Monday, June 6, 2016

Giving up the Struggle… Our Political Frustration, Emasculation & Despair

Giving up the Struggle… Our Political Frustration, Emasculation & Despair

By Dr David Quek, 06.06.2016

Just 2 weeks ago, I had a heated exchange with a fellow colleague, a physician, at our doctor’s lounge in the hospital. It began cursorily enough when we inevitably exchanged our viewpoints on the dismal state of politics in this country of ours.

Then, it escalated when I mentioned in passing that perhaps I’d given up on this country in expecting change or reform for the better… I’d declared en passant that it’s perhaps a ‘lost cause’… Unbeknown to me, that evocative phrase set the sparks flying!

He was suddenly angry with surprisingly pent-up fury… I wasn’t sure exactly why, but on hindsight, perhaps I understood why he was so irascible, so angst-driven of feeling so hopelessly inadequate, as a thinking citizen, a Malaysian. Perhaps like all who aspire for a better modern Malaysia, he had hoped to be able to influence the more positive direction or future of this once beautiful and multi-culturally rich and united nation.

Sadly, this Malaysian dream now appears to be in tatters. Malaysia Boleh or ‘Can-do’ism is dissipating, some would say even disappearing into the black hole of mono-ethnic supremacist politics and systematic clientelistic ‘grand corruption’!

Malaysia by most reckoning among the world’s press of alleged biased ‘noises’, is now seemingly drowning in its quagmire of humongous ‘corruption’ by any other name. The government can choose to call this anything else, even the implausibly farfetched ‘donation’ but this would remain an inerasable blemish that cannot be whitewashed away, or expunged… It is nothing short of shameless political arrogation of ‘business-as-usual’ power-play, that can fool some of the people, some of the time, but certainly not all the people, all the time… Our shrinking Ringgit is testimony to the world’s confidence or incredulity in our economic, fiscal probity and political stability, vis-à-vis our neighbours.

This physician then berated me for having given up on the country. He was aghast that I had so ‘easily’ given up the ghost of so many people’s struggles, after having been quite vocal about our troubled political state in the recent past. He asked what had happened that I had chosen to remain ‘silent’ of late!  I’d plainly stated that I’m just too tired, too jaded, too disappointed, to respond to the unending political shenanigans that go nowhere…

Obviously he had expected me (or for that matter someone, anyone else!) to continually pursue raising the socio-political tempo or ‘consciousness’ as to our devolving nationhood and its meandering collapsing moral compass…

Our opposition politicians are not enough to highlight the woes and tribulations of this punch-drunk nation, now stumbling and staggering to keep afloat and standing. Our social activist groups like ‘Bersih’, G25, G40, or Islamic Renaissance Front, etc. are not enough to spotlight our citizens’ plight and political follies. Ordinary citizens must also stand up to be counted, so he said.

He obviously was happy that someone else was making the correct melancholic noises of angst that is enveloping our sadly besmirched nation. As if these soundbites could help assuage the widespread feeling of anguish and disappointment among many Malaysians who can’t express more clearly or boldly enough… But oh, what’s the point, really, I’d asked?!

He wanted to know if I’d chickened out and why I haven’t been contributing to the national discourse, to lament, nay to articulate, to concretize, to denounce, our declining status, our contentious flirtation with politically-manoeuvred Islamization, of casuistic ‘hudud’ threat of passage in Parliament, our unchecked ranting racism, our selective political persecution of human rights activists, and ‘freedom of speech’ artists, cartoonists, advocates…

Why haven’t more spoken up against those recurrent political and prosecutorial abuses that shatter our hopes: what about those now languishing in jails and/or are being accused, charged and fined for seditious remarks, merely for undeclared gatherings, for throwing yellow ‘Bersih’ balloons, for criticising this government’s corruption and its foundering feckless leaders, its moral decline, its wanton cronyism and its decaying institutions…?

Why are some blatant pro-government troublemakers and racist taunters and instigators let off the hook? Why this flagrant discrepancy in application of the rule of law or by law, by our wayward authorities?

He pontificated that we all have to do more, to contribute more to effecting change in this nation of ours. He wants more of us to speak out more aggressively, and engage more people in this increasingly futile struggle. He expressed that pent-up sense that many intellectuals and the comfortable middle class Malaysians in particular are increasingly feeling, that we as a nation is devolving into a self-destruct mode of a pariah state, an arrogant, corrupt banana republic!

So I asked him perhaps too sarcastically what he thought, would be doing enough to bring about meaningful change for this beloved nation of ours. What should we do, as conscientious and patriotic Malaysians?

Both of us had returned to this country after having worked abroad professionally, so no one can actually accuse us of having copped out as emigrants or ‘pendatang’ immigrants! Even if we chose to remain the silent majority! Even if we opt to hold our tongue, bite our lips, and seethe inside… But does choosing to come home or remain here in Malaysia, signify that we are patriots, who are wholeheartedly entitled or just nominally labelled as citizens? Are just paying taxes, abiding by the law, enough as contributing to nation building? Is being here enough?

Should we just moan, grumble and engage in coffee talk per se? Does just speaking out in the comfort of closeted isolated corridors, doctor’s lounge, ivory towers, ‘sarabat’ (‘mamak’) stalls, or kopitiams, or pubs and/or home lounges, or simple engaging in social media WhatsApp cyber-messages and petulant Facebook/Twitter haranguing, qualify as meaningful efforts on the part of citizens, as working towards a better democracy, a better nation?

Can we indeed help shape our nation’s true destiny or are we doomed to the sophistry of our lost-cause political leaders?

Finally, I asked this fellow physician what he has been doing so far to further the noble cause for a better Malaysia. Has he ever walked the talk? Has he engaged with like-minded people to inspire them to work for a better Malaysia, against the travails of extremist ideologies? Has he spoken up or written anything to the media to express his trenchant views?

Has he taken part in leadership roles or participatory roles to help bring about consciousness or awareness, such as Bersih and others? Has he contributed in kind to help fund change for the better? Or is it all just talk or angst-driven rhetoric?

He clamped down, thoughtful for a minute, seething in anger once again but then vehemently argued that: “I’ve my profession, my family and own musical interest to think of…” he said, as an apologetic climb down…

Thus, I remain deflated, unconvinced, frustrated, emasculated, for indeed, I too am lost… What more do you expect of me, as a Malaysian to do? What more can I do, say or write? What and how much more can I contribute?

Perhaps, each and every one of us must at least engage in this personal and collective conversation with ourselves and others. But at least, we have to try, to start, or else some others out there would… and they have! Life-changing policies are being driven through with minimal thoughts for the greater Malaysian good or common future, except for short-term political gains and Machiavellian scoring points… So what are we to do?

