A letter from an ex-government specialist

Here's another letter which might be of interest to you guys.

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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.

EX-GOVERNMENT SPECIALIST

Kuala Lumpur

Source

Just sharing a link

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

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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.

OECD TRAINED

Petaling Jaya

Source

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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.

Updates

Okay, just some updates.

So I received a letter from Hospital Serdang regarding the salary that they still banked in even after I quit, for a total of 6 months, which sums up to RM26k. No I'm not missing a dot. That's RM 26,000. And I have to pay it back of course.

I've called the finance/account department of Hospital Serdang, and they explained a few things:
-If I still work with the government, the amount I owe them will be deducted from my monthly salary. Based on my friend's experience, it won't be like 10% or 20% of your salary. It will be EVERY SINGLE CENT from your monthly salary until the debt is settled. Unless,
-I write a letter to appeal and request for payment in installments. The max limit given is 18 months. However this is for government servants only. He's not so sure about those who are no longer working with the government.

I've sent an appeal letter, but I've yet to receive a reply. I'll update you guys when I have more info.

Protip: Don't spend the money that don't belong to you.

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So how about my life, some of you may wonder. Well, after more than 2 years of leaving housemanship, I can say that there is NOT a single day I regretted quitting my housemanship, regardless of all the things that has happened.

I'm still working as an underwriter. Probably planning to jump ship sometime next year, to another company, 'cos the working environment here sucks.
I'm coping with my job well. Not excellent, but I think I'm doing a pretty good job, although the higher ups probably don't see me doing that much. I don't give a fuck. If you can't appreciate my job, I'm gonna find someone else who will.
Salary is okay. My car is 800 monthly, rent is 260 monthly. End of the month I can save up around 200-300. Not much I know. I spent a lot on shopping.
Work finishes around 5-6pm. So I have plenty of time for dinner, and hanging out, and getting a good night's rest.

If I were to rate my life now, on a scale of 0 to 10, with 10 being living the dream, and 0 being a houseman, right now I'm probably at 6-7. So yeah, not too bad.
Aything else you might be wondering, feel free to ask.

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Some of you guys have enquiries, either via blog comments or e-mails, which I still haven't replied. If I don't reply within a week, then it's because I don't know the answer. I'll leave those to someone else who might know the answers.

Attention to all parents!

Just sharing some news:

1. A medical student from Universiti Kebangsaan Malaysia (UKM), identified as 21-year-old Alvern Loo, committed suicide after failing to get consent from his parents to switch to another course. 
2. He wrapped his head with a white plastic bag and hanged himself with a belt at his parents' bedroom. It was believed that he took the opportunity to kill himself when his parents were not at home.
3. Oriental Daily understands that Alvern's father is the assistant principal of SMK Chung Hwa, Kuala Pilah while his mother is a teacher attached to SMK Tuanku Muhammad. 
4. Alvern's father told Oriental Daily that Alvern is the eldest son in the family and has a bright future.
5. The parents had initially disagreed with Alvern's decision to change to another course, but backed down few days after. 
6. The depressed father explained that he was upset at first because his son had studied MBBS for 3 years, so he had wanted him to persevere. He didn't expect Alvern to end his life as he had already given a green light to Alvern thereafter. 
7. When Alvern's mother chanced upon the dead body in her bedroom, she broke down in tears and hugged the body tight. 
8. Kuala Pilah OCPD Supt Azmi Abdul Rahim said the case has been classified as sudden death.

Source

So parents, please think carefully before forcing your child to take up something he doesn't want to. What you think might be best for him, might end up being the worst. R.I.P. Alvern Loo.

Should You Quit?

Okay, let's get straight to the point, since I'm not good with lengthy opening statements. Plus, no one ever reads them anyway.

Here's the deal. Since I started writing this depressing blog, I received quite a lot of e-mails, comments, messages, and phone calls from fellow housemans, all asking me this question: Should I quit?

Come on guys, I'm a nobody. You shouldn't quit just because some random guy on the internet told you to.
What're you gonna tell your parents?
"Mom, there's this one guy on the internet with a picture of a unicorn as his profile, and he said that I should quit my housemanship."

Listen, I didn't write this blog because I want to encourage HOs to quit. That was never my intention.

I wrote this blog so that I could share with HOs who want to quit and will quit anyway regardless the existence of this blog, that quitting is not the end of the world, and that there are alternatives.

If your heart really wants you to quit, but you're afraid to do so out of fear of job insecurity, parents' objection, financial issues, etc, then this is where I hope my blog would serve its purpose as a platform to share our experiences, our decisions, and our dreams.

But if you wanted to do medicine yet you feel like quitting just because you can't stand the long working hours, the tough job, the scoldings, then no, you shouldn't quit just because of that. Other jobs are tough too. Just because housemanship is shitty, doesn't mean other jobs out there are like a bed of roses. Being an underwriter might not be as shitty as being a HO, but it's still shitty nevertheless.

Final word is, the decision to quit or not to quit, that's all up to you. Ask yourself, why do you want to quit.

Don't quit because you feel that you are not worth it, or you feel you won't be able to make it through, because I have tons of friends who don't know shit during medical school, who can't do anything right, whose voice tremble everytime they try to answer a question, yet they are still doing their housemanship and they're doing great, because they want to become doctors. It is their passion. So if you have the passion for it, go for it.

If you already decided that you want to quit, but you don't know how, and what can you do after you quit, then this is where I hope I can help you guys with whatever bits of experience I have.

Underwriter Q&A

Hi guys,

This post would hopefully address some of the common questions that I get from housemans (in plural form, is it housemans? or housemen?) in regards to what being an underwriter is all about.

