It is another failing that led to a death connected to Heartlands Hospital, in Bordesley Green, which has already come under the spotlight for a series of fatal blunders.
Richard Clayton

The General Medical Council (GMC) found that the actions of junior doctor Dr Sudharsan Nagendran, from Heartlands, directly ‘contributed to the death of 45-year-old bin man Richard Clayton, from Stechford, who went to the hospital with concerns he had contracted Malaria during an African trip to the Gambia.

Two GPs from an out of hours service, who also misdiagnosed the patient, Dr Asad Zaman and Dr Kevin Woollaston, were criticised and given warnings.

Dr Nagendran wrongly diagnosed gastro-enteritis or food poisoning, and failed to get a second opinion at Heartlands on December 29, 2007.





On January 1, after seeing no improvement in his condition, Mr Clayton and his wife then phoned an out-of-hours GP service, where Dr Zaman failed to diagnose malaria and made the same stomach illness prognosis over the phone.

A second call out to the out of hours service also resulted in Dr Woollaston diagnosing gastro-enteritis over the phone without even speaking to Mr Clayton just hours before his condition worsened and he went to Solihull Hospital, where the deadly illness was finally picked up.

Mr Clayton was admitted to intensive care with severe Plasmodium Falciparum malaria but died of multiple organ failure on January 29, 2008.

A GMC panel ruled that all three doctors had been guilty of behaviour ‘that did not meet with the standards required of a doctor.’

In particular, the investigation criticised the actions of the out-of-hours GPs for failing to obtain a full clinical history, to consider malaria as a diagnosis or to arrange examination or referral of Mr Clayton.

Mr Clayton’s widow Linda said the GMC findings confirmed her belief that the failings of the three GPs directly contributed to her husband’s death.

Family solicitor James Bell, from law firm Russell Jones & Walker solicitors, said: “Although nothing will make up for the tragic death of her husband, Mrs Clayton is pleased that the GMC have taken action against the doctors involved in this case.

“Although he repeatedly expressed his concern that he could be suffering from malaria, his assertions were ignored. He was diagnosed incorrectly three times even though his condition continued to worsen and was not referred to a hospital for examination. Had he been referred in good time, Mr Clayton’s death would have been avoided.

“All three doctors have now been issued with a warning by the GMC which considers it appropriate to register concerns regarding a doctor’s behaviour or performance.”

The system failed, it fell down
Mathilda Cooper's mother

He said: "It was a diagnosis that shouldn't have been missed but it was, with tragic consequences.

"Something in NHS protocols needs to be strengthened. The fact information about her trip to Uganda got lost is quite wrong."

The inquest heard how Miss Cooper, originally from Burrington, Devon, had been visiting her father in Uganda for Christmas.

She had not taken anti-malarial drugs because she had previously lived in Africa, and as a frequent visitor, thought she was immune to the disease.

The politics, philosophy and ancient history student, was feeling unwell by the time she arrived back at her halls of residence in Cardiff in January 2006.

Friend Helen Wheeler said: "She was tired and not her usual self and said she had flu-like symptoms.


She was told during a face to face consultation she had flu. This was not the case
Coroner Mary Hassell

"It was unlike her. She said she had felt ill for a couple of days."

Ms Cooper's condition worsened over the following days, and she displayed symptoms including general tiredness, nausea and upset stomach.

She contacted NHS Direct on her friend's behalf and advisers asked Ms Cooper a series of questions - including whether or not she had recently been abroad.

She was diagnosed with flu and told to see her GP.

The following day she visited her doctor but was not asked if she had been abroad, and did not volunteer the information, so malaria was not suspected.

She was diagnosed with a viral infection and told to return if she continued to feel unwell.

But within four days, the student died, and was discovered in her room by Ms Wheeler.

Mosquito
Malaria can be spread by through mosquito bites

Recording a narrative verdict, Mary Hassell, coroner for Cardiff and the Vale of Glamorgan, said: "I have no hesitation Matti died from malaria.

"In that sense she died from a natural cause, but in this situation it doesn't adequately reflect the sequence of events.

"On 22 January, she was told during telephone conversations with the NHS Direct and the out of hours doctor service, she had flu. This was not the case.

"On 23 January she was told during a face-to-face consultation she had flu. This was not the case.

"Matti died on 26 January from cerebral malaria.

"It was not diagnosed because health professionals did not elicit the information she had been in a high-risk malarial area, or they elicited the information but did not recognise the significance of this."