Martin Jalleh in one of his powerful PowerPoint graphic quoted this apt remark by Joan Kirner:

“There is no such thing as being non-political. Just by making a decision to stay out of politics you are making the decision to allow others to shape politics and exert power over you. And if you are alienated from the current political system, then just by staying out of it you do nothing to change it, you simply entrench it.”

And of course, this is paraphrased from one of the more famous Platonic platitudes: “One of the penalties for refusing to participate in politics is that you end up being governed by your inferiors.”

John F Kennedy perhaps states this more magnanimously:

“Let us not seek the Republican answer or the Democratic answer, but the right answer. Let us not seek to fix the blame for the past. Let us accept our own responsibility for the future.”

So, who else can save Malaysia, if not each and every one of us? God Bless Malaysia!

Friday, November 20, 2015

A rent in the curtain...

A rent in the curtain...
Of nocturnal shadows and fading somnolent thoughts....

Light, folds,
grains, patterns, ...
overblown highlights,
contrasts, shadows...
darkness of night stealths
through a rent
in my bedroom curtain...
creeping penetrating fog
of distempered* darkness,
of bleary spreading tentacles
of shadows into nooks,
corners, crannies...
hardening into
the penumbra of opacity
through the cataract
of null light...
seconds... minutes.....
zzz zzz zzz...
soon... to usher in
the first new rays
of dawning light...
A new morn,
a new day beckons!

Why Distempered* darkness? (vexed, troubled, discontented, ill-humoured), my sentiments are clear from the poem above but aptly reflected in the following historical if reflective note:

Newton wrote a letter to John Locke in reply to one of his about the second edition of his book, (15 October 1693): "The last winter, by sleeping too often by my fire, I got an ill habit of sleeping; and a distemper, which this summer has been epidemical, put me farther out of order, so that when I wrote to you, I had not slept an hour a night for a fortnight together, and for five days together not a wink."

Bleary: With eyes blurred or reddened, as from exhaustion or lack of sleep, dull of mind or perception.

Tuesday, September 22, 2015

Why every patriotic Malaysian should participate in Bersih 4 – by David Quek

Why every patriotic Malaysian should participate in Bersih 4 – David Quek

I know that many people are afraid of confrontation and the possibility  of violence, the fear of the unknown, the fear of disrupting our lives.

Some have argued over the futility of Bersih rallies but they are wrong, because the groundswell is growing ever bigger and more powerful. The world and yes, even our detractors, our intimidators are listening and they fear us more than we do them!

There are enough naysayers who believe that being placid and non-provocative is the safest path in our humdrum lives – just pray for karma, divine intervention and trust in our own spiritual supreme being, our god and the inherent “goodness” of our leaders. Vote them out at the next election if we disagree with their wayward governance, we say. Stay the peace, don't provoke the unknown, the possible retribution.

But this would be the easy way out, the cowardly “safe” way out, I would dare say. History has amply shown why staying apathetic in the face of great wrongs and evil is not an option for beneficial social change.

People power has more often than not shown the forceful exit of dictators and autocrats (sometimes sooner but occasionally later, after much hardship and bloodshed even). But we owe it to ourselves and our children to reclaim our stake in a righteous cause and be part of it.

We cannot afford to sit by as history pass us by. We must have the gumption to be morally and physically brave and courageous to play each of our parts as a collective current to sweep away the political leeches who are shamelessly corrupting, pillaging and impoverishing our beloved nation and our limited resources.

Our shrinking ringgit is emblematic of the discontent and the sharp devolution of our once great nation now gone rogue and on the verge of bankruptcy and default. We can't stand idly by as we slide down the increasingly slippery steep slope of a possible failed state.

Don't let the bullying detractors of true democracy derail us from our righteous cause. It behooves each and every one of us who love this nation to stand up and be counted. As playwright and social activist Kee Thuan Chye posits, if not now, when; if not us, then who?

Robert Kennedy expressed this most poignantly: "Each time a man stands up for an ideal, or acts to improve the lot of others, or strikes out against injustice, he sends forth a tiny ripple of hope, and crossing each other from a million different centres of energy and daring those ripples build a current which can sweep down the mightiest walls of oppression and resistance."

Jom Bersih 4! Let's rally and walk for a better Malaysia for all Malaysians, for our dignity, our future and those of our children and our children's children! – August 27, 2015.

* Dr David Quek reads The Malaysian Insider.

* This is the personal opinion of the writer or publication and does not necessarily represent the views of The Malaysian Insider.

- See more at:

Tuesday, March 24, 2015

Mr Lee Kuan Yew: Lessons in Nation-building from a Master Statesman

Mr Lee Kuan Yew: Lessons in Nation-building from a Master Statesman

By Dr David KL Quek

A truly world class statesman passes on...

The past week saw the gradual mawkish deterioration, then finally the demise of one of Asia’s truly iconic statesmen, 91-year old Mr Lee Kuan Yew. It is the closure of one very long sturdy chapter of nation-building at its iconoclastic best or worst, depending on one’s perspective. But I would argue, that the ‘success’ of Singapore speaks for itself, warts and all…

What do we in neighbouring Malaysia think about that, except for the fact that Singapore was once upon a time, a part of Malaysia? That Singapore was unceremoniously kicked out for being that unwanted ‘tumour’ that had to be excised! Mr Lee and his uncompromising coterie of PAP leaders and that ‘small red dot” Singapore were expelled from the then fledgling Malaysia in 1965.

The actual historical reasons for this enforced separation might never be known. But many historians are at pains to note that perhaps Mr Lee Kuan Yew was just too brash, too bull-headed, a tad too chauvinistic, too ethnically Chinese-dominant, to fit into the aspirations of  Malaysia’s fractious founding partners then.

One could argue that his vision of the presumptuous “Malaysian Malaysia” then was perhaps a little too premature for the ethnically-sensitive Alliance leaders of the cobbled together Malaya-Malaysia polity. Even Alliance’s Chinese (MCA) counterpart Tun Tan Siew Sin went on to berate Mr Lee’s “nauseating hypocrisy” at that juncture to reject that call for ethnic inclusiveness as “Lee Kuan Yew’s Malaysia”.

