I found this interesting article from a fan of mine’s blog, Dr Simon: http://simonsim.wordpress.com/2011/05/27/houseman-stress/#comments. I find it rather amusing and at the same time don’t know whether I should cry. Infact I had mentioned all these in my blog before. Please read the case examples below. Soon, I will write more issues about the standards of our doctors and the future direction that our public healthcare is taking.
Houseman Stress..??
27 May
is it really the house officer’s life so stressful?
few months ago i sent a message to our beloved Health Minister Datok Seri Liow Tiong Lai..
i told him “i think Malaysia should limit the number of medical schools, i’m very surprised that the surgical house officers do not know how to insert a branula”..
he didn’t reply my message.. but few days later in a press conference, he said “the Ministry of Health will look into the issue of the quality of house officers”..
and recently, the Ministry of Higher Education announced “no more new medical schools in the next 5 years”..
to me, this is a great news.. hahaha.. 
but to those businessmen and money-orientated academicians, this is a shocking news coz they are losing their opportunity to earn easy money…
well, is the quality of the house officers (HO or commonly known as houseman) in our country really that bad..?? emmmm, i think those who are working in the hospital definitely know the answer..
there are few factors contribute to the poor quality of the house officers, one of them is the business-orientated money-digging poor medical education system, both local and abroad; other factors include poor attitude from the house officers themselves, as well as lack of support from the senior staffs (MO and specialists)..
let me draw an analogy how is a doctor being produced in this morden day..
first, you must know the concept of instant noodle..
you can choose vegetarian flavour, or spicy ramen flavour.. similarly you can choose to study medicine in local or abroad..
open up the cap, throw all the seasoning into the cup.. similarly, you attend the medical school and the lecturers throw all the textbooks on you.. (it is very sad to say that when the students approach the lecturers for any doubt in their study, the lecturers most of the time and most likely will answer like this “go back and read your books, come back and tell me the answers tomorrow”.. so basically the doctors nowadays are produced by medical textbooks and not by medical schools.. and this also means that most of the medical lecturers nowadays are makan gaji buta (earning easy money).. surprisingly, some of these lecturers even do not know their subjects well and do not know how to perform a clinical examination in a proper way..!!!!!
then, pour in some boiled water.. similarlly, the students are “floating” in the medical schools.. study just because of assignments, tests, examinations.. but do not know how to link the basic sciences with the clinical problems, do not appreciate the progress of a disease, everything also main hentam and tembak (shooting the answers all around)..
and finally, you get your instant noodle, and instant stethoscope.. :p
so how can we expect these instant noodle doctors to perform their tasks competently and to function as a house officer confidently..?????
here are few examples of the instant noodle house officers that i have met..
# case 1
patient in hypovolemia with hypotension..
MO: pls do fluid resuscitation..
HO doesn’t know what fluid resuscitation is, and malu (shy shy la) to ask the MO.. but he remembers resuscitation is something to do with CPR (cadiopulmonary resuscitation).. so he performs chest compression in a CONSCIOUS patient, causing respiratory distress to the patient, and the patient is looking at him in one kind.. and the smokes come out from the MO’s head..
deserved for HO paling tukul award.. (this HO graduated from Russia, recipient of scholarship from a famous local body)..
# case 2
vital signs stable on a dead body..
the HO did his evening round in the acute bay.. one of the patients was intubated due to head injury.. the family members told him the body became stiff 2 hours ago.. but the monitor still showing pulse rate (patient on ionotropes).. so he documented “patient GCS remains poor, vital signs stable, continue the same management”.. huh..????? how to become a doctor even he/she can’t even differentiate between LIFE and DEATH..????? why do they want to spend the parents and tax payers money to study medicine but the medical knowledge is lousier than a layman..?????
deserved for HO otak ketam award.. (again, this is another HO graduated from Russia)..
# case 3
for MO to resus patient..
i was attending a patient in the female surgical ward..
suddenly another patient in the same ward collapsed and desaturated.. the nurses were shouting and called the surgical house officer who was sitting at the counter doing nothing at that time to attend the patient.. he walked slowly to the bed of that patient but did not examine the patient, he just pointed his finger toward me “neh, doktor dekat sana”.. huh????? what type of houseman is this..????? asking a MO to attend a collapsed patient without examining and doing the initial resuscitation works..?????
deserved for HO ubi kentang award.. (this HO graduated from a local public university, one of the three oldest medical schools in this country)..
