Well, I just returned from my holidays down under. During my holiday, I read a lot of news regarding housemanship situation back home. In fact, before I left to Australia, I did receive few emails and phone calls regarding latest development in housemanship postings. However, I did not have the time to write anything till today.
In my earlier post over HERE and HERE, I wrote about the waiting period for housemanship and the worsening disciplinary problems among housemen. I would not elaborate further on these 2 matters. Before I left for my holidays I received at least 3 emails/blog comments regarding new developments in housemanship employment. We all know that Malaysia do not provide housemanship for foreigners. I had received many queries from foreigners in India, Pakistan etc enquiring about this. However, foreigners who are married to Malaysian can be given housemanship post under contract if your degree is recognised in Malaysia. Unfortunately, the situation seem to be changing rapidly.
About 2 months ago, I received information that a Malaysian PR was told that she will not be given a job by KKM. She is a Singaporean who grew up in Malaysia right from kindergarten days. She graduated from one of the private college here. Following that, I received 2 emails from foreigners ( one from India and another from Indonesia) who are married to locals. Both had degrees which were not recognised by MMC. Thus, they spend almost RM25K going for attachment and sitting for MQE exams. They passed. Unfortunately, when they applied for housemanship, KKM told them that a new rule will be implemented . They will need to sit and pass/get credit for SPM BM paper!! It is very clear that KKM do not have enough post to provide housemanship for foreigners or PR holders. Thus, they are creating “so-called” new rules as an excuse. As I have said many times before, passing MQE do not guarantee you a job. This applies to any country in this world. Every country will give priority to their citizens followed by PR. BTW, even Malaysians who do not have BM credits may not get a job soon!!
Many at times, when graduating students ask me whether they should start their housemanship while planning to sit for USMLE or AMC exams, I had always advised them to do so. This is because, passing AMC or USMLE or PLAB DO NOT mean you will get a job in those countries. Unfortunately, there are students who felt otherwise. They felt that if they start housemanship, they will not have enough time to prepare for these foreign exams. Well, they may be right but life in medicine only gets tougher and never gets easier. As I had mentioned since 2012, Australia is also facing internship crisis. The situation will only get worst from next year, as mentioned over HERE. So, if even their own medical school graduates may not be able to get internship post, what more foreigners, who are sitting for AMC exams. So far, I heard only 5 Monash Malaysia graduates manage to get internship post in Australia for 2015.
I received an email from a local university graduate who wanted to migrate to Australia. She declined housemanship posting in Malaysia mid of this year and decided to sit for AMC exams. She had passed her Part 1 and planning to sit for her Part 2 soon. Then came the bad news. Her senior of 1 year who had already passed her AMC exams is returning to Malaysia to apply for housemanship as she could not get an internship post in Australia. It is the same for USMLE as well. I know many who never manage to get residency of their choice. Thus, I will say this again : NEVER do medicine if your intention is to migrate!!
Over the last few weeks there have been multiple letters to newspapers regarding the working condition of house officers. While I had written many times about these issues before, what interested me most was the letter written to Prime Minister’s office. I received a copy of this letter which I would not publish over here, presumably written by a group of housemen from Klang Valley. The letter states 2 main issues: one on bullying and another on long working hours(supposedly 17-18 hours). Few days after I received the letter, I also saw the letter from PM’s office instructing the state health department to investigate the truth of the matter. It also appeared in the Star. Let me elaborate on both.
2 days before I left to Australia, I received a phone call from a mother whose daughter is doing housemanship for the last 3 months. She informed me that her daughter is very depressed and wants to quit housemanship. She claim that she is being bullied and she is unable to handle it any further. Surprisingly, according to her, the biggest bullies are NOT specialist or even MOs. It is the senior house officers!! Firstly, we need to define what is bullying and what is scolding. Medicine deals with patient’s life and thus certain mistakes have serious repercussions. You go to medical school to learn the basics of medicine and housemanship is to apply those basics in real world clinical medicine. The problem now is the fact that the quality of house officers has deteriorated tremendously to the extend that the senior doctors just throw their tantrum all over the place. Who will not get angry when you do not know how many chambers does a heart has? They should not have graduated in the first place! While I agree that scolding your juniors in front of patients and public should not happen but sometimes, the hectic work life of specialist or MOs just shoots them off the roof.
Bullying on the other hand has nothing to do with scolding for making mistakes.Bullying includes actions such as making threats, spreading rumors, attacking someone physically or verbally, and excluding someone from a group on purpose. Unfortunately, this seem to be an Asian culture. I had said it many times in this blog that the very same person who is complaining about bullying, will become a bully when he becomes a senior. I had personally seen this right in front of my eyes. AND that is exactly what is happening in the case above. The biggest bullies for her daughter were Senior HOs!! As long as these happens, bullying will not end. While KKM do have protocols to make complains on bullying, the line that demarcate bullying and scolding is blurry. The deteriorating quality and the surge in the number of housemen will only make bullying worst.
The second issue was ” working hours”. I had also written about this before over HERE in 2011. While I don’t agree working 32 hours continuously as what we did when we were housemen, being a doctor means we have to work long hours! That is a fact that most students should know before doing medicine. We cannot just let go of our responsibility to the patient before going home. WE must make sure we have done what we need to do. There is NO such thing as office hour job for doctors. In the court of law, patient safety is the most important consideration. These housemen think that they are the only one working 17-18 hours a day. Most doctors do and even people in other profession work long hours. The only difference is in other profession, you can bring your work back home where as in medicine, your work is done in the hospital. Even after 18 years of service, I am still working 24hours a day, 7 days a week. I can be called anytime of the day, even on weekends. Life in medicine will never get any easier. You must learn to work long hours. If you can’t, then leave.
