I walked into the Emergency Department in 2019, ready to save lives. I walked out in 2021 — not because I had lost my compassion, but because the institution I served made it impossible to practice safely.
Let me be clear: this is not a story about pandemic pressure or personal exhaustion. This is a story about institutional silence, dangerous protocols, and a Ministry of Health that repeatedly failed to represent the best interests of patients or the doctors trying to care for them.
The Nebulizer Crisis That Should Never Have Happened
Early in the pandemic, respiratory patients — those with acute asthma attacks or COPD exacerbations — were diverted to open-air screening tents upon arrival. Under normal circumstances, these patients would receive nebulized bronchodilators within minutes. Instead, they waited. And worsened. And waited some more.
I watched people struggle for air while administrators prioritized protocol over clinical judgment. Multiple emails were sent to the then Health Minister detailing this danger. No substantive reply ever came. Silence was the only answer.
Speaking Up Made You a Target
Within my own department, raising legitimate safety concerns was met neither with discussion nor a willingness to rely on published evidence, but rather with aversion — and in several cases, outright hostility. Colleagues who should have stood together instead looked away. Senior figures who should have protected us instead defended unsafe processes.
The message was unmistakable: keep quiet, follow orders, and don't question the system — even when patients suffer.
The Silence Never Ended
I left in 2021. But the pattern of obfuscation continues today.
Consider this: earlier this year, major revisions to general nutritional guidelines were announced by US health authorities — changes with direct relevance to metabolic health, insulin resistance, and chronic disease prevention. The Malaysian Health Authorities have said nothing.
Meanwhile, outdated Food Pyramids — models that have been scientifically obsolete for over a decade — still hang on the walls of government clinics and hospitals across the country. This is not benign neglect. It is active institutional inertia that is directly contributing to rising insulin resistance in our population.
Then there is water fluoridation. Several US states have recently ended the practice, citing mounting scientific literature on adverse effects. Malaysian authorities have shown no similar initiative to review the evidence — or even acknowledge the debate.
And That Is Only the Medical Side
The same government that assumes control over large portions of our earnings — through EPF, SOCSO, and other mandatory contributions — has shown almost no initiative in curbing predatory lending or integrating basic financial literacy into school curricula.
We are taxed, deducted, and managed — but not protected. Not educated. Not heard.
What I Am Asking For
I am no longer in the system. I have nothing personal to gain from writing this.
But I am asking for four things:
1. A public response from the Ministry of Health regarding instances where due processes and safety reviews were set aside during COVID, including whether any internal review was ever conducted.
2. An independent, clinician-led review of protocols that override emergency clinical judgment.
3. A clear timeline for updating public health education materials — starting with the Food Pyramid.
4. An acknowledgment that silence in the face of repeated clinician warnings is itself a form of institutional failure.
Concluding remarks,
I became an emergency doctor to reduce suffering. I left because the system made that impossible — not through malice alone, but through indifference, fear, and a reflexive protection of process over people.
I have not named individual ministers or administrators here. I don't need to. The failure is systemic. But systems are built and maintained by people who choose to look away.
I am no longer looking away.
If you are a current or former healthcare worker in Malaysia who has experienced the same — I see you. If you are a patient who waited too long for care, you should have received it immediately — I am sorry. We failed you. Not because we didn't care, but because the institution silenced those who did.
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Dr. Kavesh
Recovering Physician
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