Amongst the uproar and controversies about student's abilities, medicine, education, meritocracy, the NEP, university admission policies and the politics of it all, I would like to ask this question:

What is it like being a doctor in the new millennium and what is new?

The rote learning of yesteryear should not be with us anymore. The ability to gorge, retain and then vomit information for the purposes of passing an examination is the worst way to become a doctor (or any other professional). Yet, this appears to be part of the system and is accepted by institutions and the public.

My hypothesis for why there are so many 'straight A' students today is this - it is not that they are cleverer than their forebears but that they are better at learning from past examination questions, that's all.

And I wish I would be proven wrong. The indirect evidence for this assertion is that I have taught clinical medical students in Malaysia, the UK and in Australia and find that many of those 'straight A' scorers have a disproportionately limited capacity to solve simple problems compared with their peers.

Other university teachers will tell you the same. There are, of course, those who will do well everywhere they go (and they need not study past years' questions too).

How do we solve this? The problem appears to be a systems error. The first way to solve it is to focus on quality and not quantity. A good yardstick is to eat humble pie and try to get re-accreditation by the General Medical Council of the UK, which Universiti Malaya lost some years ago, after which politicians arrogantly asserted that 'we do not need them to tell us what to do.'

Another is to look critically at those many global medical schools which offer to train students on a capitation fee system. If these are ever considered, more stringent criteria ought to be applied and with two or three phase recognition processes.

Here is an example of what I consider what a contemporary medical curriculum might be like as written brilliantly by a medical student.

Authorities must never believe that they can churn out large quantities of robotic doctors who will follow their directives for their grandiose plans of privatisation or for increasing competition in a free-market system.

In any decent democratic society when there are poor people, the government must have some form of social welfare to support this group on health matters and it needs to have high-quality doctors to hold the public fort.

The issue of high quality bumiputera doctors being trained, should also not even be considered. Instead, the real issue is that the nation should try its utmost to produce good quality doctors from all who win places at local universities.

For all races, there is a biological distribution of intelligence and ability, and manipulating this is probably asking for trouble. Both nature and nurture have their place even in medical education. This is not meant to be a racially provocative statement but one which is scientifically sound. I have good bumiputera friends who are good doctors by global standards but many choose not to return.

I also know of many non-bumiputera (as well as bumiputera) doctors who are not-so-good doctors by global standards, and who, in all honesty, will never make it to be doctors in nearby Asean countries, let alone the developed world.

They may be my friends but I will not see them as a patient and neither will I entrust my family to see them. Last year, whilst on vacation, my wife took our daughter to see a private Bolehland-trained child specialist who claimed to be an expert in chest disease and a full professor at a university in the Klang Valley.

Furthermore, he was and is the chair of a working group for drawing up Malaysian practice guidelines. Much to my horror, and for no good reason, he prescribed steroids and when challenged, flimsily defended his decision though he realised that he was dealing with an overseas-based specialist who continues to learn like a medical student. Enough said.

Medicine is a journey of life-long learning and humility - unlike the popular and false concept that once qualified, one is able to 'let loose'. The former is not new and was noted by Hippocrates himself.

David Sackett, the father of modern evidence-based medicine asserted that half of what we learn as medical students is either wrong or will be proven to be wrong - the problem is that we do not know which half!

In a well-written inspirational Christmas lecture to students, Richard Smith, editor of the British Medical Journal, wrote of the difficulties one faces on a medical journey and this should be essential reading for all the doctor wannabes in Bolehland.

For those young people who aspire to be doctors, again, may I tell you it is not going to be an easy journey. It is a lifelong process of self-learning and unlearning, balancing social challenges against an exponentially expanding scientific evidence base and still having to retain those humane qualities of empathy, humility, inquisitiveness and creativity.

And, to add to all this, they will need to support and entertain their families. That is why it is hard to get into medicine - even in Bolehland. But, amongst all this, it is still alright to say, 'I don't know.'

And, to those consumers and politicians out there, do acknowledge that it is not easy to be a good doctor - and that it's not difficult to be a bad one either!