Surviving Private Practice in Malaysia -16 Tips on how to be progressive in Private Practice

“There are 2 types of people in the world – learners and non learners” – Rakesh Sinha

A few years ago, the moderator of a lecture, to a group of surgeons, introduced me saying, “The norm is, for a specialist to learn everything that needs to be learnt while in government service, then move on to private practice. However, our next speaker did most of his progressive work while in private practice”.

His observation was correct. I left for private practice 3 years after receiving my membership from the Royal College of Obstetricians and Gynaecologists. I did most of my learning after leaving for private practice. These are some of the things I did since joining a private hospital.

1994 – Training in Laparoscopic surgery training at Chang Gung Memorial Hospital

1997 – Training in IVF in King’s College London then started the Mahkota IVF Centre

2000 – 2003 Masters in Reproductive Medicine – University of Western Sydney

2004 – Organised the International Society of Gynaecological Endoscopy’s
Annual Congress (ISGE)

2006 – Organised a workshop: Laparoscopic Radical Hysterectomy then together with Dr Vijaendreh started performing laparoscopic radical hysterectomy

2008 – Started performing laparoscopic Burch colposuspension and laparoscopic sacrocolpopexy with Dr Suresh Nair

2009 – Became President of the Obstetrical and Gynaecological Society of Malaysia

2010 – Started office hysteroscopy

2011 – Organised the First animal workshop in laparoscopic surgery at Mahkota Medical Centre, Melaka, This was a real challenge as it had never been done before.

2011 – 2017 Organised numerous laparoscopic live surgeries and animal workshops at Mahkota Medical Centre

2012 – Pioneered Single incision laparoscopic surgeries in Malaysia

2013 – Obtained Bachelor in Laparoscopic Surgery – Belgium

2014 – Pioneered 3D laparoscopy in Malaysia

2014 – Organise The Annual Congress of the Asia Pacific Association of Gynaecological Endoscopy and became its President

2014 – Started a Fellowship in Laparoscopic Surgery and Infertility ; the first of
its kind in a private hospital in Malaysia

2015 – Became a board member of International Society of Gynaecological Endoscopy

2016 – Published book entitled “Laparoscopic Surgery in Gynaecology and
Common Diseases in women”

2017 – Became a board member of Asia Pacific Gynaecology Endoscopy Training group (APGET) and help organise 4 laparoscopic surgery training workshops every year in the Asia Pacific Region

2019 – Attended vNOTES workshop and pioneered vNOTES surgery in Malaysia

2020 – Published 4 papers in local/overseas journals
2020 –HIFU training, Blog, Youtube teaching videos

2021 – Pioneered Ultrasound based HIFU for fibroids and
adenomyosis

Most specialists in private practice continue in their comfort zone using whatever skills they acquired in government hospitals. They stay in their comfort zone and so not venture out because of the worry of complications or just plain complacency. With so much technological advancement nowadays, if one does not progress, one will regress. The following are some tips as to how to be progressive in Private Practice.

1) Keep your own records

When I started private practice in 1994, computerization in medical practice was at its infancy. I kept all my patients‘ records in Microsoft Excel and Access. The data included all the surgeries, deliveries and IVF that I performed since the first day at the hospital. I have records of the first patient I operated on and delivered at Mahkota Medical Centre.
When I started my own clinic in 1999, I also started keeping outpatient records in a dedicated software. I have complete outpatient records of all my patients in my practice for the last 20 years. There are many benefits of keeping your own records.

  1. Learn from your patients’ data.
  2. Research.
  3. Create your own teaching videos.
  4. You can carry the records with you if you decide to move practice.

2) Keep a journal

I have been keeping journals for many years. I write down what I have learnt the previous day. These include reflections  of surgeries  I have performed, as well as, any interesting cases I have seen. This has help me improve my surgical techniques in future surgeries.

3) Keep a record of all the procedures you perform

I keep video recordings of all surgeries (laparoscopy and laparotomy) and office hysteroscopies. These videos are edited down to about 10mins and kept in my own server in my clinic so that I can access them easily. I also keep all ultrasound images of patients in a programme called OSIRIX. When patients return for their followup, I can easily review their surgeries and ultrasound images and in this way, I am constantly learning from my patients’ data. I have designed a method of archiving and storing all these data.

4) Look for opportunities to learn from others

Early in my career, I realised that the best way to learn surgical skills is to assist. The best way to assist is to invite experts to perform surgeries at your own centre. That’s when I decided to organise laparoscopic surgery workshops and invite experts to operate with me. In this way, I am always the first assistant and the one who will learn the most. I have had the privilege of assisting some of the greatest laparoscopic surgeons in the world such as Lee Chyi Long, Masaaki Ando, Shailesh Puntambaker, Arnorld Wattiez, Joo Hyun Nam, Harry Reich, Bruno Van Herendeal, Stefano Betocchi etc. When I am not able to invite an expert to my hospital, I travel to his centre to watch him perform his operations. Although this is not as good as assisting, much can be learnt while observing and interacting with the experts.

5) Learn from everyone

As we grow older, we shy away from learning from people who are younger than us. One should be prepared to learn from everyone. For example, during a recent vNOTES workshop, most of my teachers were decades younger than I was. I also like to have young Fellows with me because I learn a lot from them. Swallow your pride and learn from everyone, even younger colleagues.

