Of Fake dentists, and You tube tutors

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Cobwebs on my blog from the lack of entries but it was for a good reason. I was working on a proposal paper and told myself that I can only write my blog once I’ve completed. But recent events have of falling sick for a good 2 weeks and then my birthday and then all the hype in the media made me decide.. I cannot contain my itching fingers anymore.

So I celebrated my birthday last Sunday without much planning or expectations. Being sick for two weeks prior really takes the life out of you and handling kids enduring exams adds more to the misery. But it turned out much more than I expected, and I would like to thank everyone who took the effort to wish me Happy Birthday via FB, Instagram, Whassap, calls and also those who took the effort to take me out and treat and sing happy birthday to me. Altogether more than 400 wishes, I feel so blessed and loved even though I do not get to see most of you a lot. Also thank you to those who are planning to take me out for a treat. I really appreciate these little things since these are the things that no robot or digital technology can ever replace, the human touch.

Speaking of the human touch, it brings us to the topic of my blog today. This is not an entry on aesthetics, but rather an overall of our medical ethical practices in this country. Recently, there was news of a young girl who played dentist despite not having any proper qualifications or training and was offering services to the public. The Dental Association was quick to report and she was sued for fraudulent practice and was given fine of RM 70,000 and jail for her offence. What made this story interesting was how the media and the society reacted. One association started to collect donations on her behalf stating that we should help her since she was young and she was sorry and then later denied any claims of doing so. A deputy minister was said to be backing her up and later denied helping her, but then admitted to forwarding her letter of appeal to the Dental Association. Finally the issue settled and she paid the fine and spent a few days in jail and hopefully she has learnt a thing or two from this incidence. Kudos to the Dental Association that stood their ground in maintaining the quality of practice.

What impresses me is really how shallow the mindset of our people. A medical and dental degree is a very expensive degree. Not just expensive in terms of money but the time commitment and dedication towards the fraternity and practice. The study requires really high level of competency, intellect and discipline hence why only the cream of the creams are accepted into public medical and dental colleges and even that some do not even make it to the end. Doctors and dentist spend their lives studying to perfect their art, and people can simply assume that you can learn these things via Youtube? I cannot comment too much on dentistry but I know the things going on in my own fraternity.

Medical aesthetics is a relatively new field in this country despite a lot of us already practicing for decades. However, only recently in this past few years has it been recognized as a new field that requires accreditation and training. There is actually a very distinct line between an aesthetic medical practitioner and a beautician or aesthetician, where as only medical practitioners are allowed to use injections, injectibles or any of the semi invasive treatments such as threads or mesotherapy etc. And even among medical practitioners, only those trained to use injectibles, threads, chemical peels, etc are suppose to use them.

You notice how i use the word suppose. Unfortunately in this country, every Tom, Dick and Harry wants to do medical aesthetics. The beauticians, the aestheticians, general practice drs who are untrained, specialists who are untrained, nurses, medical assistants, bogus doctors, hairdressers, traditional healers and the list goes on. And surprisingly patients still go to them despite knowing that they are not suppose to be offering this service. In fact, some people can arrogantly claim that non doctors inject better than doctors where as, the truth is, they have never seen a properly trained medical aesthetic doctor. Most of these people refer to You Tube to learn how to do Korean threads, lifts, eyelift surgeries, filler injections and botulinum toxin injections and assume it is that easy.

Apparently, it is not. If you are in the loop of the fraternity and the industry, you will start to understand the evolution of the medical aesthetic practice. In the past, we all regarded it as an additional procedure done by the dermatologist, or general practice, but sooner or later we realized that it was more to that. It did not fit just one specialty as it comprises of knowledge of surgical anatomy, physiology, dermatology, art, angles, technology and also a lot of psychology. Patients who came for aesthetic treatments were not sick, hence they act differently than sick patients. All procedures done to them are elective, hence informed consent must be given and the consultation is not your mere 15 minute GP consultation. The pros and cons need to be addressed. The procedure, the results and the cost. Being non-invasive or semi-invasive means multiple sessions will be required for the results to be apparent and sustainable.

