I refer to the letter Profit shouldn't be a doctor's motive and completely agree with Thomas Cramer that a doctor should stick to his altruistic ideals and treat the sick with resolute dedication and commitment. However, in the local setting we should take a few obstacles into consideration that prevents our committed young from discharging their onerous duties.

A medical student, unless he is on a government scholarship, would need to spend RM200,000 to RM1 million depending which medical school he is going to over a period of five to six years to complete his studies. Upon returning home, he would have to spend four compulsory years in government to fulfill his service requirements. The pay during this time is barely enough to sustain him, his family, let alone service the loan (if he had taken one to complete his medical studies).

During these four years, if he had specialised, he would have probably gotten himself into deeper debt. If, like many others, he says four years is enough, he steps into the private sector to 'open a clinic'. He is now in charge of renting the premises, renovating them, buying pharmaceuticals and equipment, hiring staff, billing, chasing after bad debts, negotiating with pharmaceutical companies for better pricing and also marketing his services to factories and ensuring they pay up on time.

He has in fact become a businessman. Not that he wanted to, but the system in this country works that way. Of course, if help comes along from other investors who would be willing to take on the task of administration, the doctor would possibly be more then happy so that he can focus on his work.

Cramer may have his ideals and personally I would just like to see all our doctors properly employed and paid their dues so that they can concentrate on their work but the system in this country dictates otherwise. Perhaps Cramer could lobby his local assemblyman to ensure that doctors need not be forced into business and instead be paid commensurately so as to enable them to work within the ethics of Plato and Hippocrates. All of us have indeed been trying for the last 50 years to change the system with little luck.

Plato's point that medical care is a basic human requirement and Hippocrates stating that it is so clearly wrong for a doctor to put money before treatment and certainly a greater wrong if a businessman sought to profit from treatment given by a doctor are noteworthy. These are true ideals if only we are all employees in a well-funded healthcare system. However, if you are on your own, you need to think about paying your malpractice insurance on time so that if your sometimes non-appreciative patients sue you, you have at least legal and financial cover.

You also need to make certain you pay your rental on time lest the landlord takes a distress order out on you and you must worry about paying your creditors on time before they take a Section 218 notice on your firm and you shouldn't be late paying wages to your nurses, etc so as to avoid sitting in the industrial court for the next ten years.

We all fall to that calling of selfless service of mankind just after school - until we realise there indeed is a real world out there. Perhaps Cramer has yet to visit this world.