We did it

It was crazy but we did it. We took the exploratory journey on the LRT to Taipan, a recently opened line, at night. Actually it was more of the experience of the train ride for the little ones. Ended up walking at least 500m to our destination in Taipan, MacDonalds. The newly launched mango sundae must have tasted exceptionally better there. It was an activity for the children. They will remember it, as they did with other train rides. It was fun and worthwhile. 

The downside of streaming

Despite having fiber optic broadband with 10Mbs data plan, the streaming of Apple TV movies is pathetically slow. This is the problem of streaming and cloud based services, when the infrastructure has not coped with the advancements. Had to resort to the reliable DVD player. 

English among doctors : What has gone wrong in Malaysia?

This article appeared on Medicine Malaysia,


Recently there had been a report in the press about the poor proficiency of the English Language that led to a lot of doctors leaving the profession. Link to article here.

So the question that is begging to be answered is, how well should a doctor or even other healthcare professionals know English? What’s the minimum requirement in a country, where English is not the main spoken language?

For a start, most medical schools are run in English. In Malaysia, all medical schools are run in English. Most medical schools that are recognised by the Malaysian Medical Council, are run in English. It would be rather quite difficult to pass your medical qualifying examination without having a satisfactory level of English competency both written and oral.

The problem lies in the fact that some medical schools are not run in English. In particular medical schools in Indonesia. They are taught in Bahasa Indonesia. Many of the medical texts have been translated to this language.

It is rather perplexing why this would be so, considering that a large majority of the medical texts and journals are in English. Almost all international medical conferences are run in English. Indeed, the international language to communicate amongst doctors is English. Perhaps, Indonesian medical schools are trying to create doctors competent enough for their local environment.

Countries like Japan and China have long understood the necessity to master English in order to compete in a globalised world. Japan requires English be learnt as part of their educational system. In China, teaching English is widespread, especially in more urban communities. The question is, how are their doctors surviving with a still poorer command of English as compared to those from English speaking countries?

Humans have the capacity to learn and master at least 3 different languages. So understanding English and the local language should not have been a problem.

So having good language skills for a doctor has 2 main important purpose.
1. To communicate well with your patient
2. To communicate well between colleagues and healthcare professionals
3. To understand the field of medicine better

One would think that Malaysia, being a former British colony and where English is still part of the educational system, would not have problems. Thus, reporting on Malaysian doctors leaving the profession because of poor English should ring alarm bells for those curating the education system in Malaysia. What has gone so very wrong with our standard of English?

Back to our original question of what is the minimum requirement of English? There has been many reports worldwide of medical errors and negligence due to a poor command of English. In Malaysia, English is still the predominant way of communicating and documenting notes. So if the command of English is poor, what is presumed straightforward may be unnecessarily misunderstood to complicate matters. This may sometimes put the patients’ lives at risk.

‘Limited English proficiency is a barrier to medical comprehension and increases the risk of adverse medication reactions. Access to language-concordant physicians substantially mitigates but does not eliminate language barriers.’ [1]

The best answer to our question is that the higher the proficiency in English, the better it would be. This is especially so among doctors and doctor wannabes. Putting the bar too low will allow doctors with poor knowledge of the language to sieve through. The mushrooming of medical schools, especially private ones, where passing grades may be the difference in students’ choices, is a worry, where standards may be compromised to ensure high passing rates.

Hence the graduation of doctors, ill-equipped with a language that will help them survive in the medical world and keep abreast of important developments and launching them into the cutting edge of medicine.

But the error actually started when the first seeds were sown during the early years of education as a child.

If Malaysia has Malaysian doctors leaving the service after many years of sacrifice because of a poor command of English, then some things have gone very wrong with our current education system, from primary level right up to tertiary institutions.

What we are witnessing now is the result of irresponsible tampering of our education system from decades before. It is now emerging as a growing threat to our competitiveness in an already globalised and connected world.

1 Elisabeth Wilson, MD, MPH, Alice Hm Chen, MD, MPH, Kevin Grumbach, MD, Frances Wang, MS, and Alicia Fernandez, MD, Effects of Limited English Proficiency and Physician Language on Health Care Comprehension, J Gen Intern Med. 2005 Sep; 20(9): 800–806.doi: 10.1111/j.1525-1497.2005.0174.xPMCID: PMC1490205

Learning from mistakes 

This article first appeared on Medicine Malaysia

The recent ‘victory’ for vapers may be the start of a long journey against its ill effects. Cigarette smoking had an eerily similar start with its perceived safety and the false promotion of ‘the’ lifestyle. That has since been debunked in 1964 after the announcement of the Dr Luther Terry, the Surgeon General’s report on the ill effects of smoking. [link]

Vaping has had a relatively short history. We attempt to look at the evidence thus far.

Marini S1, Buonanno G2, Stabile L3, Ficco G3., Short-term effects of electronic and tobacco cigarettes on exhaled nitric oxide, Toxicol Appl Pharmacol. 2014 Jul 1;278(1):9-15. doi: 10.1016/j.taap.2014.04.004. Epub 2014 Apr 13

This article looked at the short term respiratory effects of e-cigarettes versus conventional cigarettes. They measured exhaled nitric oxide (eNO) as a representation of the average particle deposited in the alveolar and transbronchial region of the lungs. Vaping and conventional cigarettes had similar effects and was, as expected, higher than controls. So vaping certainly does not do less harm to the deeper regions of the lungs.

Tierney PA1, Karpinski CD2, Brown JE1, Luo W2, Pankow JF3., Flavour chemicals in electronic cigarette fluids, Tob Control. 2015 Apr 15. pii:tobaccocontrol-2014-052175. doi: 10.1136/tobaccocontrol-2014-052175. [Epub ahead of print]

This looked at the content of e-cigarette fluids. Many had aldehydes, known lung irritants and other formulations/chemicals which are of toxicological concern. The concern is the poor regulations surrounding the production of these fluids and many of them are unlabelled. Many are also self-produced by those trading with these fluids.

There are still many unknowns with vaping. The long term effects will likely be better known in many years to come, especially when more people pick this habit up. It is unfortunate that we are likely to repeat the past and the errors of judgement and deceit prevalent during the heydays of cigarette smoking. Pro vapers have used the notoreity of cigarette smoking to justify their existence, without truly understanding the safety surrounding vaping.

Giroud, de Cesare, Berthet, Varlet, Concha-Lozano, Favrat, E-Cigarettes: A Review of New Trends in Cannabis Use, Int J Environ Res Public Health. 2015 Aug 21;12(8):9988-10008. doi: 10.3390/ijerph120809988.

Vaping apparatus opens up a new method of ‘smoking’ illicit drugs. It brings a dark parallel to the days of opium smoking. There is nothing dissimilar in this episode. Malaysia’s fight against drugs could take an unfortunate turn with the acceptance of vaping. It will create a new environment where the battle against drugs could get complicated and more widespread.

We should not succumb to a still small numbers of pro-vapers, and sacrifice the future of generations to come, just to score a few brownie points. There is no harm stopping it in its tracks while a more detailed study is done.

Let history be our guide and let’s not make the same mistake twice!