Being a doctor is never an easy path. For us, students who want to pursue medicine as our future career, we still have a long way to go. Guidance from experienced professionals is crucial to us. But don’t worry if you haven’t got a chance for that. Now, the opportunity is in front of you. We are very honoured to have Prof. Datuk Dr. Awang Bulgiba bin Awang Mahmud to share with us his experience of being an epidemiologist and a professor, as well as giving us some useful advice.
Prof. Datuk Dr. Mahmud is the first Malaysian doctor to be awarded a Doctor of Philosophy (PhD) in Health Informatics. He is now in the Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya. At the same time, he is also the president of the Malaysian chapter for the Asia-Pacific Academic Consortium for Public Health.
Apart from that, he is the Secretary-General for the Academy of Sciences Malaysia, Council Member for the Academy of Medicine Malaysia, lead author for “Strengthening Academic Career Pathways and Leadership Development”, a book used for the University Transformation Programme in Malaysia and Project Director for Malaysia’s National Policy for Science, Technology and Innovation 2021-30.
Why epidemiology?
Surprisingly, being a doctor was actually not Prof. Datuk Dr. Mahmud’s dream job at first. Since he was in high school, he dreamed of being an engineer. But his mother wanted one of her kids to study medicine. Being the eldest of his six siblings, Prof. Datuk Dr. Mahmud took up the responsibility.
When it comes to specialising, Prof. Datuk Dr. Mahmud chose to be an epidemiologist without any doubt because he thought that epidemiology would be similar to engineering! However, as he became the medical and health officer in his district, his passion towards epidemiology sharpened and became clear. He enjoys interacting with people a lot, and loves carrying out projects. At the same time, he also enjoys teaching students. Gradually, epidemiology has become the field he is truly passionate for!
Epidemiology is a very multi-disciplinary field. An epidemiologist has to work with experts from diverse fields, such as nutritionists, and even engineers (the irony!). There are a lot of interactions involved. “Epidemiologists don’t have a high income,” says Prof. Datuk Dr. Mahmud, “but it is very satisfying to know that what you do is having an impact on a lot of people.” Like most other doctors, he has worked in several departments such as emergency medicine before, but he finds epidemiology the most satisfying.
Are there any relationships between infectious or non-infectious disease?
The problem of infectious and non-infectious diseases is very complicated. For infectious diseases like Malaria and even COVID-19, although the public may find a cure for these diseases, Prof. Datuk Dr. Mahmud thinks it is very difficult to completely get rid of them. For example, for the dengue virus, there are many serotypes. Once the public gains immunity to one serotype, the cases will die down. But later, it will be picked up again as another serotype comes, which the public has no immunity with. It keeps cycling down and hence, there is almost no real control method for these diseases.
But as infectious diseases occur anyway, Prof. Datuk Dr. Mahmud thinks the more present problem is non-communicable diseases, such as diabetes and high blood pressure, which will continue to be the main problem in the future. The main issue with these diseases is that they are associated and linked with lifestyles. Unless we tackle the root cause, which is the lifestyle of the public, it is hard for us to decrease the number of people having non-communicable diseases.
In fact, the problem of non-communicable diseases always worsens the problem of infectious diseases. In the case of COVID-19, countries with higher proportions of obesity often also have a higher proportion of deaths. Although he is not sure because the underlying mechanism isn’t clear, the systemic inflammation caused by non-communicable disease somehow exacerbated the problem infectious disease cause to people.
What is your proudest work in your career?
Prof. Datuk Dr. Mahmud has done a wide variety of things in his career. For example, he used to be in the IT department in a hospital which initially only had 6 members on staff. But now, there are probably around 60 staff in that department. He has spent a year turning the unit into an independent department, allowing it to run smoothly and efficiently. He has also set up a couple of centres and taught in the highest ranked university in Malaysia.
However, his proudest work in his career is not about his achievements, but to see his students have grown up and get a very good result in their own field. Some of his students have even become professors now. While it feels like mere moments, mentoring them was more than twenty years ago, and seeing them become professors makes him feel really proud of them.
What do you think the future education model will be like?
Prof. Datuk Dr. Mahmud believes that medicine is very different from many other subjects as it prepares you to become someone who does things with your own hands. Doctors have to see patients and interact with them, instead of just working with machines. Therefore, the use of problem-based learning is a good model to educate medical students.
