Allow me to converge some of the current discussion threads in malaysiakini - meritocracy, medical seats in universities, seeking overseas medical treatment and Anwar Ibrahim's right to medical care of his choice.

'Acting in the patient's best interest' is a dictum that underpins a doctor's weighty ethical and legal responsibilities. With some imagination, an extension of that maxim could be that it would be in the public's best health interests that future physicians are selected from the brightest and best brains that the country has to offer.

Failing to ensure that the public receives its medical care from the cream of available talent is tantamount to a doctor failing in his duty to act in his patient's best interests. The government should make sure that in matters of health care, only the best is acceptable.

(This argument presumes that our present system of 'two-examination-systems-both- meritocractic' can be dismissed as yet another act of imbecilic wool pulling over our eyes.)

It seems dangerous that a policy of affirmative action could conceivably be applied in the selection of personnel for several critical professions airline pilots, structural engineers and judges to mention a few.

This is unfortunately what we are forced to live with in Malaysia.

I am perturbed by the fact that the main guardians of Malaysian medicine [the Malaysian Medical Council (MMC) and the Malaysian Medical Association - MMA)] are not major participants in the debate on the lack of the application of merit in the selection of local medical students.

Surely these bodies would agree that it would not be in the best interests of Malaysians' medical care in general if sub-optimal candidates are being trained to be the nation's future doctors. How would public trust in the capability of the local medical profession be nurtured if this persists?

Anwar's seeking overseas treatment is not very different from the trend that we notice elsewhere in Malaysia. VIPs and rich Malaysians frequently seek overseas treatment for everything but the most trivial of conditions.

Part of it is the syndrome that 'St Elsewhere' provides better medical care, a situation certainly not unique to Malaysia. Call it by any name, it boils down to lack of final trust in the local scene.

If a person wants to retain the services of a specific specialist for treatment and has the resources to support his faith in that person, it is very difficult to change his mind. Think about how health decisions are made in one's own family.

It is a well-known fact that many Malaysian dignitaries and business tycoons very rarely receive their medical treatment locally. They may seek medical care from Malaysians practising in Singapore and somehow that is acceptable!

Sometimes there is anxiety over personal safety and the need for confidentiality and this is fully understandable. A recognisable name appearing on an operation list for a deadly disease, in a local hospital, could potentially devastate a major corporation.

Malaysian personalities, who are used to being accompanied by bodyguards 24/7, feel very vulnerable in the context of unprotected hospital corridors or operation rooms.

Perhaps we should all wait for the outcome for Anwar's final appeal before we agonise any further about whether he is in a position - as a prisoner (political or otherwise) - to exert a fundamental right to choose his medical treatment.

By common wisdom, if justice is going to be done, he should walk out a free man pretty soon. If it is not, denying him surgery in Germany will simply confirm the fact of on-going abuse of this man.