Please take note that I'm just entering my second week of training as an underwriter, so I might not be giving you the most accurate description regarding the job as an underwriter. Nevertheless, I'll see what I can do. Here goes.

Question 1: What is an underwriter? Is it like an undertaker? (common lame jokes that I often get, hardy har har)

Answer: No, an underwriter is not an undertaker. There are a few types of underwriting, which includes medical underwriting, financial underwriting, etc. But the one you should be concerned about is medical underwriting since you have a medical education background. Do note that the underwriting categories usually overlaps, so even a medical underwriting case would have some financial aspects that need to be taken care of, although you don't have to worry too much about this.
Underwriting is basically going through a client's personal and medical details, so that you can decide whether you should approve his insurance application, decline it, or perhaps approve it but at a higher premium.

Example:
Encik Ali would like to apply for an insurance plan. He filled up a few forms containing his personal info and his health background. He submitted these forms to his agent, and subsequently the case will be passed to you for you to decide whether to approve or decline his application.
So your job is to go through the relevant documents, which includes details of the insurance plan that he is planning to purchase, his health background, his personal details, and so on. A few scenarios are possible:

Scenario A) If his forms are correctly filled, and he has no major medical problems, perhaps just a simple appendicectomy 10 years ago and now he's fully recovered, then you can just approve the application.

Scenario B) Let's say he declares that he has hypertension, then you might want to impose a higher premium for him, since he is at more risk to develop hypertensive complications in the future. It's only fair. You might also want to request for a medical checkup at one of the panel clinics, to see if he already has any complications from hypertension, and how is his current blood pressure control. If a medical checkup seems insufficient, then you can request for a medical report from the doctor who's been attending to him.

Scenario C) Perhaps he might declare that he already has hypertension for 20 years, and that his kidneys are failing, and he is also under cardiology folllow-up for a heart problem. Then in this case, you might want to decline his application altogether since it is very likely that he will make a claim in the near future.

Although it might seem cruel to reject Encik Ali's application, it's what you have to do to keep the company running. If you're going to approve everyone's application and then everyone starts making claims, then who's gonna pay them once the company runs out of money? This is an insurance company mind you, not Bank Negara. Sorry Encik Ali.

Question 2: How much salary should I expect?

Answer: Somewhere between RM2300-3000, depending on the company, and your degree and experience. Experienced underwriters might get around RM3500. This will further increase once you have gained more experience and you gain the authority to handle more complex cases.

Question 3: What's the job like?

Answer: Come to work at 8.30am, switch on your computer, and start doing the cases until you finish at 5.30pm. Expect some back pain at the end of the day. On average you would be handling 20-35 cases per day. At the end of the month, there will be tons of cases, and you might need to stay back until 9 or 10pm. You might need to work on Saturdays as well.  But you can claim your overtime.

My job is a bit different though, since I'm just a part-time underwriter. They hired me because they wanted someone with a medical background to train new underwriters on the medical aspect of underwriting, as well as someone to liaise (that's hard to spell) with the panel clinics. So I'm not doing full-time underwriting.

In terms of working environment, it's awfully silent here. Just the sound of keyboards going 'clack, clack, clack'. It's like being in a library... with keyboards. No one seems to be chatting casually, even during lunch time. But perhaps other companies are different.

Question 4: How do I apply?

Answer: Browse through insurance companies websites, and look under the "Careers" or "Join Us" tab. Sometimes they have an online job application form, but sometimes you have to e-mail them. If you have to e-mail them, provide a nice cover letter.
Other sites: JobStreet, JobsDB, JobsCentral, etc. Just type "underwriter" or "underwriting" in the search box.

Question 5: Wow, thanks for all the info man! Can I treat you to a nice dinner tonight?

Answer: Yes. Yes you can. I'm a bit short on cash. Naah, just kidding. I'll survive.

Looking for a job?

I took up the offer with the insurance company, and I've just handed in my 1-month resignation notice last week. I've asked my current boss, and he said that since I'm leaving, they'll need to recruit someone else to replace me. So to my fellow ex-housemans out there, here's your chance.

If you:
-are still struggling to find a job after quitting housemanship
-love doing sales (most important)
-love to meet new people (doctors, specialists, and clinic managers)
-love challenges
-are greedy
-are able to work as a team, as well as independently
-have a car and are willing to travel
-have the confidence to promote your product and convince doctors to buy them
-are good at doing demos and presentation
-have persuasive powers
-have experience working with a clinical software to manage patients in your hospital
-are good with basic computer skills (Word, Excel and PowerPoint at the very least)
-having a laptop would be an advantage

Then you might be the right person to replace me.
A few things though,
-your salary is lower than a houseman's salary (not including commissions).
-this product is hard to sell. Your competitors are like Toyota; cheap and easy to sell. You are like BMW; premium but expensive, and hard to sell.
-you're expected to go to 30 clinics per week, and close 6-8 deals per month.
-what you're selling is basically a software to manage GPs and Medical Centres, and the software covers both patient management, as well as the administrative tasks such as billing, invoicing, appointments, etc.

If you think you're up for the job, then bookmark this page first.
Don't start e-mailing me yet though. I'll need to confirm with my new sales director if it's okay for me to give you guys his e-mail so that you can send in your resumes to him.
If he gives the green light, then I'll update this post sometime next week.

**Update: The sales director has given me the permission to give you guys his e-mail so that you can send in your resumes to him. Those interested, kindly e-mail me at danny.sp87@gmail.com, and I will pass his e-mail to you. If any of you have gotten the job, then please update me through e-mail or through the comments form below. Good luck guys!

***I heard they already hired a new product specialist to replace me. So I guess the position is closed.