Mr Tan Siew Sin had claimed (1st June, 1965) then that ‘The concept of a Malaysian Malaysia was born on the day the Alliance was born.” But alas, this bold but explicit declaration has been stillborn since Merdeka! Many Malaysians of other ethnic origins than the Malays, now feel increasingly alienated that this precept was not to be, and has never been cast in stone by the current Alliance-Barisan Nasional regime for the past 57 years! Many continue to feel second class, and have been shouted down repeatedly as ungrateful “pendatangs”! In nearby Singapore, Mr Lee’s remit had been singular and plain: race and religion should not foreshadow national vision and mission, so that in that regard, the nation has moved forwards, more united in its (yes, lesser) diversity, with all ethnic groups in tow!

This expulsion of Singapore on August 9, 1965 was a momentous decision made by Tunku Abdul Rahman, our benign if lovable Malaysian founding father, then guided by the political realities of ethnic numbers, Alliance affiliations, and Machiavellian options… The rest as they say, is history… the unparalleled history of Singapore.

What of Singapore then? Resource poor, it has thrived against all odds. Small tiny island, with no natural resources, no water even. To quote Mr Lee who had said in an 2007 interview with the BBC: “To understand Singapore and why it is what it is, you’ve got to start off with the fact that it’s not supposed to exist and cannot exist. To begin with, we don’t have the ingredients of a nation, the elementary factors: a homogeneous population, common language, common culture and common destiny. So, history is a long time. I’ve done my bit.”

But its geographic locale at the tip of the Malay Peninsula was its saving grace—its historic and geographic entrepot trading centre nonpareil continues to bask in its well-tended, well-honed logistics for convenience and superlative efficiency—it continues to be the regional-international hub for trade and financial services. BBC’s recent obituary lauds LKY as one “who transformed that tiny island outpost into one of the wealthiest and least corrupt countries in Asia,” indeed the world over!

It has challenged the wisdom of historical templates of successful or failing nation states, to succeed as never before understood. As well put by contrarian political journalist Zainuddin Maidin (Zam), Lee Kuan Yew “turned tragedy into a blessing”. It has trumped and dismissed snide and disparaging calls as to its unabashed leader-knows-best dictatorship and sometimes arrogant autocracy controlled by a small cabal of political elites.

Over the decades, Lee and his PAP party members have been accused of fostering a state-wide orderly but love-hate-fear relationship with its no-nonsense authoritarian stance. Many of their political dissidents and opponents have faced the jagged edge of ruthless and impenitent repression! Mr Lee and his government brooked little dissent particularly when anti-establishment critics were disdainfully viewed as dismissible unequal upstarts, not at par with their unmatchable standards or calibre for political challenge or debate.

Against political oppositionists—and many have been bankrupted by libel suits—careless, less than impeccably error-free comments or criticisms were punishable under the full weight of the law! Critics, even foreigners and journalists, have been sued for daring to utter other than the un-interpreted facts as deemed ‘accurate’ or have their commentaries retracted when these have been found to be construed as willful distortions, by the Singaporean government.

It has systematically and unapologetically crushed most of the ruling party’s political opponents. Said Mr Lee: “If you are a troublemaker… it’s our job to politically destroy you… Everybody knows that in my bag I have a hatchet, and a very sharp one. You take me on, I take my hatchet, we meet in the cul-de-sac.”

“I had to do some nasty things, locking fellows up without trial. I’m not saying everything I did was right. But everything I did was for an honorable purpose,” Lee had no qualms in saying, in a later interview with The New York Times published in September 2010.

Therefore, the usual Singaporean psyche has been dumbed-down to one of apathetic circumspection and timorous acceptance… the begrudged nanny state might be obvious for all to see, but the manifest economic benefits and wealth generation for the common man in the street, appear to outpace concerns for the lowly-placed neo-Confucianist individual freedom and rights… all for the ultimate greater good! But, be that as it may, many the world over, continue to admire Singapore’s zero-tolerance on corruption, and its indisputable economic success!

“I say without the slightest remorse, that we wouldn’t be here, we would not have made economic progress, if we had not intervened on very personal matters — who your neighbour is, how you live, the noise you make, how you spit, or what language you use. We decide what is right. Never mind what the people think,” an unapologetic Lee had earlier said in 1987.


Being a Johor Bahru born just across the Johor Straits has given me a unique perspective for what it was like to be born and raised in the long-overshadowed sleepy border town, in shocking contrast to our much hallowed and prodigious neighbouring city-state. When I was pursuing my medical housemanship in JB, the Ringgit and the Singapore dollar were at par value, in 1979-1980. The current state of our currency disparity speaks volumes for itself!

In my teens, we students visit each other through societal exchanges, science and math competitions and youth camps, we were not much different both in intellect or education, then… But the contrast in Singapore’s educational push for excellence and meritocracy really began to sweep in, in earnest in the mid-60s and 70s onward.

When I did well enough in the Lower Certificate Examination (LCE), many of us were invited to interview for ASEAN scholarships to study in Singapore, through offers made to individual schools. I opted to stay, but again following good grades at the MCE (Malaysian Certificate of Education), we were offered again to further our education with scholarships to their Junior Colleges, about one quarter of my class left. I stayed on in English College (Maktab Sultan Abu Bakar) for my ‘A’ levels. And the ASEAN Merit scholarships were offered for those of us to further our tertiary education in the then University of Singapore.

Of the top scholars from JB who opted to study Medicine, 4 accepted the Singaporean offers, but 2 of us chose University of Malaya in Kuala Lumpur, for whatever our youthful minds decided—patriotism or fear of the unknown, or just pure whim... More importantly nearly half of those who did well in their A levels went on to study in Singapore, and most have stayed on since…

It is said that most ‘migrants’ to Singapore from Malaysia then, were from Johor, Melaka and Penang. It is now estimated that some half to one million former Malaysians are now Singapore citizens or permanent residents. How much these highly educated migrants have contributed to the nation building of Singapore can be debated and is arguable, but they must have played sufficient if not significant roles in improving the talent pool. These days, the easy immigration policies of Singapore for talent are legend and extremely attractive. Migrants not only come from the usual Chinese/Indian diaspora, but also from the Indian subcontinent, Greater China and indeed from Europe too.

The lure of Singapore as an educational hub, global financial and service centre, world-class healthcare services, high-value manufacturing industrial state, and a decent safe place to live in, has continued to flourish. While Malaysians were attracted by its orderly growth, wealth, proximity and job opportunities, these were initially and predominantly made more attractive because of our close cultural and familial roots. Now Singapore’s global reach remains even more tangibly magnetic. The subtle but increasingly compelling pull effect of Singapore has now blossomed into full bloom: a small, dynamically vibrant, wealthy, corrupt-free and orderly first world polity in the background of third world developing nations… This must surely rank as one of the notable but indisputable achievements of that singular vision of Mr Lee Kuan Yew and his charges.