# case 4
for MO to insert branula..
during my housemanship time in 2006, when we have problem in inserting a branula, we NEVER called our MO for help (except for neonates).. we would call our senior houseman (most of the time, the captain) to help us to insert the branula.. during my second housemanship posting, i started to insert the femoral line and i did my toes amputation for diabetic patients ALONE while my MO was sleeping the whole night.. i did my first peritoneal dialysis together with my houseman friends without the presence of our MO when i was in the medical posting.. but now, what types of procedures that a houseman can perform..???
recently, during my busy oncall day, suddenly the nurse called me up “doktor, tolong insert branula, houseman dah cuba 2 kali tapi tak dapat”.. huh??? why can’t the houseman call me directly if he/she cannot get the line?? just left the patient and ordered the nurse to call me..?? what tpye of attitude is this..?? no responsibility at all.. when i went to see the patient, i found the vein of the patient was BIGGER than the vein on the manikin..!!!!! how could the HO fail to insert a line into such a huge vein..?????
deserved for HO kurang asam garam award.. (this HO also graduated from a local public university)..
# case 5
in the past, we houseman worked like lembu and donkey.. there was no time for us to sit and rest.. the MO just sat over the counter and monitored what we were doing.. we used to offer ourselves to assist the MO in doing any bedside procedures..
nowadays, the house officers are sitting over the counter and “observing” the MO doing their job.. no greetings, no offer, no initiative to learn..
deserved for HO kurang upaya fizikal award..
# case 6
houseman manja..
a female houseman is a little bit slow in doing her job and her medical knowledge is very poor.. but she likes to come to work late, and goes back home early.. every morning during the ward round, one of the surgeons likes to ask her a lot of questions to test her medical knowlege.. and most of the time she can’t answer.. one day, suddenly the surgeon receives a phone call when he is doing surgery “i’m the mother of @#$%, please stop asking my daughter any questions, or i will make a complain to the state health director..” huh?? like this also can arr..???
deserved for HO lampin pasti tak bocor award.. (this HO graduated from a local private medical school)..
so, is it really a houseman’s life so stressful..?? to me, YES in the past few years.. but NO in these days.. i don’t understand why the HO nowadays like to complain, small small things also complain, even language barrier with patients also become an issue to them.. in my opinion, these HO are too pampered by parents, not competent in clinical skills, too ego, and not taking positive attitude and initiative to improve themselves.. today, there are so many house officers in the ward compared to few years back, the workloads are markedly reduced.. so what are they complaining about..??? the stressfulness is mainly due to their incompetency to function as a house officer.. (of course there are still a lot of hard working, capable and reliable house officers around, but the numbers are not many now)..
as a trainee lecturer, i’m willing to teach and guide the house officers in any aspect, but only if they are really interested to learn.. my advice: don’t become a doctor just because of the title “doctor”, or one may end up like them..
Pagalavan's Avatar 
nice article describing various situation regarding HO in Malaysia.. Actually it all depends on attitude of the HO. If he/she willing to learn, then he/she will gain more experience. Yes, when you are MO, u will ‘kutuk’ HO. Same as when you’re HO, your MO will kutuk you.. It is happening all the time..
Let me tell you one story, 1 MO UD48 (really big experience is it?), referred 1 case of total amputation of finger. this so called stupid HO as described by this article, read the referral letter and notice what this big MO wrote in the letter “refer for Ray’s amputation”.. What?? That finger already amputated, what amputation do you want????
Another case, 1 ‘stupid’ HO reviewed pt of D3 post laparotomy, he noticed that pt having persistent vomiting, looks lethargic, and abd distension. So in clinical plan, wrote KIV for USG Abdomen, KIV for re-laparotomy. When the surgeon and MO came, he presented the case and tried to convince his plan. But, because he is only silly HO, so his opinion only setaraf the janitor, so nothing was done. Worse thing is, that surgeon allow oral intake than transferrred the pt to the non acute cubicle. The next day, another surgeon came and noticed the pt pt’s condition. Ordered USG Abdomen urgent, and relaparotomy done, and pt was found out to have infected peritoneal fluid. Luckily pt survive.
I don’t want to describe any more story regarding MO. But, as HO, i’m really happy if MO is really nice to teach us.. We are also glad to learn and ask the questions. But if you’re MO with bad attitude, always stories bad thing regarding HO to the specialist, then u will get the poor HO. Me, myself, i had good MO’s when i was in medical. That’s why, now i’m able to the femoral and neck line, intubation, resuscitate the pt, chest tube, and LP all by myself. Becoz all the MO’s were very nice in teaching me.
For MO’s, pls don’t ‘cari’ your HO’s fault. Try to be nice and teach them what u know.. Yes, bak kata pepatah melayu ‘Dalam setandan Buah, pasti ade yang busuk’.. There are HO’s with bad attitude, but only a few. If u only see this few bad HO rather than a lot good HO, then u will see only the bad thing.