6) Write down what you have learnt

Whenever I attend a conference, assist in a surgery or watch a webinar, I write down what I have learnt from the session. I try my very best to implement what I have learnt within 2 weeks because after that duration, what is learnt is often forgotten. This helps me acquire better habits.

7) Keep a notebook with you all the time

When seeing patients, I often write down interesting cases or questions that arise with these cases. I have tried using a computer but I found that a book is far better because it is easier to review what I have written down. During my free time, I look for answers to my queries. An interesting case may be a subject for a youtube video, blog, article or case report. In this way, I am learning every day and from every interesting patient.

8) Try to learn a new skill every year

At the end of every year, I will write a summary of what I have achieved that year. After that I will decide which skill or topic I want to improve the subsequent year. By focussing on just one topic, I will have a better chance of focussed self-improvement. For example the new skill I learned in 2020 is how to do HIFU for fibroids and adenomyosis. I was in China for 1 week in January to learn this skill. Unfortunately due to the pandemic, the machine could not be installed so I switched to writing blogs and research papers, creating teaching videos and learning to speak into a camera.

9) Aim for doing things differently

We live in a very competitive world. Many of us do the same things. You have to attempt to do things differently so that your patients have a better experience and will recommend others to you. Some of the things I have done differently include: editing patients’ surgical videos and showing it to them in 3D;creating DVDs for my pregnant patients, with all their ultrasound pictures and videos and even a video recording of their Caesarean section (this is a very laborious task which I did for many years but abandoned).

10) Set aside some time everyday for self improvement

I am a lark. I wake up early in the morning to be in my clinic by 630 am. 6.30 and 8 am is my time for study and self-reflection. It is during this time that I produce the most, because my concentration is at its peak. In his book called “Deep Work”, Cal Newport suggests that in this distractive world, one must set aside time to do constructive work. By doing this regularly one maximise work productivity.

11) Learn to type

Most of the time I am spending writing on a computer. It took me a long time to realise that I can safe so much time if I could type with all my fingers not looking at the keyboard. I taught myself to do this and now I safe so much time being able to type efficiently.

12) Teach

As the saying goes “The best way to learn is to teach”. I have been teaching throughout my career. At first I was teaching medical students and now Fellows in laparoscopic surgery and infertility. I have also become mentors to many specialists who either come to my operating theatre to watch and assist me or I go to their centres to operate with them thus teaching them the skills I possess.

13) Give talks

Preparing for a talk is a very good way to learn. Some of my greatest learning experiences have been when I have been asked to speak on a topic that I have never spoken on before. A good talk, will require extensive research and consolidation. Besides, one also learns presentation skills.

14) Record Webinars

This pandemic has caused an explosion of webinars. Webinars are good but can be boring. I record all the webinars I watch. I watch again the good ones and write down what I have learnt. These recordings will also assist me in the preparation of similar talks in the future. I file all these recordings in my server so that I can retrieve them easily when required.

15) Publish

Although I have written a book as well as several chapters in other gynaecologists’ books, one of my greatest regrets until 2019 was that I had never published any paper in peer review journals. My excuse was that I was busy in private practice. In late 2019 I decide to change this attitude. I have been in private practice for 25 years and it is time to publish some papers. I employed a medical graduate to help organise my data. We managed to write and publish 4 papers. Now, I am keen to publish more. Most private practitioners do not publish because publication does not bring more patients. Many successful private practitioners do not publish any papers while in private practice.

16) Serve in Professional Bodies

Over the years, I have been serving in various professional bodies. The first was The Obstetricial and Gynaecological Society of Malaysia. I started as an assistant Secretary and later rose in rank to become its President in 2019. Now I serve as its endoscopic subcommittee chairman. I am a board member and a Past President of the Asia Pacific Association of Gynaecological Endoscopy, past board member of International Society of Gynaecological Endoscopy and currently a board member of Asia Pacific Gynaecological Endoscopy group. Being part of these professional bodies, I have learned so much about leadership skills. I am in constant touch with the best in the field of gynaecological endoscopy and this has helped me to constantly improve my self. Through these associsations I am also able to fulfil my passion of teaching endoscopy to young gynaecologists. I urge all private practitioners to get involved in professional bodies to keep up-to-date in your speciality.

Conclusion

The common thinking is that self- improvement should be the domain of those in the universities or public hospitals and that a private practitioner’s duty is only to provide service. I beg to differ. In his book entitled “ The Anatomy of Success’ the late Dr. Rakesh Sinha said that there are 2 types of people in the world: the learners and the non learners. The best doctors are, are the ones who want to constantly improve themselves: the learners. By doing so they are providing the best treatment to their patients.

Acknowledgements

I would like to thank:
My wife Sarojini Palany for editing this document

My daughter Amita Sevellaraja for the Illustration

Dr. Gunasegaran for proof reading the document and suggesting point 15.

Selva

Sevellaraja Supermaniam

25/12/2020

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Dr. Selva

Dr. Selva

Dr S. Selva (Sevellaraja Supermaniam) is a Consultant Obstetrician and Gynaecologist and a subspecialist in Reproductive Medicine at a private hospital in Melaka, Malaysia. He heads the O&G unit and the IVF Centre at the hospital.

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