects at play, such as the lack of job satisfaction and opportunities for self-actualisation.
On a more personal note, I wrote it as a form of closure to my dream of lifelong public service in Malaysia.
While that personal dream has vanished, I am still hoping that my dream for the Malaysian healthcare system will eventually materialise. What can I say? I am a stubborn idealist and fervent dreamer.
I dream of the day when our healthcare system is optimally staffed at all levels and properly equipped. The day when “work-life balance” is a reality rather than an aspiration.
The day when we no longer worry about disruptions in the availability of laboratory tests and medications due to funding issues.
The day when we can rely on regularly maintained equipment rather than rolling the dice with malfunctioning ones.
The day when staff nurses and assistant medical officers are not forced to cover double gruelling 8-hour shifts every other day because there is simply not enough manpower.
The day when we read about doctors dying in car accidents after pulling 36-hour shifts becomes part of history books, rather than newspapers.
I dream of the day when the workload ceases to be overwhelming. Only then, would each patient receive the time that they deserve to better understand their illness and medications.
Doctors and pharmacists would be able to properly educate and counsel every patient. No more would they be compelled, under the pressure of time, to barrage patients with an avalanche of information and hope that it sticks, all within a grand total of two minutes per patient.
Perhaps then our patients will have good health literacy.
I dream of the day when Malaysian patients and doctors are equal partners in the pursuit of health. Patients need to take ownership of their own health, and to seek treatment earlier rather than later.
At the same time, we also need to ensure that they are able to do so by ensuring easy accessibility of tertiary services, not just primary care, across the country.
The elephant in the room in any discussion on healthcare reform is of course healthcare financing.
Without funds, the whole matter becomes moot. The lack of a sustainable financing model underpins all other symptoms of our ailing system.
This thorny issue has been debated multiple times before, with no concrete outcome. Before we demand for action from the government, perhaps we, the rakyat and the owners of our Malaysian public healthcare system, have to recognise the hard truth – the current financing scheme is not tenable and needs urgent review.
A cup of coffee costs way more than RM1 these days, yet we somehow expect that same ringgit to cover a doctor’s consultation, adequate staffing of allied health support services, costs of laboratory and radiological investigations, and even medication supply. This is one pipe dream which will never materialise.
On the other hand, I know that my Malaysian healthcare dream is definitely within our reach. Our country has the brains, and it is slowly building up the necessary will required to affect these changes.
Sustained public discourse and institutional action to revamp healthcare financing is imperative, lest this dream remains exactly that – a mere dream.
Happy 2023, Malaysia. May this year be the year of healing for our public healthcare system.
Dr Leonard Goh served as a contract doctor in a government hospital from 2019 to 2022 and is an FMT reader.
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