Primum non nocere and other random ruminations

There are many ills in the medical sector to shout about today, thanks to the emergence of a healthcare industry with too many players, agendas and vested interests.

From Dr Venugopal Balchand

Taking a wild swing at the medical fraternity, it seems, has become part-and-parcel of this New Year celebrations in Malaysia.

Doctors, hospitals, regulatory bodies, insurance companies and the ministry of health have all featured in the lyrics of our own version of Auld Lang Syne sung with a fervour that eclipses the need for a perfect pitch.

And why not? From the totally avoidable imbroglio involving the Annual Practicing Certificates (APCs) for doctors, the alleged trespasses of the medical insurance industry into the arena of clinical medicine, the alarming rise in the cost of private healthcare and insurance premiums, the physical and emotional burnout of the personnel in an overstretched, overutilised, grossly underfunded and certainly inadequately staffed public healthcare system to the rising instances of alleged medical negligence and the debatably insane quantums awarded to victims of such negligence, there indeed have been so many issues to shout about.

When I walked out of medical school exactly 40 years ago, medicine was still a vocation. A noble one. There was a doctor who wanted to help, a patient who hoped to get better and a mountain of trust across the consultation table.

Today that vocation has metamorphosed into the industry of healthcare! Now, there are far too many players, agendas and vested interests so much so that many doctors feel like they are the low hanging fruits in this manicured garden.

Often ripe, easy to pluck and chew on and spit out if the fruit tastes bad or the seed is too hard to swallow.

The Malaysian Medical Council (MMC) certainly messed up with the issuing of the APCs for doctors for the year 2026.

With 75,000 of those certificates issued at a minimum cost of RM100 each, one certainly had every right to expect the MMC to show much better preparedness, efficiency and a sense of urgency for a largely automated task.

For a revenue of RM7.5 million just from APCs, they should have put the processes in place for the anticipated last-minute surge in applications, hired the necessary manpower and also kept in readiness an eloquent statement should there be a delay.

Sadly, they did not. But it does not take anything away from the fact that the MMC is the sole authority vested with deciding who can practice medicine in this country. Not the courts. Not the lawyers. Not the media.

And the MMC did issue a statement dated Jan 3, 2026 saying that all those who had submitted valid and complete applications on or before Dec 31, 2025 would now be granted an extension, with the APC backdated to Jan 1, 2026.

To me, this statement was eerily similar to the notice put up by the Bar Council on their website dated Dec 30, 2025 regarding the APCs for legal practitioners for the year 2026.

In spirit, both the MMC and Bar Council statements were identical in their message. The matter should have ended there. Yet the doctors courted so much attention, even from their learned friends at the Bar.

Hypocrisy? Making mountains out of molehills? Here is a verbatim reproduction of the relevant passage from the Bar Council Circular No 468-2025:

Practicing without a Practicing Certificate after Dec 31, 2025.

(B) Practicing after Dec 31, 2025

Section 29(3) of the Legal Profession Act 1976 (LPA) provides that if a member has duly complied with section 29(1) of the LPA (relating to the application for Practicing Certificates) “in the month of January of any year, the Practicing Certificate issued to him in respect of that year shall be deemed to have been in operation from the first day of January of that year.”

If indeed there are legal loopholes in the Medical Act regarding APCs, I hope that those in the corridors of power do take a leaf out of the Bar Council’s experience and plug these holes at the earliest. It is very sad if clerical and purely administrative delays are used to tarnish the entire canvas of a profession, that almost on a daily basis, goes well beyond the call of duty.

I was amused by a recent article where the author had hypothesised the possibility of thousands of unregistered doctors let loose on the streets of Malaysia! Reminded me of a scene from a horror movie where rabid dogs go around mauling and tearing the flesh of unsuspecting victims.

That was such an unnecessary exaggeration. Scare mongering perhaps, with a combined genius of the science fiction of Carl Sagan and the murder mystery of Stephen King.

And mind you, these were the same animals who until 11.59pm on the Dec 31, 2025 had affectionately licked the wounds of persons harmed by others or Mother Nature and provided the only hope of a fresh sunrise to those in the sunset of their lives. What irony!

Primum non nocere is a Latin phrase meaning “first, do no harm”. It is a fundamental ethical principle in medicine emphasising that healthcare professionals should prioritise patient safety by considering potential harm before any intervention.

Though often linked to the Greek physician Hippocrates, it is not a part of the actual Hippocratic Oath recited by doctors upon graduation.

We doctors however, take this mantra so much to heart that I do not know of a single doctor who wakes up in the morning wanting to intentionally hurt a patient.

In closing, let me put it to all of you that doctors ain’t no “country bumpkins” unaware of or unwilling to practice safe medicine within a proper legal framework.

It is exactly what clinicians have always wanted to and aspired for. Constructive criticism is the bedrock of continuing improvement of any institution, but hype, sensationalism and misconstrued assumptions can certainly be avoided by all and sundry. - FMT

Dr Venugopal Balchand is an FMT reader.

The views expressed are those of the writer and do not necessarily reflect those of MMKtT.