The MSU-IMS medical program @ Bangalore


Regarding the MBBS program in IMS Bangalore, we study medicine via the traditional method (as with most Indian medical program) and not via problem based learning (PBL).

The program structure is like this: http://en.wikipedia.org/wiki/Medical_college_in_India

Program structure for MSU-IMS MBBS (Click below):



The study environment can be stressful at most of the time (if I say otherwise, I'd be lying to you, its medicine after all). All Indian MBBS program are 4.5years plus compulsory 1 year housemanship (total 5.5years).

- There are 3 phases in the Indian MBBS program. First phase (aka First MBBS), second phase (aka Second MBBS), third phase (consist of part-1 and part-2). Then comes the compulsory 1 year housemanship. If a student fails any of the subject within a particular phase, he/she will NOT be allowed to proceed to the next phase and have to repeat the exam again - exception in Third MBBS. (max repeat phase - twice for the entire program)

Clinical postings and theory classes

- Clinical postings begin at the second year (after passing the first MBBS professional exam).

- Clinical postings (for second and third MBBS students) and clinical lectures are conducted in hospitals (for third MBBS students). Theory classes are conducted in the the IMS campus (for first and second MBBS students).

- For me, morning is for clinical postings (surgery, medicine, ENT, OBG, etc..) - It starts from 9.00AM - 11.45AM (may differ). Clinical posting is where most of the clinical teachings are done (eg; history taking, clinical examinations, etc). On alternate days, there is the Community medicine subject/posting. Clinical postings include Saturdays as well.

- In the evening, theory classes starts at 1.00PM and ends at 5.00PM. The subjects taught in the evening will depend on which phase you are in.

- Currently there are three different hospitals for clinical postings. College Buses are provided for the students to go for their clinical postings.

Exposure and Hands-on training

- First year students get to dissect real human cadavers and can even get real human remains (skulls and bones) to bring back to their rooms for study (hey~ thats India for you~  ).







- I am currently satisfied with the level of exposure and training provided in IMS Bangalore. Hands-on training on patients begins at the second year onwards during clinical postings. One can examine patients all they want in the hospital. Lots of strange and rare cases can be seen here. You can even see lepers (leprosy) walking around in the streets even today in India.







The People, surroundings and climate

- There is a LOT of people in Bangalore. If you think KL is crowded, wait until you see Bangalore. There is a wide gap between the rich and the poor here. Some are extremely and pathetically poor - from these people, we often get rare medical cases that doesn't even exist anymore in Malaysia. Additional info - here - women will be seen doing construction work.

- People can be good (particularly the educated ones) and can be bad as well.Eg; some people here in Bangalore will take advantage of you, seeing that you are a foreigner and a new one at that (this is particularly true for auto rickshaw drivers). Corruption is rampant, some of the police will ask/hint for a bribe, although they are more cautious about this when dealing with foreigners.

- Beggars... there are a lot of them here... various kinds too... they some how can sense if you are new to Bangalore and will persistently follow you around until they get something out of you. There are even special type of beggars here in India, the "pondans" here often demand money from people - this is due to some belief that the Indians have that these "pondans" can cause misfortune if their demands are not met.

- The Indian men here, have the habit of urinating almost anywhere they like, its like nothing to them. They will even stop in the middle of a traffic jam and urinate on a wall or a tree with their backs facing the entire traffic in full view of everyone on the road. They don't care what wall or tree they piss on. Some of the building owners even put pictures of Hindu Gods, Christian cross or even Muslim symbols on their walls to prevent people from urinating on them.

- Traffic here in Bangalore, suckksssss... Really..... KL traffic is NOTHING compared to how terrible the traffic is in Bangalore. For your information - fuel cost is very high here in India - 1 Liter of Petrol will cost around RM5.50 (Malaysia only RM1.90)

- English is widely spoken amongst the educated here in Bangalore, not all Indians speak the same language, hence English or Hindi is used. All lectures in Indian medical colleges are conducted in English. The uneducated however, will not understand English.

- Surroundings... all I can say .... is dirty in most areas.

- Bangalore is rather a dusty place to live in compared to Malaysia and now will be entering the cold season (no snow though, but it is cold nonetheless). Cold season can cause your lips to crack - its not humid cold but dry and cold. Monsoon doesn't seem to effect much of Bangalore since it is situated far inland. Overall... weather is OK... not as hot as Malaysia...



Food and Housing

- Food is ok once you get use to them. Diarrhea is common for the first few weeks of eating the food here. Food is relatively cheap if you eat Indian food eg; Masala Dhosa, Idli, Chapati, Rasam, Sambar etc... honestly... I've never even heard of most of these food before coming here.... Raw material is cheap if you are planning on cooking everyday...

