The letter by Dr J Veight sends interesting but provocatively conflicting messages. On the one hand, it gives an impression of sour grapes regarding his colleagues' specialist attachment

But is should be noted that qualified doctors from Malaysia who are sent overseas are seldom eligible for formalised specialist training. They take up, for example, positions as Honorary Specialist Registrars in the UK, and may not need to go through the full rigorous and structured programmes the locals compete for and get into.

At the end of that, if they are lucky, they would have acquired enough experience and critical thinking skills which would benefit them wherever they go albeit without a formal certification of specialist training (e.g. the CCST from the UK).

In reality, most Malaysian doctors who go abroad for specialist attachments, do not complete their full programmes and return partially trained, based on the requirements of the host country. This is the sad truth. Some, however, complete their training and stay on at the host country's invitation.

If the said doctor couple were able to acquire a double salary, it was their good luck and fortune. If there had been any impropriety, it would look more likely be the fault of the Malaysian authorities who administered these doctors' appointments.

If the local system had allowed it, the it was the right of the doctors and the folly of the administration (from one point of view). The fact that they towed back a 'new German car' is totally irrelevant for it was their right to do so if they had complied with the law.

The fact of the matter is that there is a shortage of doctors in the UK and Australasia. And while maintaining their high standards but are quite willing to compromise in letting in overseas-born individuals into their medical training programmes, capturing them from the intern (or house officer) year.

This, combined with an offer of permanent residence in the hope that the trainees will fill consultant posts in the future, is certainly very attractive to anyone, government scholar or not.

It boils down to the rules of economics. Patriotism may be fired and fuelled but clever survival instincts definitely play a role be for any medical position candidate. If Malaysia does not treat its public sector doctors well as compared to other countries, it is the government's problem. The blame should not be passed on to overseas countries or individuals, whether Malaysian or not.

The issue is one of globalisation and its impact on the medical workforce and education. There is also some disconcerting talk that education is fast becoming a commercial commodity where standards are compromised .

Hence, if some are trying to persuade the government not to send local medical graduates overseas for further exposure, they are depriving the country of exposure to globalised medical practice and the wealth this type of practice has.

The country will then lack the lustre of a globalised medical practice and the 'misfits' (including myself) will remain abroad while the local scenario evolves only from the influence of internal forces.

Critical thinking skills on the use of evidence-based medicine and their application to a local scenario appear to be the biggest threat to locally established doctors who face non-local and Western trained specialists.

And, this challenge is not confined to Malaysian doctors only but to all doctors throughout the world. Have readers not often heard these statements from doctors, 'At St Elsewhere's we do this' or 'In the opinion of Datuk Dr So and So, this should be done'? (despite the lack of evidence that the move would be beneficial).

Would it not be better to state: 'The good quality evidence suggests that doing this might be most optimal'?