Problem-based learning is a shift away from the model of traditional education. When Prof. Datuk Dr. Mahmud was in university, he was trained through the traditional way of teaching. He thinks it is a very difficult way of training a doctor because doctors have to see and understand the problem, and then find the way to manage the patients. But the traditional way of education emphasizes more on direct memorization of terms and ways of treatment. When he was trained, the first year was about anatomy, biochemistry and physiology and more, while the second year was about pathology, microbiology, and drugs. When it comes to the third year, which is the clinical year, students have to combine what they have learnt in the previous years, but almost nobody would remember! However, problem-based learning integrates the knowledge and experience from the very beginning, so it is less stressful and much more enjoyable.
In order to be a good doctor, knowledge cannot be spoon-fed. Students have to work in small groups and exchange ideas and solve the problem on their own without facilitating from their teachers. Professors do not teach them how to do, but instead teach them the process and let them come to their own conclusions and learn through self study, thorough thought, and discussion. It is because knowledge keeps changing, and new knowledge would appear very quickly. Therefore, it is better to teach them how to analyse and critically synthesise on how to get this knowledge from the source, instead of directly telling them what the knowledge is. Doctors are listeners. They have to listen to every patient and think and react quickly.
What do you think is the most important quality to be a good epidemiologist?
Prof. Datuk Dr. Mahmud thinks there are three important qualities to become a good epidemiologist. Firstly, you need to have a critical and inquiring mind, as one cannot blindly accept whatever people tell you. For epidemiologists, they have to analyse and find out by themselves by doing research and interpreting sources. Secondly, you need to have some skills with statistics and pattern recognition, as the ability to analyse numbers is also very crucial to epidemiologists, whose work consists of a lot of big data and statistics work of each type of disease.
Lastly, you also need to have some skills in computer work, especially since the use of Artificial Intelligence (AI) will be very common in the near future. This is even more important for epidemiologists, as a lot of big data is involved in their work. Therefore, getting yourself familiarised with the use of computers will be very useful for being an epidemiologist in the future.
What advice will you give to students who want to pursue medicine?
As said at the beginning, being a doctor is never an easy journey. Every aspiring medical student knows that getting a medical degree is only the first step of the whole journey. Therefore, if you wish to be a doctor, you have to be prepared for hard work. When Prof. Datuk Dr. Mahmud was a medical student, he slept very little everyday. He usually slept at 2 a.m. and woke up at 6 a.m., sleeping only for about four hours per day. This trained him to cope with life as a houseman, when he had very little or no sleep at all during the times when he was on-call. Sometimes, you even have to work on weekends, the time where everyone else is having a break. As a result, you really have to be prepared for such an intense and stressful schedule.
Secondly, to reemphasize once more, an inquiring mind is very very important. Do not directly jump to the conclusion the moment you see something, just because it is ‘obvious’. Suppose you are giving treatments to a patient, and the conditions of that patient seem to be improving, will you just jump to the conclusion that he or she is recovering well and stop monitoring the health condition? Sometimes the patient’s condition might take a turn for the worse, you ought to be prepared for that and have something in your mind as the secondary diagnosis of treatment.
Last but not least, remember to talk more! Talking to people is another useful way for you to prepare yourself and train your human interaction skills. Every patient you meet in the future is different. Don’t treat them as anonymous individuals, as they are all unique individuals with unique lives, and may have issues in their family life or in their workplace. Many inefficient medical treatments in the past were due to the lack of communication between doctors and the patients. With more understanding about your patient, you’ll get to know more about them and hence, provide the most suitable treatment for them!
Prof. Datuk Dr. Mahmud believes that whether you will be a good doctor or not is based on your motivation. He jokes that if you simply wanted to earn money, then you’d better be a businessman. Or if you want to be a doctor just because you want to have the “Dr.” before your name, you’ll never be able to succeed. Remember, the first priority of doctors is always to look at and care for the patient!
After reading all this, we’re sure you have got an idea on how difficult it is to be a good doctor. But don’t panic! If you truly have the passion to be a doctor, go and strive for it! Prepare yourself starting from now if you haven’t. Then you’ll be able to step into one of the most honourable and satisfying careers - a doctor.