I think this MO is talking about the attitudes of current HOs, the “tada apa” attitude. I must say that it is becoming very common nowadays.
i’m sorry DR, but as a HO, of course i want to defend myself.. Becoz for me, if you’re seeing the problematic HO, then of course u will see most of HOs are bad. In fact, in a dept, only 1@2 HO with attitude problems and under performance. But many of my colleagues are very good and willing to learn. As a HO, of course i hate people talking about the quality of HO nowadays.. For me, the major issue is the overflow of the HO. So, who fault is this? Of course the gov.
I am not sure which hospital you are in but in JB, there are plenty of HOs with attitude problems. Some even missing in action. Due to the glut, the consultants can’t keep track of them. In smaller hospitals, it will be less of a problem.
Before you “ketuk” the MO for requesting an apparently ludicrous referral for “ray amputation” following a total finger amputation, you might want to ask him why in order that you might learn a useful lesson. The MO wasn’t mad or inappropriate.
With the middle and ring fingers, an amputation proximal to the mid Proximal phalanx level results in a gap in the patient’s grasp. Each time he/she tries to pick up small objects like coins, these can fall out through the gap. One option for managing this problem is a ray amputation. Excision of the metacarpal allows the gap in the hand to be closed. It is a well described and very useful surgical solution even if it does appear excessive to the uninitiated.
Back to the issue of MO’s rubbishing HO’s, this is entirely normal practice anywhere in the world. In fact, at any level, the senior will rubbish the junior (eg: specialist will rubbish the MO; so on an so forth up the food chain). Part of the problem is that no one ever believes that they were THAT crap at some point in the past. Fact is, most of us were no matter how brief the period was! The important thing is to be able to swallow one’s pride, admit to one’s shortcomings and strive for improvement. The most dangerous physician/surgeon is the guy at the top of the food chain who cannot see or admit to his own errors.
i noticed that, most of the time, the 1 year Housemanship programme generations, always ‘memendang rendah’ to 2 years hosemanship programme generation. Are we stress? yes we are. Compare to 1 year rather than 2 year programme, of course every one will be streesful . Who want to be a HO in longer period of time??? Plus, with this current HO programme, u will get easily extended for 3 months (at least). So, tell me again, who doesn’t stress if every day your bos always threathening to extend you. Even, if your works was good, but your bos doesn’t like you, u will get extended. So easy to be extended.
So, if you think current HO is really lack of quality, then why don’t we get back to previous 1 year programme??? Correct me if i’m wrong.
Silly Ho,
You sound like a decent HO but I fear 3-4 years might not be enough for some of the current crop out there. I would put the problem figure at 25%, from the information I have (varies between hospitals). Some of these HOs should never become MOs – maybe that’s where the govt should introduce a promotion exam! Of course, what do you do then with HOs that don’t pass – too many HOs in the system already. No single fix-it solution.
I think it has nothing to do with 1 or 2 years housemanship. Previousy with only 3 medical schools till late nineties, the quality of doctors produced were much better. The reason why the 2 years housemanship was introduced in 2008 was for 2 reasons: poor quality of graduates and a more complete training. I think I had mentioned these in my articles before.
Of course, this will definately add a lot of stress to the doctors/HOs. Frankly, even when I was a HO, I can’t wait for the day I complete my housemanship. At the moment there is no standard evaluation for houseofficers. It depends on each department in each hospitals. I feel the MOH should come up with a standard evaluation since there are too many housemen nowadays crowding the system. It is only going to get worst in 3-5 years time.
The ‘standard evaluation’ they are supposed to have is a logbook and an exit interview with their supervisor. The reality is that many HOs get creative with their logbook, either copying cases/procedures from seniors or inventing them. The supervisor does not know how each HO is doing because they have to supervise 100 at a time, all starting at various periods because there is no fixed date for everyone – how can anyone keep track?! So they just sign the form after each rotation regardless of how the HO has performed. Also, many supervisors don’t want the hassle of reporting an incompetent HO because that will result in more paperwork and headache for them.
The log book is a joke and not all departments have exit interview. Of course most HODs do not bother to extend housemen because it involves a lot paperwork. Thus they just release them and hope they won’t land up in their department. I call this stupidity.
If one day i have a chance to learn from you, i will learn as much as i can. Thanks for this post
Well,
poor HOs, MOs and specialists. What happened at each department depends on the Consultants mood & mercy. If the HOD did not like you, that’s it…. your life as HO will be horrible & terrible. You’ll b disgraded, blamed, handed the dirtiest jobs, the most number of calls, weekends etc…. At the end of the day, u’ll be extended. That’s my life as HOs. Surprisingly, in other postings i excell & comes out as the best HO that the department ever had. The HOD were puzzled as to why the treatment given out in the first place………….
The only answer? i don’t know how to sapu buntut boss………….
hahahahaahaahaa……..
