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 (https://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.
Pagalavan's Avatar 
All this talk about poor housemen can only say a lot of about poor MO’s too. After all, isn’t poor performance is reflective of poor leadership?
I can only guess the only reason why the housemenship training was extended to 2 years because of all those previous poor MO’s services.
Now the MO’s are complaining because they think that HO’s doesn’t deserve the attention of the higher ups. That they are the ones bearing the burden. The one that has to clean up all the HO’s mess.
But guess what? If you (MO) haven’t created a vicious cycle whereas using HO as your verbal punching bag and bullying, this it won’t happen in the first place. Parents won’t complain, people would write official letters to the MoH demanding this and that.
It’s all going downhill I agree, but not because of the HO’s, you can only blame the yourselves for all the blunder happening in this country. From the MOs, the registrars and the specialist.
stupid idiot talking without brain..
That’s the kind of example I’m talking about. Given some simple fact, the only rebuttal you can make is akin to trolling. Stupid idiot? You can do better.
u too can do better..!
you can’t have good leadership if you are overloaded with housemen! The MOs have got a lot of other work to do other than the ward rounds. Nowadays, most MOs don’t bother about underperforming HOs. They rather concentrate on the good ones and those who are interested in learning. Saying that, the quality of MOs are also deteriorating as mentioned by the comment in my blog above
Again, it is still the maldistribution that causes the problems. Not all hospitals have 2-3 patients per HO ratio. Plus, the care system is different, with some places requiring more documentation than what would have been needed donkey years ago. And not all MO are equally as deserving, because these are the ex-HO who caused all the problems. Now that they are MO’s, they start complaining for doing so-called HO’s job. Admitting all dengue patients with no whatsoever warning sign because they are lazy to see in the ED, or simply admitting all patients with pneumonia or asthma when they are indeed stable patients, causing increased workload to everyone. Taking care of patient is actually easy, but 90% of the time, you are taking care of the documentation of the patients instead.
Seriously, the time has already come when perhaps even MO’s need to do HO tagging (not just MO tagging) before they are allowed to do their MO calls. Otherwise you’ll really roll your eyes at their incompetency. What’s worse, you can’t even extend them like you do for HO. MO is currently “untouchable” for whatever funny thing they’re doing or lazing around too. All they can get is some scolding, and all you know, they prefer to be chronic MO’s anyway! There is a policy in my hospital to transfuse before 5pm, otherwise it’ll require specialist’s consent. And there u have an MO who ordered for blood transfusion at 4.30pm, and scold the HO for causing a mess by transfusing at 7pm! The whole process from filling up the forms, taking blood from pt, going down to the lab,cross match for 1 hour, to take the blood and fill up all the verification of blood transfusion will definitely require time more than that stipulated half an hour. MO”s need to learn to plan ahead and lead and delgate properly, not just expecting all HO’s to do their jobs as smoothly without any hitch at all. This is what I call wussy and lazy MO!
The entire civil service is like this. Once you are in the service, nothing much can be done other than keep transferring you from one place to another. This goes for the specialist as well. Many of the specialists in government service nowadays are not bothered what happens to the ward or patients or even their junior doctors. Most of the good ones have left.
You know la it’s the typical gomen dance. Once you’re in, you’re in. No matter how bad you do, how worst you perform, your paycheck stays the same (Increment pun still bole dapat). Unless you quit the service.
So this creates a very good environment for ‘chronic MO’s’. Stay in the system, nobody touches you. You’ll be just fine.
Hi Dr. Pagalavan,
I’m a fresh graduate currently undergoing my housemanship training in a hospital at Selangor. I must say it has been a fun and exciting period, as from someone who was once constantly waiting for an MO to come before committing to management, I now do my own management, and later the MO either continues, or optimizes my management.
Whilst it may be true that some hospitals have each housemen only managing 2-3 patients (is this HKL?), my hospital is slightly of a different issue. I’m currently in my Medical Posting, and as a first poster in Medical, I’m sure you could relate how it goes. First and foremost, let me just say, I do not envy MO’s or Specialists. Whilst I feel my job is challenging, I feel theirs is of a greater calling. Whilst I am only in charge of one ward, they have to cover all 6 medical wards, which I suspect could house more than 200 patients on a busy day?
As someone from a non-computerized hospital, let me just say that some procedures take longer than needed to accomplish. However, I’m not complaining because this just teaches me how to divide my time, and work out an urgency order. Sometimes, even the best of planning comes crashing when unexpected events take place such as unstable patients or new developments in patients management. Despite all this, all I can say is, just continue striving and working and you’ll get to end the day fine.
I’ve never had the opportunity to be on call, but I can say that the shift system, whilst gives me some time off, doesn’t really make a difference to me. I still come to the ward to check on my patients, and see changes in managements on my off days. Sometimes MO’s catch cracks in my management, and from there I learn what I leave out. The continuity of care per se, is sometimes lost, but all it takes is for you to come to work slightly earlier than usual to check on whichever cases you wish to see how they are responding to their specific management.
I don’t know about other hospitals, but over here, it’s not really 1 housemen for 2-3 patients, although I could imagine how glorious that would be :). I’m not complaining though, exposure to so many cases has helped me learn the management of the various cases we see. There are still a few areas in which I am weak, but I feel overtime, it’s something I can learn and overcome.