My reminiscence of the Singapore-Malaysia contrast is to help me rethink the art of the possible, in the divergent political practices in our respective countries, caught in the slipstreams of increasingly widening political exigencies and experiences in our two nations.

Singapore has been brazenly forward looking, people-centred, unashamedly meritocratic, exempliflying its ‘mandarin’ bureaucratic administration par excellence, and is unreservedly development-focused.

Malaysia, on the other hand, appears to have become more and more inward looking, more racially-polarised, more religiously politically-manoeuvred. We are inundated with more unpunished corruption-linked scandals, we're more mired in blinkered rent-seeking/patronage and public-burdened financial straits; almost as if in locked-down self-destruct mode… Dare we hope to have another visionary in the style, the brand and the pragmatic bombast of Mr Lee to re-steer us in another direction?

To sum up, Mr Lee Kuan Yew epitomised that iconic benevolent if autocratic leader-ruler in the mould of an ideal Platonic philosopher-king governor. Or as Mr Lee would have preferred, the arrogant incorruptible Confucian leader-king... Resource-poor but mentally-ideologically resourceful Singapore owes its tremendous success to this one man and his political philosophy!

But that is not to say that Mr Lee had no faults. He had plenty and had acknowledged his cunning and Machiavellian approaches to politics. As can be seen in many of his cringingly brutal and frank quotations, Mr Lee had not always been his flattering best. On the low down he was as crass a bully and an unflinching a dictator as the worst that could be. But his unvarnished if cruel pragmatism and unwavering vision in life had left him in fairly good stead! Importantly the overall sum of his legacy has been more societally benevolent than that of malicious self-aggrandizement, now so prevalent among despicable political princes...

I mean let's just look at Singapore today! Not necessarily the most ideal model of a successful wholesome society, but a damn sight near close to one, that nearly every nation, every leader worth his or her salt, on earth, envy! We salute you Mr Lee Kuan Yew!

“In the end, my greatest satisfaction in life comes from the fact that I have spent years gathering support, mustering the will to make this place meritocratic, corruption-free and equal for all races — and that it will endure beyond me, as it has,” Lee said in his 2013 book, One Man’s View of the World.

RIP Mr Lee Kuan Yew! The world salutes you! Indeed what has Mr Lee left behind, except a very successful and enviable Singapore!

Sunday, January 4, 2015

Stop poisoning the minds of our children with racism ... by Ravinder Singh

Stop poisoning the minds of our children with racism

by Ravinder Singh, via email
fmt, January 4, 2015

The Cabinet’s abdication of its duty to stem the rising tide of racism that could, if not checked, lead to the Talibanisation of this county, has galvanised some very concerned, very senior and enlightened Muslims to come together to make an open stand. The original group of 25 has increased, and has a lot of support from moderate Malaysians.

These include the Sultan of Perak who stated in his Maulidur Rasul address that in 627AD Prophet Muhammad had signed an agreement with monks at the St. Catherine monastery providing a guarantee to protect Christians, their homes and their place of worship.

Why did the Cabinet neglect its duty to stop the racist bigots from spewing vitriol and driving a wedge in the harmonious multi-racial, multi-religious relations that have been the pride of Malaysia as a melting-pot of racial and religious harmony in diversity?

Did the Cabinet feel that it is ‘pantang’ (taboo) or ‘haram’ (unlawful) for it to take cognisance of the activities of the racists and bigots and stop them creating racial discord because they claim to be operating under God’s law over which the Cabinet has no jurisdiction? Who authorised them to speak on behalf of God?

Was the Cabinet afraid of a backlash from the racists who are quick to condemn anyone who dares say that what they are doing and preaching is un-Islamic? Did the Cabinet feel that the words and actions of these bigots had to be allowed in the name of “freedom of speech” although they clearly run foul of provisions in the Penal Code?

The immediate concern of the G25 is no doubt to put a stop to the activities of the racists in operation at the moment. But these racists are just the tip of the iceberg.

An even greater worry than the small band of the noisy, aggressive bigots operating today is the racial indoctrination of children that is talking place. Since the 1980s parents have complained of rising racism in schools and of the ‘Islamisation” of national schools. This is one reason that many non-Malay parents have taken their children out of national schools.

This has become so bad as demonstrated by some incidents in the recent past, e.g. head teachers telling children during assembly to “balik China/India”; putting non-Malay children out of sight of fasting Muslim children during recess so the latter would not be tempted to eat; slaughtering cattle in school compounds; introducing a literature book with a derogatory reference to Indians.

There is a very challenging task ahead for G25 to take race-relations back to the era of the 1950s and 60s. Stopping the present day bigots, be they professors or self-acclaimed religious authorities, is an immediate need before more damage is done to racial harmony.

In the long term, the racial indoctrination of children and young persons must be stopped. If not, the next generation would see droves of racists and bigots, too many for anyone to stop. Talibanisation of Malaysia would then be a fait accompli. What is the number of today’s adults who have already gone through racial indoctrination in some way or other, subtly or directly?

I hope G25 will take note of the greater importance of stopping the racial indoctrination of children and young persons in all institutions of learning, including outfits such as Biro Tata Negara. The real evil is in the indoctrination of tender and young minds who are innocent and know not the treachery behind such teaching of racism.

Something has definitely gone seriously wrong in the teaching of religion for people to become racists when religion does not teach enmity and hatred of people of other beliefs and cultures. In fact religions teach people to ‘do unto others as you would have others do unto you’ and ‘love thy neighbour as thyself’.

Copyright (C) 2009-2014 MToday News Sdn. Bhd.

Saturday, December 20, 2014

Americans Rate Nurses Highest on Honesty, Ethical Standards.... by Rebecca Riffkin, Gallup

Americans Rate Nurses Highest on Honesty, Ethical Standards

Story Highlights

  • Nurses continue to be rated the most honest and ethical
  • Members of Congress, car salespeople get lowest ratings
  • Ratings of bankers and business executives declined this year

