For so many years, ever since my housemanship days, the issue of overworked doctors have been appearing on and off in the newspapers. Today’s Star headline is about the same issue all over again http://thestar.com.my/news/story.asp?file=/2012/4/14/nation/11106586&sec=nation, http://thestar.com.my/news/story.asp?file=/2012/4/14/nation/11106584&sec=nation. Nothing happens after that,as the usual Malaysian style. All talk but no action! BTW why only HOs are overworked? what happen to the overworked MOs and specialist!!
When the shift system was implemented I wrote this http://pagalavan.com/2011/05/15/for-future-doctors-shift-work-for-housemen/. The whole idea of the shift system is to reduce the number of housemen in each shift so that they will have a better exposure to patients and more rest time. If not, 50 housemen will be running around in the ward every morning !! However, it will definately increase the workload of the housemen during each shift as they will end up seeing more patients at any one time, especially in busy and big hospitals. The entire shift system was not properly implemented and thought of. Our DG, with just a single circular forced all the hospitals to implement the shift duties in September 2011 without proper discussion. Before the implementation, only 2 “small” hospitals were used to run a pilot project. The same principle cannot be applied throughout the country as different hospitals have different problems, different number of ward etc etc. That was my concern then. It is now proven to be correct.
SCHOMOS had a discussion with MOH and came up with the flexi system with total number of hours capped at 60 hours/week. Thus, every hospital was given the authority to implement the shift system based on the best model for the respective hospitals. I was informed that the shift system only made the situation worst in some big and major hospitals in the country. Whatever it is, the rest time was adequate in total.
I have said this before and I will say this again that being a doctor in stressfull. If you can’t handle the stress then leave! If you are incompetent to be a save doctor, then you must be sacked as patient safety should always be the priority. From my experience, most housemen who can’t cope are people who did not realise a life as a doctor and forced by parents. Parents were only concerned about glamour, money and nothing else. So, when they see their child working like a “dog” they get upset and start complaining. I feel the generation Y youngsters are over pempered and unable to handle stress. Probably there is something seriously not right about our education system or the parents!
Everyone is talking about housemen nowadays just because there are too many of them and many are from well to do families and VIPs. If not how can you afford RM 500K to do medicine locally in all our dubious medical schools. Quality is dropping very fast and the consultants are having tough time handling this situation. That could be the reason why the MOs and specialist are beginning to shout at the housemen nowadays, thus labelled as “bullies”. I pity all those medical officers and specialist who are also overworked but never appeared in the newspaper!! This is because, these people have gone throu worst scenarios and able to handle all these situation. Wonder how I can work 24 hrs a day, 7 days a week? good training when I was a housemen.
BTW, the dead of the housemen has nothing to do with being overworked from what I gather and he never worked 5 consecutive days. The director of Kajang hospital said that he has 180 housemen, which means each department should have atleast 30 housemen!!
Housemen still being overworked and bullied, sending some into depression
Stories by LOH FOON FONG, LIM WEY WEN, P. ARUNA and SHAUN HO
Under the Graduate Medical Officer Flexi Timetable system, introduced last September, housemen can only work up to 60 hours a week with two days off. But implementation has been reportedly poor at some hospitals.
Health director-general Datuk Seri Dr Hasan Abdul Rahman said the ministry would seek explanations from hospitals found overworking their housemen, adding that the ministry was willing to help them implement the system effectively if they were facing a shortage of housemen.
However, he said he had checked timetables in Kuala Lumpur Hospital, Ampang Hospital, Serdang Hospital, Klang Hospital, Selayang Hospital and Sungai Buloh Hospital but had not seen any houseman made to work for more than five days a week or to do double shifts.
Earlier, Malaysian Medical Association president Dr Mary Cardosa urged the ministry to review the shift system and conduct a study on the mental health of junior doctors.
On the death of Dr Lee Chang Tat, 29, who was found dead in a restroom of the paediatrics ward at Kajang Hospital with a used syringe beside him, she said there was no data to show the number of housemen who suffered from depression due to their long working hours and stress.
“There should be some kind of mechanism to assist troubled doctors, whether they have personal or work-related problems or can’t handle the stress.”
The Malaysian Medical Council, meanwhile, reviews an average of five cases of doctors with mental health issues each month. It is learnt that there were 20 cases last October.
“Most of them are housemen, but we have also heard cases on medical officers,” said former Health director-general Tan Sri Dr Ismail Merican.
“The types of issues range from psychiatric problems to anxiety and coping problems,” Dr Ismail said.
Dr Ismail, who is also former MMC chairman, said the working hours for housemen may not be as demanding as before the shift system was implemented, but they were exposed to other sources of stress in their work including demands from patients, their superiors and other colleagues,” he added.
System that’s a burden to many housemen
PETALING JAYA: A 27-year-old houseman lamented that although the shift system was good, it was poorly implemented at his hospital.
He claimed that it was up to each department to implement the system.
The houseman alleged that when he first joined the hospital, he had to work 92 hours a week and on 24-hour shifts for up to one and a half months.
But things improved after someone brought up the issue to the management.
However, for departments that lacked housemen, they had to work long hours and without on-call allowance.
This was because allowances were not provided for in the shift system and housemen were not expected to work more than 72 hours a week, he added.
The houseman said they were paid a fixed RM600 a month but without the RM100 to RM200 allowance for each on-call duty.
He also claimed that eight housemen suffered depression and were under psychiatric observation as they could not take the bullying from senior doctors, whom he said constantly shouted and belittled them.
They were also burdened with a training duration that was extended from four to six or seven months for each department.
“One houseman went into depression after he failed his assessment twice,” he said, adding that some housemen got themselves transferred to another hospital or just resigned.
Another houseman Dr G.M. Pillai, 28, said Ipoh Hospital was trying its best to adhere to the rules set by the Health Ministry.
“We work 60 to 65 hours a week and sometimes up to 70 hours. But if we have to work up to 70 hours, we are given less hours the following week,” he said.
Before the shift system was introduced, he had worked up to 36 hours.
But, after it was implemented, the hours were capped at a maximum of 20 and they get a whole day off the next day, he said.