I came across this blog today: http://jimbocyberdoc.wordpress.com/2011/09/09/disowned/. An interesting and short write-up about the current situation of the glut and the problems with shift duties. The situation is only going to get worst. I just completed writing an article for MMA magazine about the situation of oversupply of doctors and poor quality of medical schools which will be published by next month.
I have said this before that if the shift duties are not done properly, it will make the situation worst than before. I like the last sentence written by this blogger “So, if you are sick, come to the hospital at your own risk – you shall be DISOWNED!” The shift duty may actually deteriorate the continuity of care of the patients. We can already see a lot of half-baked houseofficers who are not interested in taking care of the patients and this shift duties will only give them more chances to take their own sweat time to do their work so that they can dump it to the next person. Please read the comments on this blog above for the said article and you will realise that these problems have already started.
I was also informed by various sources that soon, you will need to apply for a medical officers(MO) post after your housemanship! It seems that the government may only provide post for housemanship on a 2 year contract basis after which you need to apply for a job! Compulsory service will be scraped! So, you’re going to see a lot of jobless doctors running around as I have predicted before. And some said, it will not happen……………..! of course, JPA and all other sponsored students including local public uni students will be given priority. The rest can say sayonara! Being in Malaysia, you can forget about a transparent selection process.
Disowned
Much has been written about the oversupply of new doctors, like this well written article by a concerned medical student: Too many doctors, too few hospitals.
I said in jest to a group of medical students yesterday while taking them for bedside teaching: “If I close my eyes and walk, I’d likely walk into 10 house officers and if I throw a rock, I’d hit 5 of them!”
Actually, at the rate we are going, there won’t be any bedside space left for teaching – right now the hospital where I am working in serves as a teaching hospital to medical students from 1 private university, nursing students from at least 3-4 private and government-owned nursing colleges and physiotherapy students from similar number of institutions. When I walked into the ward in the mornings, I get a feeling that I am walking into a Jusco sale.
The reason I jested with my students was because I was trying to impress upon them the need to “shine and rise above the rest”, because despite the sudden rise of number of house officers, the number of training centres have more or less remained stagnant, likewise with the number of specialists/consultants to train them and similarly with the number of postgraduate places available; and this does not bode well for the nation.
We will (or already have) produce a generation of incompetent doctors who will be a danger to society.
When I came back from Melbourne 2 months ago, I discovered that I had 4 house officers assigned to the 2 cubicles that I usually perform my rounds. These 2 cubicles have 16 beds, giving an impressive ratio of one doctor to 4 patients! Since the beds were not often fully occupied, the ratio was much higher in most instances. There is a medical officer overseeing these 4 house officers and then there is me…so the doctor:patient ratio was indeed very impressive.
At least on paper it was.
I don’t want to go into details but suffice to say, I’d rather have 1 house officer who thinks and analyzes than many who merely act as scribes, penning down every word spoken by the medical officer or by me or what I would term as “palliative doctors” – prescribing Panadol for fever or Benadryl for cough, without much thought on why a patient has fever or cough to begin with!
And to add to the woe, these house officers are rotated between cubicles or wards every TWO weeks making it very difficult for me to train them. By the time I see something positive in them, they would have vanished to the next ward or cubicle!
Frankly I’d rather that house officers stay in a single ward or cubicles for a prolonged period of time instead of being moved around. Like they say, “a rolling stone gathers no moss”; likewise a junior doctor being constantly moved gains no knowledge or skills.
And then last week, the department started the shift system for house officers – basically now, medical house officers work in 2 shifts per day. I am not too clear about the way it works but I believe those who work 3 night shifts would be given the 4th day off being starting the day shift. It’s the ‘knee jerk’ reaction from the powers-that-be as a short term solution to the oversupply of young doctors.
Again on paper it looks good. Shorter working hours for young doctors (no one gives a hoot to the long working hours of more senior doctors), the massive amount of money saved because technically since these doctors are no longer “on call”, they are not paid call claims, and it clears the congestion in the wards.
All very good indeed.It’s a win-win situation, they tell us.
I tell you this is NOT a win-win situation. Now, house officers change places faster than you can say “dysdiadochokinesis”!
The BIGGEST LOSER in this whole fiasco, ironically, are the very ones the health care system was set up in the first place: THE PATIENTS.
Now patients had to content with seeing different doctors every day in the wards, each doctor not knowing the management plan for the patient because with all the shifting and moving, no one will take ownership of the patients!
So, if you are sick, come to the hospital at your own risk – you shall be DISOWNED!