WASHINGTON, D.C. -- In 2014, Americans say nurses have the highest honesty and ethical standards. Members of Congress and car salespeople were given the worst ratings among the 11 professions included in this year's poll. Eighty percent of Americans say nurses have "very high" or "high" standards of honesty and ethics, compared with a 7% rating for members of Congress and 8% for car salespeople.
U.S. Views on Honesty and Ethical Standards in Professions
Americans have been asked to rate the honesty and ethics of various professions annually since 1990, and periodically since 1976. Nurses have topped the list each year since they were first included in 1999, with the exception of 2001 when firefighters were included in response to their work during and after the 9/11 attacks. Since 2005, at least 80% of Americans have said nurses have high ethics and honesty. Two other medical professions -- medical doctors and pharmacists -- tie this year for second place at 65%, with police officers and clergy approaching 50%.
Historically, honesty and ethics ratings for members of Congress have generally not been positive, with the highest rating reaching 25% in 2001. Since 2009, Congress has ranked at or near the bottom of the list, usually tied with other poorly viewed professions like car salespeople and -- when they have been included -- lobbyists, telemarketers, HMO managers, stockbrokers and advertising practitioners.
Although members of Congress and car salespeople have similar percentages rating their honesty and ethics as "very high" or "high," members of Congress are much more likely to receive "low" or "very low" ratings (61%), compared with 45% for car salespeople. Last year, 66% of Americans rated Congress' honesty and ethics "low" or "very low," the worst Gallup has measured for any profession historically.
Other relatively poorly rated professions, including advertising practitioners, lawyers, business executives and bankers are more likely to receive "average" than "low" honesty and ethical ratings. So while several of these professions rank about as low as members of Congress in terms of having high ethics, they are less likely than members of Congress to be viewed as having low ethics.
No Professions Improved in Ratings of High Honesty, Ethics Since 2013
Since 2013, all professions either dropped or stayed the same in the percentage of Americans who said they have high honesty and ethics. The only profession to show a small increase was lawyers, and this rise was small (one percentage point) and within the margin of error. The largest drops were among police officers, pharmacists and business executives. But medical doctors, bankers and advertising practitioners also saw drops.
U.S. Views on Honesty and Ethical Standards in Professions Compared With 2013
Honesty and ethics ratings of police dropped six percentage points since last year, driven down by many fewer nonwhite Americans saying the police have high honesty and ethical standards. The clergy's 47% rating last year marked the first year that less than 50% of Americans said the clergy had high ethical and honesty standards -- and the current 46% rating is, by one percentage point, the lowest Gallup has measured for that profession to date.

Bottom Line
Americans continue to rate those in medical professions as having higher honesty and ethical standards than those in most other professions. Nurses have consistently been the top-rated profession -- although doctors and pharmacists also receive high ratings, despite the drops since 2013 in the percentage of Americans who say they have high ethics. The high ratings of medical professions this year is significant after the Ebola outbreak which infected a number of medical professionals both in the U.S. and in West Africa.
At the other end of the spectrum, in recent years, members of Congress have sunk to the same depths as car salespeople and advertising practitioners. However, in one respect, Congress is even worse, given the historically high percentages rating its members' honesty and ethics as being "low" or "very low." And although November's midterm elections did produce a significant change in membership for the new Congress that begins in January, there were also major shakeups in the 2006 and 2010 midterm elections with little improvement in the way Americans viewed the members who serve in that institution.
Previously in 2014, Gallup found that Americans continue to have low confidence in banks, and while Americans continue to have confidence in small businesses, big businesses do not earn a lot of confidence. This may be the result of Americans' views that bankers and business executives do not have high honesty and ethical standards, and the fact that their ratings dropped since last year.
Survey Methods
Results for this Gallup poll are based on telephone interviews conducted Dec. 8-11, 2014, with a random sample of 805 adults, aged 18 and older, living in all 50 U.S. states and the District of Columbia. For results based on the total sample of national adults, the margin of sampling error is ±4 percentage points at the 95% confidence level.
Each sample of national adults includes a minimum quota of 50% cellphone respondents and 50% landline respondents, with additional minimum quotas by time zone within region. Landline and cellular telephone numbers are selected using random-digit-dial methods.

View complete question responses and trends.
Learn more about how Gallup Poll Social Series works.

Wednesday, December 17, 2014

Doctors Prescribe, Pharmacists Dispense, Patients Suffer .... by Product Of The System

Doctors Prescribe, Pharmacists Dispense, Patients Suffer

Real Life Scenario
Madam Ong is a 52-year-old lady with a twelve-year-history of hypertension and diabetes. She complained of generalised lethargy, lower limb weakness, swelling and pain. She brought along her cocktail of medications for my scrutiny. Her regular medications included the oral antidiabetics metformin and glicazide and the antihypertensives amlodipine and irbesatan. Madam Ong also had a few episodes of joint pains three months ago for which she had seen two other different doctors. The first doctor suspected rheumatoid arthritis and started her on a short course of the potent steroid prednisolone. Thereafter, she developed increasing lower limb swelling for which a third doctor prescribed the powerful diuretic frusemide. 
Madam Ong was not on regular follow-up for hypertension and diabetes. Additionally, she has been re-filling her supply of steroids and diuretics at a pharmacy nearby with the purpose of saving up on the consultation charges. 

