The letter in the Star below is well written, http://thestar.com.my/news/story.asp?file=%2F2011%2F11%2F27%2Ffocus%2F9978991&sec=focus. I am not sure why so much attention is given to these housemen. I presume that the government knows what is coming. So, before the storm comes, better give these doctors some goodies. As someone said in this blog that the honeymoon period may just last another 2-3 years before everything start to fall apart. In fact at this very point, SPA is asking MMC to review the need for compulsory service as they may not be able to provide job to all graduates in another 2-3 years time. Housemanship will be given on contract basis. Dr David Quek has confirmed this as in my earlier blog posting (http://pagalavan.com/2011/11/17/for-future-doctors-the-standards-of-medical-education-in-malaysia-and-its-acceptability-by-david-quek/)
From what I gather, the medical officers (MOs) are being burdened to do almost all the ward work now, as the housemen keep changing due to the shift system. Basically, MOs have become HOs nowadays withour any extra benefit.
I also like this comment which appeared in my blog today which is entirely true and has started to happen:
With Malaysia’s mediocre housemen, comes a generation of mediocre medical officers, training even more mediocre housemen.
With Malaysia’s mediocre medical officers, comes a generation of mediocre master’s students or MRCP holders. Especially if there is a pressure to open the floodgates to specialist position.
With Malaysia’s future mediocre specialists, why will Malaysia not recognize other Malaysians who did their specialization overseas? It should be a joy for Malaysia that Malaysians with Masters (Sg), who went through proper well constructed training program, to come back to Malaysia to serve.
Maybe the residency system is too fast tract? But I don’t see how Malaysia’s 2-3 patients per houseman, shift system without consultant ward round, 30-40 houseman per ward etc can be any better.
As they say, many times, the desire to learn is environment dependent.
Housemanship is good training
I AM amused by all the fuss about housemen (HO). I have served enough years in a government hospital to have seen “enough”.
Remembering my time as a houseman, I have to say it was a very crucial learning phase in my career.
Fresh out of medical school, I was given the responsibility to be in charge of every patient in the ward. It didn’t matter that we had three housemen, two medical officers (MOs) and one specialist/consultant in the ward.
Each houseman had to keep tabs of every patient’s progress, on top of “clerking” new patients, carrying out orders and performing procedures.
I can’t remember the hours I clocked in per week, and nobody cared. Work had to be done as we were dealing with people’s lives.
I didn’t have my parents writing in to complain to the Health Minister or the director, saying that I had been overworked or deserved better incentives.
We did up to 10 on-calls per month and the allowances were quite pitiful that some of us didn’t even bother submitting our claims.
I still had leisure time for sports and family, although it was not frequent. But I didn’t mind as the experience gained during housemanship helped me throughout my service as a MO.
Now, we have a lot of housemen. But is there any change in delivery of healthcare?
There are so many of them in a ward that you wouldn’t notice if some are absent. They have a “couldn’t care less” attitude when on duty, lack of respect or teamwork and most of all, behave like schoolchildren. Imagine a specialist having to do a roll-call daily.
They do not take the initiative to learn hands-on, examine as many patients as possible. They are so calculative to the point that a name list has to be used, just so every houseman will have to clerk in new patients according to turn.
Many a time, a ward in a major general hospital can have an average of 40 patients. So, this makes life easy for the houseman – only review three patients and no need to know everyone of them.
Imagine how clueless they are when doing ward rounds with the specialists. On top of that, orders made in the morning are not carried out, with the excuse “I thought so and so was doing it”.
So, needless to say, big numbers don’t do well if work is still not done.
Given the poor performance of many housemen, getting extended in a posting is a norm nowadays. And they are also “stripped” of many responsibilites due to incompetency for fear of patients’ safety. And they are enjoying better salary scales and promotion.
All the fuss about the HO has gone overboard. Does anyone care about the MO or specialist? For those who work in a government hospital, they will know the MOs are the most stressed out, unappreciated and underpaid lot.
Their duties involve every patient’s medical management, carrying out procedures, attending emergencies, outpatient clinics, escorting ill patients, making referrals, being on call, supervising housemen, attending continuous medical education activities and studying for a postgraduate degree, etc.
Most of them at that point in life would have settled down and started a family. They have to sacrifice time with family due to work commitments.
So, it doesn’t help that only housemen are pictured as the poor deserving lot when we compare work quantity, responsibilities and sacrifices.
Housemen are meant to work for their own good. The more time spent voluntarily (or involuntarily) working will definitely build their foundation, and also character.
They will be better MOs and specialists after that. Pampering them now is not doing them justice. And I would also like to remind all parents of budding young doctors, not to live in the clouds.
Graduating from medical school isn’t such a big deal anymore. It is how these young doctors take it from there that matters most. I rest my case.
POOR MEDICAL OFFICER,
Kota Kinabalu, Sabah.