Hey doc, recently i’m having my internship as a biochemist in hukm, i really felt that what u said was right……production more than demand…..i saw many ppl wearing their white robe, medical students or doctors…..sometimes they even outnumbered those patients’ family members that paying visits…….200 intakes from ukm for medicine course annually!!! Have u ever thought of joining the politics??? i think u can make more changes if u’re one…..
I think I will stay away from real politics.
there are so many HOs nowadays and that causing lot of lackadaisical HOs. back then there was only 1 or even max 2 HO per ward, i didn’t dare to “lari-lari/tido-tido” cause there are no other guys you can rely on,and that relax mental attitude not even crossed in my mind.
Flowchart for current era of HO (note that “—–” is the consequence of previous condition)
lot of HOs — less opportunity — less workload —- lazy —- incompetent —- less confident —-less credible —- lot of craps —– mismanage/negligent/malpractice —– cover up a** —- Dr Jekyll
dear Dr Pagalavan.. thanks for sharing my article in your nice blog.. i really appreciate..
this is my second weeks in JB.. and the HO atitude problems are seen here as well.. #1: the HO in the ward went out for lunch for 2 hours, and i was doing the ward round ALONE with an empty stomach (they know i am doing round, but they just leave the ward like that).. #2: i was oncall last week, and i can’t find the HO.. (the oncall HO only need to take care of 1 ward).. it was 8pm in the evening, but the oncall HO was playing MIA, no evening round was done.. i have to ask the nurse to look for her.. but when she came to the ward, she didn’t explain why she didn’t do the evening round, and even worse, she didn’t introduce her self to me..! i m one of the benign MO, and i don’t like to meleter.. the age of HOs averagely are 26-28 years old, they are all adult, they should have the brain to think and behave like an adult.. i remember the time when we’re houseman, we introduce ourself to all the specialists and MOs in the department.. and whenever there are any othe MOs from other department come to review patients, we would offer ourself to assist the MOs, or at least stand beside the MOs and hoping to learn something from them.. but nowadays, we are transparent to the HOs, no greetings at all.. i am not sure if they are interested in treating patients or just merely enjoy of being called as “Dr”..??
during our time, we’re stress becoz we worried we could not handle patients well when we’re posted to district hopsital, we forced ourself to learn as much as possible.. but the stress of the HOs now are totally different.. they just worry the ward works may take up their lepak time.. but in fact there are not many ward works now since there are so many houseman..!!
these incompetent HOs are going to end up as incompetent MOs.. recently i received a referral from a junior MO from a district hospital, it was a head injury case, and she can’t really tell me the neurological findings, when i asked her if the patient still have gag reflex, and she asked me back what a gag reflex is..???
thanks for “silly HO” comments.. it is not easy for a HOD to extend a houseman actually.. it involves meeting among the specialists and a lot of paperworks.. if a HO is really good, the other specialists can back you up, no reason for you to be extended.. there are commonly 2 reasons why a HO being extend: 1) the HO has made a BIG MISTAKE that cause harm to the patient, or 2) when the specialists think that the HO is not up to the standard yet and the HO needs more time to learn.. as far as i understand, HOD cannot extend any HO with the reason “atitude problems”.. there are too many houseman, and most of the houseman do not take initiative to learn, so it is not surprising that many HO get extended due to their incompetency..
bak kata perpatah Melayu, siapa makan chilli dia terasa panas.. if a HO is really good, than just prove to every one of us that you are good, there is no need for a HO to worry to be labelled as “low quality” graduate, and no need to worry somebody is cari your fault.. i would remember the name of the capable and reliable house officers.. for the past 4 years, i only can remember 3 names.. these mean the good quality house officers are not many now.. if you are really good, the bosses will definitely trust you, there is no need to crack your head to convince your specialists / surgeons on your clinical findings..
i myself is not an “A” star student.. and an “A” star student may not neccessary will do well later in his/her career compare to a so-so student.. my article is mainly to alert the prospect students, think carefully before he/she decides to choose medicine as a career.. it is no point to waste the money to produce a doc who is not able to take care of the patients..
best regards.