One of the things that upset me the most was that some doctors only use You Tube to learn and do procedures on to patients. You can use You Tube to revise, or to research a procedure, or look at alternative ways a procedure is done, but a proper hands on training is still required before you touch the patient. When I first started doing medical aesthetics, I admit I was really new. I started with the machines in the office first before I went to injectibles. And even that, it was only after 6 months of attending courses, watching demos and hands on did I inject my first paid patient for botulinum toxins and close to 18 months before I did  any filler injections. Now its close to a decade, and when I look back, I am happy I took my time to learn everything well before starting. A paying patient is not an experiment ground for you unless of course the patient knows and you both agree.

The government is trying to regulate the emergence of aesthetic doctors to ensure that they have a standard quality of practice that they follow. But a few years in with the LCP programs have shown a lot of flaws in the system. But I still applaud their effort although sometimes I wish they would elect people on the committee with true interest in expanding the industry rather than safeguarding their own pockets. Worst still, there are news of doctors charging in thousands for their signatures since it is compulsory for the person applying for LCP get 2 referees who are LCP holders to vouch and sign their log book. But in a way, I do not blame the doctors much. What would you do if you have to sign someone that you do not know and then the government says that if there is any malpractice or mistake done by the doctor you signed you are also liable? There is also this requirement for some doctors to attach to more senior aesthetic doctors or surgeons in order for them to fill up their log book and allowed to sit for the exam.

This is my take on this. The LCP exam is a good idea but the government needs to create a system where the interviews are non-biased. Previously, I do hear complaints of some doctors denied of the LCP due to personal dispute with one of the examiners. Secondly, there should be a rotation of the committee where every LCP holder is given equal chance of being on and contributing their ideas and service for the betterment of the industry. This is to avoid monopoly by certain parties. Thirdly, The ministry of health should regulate all colleges that offers any form of medicinal or dental science program i.e. in terms of syllabus, program cost and the certification awarded. Random checks on the programs to ensure that they are not fly by night courses which will deem useless in the future with unrecognized certifications and all. This help tackle issues of incompetent graduates etc. MOH should play a more role in acknowledging courses done by giving the courses an official stamp etc to show they have complied and met the requirements (even though most education is under the Ministry of Education but I think it is high time the ministry has a strong say, since in the future, they will be the ones handling these people. Fourthly, I don’t think it is fair for LCP holders to be accountable for the mistakes done by the drs that we sign. We are all responsible adults, hence we should be accountable for only the things we did rather than some other person’s mistake. As for in house tagging, I think without any incentives from the government for doctors to tag, I doubt anyone would want to have a junior poking their noses in a private practice.

As for the public, I think you need to open your eyes to a lot of things. Non-invasive treatments are a misnomer. Some of them are quite invasive such as threads, lasers etc. Everything comes with a risk. Do you really want to risk your face just to save a few dollars? Medical aesthetic treatments are elective treatments and therefore, if you can’t afford it, it is better to make do without for the time being. Maybe in the future we will have insurance for medical aesthetics but as for now it is a self paid treatment. Injectibles can appear easy but there are a few cases of nerve damage and blindness from botulinum toxins and fillers. Wrongly placed threads can cause scarring. Lasers and chemical peels can cause burns. And if you really think that your beautician is going to hold your hand after a complication you are mistaken. You cannot even sue them because you did an illegal procedure, by an untrained person in an unregistered premise. The court will throw the case out the door. As for cheaper? I doubt so. I have worked with beauticians before and I have queried prices for procedures and there are many times, the procedure is way more expensive than the usual current rate using unregistered products which God knows contain what and what outcome. Its not uncommon for me to get whassap photos of botch jobs asking me to help but unwilling to pay my consultation fee (yeah, exactly right? You want my knowledge and you are not willing to pay, but you were willing to pay for an idiot to destroy your face).

I really hope Malaysia’s scene will change soon. I really wish people would just start thinking and stop wasting their money on untrained people to fix their problems. When dealing with medical stuff, it can really bring long term disability or even death. And dear Malaysians, please pay your real doctor’s consultation fee. It is after all a professional advice. You can pay a plumber RM 60 just to come and look at the problem and yet some people still question doctors and their professional fee. (We are really entitled to it, its just that Malaysian doctors have been too kind to patients). The government is partly to be blamed as they insist to offer RM 1 service for a full government hospital. I seriously believe that this needs to be revamped and government hospitals should charge more so that people realize that health is valuable and perhaps this will create incentives for them to stay healthy rather than not be sick.