I had mentioned many times in my blog since I started writing early last year that the situation is getting from bad to worst in Ministry of Health and soon it will affect the entire healthcare system in the country. Commercialisation of medical education will soon affect all of us. The glut of doctors is getting worst and many of them are being under trained and given “license to kill” . One of the major outpatient clinic in JB use to have only 6-7 doctors before. Now they have 17 doctors running the show and the MA’s are not seeing any cases anymore. A 54-year-old man who is known to be a diabetic for 20 years under follow-up at this OPD has been vomiting for the past 1 month. This was associated with nausea, lethargy, generalised weakness and mild shortness of breath on exertion. He went to this clinic several times and just given meds and told to go back. The moment he walked into my clinic, I knew what is the diagnosis! He is completely sallow looking and even a good medical student should be able to pick it up. His creatinine was 889 and blood urea of 26 mmol/L. Again, I had to refer back this patient to the hospital for dialysis and further management. At one point we were complaining that MAs are running the clinics and screwing up things but unfortunately having doctors does not seem to make any difference either!
The shift system was introduced without proper planning and making the current situation worst. It is going to produce more incompetent and uncaring doctors(as their responsibility is less!). The 2 comments below will sum up what is happening in the hospitals currently:
Comment 1:
The time i enjoyed most was when i was a houseman. Because i don’t have any responsibility.What i did, just following orders from MO/specialist. i don’t mind came early as 5.50 am and went back at night everyday. Tried to learn their management and makes a notes. I hate most when i a MO at district officer. I was alone, no guidance, a lot of responsibility.
Now i am a specialist taking care of HO in my department for almost a 2 years. i have minimum of 30 and max of 60 HO. i tried to remember their names. My department used to receice all the first poster HO. From there i have seen many HO with different attitude, knowledge, missing in action, taking EL, we ask something else then they write something else ; from different University all over the world.
What can i say is, if they committed, make their own effort to learn/ask, be nice to their colleague/staffnurse/JM/attendant in the ward, follow orders that has been ordered; they will be a good doctor. BUt..if they are just standing there like a consultant and quite, have to ask then only they move..BIG problems!.
However…since we are ‘forced’ to start shift system, everything is haywire. i don’t know which patient is being taken care by which HO. 3 shift means 3 HO, MO..not always in the ward because number of MO less than number of specialist. Patient also does’t know which doctor they want to speak to after ward round, staffnurse also does not know which HO to call.
If we do teaching during rounds, next day we asked the same question. No body can answer because, it was a different HO. so..
To all HO, don’t think that you are overwork or asking why you have to do all ‘clerk’ job. You have to know the basic how to trace result, how to get appt, putting IV line/taking blood, that will make you as a doctor. All this will connect you to other people in other department. This will make your job easy in the future. You will realize that once you become MO/specialist.
Comment 2:
Having read all these comments, I am prompted to write about my recent experience.
I am a medical officer in OBGYN for the past 5 years, currently a postgraduate trainee.
I have always treated my house officers as juniors, in fact I treat them like my brothers/sisters
for 5 years, I have never shouted at anyone, never discriminated against any particular grad, and I have never made any judgements on where they have graduated from. This is mostly due to the fact that I was being traumatised an awful lot during housemanship and I don’t like to impose the same to my fellow juniors.
I printed out handouts, notes that I have made, so that they could learn during spare time. I have even printed out materials multiple times and tried to teach them whatever I can recall after studying the previous day.They never read it even though I was spoonfeeding them.
I got scoldings from my Head of Department because they can’t finish doing rounds, or sometimes they cant even fill in the proper names or details in the particular operating notes. I have written all the operating details and all they had to do is help me fill in the time our surgery starts, because I was being called elsewhere for an emergency, I had to leave that to them. Something this simple that even a primary school student can do, they failed to do it. Next thing I know, I got penalised again.
Still, I tolerated all this, I have even offended some senior specialists because I tried to cover for the house officers when they made a mistake.
but few days ago I decided enough was enough. Houseman A was working 7am to 6PM shift. He is supposed to finish his afternoon rounds of 30 patients before going back at 6PM. The MO has already done his rounds on the same day and plans have been made for the patients.There were no bloods to be taken. This HO did “half rounds” till bed 15 and then told the nurse that he is going home sharp at 6PM. He expects his poor colleague who clocks in at 6PM to cover 3 other wards and also finish his rounds. There was a 29 weeks pregnant lady with sepsis and URTI in Bed 16. The nurse told him to check out the patient, but he refused since the “next guy is already coming”.The poor patient spiked temperature 2 times, 39 degrees and 39.5 degrees. I was busy attending to all new cases in the delivery suite. I went to all the wards and checked on all the patients and by the time I reached the 92nd patient I noticed this neglected lady. Nobody bothered to inform me about this patient, and nobody did anything for her. Best part is they actualy tagged the patient’s case sheet” MO TO review”. This same patient has problem conceiving and she had 2 miscarriages before.
I called up HO A :
Me:are you married?
HO:no
Me:If you have a wife who is pregnant, do you want a responsible doctor to see her or an irresponsible one?
HO: of course I want the responsible one
Me: DO you think you are responsible?
HO: silence
then for the 1st time in my career I shouted,yelled and warned him then asked him to write an explanation letter to my head of department.