Welcome to JB! HSA is the best hospital to learn if you are keen. A lot of cases and even weird ones! The HO attitudes will only get worst soon……………………..
yeah, i totally agree wv u, dr sim:).our prev mo even specialist can rem all of our names, even after solong post HO when we meet in hospital elsewher. i personally saw a HO told a pt in cc post mva in the morning round:” why u dun asw my questions properly, do u now im a dr, u dun respect me at all!”:the pt just stare at him blankly try to figure out y the dr shouting as he is not fully well yet:P
very sad to say the junior doc nowadays not only not respect to their senior / specialists but to the patients as well.. i myself have seen few cases like this where the HOs are blaming the patients for something non-sense..
this is such a good article showing the true colours of malaysian housemen. i just graduated from my HO-ship 3 months ago. while i was doing my last posting i.e. paediatrics, i had been in difficult situations when there was a large number of new HO in the dept… some were hardworking and eager to learn, but the other half….what can i say? the junior HO actually bullying the senior HO. i had one experience where one of this newbies already being told to take care of the general cubicle but instead, during HO rounds, he would ended up in a different cubicle with some “other” work. my captain had told him multiple times yet he seems could not understand the simple job description. on another occasion, he was specifically been assigned to take blood from a child and get further family history of the same patient by our specialist. instead, he went to the counter and shook his leg doing nothing. my friend and i were rushing thru our work and yet he did not help us a bit. i dont mind doing all the work because i think its an opportunity for me to learn. besides that, i’m used of doing a lot of work without rest. i got really fed up looking this HO shaking his legs that i decided to take the blood, because this is to assure the result would be ready by afternoon round, hence easier for the specialist to make the decision. but i refused to clerk the patient because it was suppose to be his job. not that i am so calculative about it, but i want him to learn to be more responsible. as for him, only until the afternoon round he came and approach the parents to get the family history and buat2 tak perasan that he did not take the blood. in fact the parents were already around in the ward very early in the morning.why only start clerking in the afternoon? when MO around, he will be showing of as if his doing most of the work when actually other have been covering his work. he went out lunch so early leaving unsettle work unsettled. but when the specialist asked him question, he was able to answer extremely well. in other cases, during oncall, we took turn to clerk cases, but when it comes to his turn, he “pura-pura” tidur and pushed the work to my other friends. in contrary, i had few HO colleague who is not so smart in their knowledge when being asked by specialist but they are hard working, eager to learn kind of HO. they dont push their work to other people.
working as a HO can be stressful but if you have a bad colleague, it will spoil everything and worsen the stress. but if you have really good, hard-working colleague, you will go thru it all fine. when i was in NICU, i had no problem at all with my friends, we learned from each other. we work together, when one person clerk a case, the other would help to take the blood. others will prepare the forms etc (provided all other work done). no matter how busy we were, we helped each other. so basically no one actually shaking legs. or if we do shake our legs doing nothing, we will make sure other friends do the same thing (meaning, make sure everyone finish their work and can rest together)
all these spices will make you a better, more matured MO.
i actually like the 2 years HO-ship because i had the chance to learn more in other dept. you are able to have a feel of all the major dept. i like my O&G (esp the “O” part), paediatric and ED posting most. and if i were in the 1 year HO-ship, i might be missing the best part of other dept. during my first posting, i’m so not good with b branula. but i attempted multiple time to learn eventhough my MO already reminded me to call other senior HO to help of failed after 3 attempt. i did not give up. i asked for the patient’s permission first to proceed, if they are uncomfortable about it, then i would asked for help. this is to ensure when oncall, i can safely oncall…well, during my first two postings, we still oncall alone by ourselves taking care of 3 wards alone – male/ female/ paeds. so if you do not know how to insert branula, it will cause problem to you. now a days, each oncall will have about 5 HO on the same night, so i guess new HOs dont feel the need to acquire such skills as they think they can just count on their friends’ existence.
so all in all, i’m saying, attitude is above all. this will bring you higher up. as what SILLY HO was saying, we are not generalising all HO. but once you are an MO or at the verge of becoming one, only then you will understand what your MO feel about all these. i felt it when i was in my last posting of HO when most of my MO already giving the trust to me to handle certain cases on my own especially during oncalls. looking at that situation and current HO attitude, eventhough i was still a HO then, but i felt really insecure having this kind of HO because knowing the fact that once i am an MO, they will be my HO, they will be doing most of the running jobs. what will happen to the patients and the ward if i have this kind of irresponsible HO. at times, when you are an MO, you need to trust your HO in doing jobs because you yourself will be busy doing other MO jobs like running the outpatient clinic etc.
Wow. I am a medical student in the uk, and frankly never been to a hospital in malaysia, am hoping to do that on my elective. As i am under jpa, i shall def be going back to work next year. Am a bit worried about working in malaysia now. But hearing it from an mo point of view, im surprised that the ho are so rude!! I have only heard it from ho point of view, and it hasnt been that great either. Lets just say, i am a bit wary as to how it would be for me next year!
My question is, how are the nurses? The nurses here are amazing! If u dont know anything or get stuckj, the nurses are def the go to people especially if your senior ho or registrars are nowhere and cannot be bleeped.
How is the work environment in general? Is it supportive? Do people help each other out (seniors to juniors) if u faced a problem. I like the environment im in now because the seniors are always helping the juniors (either it is to write up discharge or if the junior wanted to learn how to put in a central line).
