I am a UK graduate and I’ve been working in Malaysia for almost a year. On my first day, I called my MO by her first name (respectfully) to ask her a question, and she did not answer, so I asked again, and she said to me ‘I would like to be addressed as Dr xxx’. For someone who has been calling all doctors, even my consultants in medical school by their first name, how lame that is, I thought. But I’m used to that now. Just because I am addressing them by their title doesn’t mean that I respect them all of them, especially ones who are obviously empty tins. If I disagree with something, I will say it out.
In Malaysia there is this thing that HO should round early in the morning first, then the MO will round again (which we are suppose to follow and write), then again with the reg and the specialist. I have never encountered anything like this where I studied. There is just so much repetition here. What is the problem with everyone just arriving at the same time and then we do ONE single round together? Are consultants too mighty high to be asking questions or examining patients? Yes, the juniors should know and present the cases, but so should the specialists and the consultants. Here, we come at 6:00-6:30am in the morning to see all the patients, then there will be another 2 or 3 rounds with people more senior than us so we can ‘update’ them patient condition so that they are able to add on their own management plan. Most of the specialist/consultant would just stand at the bedside listen to the juniors present, bombard lots of question, dictate some plans then move on, without even saying a word or looking at the patient. Then when the intimidating boss-like figure is finished, the patient would rush to ask me what had he just muttered before I had to rush off to tail ward round. In the UK, junior doctors come half an hour earlier than the consultant to get the investigations results ready and find out if anything happened overnight/over the weekend, then wait for the consultant to turn up to start the round. If it is a non-consultant round, everyone would get on with the round as a team. There is no such thing as HO to see the patients before the reg. There, the registrars, SHO and HO help each other out so they finish their work as quickly as possible. Isn’t that a much more efficient use of everybody’s time? Once, my nice MO was helping me with a particularly difficult IV line, and another MO asked him ‘why are you doing HO’s work?’ You see the attitude? Don’t get me started on the TDS round. Yes, they do rounds three times a day here (in most specialties), sometimes x 3 due to the hierarchical arrangement as I have mentioned above.
The worst part is having to play the servant for MO/reg/specialist/consultants. In my hospital, HOs have to regularly to go the record department to trace files for the reg’s case presentation/ write up. Last week, my friend had to go to my specialist’s car to fetch a stack of photo frames to her office. In departmental census, the HOs does all the data collection (trawling through the case records) not knowing the end results whilst the boss gets to present and publish. We call patient up to inform op date, cancelled op, rearrange op so often I thought we sounded like a professional telephone operator. You can’t blame me for cursing under my breath whilst performing these stupid errants.
In Malaysia, HOs are unappreciated slaves. Everyone, senior and junior figures in the medical profession, should rethink the way we are doing things here. You may say the practice has stood the test of time but is it really worth wasting so many hours for sometimes so unproductive as three morning ward rounds in a day just because of hierarchy? Is it fair to treat HO as your servant doing your secretarial job? Are MO/Reg/Specialist incapable of occasionally helping your new HO make some referrals or write a prescription or ask for a CT scan, or God forbids, take blood? Are we not in the same boat to make patient better? I foresee that it will take another 10-20 years for us to change the culture, if it ever will. The seniors always have their ‘back in those days’ or ‘you have to learn’ excuses
The above comment was posted in my blog by a houseman. I must say that he was right on certain issues that are ingrained into our system. It is a culture here that you must address a senior by the title and not by his/her name. I know that in western countries, you can call a consultant by his/her name but in Malaysia, you will be considered as disrespectful. It is part of the Asian culture and you just to accept it. It will take many more years to come before it chances. It is the same for all Dato’s and Tan Sri’s. When I refuse to address them as Dato so and so when they come to see me as a patient, they will look at me differently but I do not give a damn. It is not a God-given title for me to address them by the title. At least if you are a Professor or something, I will address them as such. Same goes to the community who are so enthusiastic to make their children a doctor by hook or crook just to get the title “Dr” infront of their names.
Let’s come to the ward round system in Malaysian MOH hospitals. The system that the HO is talking about has been around for many years, even when I was a houseman. In fact, even I use to ask the same questions when I was a houseman. It is really a time-wasting situation. That’s the reason when I became a specialist; I made sure that I am in the ward by 8am every morning unless I am stuck in a meeting or jam. I usually walk into the ward around 8am and wait for the houseman to finish taking blood by 8.15am. By 8.15am I will start my rounds and the houseman must join the rounds by then. It is mandatory for them to finish taking blood by then. My idea is always to finish the rounds by 10-11am so that the houseman and medical officers will have all the time to do what that has been ordered.
Then, when I went to a hospital in Klang Valley to do my subspeciality training, I entered the ward at 7.50am and noticed that I was the only one around!! I asked the nurse where the housemen and MOs are; and they smiled at me. It seems the HO comes at 8am, MO comes at 8.30am and the specialist only comes at 9.30am!! WTH!! Sometimes the specialist comes only after the MO/HO has completed the rounds and starts all over again. Of course, the specialist who does a consultant round has all the right to start the round again BUT I always felt that it is counterproductive. By the time they finish the round will be around 12-1pm and you are just left with another 4 hours to settle everything else! Sorry to say but most of the current specialists in government hospitals are in this category. Majority of the good ones have left the service not due to money but due to frustration with the system. No matter what you do, the system will always frustrate you. As someone said: either you join them or leave!
Now, housemen doing office boy’s job? Well, no matter what you become or what job that you do, you always have to start from the bottom, unless you are self-employed. It is common for all profession. Even fresh law graduates have to work as an office boy when they do chambering. There is no such thing as easy way to learn. You have to go through tough times and even be a slave to become a better person in the future. That’s why you are known as government “servants” ! But of course, I think it is atrocious for the specialist to ask the housemen to do the data collection and tracing of notes for something that the consultant is going to publish. If they do so, then the houseman’s name should be included as one of the author. When I was a houseman, the Head of O&G department challenged me to do a study on maternal weight gain during pregnancy for the 3 different races in the hospital. I took up the challenge and completed the study just before I completed my O&G posting, which was my last posting as a houseman. On my last day, I submitted the report to him and he was shocked. He never expected me to do it. The data supposed to be presented at the state scientific meeting but I was transferred before that.
I know that not everyone will be interested in academic life but the houseman should take the opportunity to get involved in the study and learn something. I am sure most specialist or consultants will be happy to welcome you into the group. Having said that, I must admit that most of the good specialists and consultants are not in MOH hospitals anymore. That is the sad part! And also, please remember that no one appreciates you in government service. You will always remain unappreciated. Your job is to serve the community, paid by the government/tax payers. Before 1994, there was no such thing as “oncall” allowance and then we were offered RM20 for every call! pathetic.