I took a more complete medical history and performed a thorough physical examination. I concluded that this lady’s health was in a complete mess. 
She was under sound management by the family physician until the day she defaulted follow up and was started on prednisolone by a doctor who was unaware she was diabetic. The steroid probably helped in relieving her arthritic pains though the suspicion of rheumatoid arthritis was never proven serologically.
However, it also worsened her sugar and blood pressure control and weakened her immune system. 
Her legs swelled up because of the fluid retentive properties of the steroids. In addition, early signs of cellulitis were showing up around her legs due to a weakened immune function. The diuretic prescribed by the third doctor helped a little with the swollen limbs but she became weak from the side effects of diuretics. 
Madam Ong’s problems escalated when she decided to forgo her doctors’ opinion altogether and decided to self-medicate simply by collecting all her medications from the pharmacist who supplied them indiscriminately. Unknowingly, the pharmacist had added to the lady’s problems in spite of the wealth of knowledge the pharmacist must have possessed. 
The above scenario is a fairly common scene in the Malaysian healthcare. We see here an anthology of errors initiated by doctors, propagated by the patient’s health seeking behavior and perpetuated by a pharmacist.
Noteworthy but Untimely Move 
The Ministry of Health is set to draw a dividing line between the physician’s role and the pharmacist’s, restricting physicians to prescribing and according dispensing rights solely to the pharmacists. 
Such a move virtually has its effects only upon doctors in the private practice and particularly the general practitioner who relies on prescription sales for much of one’s revenue. 
Doctors prescribe and pharmacists dispense. It’s the international role of each profession and very much the standard practice in most developed countries. 
The Ministry of Health however, has failed to take into account the local circumstances in mooting this inaugural move in Malaysian healthcare. The logic and motive behind the Ministry of Health’s proposal is in fact laudable, but only if the Malaysian healthcare scenario is more organized and well-planned.
Spiraling Healthcare Costs
In the United Kingdom, all costs are borne by the National Healthcare Services. In the United States, despite all the negativity painted by Michael Moore’s Sicko, most fees are paid for by health insurance without which one cannot seek treatment. In these countries and many European nations, there is hardly any out-of-pocket monetary exchange between patients and their clinicians. 
This however is not the case for Malaysia. Most patients who visit a private clinic are self-paying clients. The costs of consultation and medications are real and immediately tangible to patients. A visit to the general clinic for a simple upper respiratory tract infection may set one back by as much as RM 50.00 inclusive of consultation and medication. Most clinics these days are charging reasonable sums between RM 5 to RM 15 for consultation. Some are even omitting consultation charges altogether in view of the rising costs of basic healthcare. The introduction of the MOH’s ‘original seal’ to prevent forgery of drugs contributed much to this.
There is no denial that most clinics rely on the sales of medications in order to remain financially viable. From my personal experience, the charges for medications by private clinics are not necessarily higher than pharmacies. In fact, since each practitioner has a stockpile of one’s own preferred drugs, the cost price of the medications can be much lower than that obtained by the pharmacists who need to stockpile a wide variety of drugs. It is therefore a misconception that pharmacies will provide medications to patients at a much lower cost all the time for all medications.
Retracting dispensing privileges from the private clinics will only force practitioners to charge higher consultation fees in order to sustain viability of their practices. In the end, the patients end up paying a greater cost for the same quality of healthcare and medications. Inevitably, much of the increase in healthcare costs will also be passed on panel companies who will then be paying two professionals for the healthcare of their employees. 
In this season of spiraling inflation, this proposal by the Ministry of Health is ill-time and poorly conceived. 
Unequal Distribution of Medical and Pharmacy Services
As it already is, private general practice clinics are mushrooming at an uncontrolled rate. A block of shoplots in Kuala Lumpur may house up to five clinics. Does Malaysia have a corresponding number of pharmacists to match the proliferating medical clinics? If and when clinics are disallowed to dispense medications, the market scenario will become one that heavily favors pharmacists. The struggling family physician suddenly loses a significant portion of his revenue while the pharmacist receives a durian runtuh overnight. 
The situation is worst in the less affluent areas and rural districts where the humble family physician may be the solitary doctor within a 50km radius and no pharmacy outlets at all. For example, there are no pharmacies in Kota Marudu, Sabah and only one in the town of Kudat. Patients seeking treatment in these places will get a consultation but have no avenue to collect their prescription if doctors lose their dispensing privileges. 
The absence and dearth of 24-hour pharmacies is also a pertinent issue. At present, many clinics operate around the clock to provide immediate treatment for patients with minor systemic upset. These clinics play an important role in reducing the crowd size and the long waiting hours at the emergency departments of general hospitals. 
Without a corresponding number of 24-hour pharmacies to dispense urgent medications, the role of 24-hour clinics will be obtunded. The MOH’s plans of implementing its doctors-prescribe-pharmacists-dispense policy will merely backfire and result in the denial of services to patients. 
A Bigger Problem Is The System Itself
The increasing number of medical centers around the country is not necessarily in the patients’ best interests or an indicator of improved healthcare provision. Most clinics and medical centers serve an overlapping population of patients. A person may be under a few different clinics simultaneously for his chronic multiple medical problems, resulting in a scattered, interrupted medical record. One doctor may not be informed of the interventions and medications undertaken by the patient at another practice. The concept of continuous care and a long term doctor-patient relationship is practically improbable. 
This is unlike the system in the United Kingdom where each family physician is allotted a certain cohort of patients for long term care. The doctor remains in full knowledge over his patients’ progress, making general practice one that is rewarding and meaningful. 
The trouble-ridden Malaysian healthcare system prevents optimal clinical practice especially for doctors in the private sector. 
Until the Ministry of Heath puts in place a more systematic and organized approach to healthcare, patients will still be denied optimal medical services despite a clear division between the roles of doctors and pharmacists. The process of prescribing and dispensing is but one step in the cascade of events that may result in harm being done to the patient. Role separation between the doctor and the pharmacist will not eliminate drug-related malpractice and negligence, as I have illustrated in the real clinical scenario above. 
Loss of Clinical Autonomy
Private practitioners in Malaysia are at present enjoying a reasonable sense of autonomy over the health of their patients. In many ways, the freedom of clinicians to make decisions with adequate knowledge of the patient’s needs and circumstances is a plus point in clinical practice. 
Involving the pharmacists in the daily management of every patient removes a great part of the doctor’s control over the clinical circumstances of the patient. He may prescribe one drug only to be overruled by the dispensing pharmacist later. The clinician has privy to much information about the patient’s circumstances that are available only in the patient’s medical records. It is based on this information that a clinician makes decisions on the final choices of medications for the patient. 
A dispensing pharmacist does not have access to such priceless clinical history and may very well make ill-informed decisions in the patient’s medications. Once again, my introductory scenario demonstrates how pharmacists can help perpetuate a patient’s mismanagement. 
Selective Implementation of Rules
Rules in any game should be fair and just and implemented on both parties. If doctors are to be prohibited from dispensing, shouldn’t pharmacists too be forbidden from diagnosing, examining, investigating and prescribing? 
Yet this is exactly what takes place everyday in a typical pharmacy. 
I have seen with my own eyes (not that I can see with someone else’s eyes anyway) pharmacists giving a medical consultation, performing a physical examination and thereafter recommending medications to walk-in customers. It is also not uncommon to find pharmacies collaborating with biochemical laboratories to conduct blood tests especially those in the form of seemingly value-for money ‘packages’. These would usually include a barrage of unnecessary tests comprising tumor markers, rheumatoid factor and thyroid function tests for an otherwise well and asymptomatic patient. 