Another question is, i admit my practical skills leave a lot to be desired mainly due to the lack of opportunity to practice. So, i admit i shaall be crap at them. Are the seniors understanding enough that they will take the time to teach me these procedures or will i just be ridiculed like how uve been complaining about ur juniors?
Nurses are hopeless in Malaysia except ICU, CCU and Labour room nurses. You can’t expect much fom the ward nurses. Whether senior will help the juniors depends on you and the type of seniors you have in your ward. Generally OK.
Most procedures you will learn during housemanship if you are hard working.
sarah, some nurses in certain dept are really good in their jobs as they had been there longer than us. when i was a houseman, i always asked them things that i dont know especially things that they are expert at like dressings etc.
from my experience, nurses at my medical ward were really good and efficient. during my time, not many HO, but many patients and too many bloods to be taken therefore too many investigation forms to fill in. they actually help me by filling in the forms for me. all i did was take the blood and signed the forms. another time, when i was in orthopaedic, i was oncall all by myself taking care of 3 wards. i have to clerk new cases, do ward rounds, assist in OT…so basically running around up and down from one ward to another. as i was busy, the nurses actually helped me to take blood. one of them took the blood and another helped to fill in the form. dont get me wrong, not that i’m lazy to take bloods, but being oncall alone, i was out of hand to do everything. nurses in ED too are very good.
the secret recipe is to respect them. if you do, they will respect you back, help you in difficult situation and back you up, they will teach you too. if you dont, they too will turn their back at you. be their friend, not their “boss”
i think as MOs, we should teach and guide the Hos to become better Doctors, because someday These Ex-Hos will be alone treating the tax-paying patients in District hospitals…. I try to do my best and hope they improve but “You can take the horse to the water,but you can’t make it drink it”… It up to the individuals to take the effort to improve.
100% agree!!!!!!i’m m/o in 1 of the institutional hosp in malaysia……my experience…..1 fine day…..1 h/o called me……she wanted to refer case…..seems that she doesn’t know about the patient…….just called for the saked of referral….when i asked further……she can’t answered me…….she raised her voice to me because im asking her……..definitely you need to know the patient’s history…patient’s condition..patient’s result and reason for referral…..so…im asking her…..indication for referral????? she answered me.. “MY MO ASK TO REFER”…..wasting 5 years in medical school!!!!!!! public also can give same ranswer……huh!!!!!!! juz 1 of my experience…..+ if we recall that the h/o in that hosp have done before…….the story can be as thick as Harrison’s + Kumar & Clark…….huh…we need QUALITY…not quantity……..
ya, i have the same experience as well.. usually i will ask the HO to go through the case note and call me back again, or i will tell the HO i m going to call their MO for further history if they can’t give me the information i want..
Personally, I think Malaysia is a very good place to go as an elective student if you are serious in becoming a good doctor. I would like to share my experience as not only med students can learn, but also junior doctors. When I was a final year student, I did 12 weeks of elective in the Emergency Department in a tertiary hospital in KL. On my first day, I went to the department and introduced myself together with 2 other elective students, one was a MARA student in Manchester and the other was a Scottish student. The 3 of us were pretty much ignored like all other medical students in the beginning. But we were keen, we took the initiative to see patients, perform procedures, bugged the MOs to explain why they were doing what they were doing. While we were doing that, the local final year students who were supposed to be on the A+E posting did the following: show face at 10am, by 11am disappeared to midvalley. Only a handful of the group of 30 students actually stayed for 5 hours or more per day. At the same time, there were 11 manipal students, only 1 was actually serious in getting something out of the attachment. The rest of them were only present on induction day, signing off day and in between acted as if they were consultants. Shows how serious our own local students are in regards to their own learning.
As for myself and the 2 other elective students, because we were keen, by week 2, the nurses, MOs and lecturers preferred us over their own local students whenever there were patients to see or jobs to be done. In fact, most of the time, our full clerking together with management plan just goes straight into the patients’ notes after the MOs have counter checked and signed, this never happened to any of the local students. In fact, the local students kept telling us that medical students’ clerking were never taken seriously, but they did not realise how rubbish their clerkings were. We became better at clerking patients, coming to diagnosis and differentials, have the courage to initiate investigations and managements, and even write up drugs and fluids. By week 3, basically all the MOs have to do is to sign whatever that needs to be signed. We became the unofficial house officers of the A+E department.
In the department, we also learned and got very good at doing procedures, starting with venepuncture, IV cannula, progressively to more difficult procedures like central lines, intubations and chest drains. In fact, my IV access skill was so good that when I started my FY1 in the UK, if I cannot get IV access, it is because the patients’ veins are non-existent and the anaesthetist has to be called to do an ultrasound guided access. After 1 month into my job, my seniors no longer bother to look for veins if I tell them that I can’t get IV access. While these skills are taught in the UK, I actually perfected them when I was in Malaysia.
