Wednesday, 24 December 2014

A letter from an ex-government specialist

Here's another letter which might be of interest to you guys.
As a senior retired government specialist, I wish to comment on junior doctors and their current two-year housemanship training. As the saying goes, “The writing is on the wall!”
If doctor after doctor, and parent after parent write in to complain to the press that something is not right, then “Something is not right!”, and the authorities concerned must look into it.
Some years ago, a patient died during surgery in Britain due to an error by a trainee doctor. The Health Ministry investigated and came to the conclusion that the trainee doctors were overworked. It then introduced a rule capping the maximum hours of work that any trainee doctor is allowed per week.
Currently, I understand that some of our young doctors work for up to 90 hours a week! With a two-shift system, the hours will definitely be long. Thus, giving a day off after a gruelling six-day week, is hardly the remedy.
Many of us “elderly” doctors will recall our time when we were the only houseman in the ward and we worked seven days a week, often twice a week being on call i.e. working up to 36 hours in a stretch.
However, there was a major difference then. We could often get off by evening and be home for dinner with the family if we were not on call. On Saturdays, we worked till 2pm and were free for the rest of the day. On Sundays, we come in early to do our rounds and we were free after that. Work then officially began at 8am and ended at 5pm.
Not so now. Many of the young doctors start their shift as early 7am and work till 5pm or up to 10pm during their tagging period, which can go on for a few weeks. And this routine goes on through the weekend.
When on call, they begin as early as 5pm or 6pm and work through until 11am the next day.
Their social life is effectively “zero” for two years. Housemanship duration was a year previously, until recently.
My sympathies go to the young mothers, who have husbands and perhaps infants and toddlers to look after, besides their ageing parents or in-laws. Those two years will definitely be their most challenging, if not depressing working years.
The least sympathy, as always, will come from the senior doctors, who are forever saying, “We went through all that and survived. Why can’t you stop grumbling and get on with your work!”
This attitude is incorrect and not forward-looking. It is time for the senior doctors and administrators change their mindset.
For a start, we had houseman quarters located within walking distance from our place of work. Hence, we could walk back and flop into our beds within minutes. Now, the young doctor has to travel a distance and risk falling asleep at the wheel.
Secondly, in the name of progress, working conditions should improve and not worsen.
While we worked hard, we enjoyed our work and had good rapport with our seniors and consultants, except for a few notorious “tyrants”.
Working as a doctor should be fun and stimulating, if there is good team work and understanding from the boss downwards. There should never be bullying or intimidation.
We need to review the way we carry out our work, too.
In the past, the trainee doctor may be working under one medical officer and one specialist, hence doing daily rounds with the medical officer and once or twice a week with the specialist.
With the increase in the number of medical officers and specialists on the team, the trainee doctor may have to do several rounds a day with the medical officer, the specialists and the consultants.
The fact that we went through that tough and strenuous path before does not necessarily mean that we can apply the same method to train our younger ones.
The medical training programme is already a rigorous five to six years. Add in another two years of unpleasant work conditions, and we do not produce a healthy generation of able doctors.
We should be nurturing the next generation and encourage them to rise to greater heights, by setting good examples for them to emulate.
Kuala Lumpur

Tuesday, 16 December 2014

Just sharing a link

Here's a letter written by an MO who just returned to Malaysia after practising as a doctor overseas:

I RECENTLY returned to Malaysia after a long stint as a practising doctor overseas. I am currently a medical officer in a government hospital.
I have seen this “mistreatment” first-hand. I have had housemen confide in me, one saying that he felt “choked”, another asked if he should request for a transfer and another exclaimed that he may not be suited for the medical field.
Since the pressure to perform is of utmost importance when it comes to patient care, the slightest of errors carry a huge burden for the doctor involved.
In Malaysia, the housemen are made to draw blood daily, do ECGs and administer antibiotics. There are no phlebotomy services and there is a lack of trust in nurses who would normally administer drugs.
Housemen are then quizzed on various subspecialty disorders during the morning rounds and denigrated in front of everyone should they fail to answer.
Public humiliation is a part of remedial work and teaching in the Malaysian health sector.
The more senior doctors are unable to rationalise the situation as they too were a part of the system.
The hierarchial system in Malaysian society is also partly to blame. It is almost taboo to refer to a person with a conferred title by their birth name. And it is disrespectful to address an older person by their given name. But it is a cultural norm for employers to subdue employees or those in position of power to ridicule their subordinates.
Likewise, housemen refer to MOs as “doctor” though they have similar paper qualifications.
Our moral book taught us to respect our elders. Perhaps, it is time we learn to respect everyone irrespective of age, sex, title, position, creed or caste.
Petaling Jaya



I notice that in the past couple of years, there has been a rise in awareness of the difficulties and challenges faced by housemen in this country. At the same time, the issue is always being ridiculed and looked down upon by the MOs and specialists, and sometimes even the senior HOs. Have you forgotten who you once were? Have you forgotten the very first day you stepped into the ward full of spirit and enthusiasm, only to have them crushed an hour later by the MOs and specialists? Have you forgotten how you came earlier than everyone else and thought you've got everything prepared for the morning rounds, only to be yelled at by the specialist when you can't recall a minor detail? Have you forgotten how you were treated like trash for the whole 3 months of the posting, just because of one tiny mistake you made in the first week of the posting?

I have watched lots of my friends who become the very thing they hate in the first place. Once they get into the 3rd or 4th posting, then they start to act all senior-ish and look down on the junior HOs. The irony.

But of course, I'm not denying that there are a lot of good senior HOs and good MOs. And I have nothing but admiration and respect for them. In particular, the MOs and specialists of Paediatrics department in Hospital Serdang. They're the reason I managed to complete the posting even though I hated paediatrics. At the end of the posting, I even thought I might want to become a paediatrician.

But the bad ones? I had a friend, who made the tiniest mistake one day, and she was considered the most "useless" HO for the rest of the posting by the MOs and senior HOs. I was there when she made the mistake. She had her hands full that day. One MO gave her a few tasks, another MO gave her a few more tasks, the radiologist gave her a different task, the specialist also gave her some tasks as well. She managed to complete all of it, but in the rush she made a small mistake. Only one MO knew of her mistake, but he shared the story with all the other MOs and specialists, and the houseman was looked down upon for the rest of the posting. How about the absurd number of other tasks that she managed to complete that day? Did anyone share that story? Nope. People will only remember you for your mistakes. Don't ask me what kind of mistake she did. It was quite some time ago and I can't recall properly, but I know it was nothing major. Other HOs make bigger mistakes all the time but they get away with it because they're close with the MOs and specialists, or they know how to blame someone else, or they're just good at hiding it.

I always thought that the most important value a doctor should have is empathy. But it seems that it has become a value that is lacking the most.