Pharmacists intrude into the physicians’ territory when they begin to do all this and more. 
Doctors may occasionally make mistakes due to their supposedly inferior knowledge of drugs despite the fact that they are trained in clinical pharmacology. 
In the same vein, pharmacists may have studied the basic features of disease entities and clinical biochemistry but they are nonetheless not of sufficient competency to diagnose, examine, investigate and treat patients. Pharmacists are not adequately trained to take a complete and thorough medical history or to recognize the subtle clinical signs so imperative in the art of differential diagnosis. 
In more ways than one and increasingly so, pharmacists are overtaking the role of a clinical doctor. Patients have reported buying antibiotics and prescription drugs over the pharmacy counter without prior consultation with a physician. 
If the MOH is sincere to reduce adverse pharmacological reactions due to supposedly inept medical doctors, then it should also clamp down on pharmacists playing doctor everyday in their pharmaceutical premises. Patients will receive better healthcare services only when each team member abides by and operate within their jurisdiction. 
The move to restrict doctors to prescribing only while conveniently ignoring the shortcomings and excesses among the pharmacy profession is biased and favors the pharmacists’ interests. 
The Root Problem is Quality
A significant issue in Malaysian healthcare is that of the quality of our medical personnel. This includes doctors, dentists, nurses and pharmacists, therapists, amongst others. A substantial number of our doctors are locally trained and educated. If current trends are extrapolated to the future, the number of local medical graduates is bound to rise exponentially alongside the unrestrained establishment of new medical schools.
The quality and competency of current and future medical graduates produced locally is an imperative point to consider. Competent doctors with a sound knowledge of pharmacology will go a long way in improving patient care and minimizing incidence of adverse drug reactions. The very fact that the MOH resorts to the drastic step in prohibiting doctors from dispensing medications indicates that it must be aware of the high prevalence of drug-related clinical errors. 
Much of patient safety revolves around the competency of Malaysian doctors in making the right diagnosis and prescribing the right medications. Retracting dispensing rights from clinicians therefore, will not solve the underlying problem. Our doctors might still be issuing the right medications but for the wrong diagnosis. In the end, a dispensing pharmacists will still end up supplying the patient with a medication of the right dosage, right frequency but for the wrong indication. 
Patient safety therefore begins with the production of competent medical graduates. The problem lies in the fact the same universities producing medical doctors are usually the same institutions producing pharmacists. It is really not surprising, since the basic sciences of both disciplines are quite similar. Therefore, if the doctors produced by our local institutions are apparently not up to par, can we expect the pharmacy graduates who learnt under the same teachers to be much better in their own right?
Among other remedial measures, my personal opinion is that the medical syllabus of our local universities is in desperate need for a radical review. There is a pressing need for a greater emphasis on basic and clinical pharmacology. At the same time, the excessive weightage accorded to paraclinical subjects like public health and behavioral medicine need to be trimmed down to its rightful size. Lastly, genuine meritocracy in terms of student intake, as opposed to ‘meritocracy in the Malaysian mould’, will drastically improve the final products of our local institutions. 
The MOH’s Own Backyard Needs Cleaning
Healthcare provision in Malaysia has undergone radical waves of change during the Chua Soi Lek era. The most sweeping changes seem to affect the private sector much more than anything else. The Private Healthcare Facilities and Services Act typifies MOH’s obsession with regulating private medical practice as though all doctors are under MOH’s ownership and leash. 
An analyst new to Malaysian healthcare might be forgiven for having the impression that the Malaysian Ministry of Health is currently on a witch hunt in order to make private practice unappealing and unfeasible in order to reduce the number of government doctors resigning from the civil service. 
Regardless of MOH’s genuine motives, it must be borne in mind that private healthcare facilities only serve an estimated twenty percent of the total patient load in the whole country. The major provider of affordable healthcare is still the Ministry of Health and probably always will be. Targeting private healthcare providers therefore, will only create changes to a small portion of the population. Overhauling the public healthcare services conversely, will improve the lot of the remaining eighty percent of the population. 
At present, the healthcare services provided by the Malaysian Ministry of Health is admittedly among the most accessible in the world. The quality of MOH’s services however, leaves much to be desired. Instead of conceiving ways and means to make the private sector increasingly unappealing to the frustrated government doctor, the MOH needs to plug the brain drain by making the ministry a more rewarding organization to work in. 
The MOH needs to clean up its own messy backyard before encroaching into the private practitioners’. 
An indepth analysis of MOH’s deficiencies I’m afraid, is not possible in this article. 
MOH’s “To Do List”
The prescribing-dispensing issue should hardly be MOH’s priorities at the moment. 
I can effortlessly think of a list of issues for the MOH to tackle apart from retracting the right of clinicians to dispense drugs.
Private laboratories are conducting endless unnecessary tests upon patients and usually at high financial cost despite their so-called attractive packages. In the process, patients are parting with their hard-earned money for investigations that bring little benefit to their overall well being. Mildly ‘abnormal’ results with little clinical significance result in undue anxiety to patients. More often than not, such tests will result in further unnecessary investigations. The MOH needs to regulate the activities of these increasingly brazen and devious laboratories. 
Medical assistants trained and produced by the MOH’s own grounds are running loose and roaming into territories that are far beyond their expertise. It is not uncommon to find patients who were on long term follow up under a medical assistant for supposedly minor ailments like refractory gastritis and chronic sorethroat. A few patients with such symptoms turned up having advanced cancer of the stomach and esophagus instead. The medical assistants who for years were treating them with antacids and multiple courses of antibiotics failed to notice the warning signs and red flags of an occult malignancy. They were not trained in the art of diagnosis and clinical examination but were performing the tasks and duties of a doctor. There is no doubt that the role of the medical assistant is indispensable in the MOH. Just as a surgeon would not interfere with the role of an oncologist, medical assistants too must be aware of the limits of their expertise. MOH will do well to remember the case of the medical assistant caught running a full-fledge surgical clinic in Shah Alam in late 2006. 
Adulterated drugs with genuine risks of lethal effects are paddled openly in road side stalls and night markets. They are extremely popular among folks from all strata of society who rarely admit to the use of such toxins to their physicians. It is possible and highly probable that many unexplained deaths taking place each day are in some way related to the rampant use of such preparations.
Non-medical personnel are performing risky and potentially lethal procedures daily without the fear of being nabbed by the authorities. These are mostly aesthetic procedures. Mole removals, botulinum toxin injections and even blepharoplasty are carried out brazenly by unskilled personnel and usually in the least sterile conditions. It makes a mockery of the plastic surgeon’s years of training but above all, proves that the MOH is indeed barking up the wrong tree in its obsession to retract the dispensing privileges of medical practitioners. 
Closing Points 
In summary, a patient’s health is affected by many factors – a doctor’s aptitude is merely one step in a torrent of events. The health seeking behaviors of patients play an imperative role in the final outcome of one’s own health. Most harm to patients can only occur as a result of unidentified minor errors in the management flowchart of a patient. If allowed to accumulate, such errors converge as a snowball that threatens the long term outcome of an ill person. 
There are a multitude of other clinical errors apart from prescribing and dispensing, some of which are not at all committed by trained medical staff. The MOH must get its priorities right by first overhauling an increasingly overloaded public healthcare service. 
Lastly, the difference between a drug and a poison is the dose. A toxin used in the right amount for the right condition is an elixir. A medication used in the wrong dosage and for the wrong indication is lethal poison.