To continue my story in the A+E department in Malaysia, progressively, we were involved in resus. Initially, we were only allowed to do chest compression or IV access, but the longer we stayed around, the more things we got to do, especially at night when there are few MOs around and no local students at all. By week 5, the resus bay MO was happy for me to shock a patient in VF. By week 6, I was left to resus a patient with DKA alone. I was told to administer drugs and fluids as I deem fit, document them, and the MO will sign the drug chart later. Although in principle it is illegal, but this just shows that if you take the initiative, there is a lot that you can learn and do as a junior. By week 8, I was left alone to manage a 10 bay resus area while the MOs go for dinner or go for a smoke. There were no doctors around, and if anything comes through, and often things do come through when you least expect them, I was left to manage on my own, with the help of a couple of nurses who were very helpful.
I also found that if you are competent, your seniors are more likely to trust you and back you up. There was a day when I was just about to go home when a patient on majors called me and told me that his foot was getting numb. The patient had a fracture and was seen by the orthopaedic MO earlier. I examined the patient and found that his leg was cold, pale and pulseless. I was worried that the patient had an acute ischaemic foot and expressed my concerns to the orthopaedic MO who did not bother to act despite listening to my concerns, probably thinking what does a medical student know about ischaemic limb. I documented the event in the patient’s notes together with the name of the orthopaedic MO. By next morning, when the A+E lecturer who happens to be a vascular and trauma surgeon did his rounds, the patient’s leg has gone black and had to be amputated. When the lecturer checked the notes and saw my entry, he was furious and pursued that MO for the next 7 days. I never knew the outcome, but it just shows the trust that your seniors have in you and willingness to support you when you are keen and competent.
So, by the end of the 12 week period in the A+E department in KL, I was skilled at various IV access procedures including subclavian approach for central line insertion, intubation and rapid sequence induction, resusitating arrested patients on my own, using the defib, doing chest drains and doing abdominal ultrasound, all these as a final year medical student. I can assure everybody who reads this that none of the UK trained HOs will be even half as competent. The fact that we have such incredible learning resources in Malaysia just goes to waste when our own students and even junior doctors are not interested in fully using them. This is basically an atitude problem. If I was able to do all those things that I mentioned in 12 weeks, the HOs in Malaysia should be very good and competent doctors after completing 1 year of HOship. But our students and junior doctors are more interested in walking with their noses facing the sky and expect people around to worship them simply because they are doctors instead of working hard, being humble and dedicated to their work to earn the trust and respect of people around them. It has not crossed their mind that one day, they will be patients themselves (we all do, afterall, everybody gets sick and die eventually) and the person who is managing them is probably doing what he/she did to others years ago.
While I am very confident that one day, the MARA student in Manchester, Dr Y will be a competent doctor, I can’t say the same about most of our other doctors, especially those who trained at Manipal based on the performance of the 11 students that I came across. If a final year student is making up a diagnosis without even clerking the patient properly and proceed to start management without supervising MO’s consent, that person is dangerous and should not be allowed to pass med school. Ultimately, how competent a doctor is comes down to how willing and eager that person is to learn, unfortunately, these people are a rarity in the profession these days. These days, people enter medicine for all reasons other than to be a good doctor. I find it absolutely disgusting when a student in medical school asks about the fastest route to be a neurosurgeon. These people aren’t interested in ensuring that they are competent as neurosurgeons, instead they are people who will do whatever it takes to cut open others’ head and in the process kill a large number of them.
Very good observation. I absolutely agree with the crux of your posting.
However, I think as an Anaesthetic SHO, you should know better than to say that you were “skilled at intubation and rapid sequence induction, resusitating arrested patients on my own”. Performing some procedures during a 12-week attachment does not make you skilled at them, especially technically difficult procedures. Research has shown that 2-3 years in anaesthesia is required to achieve true competence in tracheal intubation – and I’m not talking about your routine lean patients. And I would be wary of any junior doctor who claims they are competent at resuscitating patients on their own. FYI, I’m an Anaesthetic Fellow.
I agree. I do apologise for the use of those words. I should have said ‘able to’, I wrote that 4am in the morning when it was a bit quiet in ICU, but what I am trying to point out is that we have very good training opportunities in Malaysia, in fact, I would say better than in the UK with the exception of surgery, the only problem is juniors are not taking them. And the reason for, well, I have tried to illustrate and explained above.
i want to teach HO and guide them..but some of the HO’s are very dificult to teach especially the Russians/Indonesian graduates..they should have some basic in medicine upon graduation but to those graduates i’ve to teach them real basic like how to palpate a liver!!!!