- MSU-IMS students are placed in one area (Gokula area). Students live in apartments (2 bedrooms to 3 bedrooms apt) on a sharing basis. The apartments are fully furnished (study tables, washing machine, water heater, TV, fridge etc). These apartments are managed by IMS. One room can accommodate 2 students, each paying around RM260/month. The electricity is separate from the rental charge but the water supply is FREE.

- Apartments are not within walking distance (although one can walk to the college - takes about 45 minutes). College buses are available in front of the apartment in the morning to carry the students to the college or to their respective hospitals.

- Additional info, read here:


http://www.tutor.com.my/tutor/dunia.asp?y=...if&pg=ps_01.htm

http://www.tutor.com.my/tutor/dunia.asp?y=...if&pg=ps_02.htm

http://www.tutor.com.my/tutor/dunia.asp?y=...if&pg=ps_03.htm


Medical Books and equipments

- Medical books are cheap here... Seriously...~ I take for example "Bailey & Love: Short Practice Of Surgery", here it cost only Rs2914 (RM215) with the standard price being USD128 (RM446).



- Even medical equipments are cheap - for example~ Wellch Allyn Ophthalmoscope and Otoscope junior set cost above USD400 (http://www.allmed.net/catalog/item/1,417,475,477), but here I got both for just USD245.



- Indian made medical equipments are cheap as well, my stethoscope cost me RM25 only and my mercurial sphygmomanometer (BP set) cost me RM70  ~ Both are reliable nonetheless~ 

- The following is my suturing practice board and my very own microscope (hobby):










.... though I'd like to show more pictures, there is a limit in this forum as to how much picture I can upload per post~
Any inquiries~ do ask~ 

Stories like Lina's are not isolated. The pathway to that "elusive" medical degree seems to be getting easier, even for those who don't meet the standards.

Over the last 10 years, Malaysia has seen a mushrooming of private medical colleges to meet the increasing number of high-achieving school leavers who fail to secure the limited medical seats available in our public universities.

At last count, there were 26 public and private universities and colleges offering medical degrees.


While the majority of these universities and colleges impose strict entry requirements, including having distinctions or strong credits in Science subjects at A-Levels, some are a little more accommodating in their pre-entry qualifications.

Many of the smaller colleges offer foundation courses in medicine for those who do not have the minimum entry requirement of strong credits in Science subjects and Mathematics. Students from these colleges go on to pursue a medical degree in lesser known foreign universities, usually in Asia and eastern Europe.

What worries the medical fraternity, and Malaysians in general, is the quality of doctors the less established medical colleges are churning out.

As Malaysian Medical Association (MMA) president Dr David Quek pointed out in the December issue of the MMA Bulletin "it's not just the medical degree from 'any' university, but the prestige and the quality of the medical university or college that truly matters".

The MMA has reason to be concerned as recent reports have indicated that many housemen, including those from local universities and colleges, are so inept that they cannot perform even simple procedures that medical aides, such as nurses, can do.

Dr Quek stresses that the government's goal of trying to achieve a doctor-patient ratio of 1:400 by 2020 is "way too fast and too soon", cautioning that it won't be long before the country faces not just a glut of doctors "but also a possible erosion of standards", due to the insufficient infrastructure and training and supervising personnel to cater to the influx of medical graduates.

A doctor who has been practising for more than 20 years concurs that standards have dropped quite drastically.

"Now, some of these housemen do not even know how to insert an intravenous drip or take a patient's blood pressure or take a proper case history... and these are basics every medical student needs to know."

He adds that when pre-entry requirement standards are lowered, then the industry would eventually churn out sub-standard doctors.

He says even when he was studying in India in the 80's, he knew of students who did not make the grade but were offered seats in some lesser known medical colleges after paying huge capitation fees.

"Some of these students who entered the university a few years before me, had still not completed their studies when I graduated. Some took up to 10 years to complete their medical degree which most of us did within seven years. One wonders how competent a doctor they would be."

He says because of the large number of medical graduates and limited number of teaching hospitals, many were not gaining enough experience during their housemanship.

"As housemen, we used to work 15 to 20 hours daily and if we were on call, it could even be 36 hours. But I am all the better for it as I was able to serve in various hospitals in Kuala Lumpur, Sabah and Terengganu and gained wide clinical experience as we were expected to do everything," he adds.

Read more: Mediocre students becoming doctors http://www.nst.com.my/nst/articles/20spmd/.../#ixzz1ESk7zO5c