Tuesday, December 16, 2014

APHM warns cost of private healthcare will rise... By Melissa Annabelle Lawson

APHM warns cost of private healthcare will rise
The Sun Daily: 15 Dec 2014
By Melissa Annabelle Lawson

PETALING JAYA: The Association of Private Hospitals of Malaysia (APHM) has warned that the cost of private healthcare will experience at least 5% increase starting from April 1 next year due to the Goods and Services Tax (GST) coming into force.

Speaking at a conference today, APHM president Datuk Dr Jacob Thomas said private hospital doctors are independent practitioners who work in the hospitals on a contract basis and are not employees unlike medical officers in public hospitals.

He said imposing the consumption tax on their services will only lead to patients having to dig deeper into their pockets.

"We have repeatedly consulted the Ministry of Finance and the Customs Department to appeal for health care services to be regarded as Exempt Supply but we were rejected. Instead, it was suggested that the hospital absorbs the additional cost but this is hardly a feasible option and will lead to small hospitals going bankrupt," he added.

He said that this was contrary to Health Minister Datuk Seri S. Subramaniam's assurance on Nov 3 that GST would not impact healthcare cost.
Jacob stressed that with the implementation of GST, hospital operational costs such as security, laundry and housekeeping services will increase and this will inevitably be borne by the patients who use them.

He also said that there were conflicting statements on whether GST would be implemented on drugs and medical equipment.

"There have been 5 different updated guidelines in the past two months. We are still waiting for the list on equipment that are exempted from GST," he said.

"Around 45-70% of a patient's medical bill, depending on the medical procedure involved, is the doctor's portion and thus when the doctor's fee and medication increase, we can predict a big shift of patients from the private sector to the public sector," Jacob said, adding that this would subsequently clog up the public healthcare system.

"If the policy on private healthcare services cannot be revised, we ask that the Government stop giving false assurances about GST not impacting the cost and instead, tell them the truth. This is to avoid the mismatch between the perception of the public, government's intention and implementation by the industry," he stressed.

In addition to rising private healthcare cost, Jacob said insurance premiums would also be affected although he could not determine the extent.
"Some 13% of the country's healthcare is in the private sector. The country's private sector ranks third in the world. It will be challenging to maintain such an achievement if prices shoot up."
Jacob said that the price increase would affect everyone as private healthcare is not limited to a certain social class.

"Doctors in the government hospitals also refer their patients to private hospitals for certain procedure,." he elaborated.

Copyright © 2014 Sun Media Corporation Sdn. Bhd.

Doctors Are Fighting With Their MBA Bosses... By Natalie Kitroeff

Doctors Are Fighting With Their MBA Bosses
By Natalie Kitroeff
Businessweek: July 31, 2014 3:16 PM EDT

Tensions between physicians and the business school types managing them have brewed for years, as health care shifted toward relying on business people rather than clinicians to run medical centers. Now the strains are beginning to creep into public view. It can get ugly.

In Australia, outrage among a doctors’ group erupted this spring after a coroner’s investigation into the suicide of a young girl suggested that medical mismanagement was a factor in her death.

Some 20 psychiatrists signed an open letter protesting the lack of a physician-led governance structure in the hospital system, according to a report in the Australian Medical Association’s magazine. Following the coroner’s inquiry, a doctors’ trade group sent a letter to the government demanding that the hospital system in question incorporate more psychiatrists in its leadership and throughout its ranks.
The incident is an extreme example of more common tensions over practices often favored by those trained in management rather than medicine.

Experts say disagreements between clinicians and managers, over such things as paying doctors based on their performance, are cropping up in hospitals across the globe. Some industry insiders fear that patients may bear the brunt of the fallout.

“It’s as if the patient’s a pawn in this struggle for influence and control between physicians and nonphysicians,” says Todd Kislak, a Harvard MBA who worked for nearly a decade as a senior manager in a physician group.

The business of health care is roaring—especially for nondoctors. Jobs in the industry increased 75 percent from 1990 to 2012, but the vast majority of new positions didn’t go to M.D.s, according to an analysis published last year in the Harvard Business Review. Today, the field counts 10 managers and managers’ helpers for every one doctor.

Doctors’ offices hold an uncomplicated allure for MBA students. The health-care industry has been good to students of business, handing out consistently reliable job offers and among the highest raises of any profession, according to a survey by the Graduate Management Admissions Council. One in every 20 B-School graduates goes into health care, according to GMAC.

That trend does not sit well with some medical practitioners.

 “Physicians may have their faults and problems, but every one of us swore an oath at some point that we would put your interests as patients ahead of everything else,” says Roy Poses, a professor of medicine at Brown University’s Alpert Medical School, adding that executives tend to put revenue first.

“If I have to work as a physician for managers like that, they may push me to do what will make them a lot more money fast, even if this would be useless, or even harmful to you as a patient.”

Hospitals run by so-called professional managers have chief executives without clinical experience or a degree in medicine. A 2009 study showed that trained physicians are the leading administrators in just 4 percent of hospitals in the U.S.

Recent research casts some doubt on whether the influx of card-carrying managers has been good for the health of Health Inc. In a 2011 performance review of roughly 300 hospitals, Amanda Goodall, a professor at City University’s Cass Business School in London, found that the ones led by physicians were ranked 25 percent higher than the average hospital. Another study, released last year, showed that hospital systems in England with more clinicians in the boardroom had lower death rates.

“Leadership positions should be held by people who have the core business expertise,” Goodall says, a description that she said doesn’t fit people who are versed in managing people rather than treating them.

Not all physicians want to be bureaucrats, however. Getting doctors to volunteer for top jobs can be stymied by their natural aversion to the C-suite jungle, Goodall says. Professional managers have “created a world in which they can live in quite happily. But that world, to a large extent, excludes the experts.”

That may change as students of medicine begin to learn about the business world. Educators have gradually warmed to the idea of teaching med students at least some of what it takes to run a business, and now more than half of all medical schools offer a joint M.D./MBA program, according to a study in the peer-reviewed Physician Executive Journal.

Making hospitals run well for patients isn’t as simple as kicking out the MBAs, however. Most agree that managers bring a crucial set of skills to health care. “Being an expert isn’t a proxy for having leadership experience and management expertise,” Goodall says.

Todd Kislak, the former hospital manager, says that doctors often “don’t have the understanding of economics finance accounting” to administer giant health-care organizations efficiently. “Hospitals are a business, and they’re also a place of caregiving.”

The only way to eliminate the tension between the businesspeople who run hospitals and the doctors who work in them is to merge the two tribes, Kislak says.

“The coats vs. the suits,” he says. “What you need is people who can wear both.”