I think HO grads from Russia and Indonesia.. MOST of them (not all ) have attitude problem!
how to become doctor is invariably depends on personal attitude. If the person who have conscious and would like to carry the responsiblity of managing sick people, he / she should prepare him/herself for the job description. the person will be potraying his / her own attitude and self by ways of getting the job done. All eye will be on the person who claim to be one in the medical field. if he / she did not prepare themselves to carry the job, people will know and they will brush or tarnish their own reputations because we are dealing with people, not stones or walls. For example, residents should be able to get history and one of the favourite “text book” answer…. poor historian… without any reasonable conclusion. I would say that the person who wrote this is poor doctor, rather than poor patient. He/she has been trained during undergraduates, or selft-trained under supervision should be able to gather information to make correct diagnosis and instill correct treatment, c.f. patient who presented with medical problems. Colleagues are at surroundings and by way of discussion intelectually, they can make better judgement. In the end, still attitude toward one’s carrier that will make him/her the way they are.
this maybe a late reply, but i’ll give it a shot. i graduated from a russian university (where we were thought completely in english) and you would need russian language (spoken and written) to deal with patients and for social communication. During the first 3 years, we studied theory but still had hospital rounds for nursing( yes we did two weeks of nursing care) and on top of that we were told to do electives in our native country during our summer vacation. so for 6 weeks instead of having a holiday, most of us( not all) did our electives in selected postings and enjoyed it.
during our clinical cycles, all our classes were hospital based. it all depends on the student if he is willing to learn or not. i used to stay back at the hospitals to assist my surgeon to a level that even if if was at 4 am, he would call me to ask if i wanted to assist and he’ll send a cab to fetch me if i wanted to assist him. all you have to do is ask and learn.
when i became a HO, i was placed in the medical department and i must admit it was really hard for me. i was not given any chance to do anything because im a russian graduate. along the way i learned fast and started doing everything on my own because i wanted to prove to people that russian graduates are not dumb. the drilling i had from my specialist was bone breaking and ear bleeding, but if not for him, i would not be where i am today.
along all postings, i had a lot of fun working. you need to love your job,in order to work. i must admit here that i didnt have many MO’s that were nice to me. Some were just too busy, some were ust busy hitting on some new house officers and some just thought they were the specialist running around. the handfull that helped me were those whom really saw what i was trying to do and i appreciate them for that.
when i became a medical officer in the emergency department, i vowed to myself that i will never treat my house officers the way i was treated as a HO. i train them well, i hold their hands when they’re intubating the first time and etc. But along the way i noticed things had changed. a new house officer asked me, where is his parking lot??? hahaha even i dont have a parking lot and got tickets for parking by the road many times. I also noticed this :
-they come in late to work daily despite being pointed out to.
-The HOs sleeps at night while the MO’s clerks cases.
– Most of them would be calculating how many cases they clerked a day.
– log book was just a joke
– everyone prays for a good call…
– the local grads looks so low on the russian grad..one even said *i will get masters from my own uni and u will be still struggling*
– most of them are not bothered when we spare our time to give teaching sessions
I was a jonah..still am..always will be..but every jonah days were eye openers for me. i learned more things every day . the more patients you see, the faster you will learn..
this note goes out for those whom thinks russian grads are just full of it and are dumb. And this note is also for my fellow russian grads who are reading this post and feeling really down like how i felt before.
for those medical students in russia..go out meet patients, mingle with them, read their case notes and ask permission and examine them. you’ll be amazed how your lecturers will be so happy to teach you.
for those HOs from russia, work, work and work…keep learning, learn from your seniors, read (never stop studying) and you’ll excel. always feel the thirst for knowledge..and never let the candle burn out.
is studying in Russia that bad?
Depends os students and college
Though I have a number of family who also are doctors, I have to agree on what you have written here (means I wouldn’t go against the truth and be on their side). Other than all what you have written here, another issues with their attitude is, they like to complaint about patients on social media , esp Facebook. Is this even ethical? Patients being patients- but you ( I am referring to these doctors I know) who happened to be educated and also choose to be doctors (patients didn’t chose to be patients); why acting lower than uneducated people venting about patients all day long and complaining about being tired at work; relationship problem due to long working hours ; this and that? Are you not being paid? And most of them studying with duit rakyat; so why not as well serve the rakyat? Without the duit rakyat, they won’t even make it to the univ. Indeed an attitude problem. Oh, I also had come a crossed doctor who in the midst trying to insert branula; which he failed so many times at this one patients; he still have the audacity to brag about the medical college he attended in UK and citing the name of several famous professors who are their alumni. Bro; u don’t even know how to insert branula; And if u are microbiologist, working for infectious disease, and have the purest intention of educating them on ID,…forget it. They wouln’t even pandang you. <– Real life experience