I know I shouldn’t have shouted, but yes, I just can’t hold back any longer,
…………………………………………………………………………………………………………………
Then I read the following letters in the Star over the last few days. One of it were complaining that the shift duties is actually making the housemen to work even longer with less rest and both mentioned about the post-graduate opportunities and new rules that has been introduced. Almost a year ago I mentioned that postgraduate education is not going to cope with the glut of doctors that we are producing. At this moment, there are only 800 seats for Master’s programme , all disciplines included. It is expected to increase to 1000 by 2015. However, by then we will be producing close to 8000-10000 new doctors /year!! Only 10% is going to get a place into Master’s programme. For surgical fields, Master’s is the only way unlike Internal Medicine/pediatrics and O&G where you can still sit for MRCP/MRCPCH and MRCOG. The new rule mentioned in the letter below will only make the situation worst and many are going to get frustrated. Well, I had written about all these before but some refuse to believe what I said and insist that the situation will not be that bad!
Latest rumour: housemanship may be given on contract basis and then you need to apply for a job! No job in civil service means , no postgraduate training ! Opening clinic after housemanship means “license to kill”! God save this country!
Hold on to our young doctors
I REFER to the letter “Clarify housemen’s flexi schedule” (The Star, Oct 18) and “Accord housemen shift work benefits” (The Star, Oct 19).
While I applaud the move by the Government to ease the burden of house officers by reducing their working hours, the Government has not considered the effects this would have on current medical officers in hospitals who do not have enough house officers, especially in east Malaysia.
Since the implementation of the shift system, many medical officers are left with only one house officer to run the entire ward during the day and another for night.
As a result, the medical officer has to also take over the houseman’s role on top of their clinic work, interventional procedures and ward duties.
It is no surprise that many medical officers refuse to stay in government service after being treated poorly and paid miserably.
Thirty-six hours of ‘on call’ for a mere RM150 is laughable.
Also, recently the Health Ministry mandated candidates, who have recognised post graduate degrees such as Membership of the Royal College of Physicians (MRCP UK), to have a total of 8 ½ years of experience in order to apply for further specialty training of four years. (This includes working experience of two years of housemanship, three years as medical officer pre MRCP, one year post MRCP, half year of gazettement and the new ruling of an additional two years of waiting before being eligible to apply for a four-year training programme).
Why does the ministry have to impose such a complicated route and impose such a substantial waiting time before enabling our young doctors to apply for training post MRCP as compared to other countries where training is immediate?
These two additional years of waiting after gazettement to enter a four-year training programme frustrates our local young physicians, with many moving to neighbouring countries who willingly accept them.
What is the point of TalentCorp and talks about preventing brain drain when all the new policies are aimed at prolonging the duration to wait for further training instead of encouraging doctors to improve themselves and serve the country as specialists.
Doctors in other countries such as Britain and Singapore pass the Membership exam at a young age of 25 or 26 and are immediately eligible to enter further specialty training. Many become senior registrars or associate consultants at the age of 31 or 32.
Instead of retaining our bright local talents, we prefer to hire specialists from overseas and complain that there are not enough specialists in the country.
Worse still, we compensate by hiring foreigners whose specialisation may not suit the local settings and whose quality may be questionable.
Why are we not offering attractive training paths to our Malaysian-made physicians? Nothing is being offered in terms of training to retain our local talents with post graduate degrees.
I hope the DG of Health can clarify this latest move and prevent our local talented doctors from being driven away.
Retain our talented professionals by providing appropriate and intensive training.
By fine tuning a training path for the doctors with MRCP qualification and offering immediate training post MRCP, without unnecessary waiting, not only helps reduce the current shortage of specialists but enables our home-grown physicians to have a great sense of purpose to stay and serve the country in the long run.
STUCK IN BETWEEN,
Kuching.
Bitter pill for young docs
I REFER to the letter “Hold on to our young doctors” (The Star, Nov 3).
I agree with the writer’s observations and comments on the crazy, demeaning and unresaonable hurdles that our young physicians face in their quest towards career development and excellence.
Instead of encouraging and motivating them to specialise and sub-specialise, the Health Ministry keeps on adding more hurdles which do not make sense at all.
Doctors have to undergo a mandatory two-year internship and a further two years of compulsory national service before they are eligible to apply to do their Masters programme at local universities.
The annual allocation for the programme is about 400 places and there are thousands waiting for years to get into it.
The only alternative and shorter route (and tougher one too) is for the doctors to sit for the external MRCP, MRCOG and other specialist examinations offered by countries like Britain, Australia and New Zealand.
On the issue of housemen’s flexi -schedule raised by the writer, everyone knows that it is actually shift work because the roster is pre-determined by the hospital administrators without any consultation with the housemen.
The Health Director-General claims that the housemen are required to work an average of only 60 hours a week and they are entitled to two rest days as enjoyed by other civil servants.
In reality, they work 84 hours a week and do not get any rest days, let alone two days.
My cousin is a houseman at a hospital in Klang Valley. He worked from 11am to 11pm last Monday and Tuesday, on Wednesday and Thursday from 7am to 7pm; and on Friday and Saturday, he was rostered to work from 11pm to 11am, finishing at 11am on Sunday.
On Monday, he worked from 11am to 11pm. And from Tuesday, the same pattern was repeated.
It frustrates me that some people in authority are completely unaware of what is happening on the ground.
I hope and pray that the Chief Secretary to the Government Tan Sri Sidek Hassan will seriously look into these issues urgently.
The concerns are downright frustrating and demoralising to our doctors and young physicians.
DISAPPOINTED TAXPAYER,
SEREMBAN
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