Our DG has given a good reply to those who complain about working hours over HERE(see below). Another reply from a Paediatrician is also worth reading for those who complain about working hours (see below). Interestingly, a recent study in US showed that work hour limit for trainee doctors do not improve patient safety!! I know many who complains about working hours but will be sitting in a clinic doing locum when they are free!.
You chose this path and you need to adapt to what medicine wants you to be. Life’s are at stake and medicine is a life long learning. Even now, I am still learning. The most important teachers are your patients! The more time you spend with your patients, the more you will learn. I may be harsh but my advise to those who complain of long working hours is : please leave if you can’t handle it.
Response to the article Trauma faced by some housemen in hospitals’ by ‘Disgusted Malaysian, Kuala Lumpur’ dated 8th December 2014.
Posted on December 10, 2014 by DG of Health
I refer to the article published in The Star entitled ‘Trauma faced by some housemen in hospitals’ by ‘Disgusted Malaysian, Kuala Lumpur’ dated 8th December 2014.
The Ministry of Health (MOH) appreciates all feedbacks which have been provided on the housemanship training. Housemanship programme emphasises on training rather than merely employment, whereas the medical officers’ main role is to provide medical service, hence their roles are different. The 2-year housemanship has started since 2008. It encompasses training in 6 disciplines namely General Medicine, Paediatrics, Surgery, Orthopedics, Obstetics and Gynaecology, and alternative postings (either Emergency medicine, Psychiatry, Anaesthesia or Primary Care) for a period of 4 months each.
The housemen flexy working system has been implemented since September 2011 and was improved further from January 2014.The introduction of the flexy system is among the continuing efforts by the government to maximise the houseman’s learning process which aims to further improve their working conditions. It provides a chance for them to gain experience and take advantage of the learning opportunities to be competent and safe doctors.The flexy system requires the housemen to work an average of 65-75 hours per week. Housemen are entitled to a one day off per week but it is not necessary for it to fall on weekends. Housemen are doctors under training and they must fully utilise the opportunity given to them to improve their competency. MOH is monitoring closely the housemanship training in government hospitals to ensure the flexy system is successfully implemented.
Feedback pertaining to Housemanship Training need to be chanelled to the Housemanship Training Committee at the hospital and State Health Department. It is worth mentioning here that the doctors’ utmost responsibility and inherent value is providing safe and quality care to the patients. The nature of doctors’ working hours is different than other civil servants because patient care requires continuous services of 24 hours a day or 7 days a week.
In appreciating our doctors’ commitment, the Government has given various incentives such as the critical allowance of RM 750 per month and a special allowance for housemen of RM 600 per month. It is hoped that with all the efforts made by the Government, the aspiration to produce quality and competent doctors for the nation will be achieved.
DATUK DR NOOR HISHAM BIN ABDULLAH
Director-General of Health Malaysia.
HOs must stop griping and learn the job
I REFER to the letter “Trauma faced by some housemen in hospitals” (The Star, Dec 8) on the trauma faced by House Officers (HO) at the hands of seemingly sadistic Medical Officers (MO).
I would like to offer a different view of the matter lest the public gets the wrong impression of how medical supervision is practised here and worldwide.
No MO will willingly traumatise a HO unless the former is extremely overworked or the HO is so hopelessly trained that the MO is so exasperated by the inadequacy of medical knowledge and lack of responsibility.
With the current standard of medical graduates coming back, some of whom with dubious medical training in institutions that have been approved through political means, it is not surprising that the MOs are stressed by these incoming HOs.
The extension of a HO after the stipulated period is the decision of the supervising specialist, and he or she has to justify appropriate reasons for extension.
If the performance is still below par after the extension, the HO’s name will be forwarded to the Health Ministry’s director-general to send him to another specialist for supervision.
Nobody likes to extend a HO because of the paperwork that is involved but due to the maintenance of a respectable standard and the future safety of patients whom the HO will be entrusted with, these MOs and specialists have to maintain these standards of care.
The writer has to understand that getting a paper with MBBS or MD is just the beginning of a lifelong journey of training and retraining.
The initial degree should have taught a basic foundation in medical knowledge, ethics and basic practice to allow the HO to function with further supervision for another one to two years and be trained to be a specialist of his or her choice after that.
Without any further training, the MO can become a general practitioner in this country.
If the HO’s performance and knowledge is below par compared to his peers, it will not be fair to let him “loose” to the general public.
This training of HOs occurs all over the world and it is one way of ensuring that the public will be given safe young doctors to treat them in the future.
Ask any supervising specialist in the profession and one hears of the deteriorating standard and responsibility of new incoming HOs.
There are good ones who perform and never write in the newspapers and there are bad ones who complain about working 32 hours at a stretch. They just have to get used to it!
That’s what they signed up when they chose medicine where the patient is paramount to our sleep, food or toilet habits.
I think the writer exaggerated about the predicament of HOs. There is not a trained specialist who has not slept in the operating theatre, patient’s bed, at the table or in the toilet in his lifetime.
A smart HO should get used to sleeping a few hours in between patients and admissions, wherever.
These complaints are nothing new and the HOs just have to get used to working unlike other workers in the workforce as they will have the lives of their ill patients literally in their hands.
The less they complain and the more they learn from these patients and their superiors, the better doctors they would become.