Perhaps I am blessed, or just merely naive that I feel all my colleagues are a hardworking bunch, don’t play truant, and finish their jobs. I have heard of nightmare stories of housemen bailing and the such, so it was quite a relief to see I have dedicated colleagues. In fact the situation must have been pretty bad at other places that a recently transferred specialist from HKL actually performed Roll Calls on housemen on his first day to check if everyone was there. Naturally everyone was, and he stopped doing that since.
Anyways, I’m only 2 months in, so perhaps by enthusiasm levels and spirits are still high. If that’s the case, I hope it doesn’t end anytime soon at all, despite all the challenges that we face everyday.
Dr. Pagalavan, thank you for highlighting everything that happens in a non-biased neutral way. Whilst I do understand the bulk of it comes from foreign graduates, rest assured, we’re not too proud of how our colleagues have portrayed us as a whole. As the saying goes, all it takes is “nila setitik” for the whole batch to get a bad reputation. Please rest assured, there are those of us who are working hard to get past the status quo. It is a hard uphill battle against stereotypes and preconceived perception, but these are all simple challenges that I feel all HO’s will face and is just something I must take in stride.
Again, I thank you for all your updates, and views regarding this matter. Please continue educating us on how things are going. We surely appreciate it.
Unfortunately, there are very few housemen who have actual interest like you. If you do medicine for genuine interest then you will be a good doctor.
good job First Poster.. keep your good work.. 🙂
When I did my Medical posting as a house officer, I didn’t have time to sit down and analyze this much. The very few moments I had in between calls and sleep was spent staring in open space, numb, and wondering what is going on with my life. Then Orthopaedic posting started and all hell broke loose!
blaiming each other is not the way to solve the probs.. Frankly speaking all the stupid complaints came from HO whom their parents are VIP/politician.. Please, for me only a few HO doens’t know how to do their works.. many of them are good. So, don’t judge the books from its covers. The important thing now is to find the solution of overflow of HO. Cut all the craps. we should fight against all jokers who want ‘sell’ the medical degree.
Which hospitals have low number of houseman?Anyone suggest…
Indeed. HO is our only path to build a better performance and character as a great MO. 6 years of studying, and too much fussing about 2 years training? It’s just a waste of time and money.
http://thestar.com.my/news/story.asp?file=/2011/12/1/focus/10008595&sec=focus
I think the community still have a lot of peoples like Britian, the annoyed observer. Britian could be parent of the poor houseman.
– The problem is this is not A FEW houseman’s problem.
– Britian still think doing 6 posting will solve the problem?
– Britian still DON’T know that SPA already asking MMC to consider scrap off the housemanship.
– How come Britian doesn’t think for patient?
Britian said during the writer time, the housemanship was 12 months but Britian doesn’t know that during the time, most of the medical students are EXCELLENT not like now.
If a complaint letter is shown up in the newspaper, mean there are a lot of wrong treatments already happened. Remember the rule – tip of the ice berg.
I would think the problem is the houseman glut and their attitude.
Even a houseman finished 6 posting is still not considered as fully competent however, I did observe some houseman who is really out perform from others.
I think we can IGNORED Britian as it appears that he/she is not in the system and DON’T KNOW what is happening actually.
He is talking rubbish
The truth is when we were to explain our dissatisfaction met in public health care, we tend to considered to be defaming the whole lot of doctors (MO’s, Housemen,specialist or whoever). The medical doctors must understand they are in a profession dealing with the public and to make it more significant, dealing with people’s lives. When people don’t get good treament( am not even talking about getting the best treatment) but then being treated well with gentleness and lots of care,it’s kind of frustrating for the patients. I am not saying the whole lot of doctors are like that but many have poor mannerism in interacting with patients. They chose this path and if they are can’t deliver the best, unfortunately the patients suffer.Again am not refering to all doctors,but if the patient is attended by such moronic doctors, unfortunately the patient will have to suffer…..
Truthfully, many patients are suffering nowadays due to poor quality front liners. The main issue is arrogance and failure to consult seniors.
I think its really due time to say enough is enough. The only real solution to this problem is by overhauling the whole health care system.
Replace the health minister ( with an actual doctor this time ), and the DG with people who actually has the brains and balls to run the system.
Give MMC and MMA more significant authoritative power in decision/policy making.
All med grads are required to pass a general entry exam conducted by an unbiased, neutral panel of examiners before being able to be admitted for work.
De-recognised dubious overseas medical schools, and oh! shut down local private med schools that are not up to mark.
Since there a lot HO’s right now, that pretty much means that it will translate to a lot of MO’s in the future. PK’s will cramped ( it already is ) and wards will be congested ( more healthcare personnel than patients ). I guess in this case, docs proven to be highly competent upon finishing HO-ship should hired on contract basis ( that is the rumour after all ) and assesed regularly. As for the problematic ones, well, too bad…no contract, defintiely no APC, and to considered for a contract in the future, the poor fella has to undergo some form of short course posting. Then at the end of it, sit for a competency assessment exam. Should he/she pass, name would probably be considered for contracts. Oh…and contracts should be limited.
( I have to say this one sounds very very cruel…but thats what happens when we’re no longer classified as critical in-need workers and surplus to requirements by the ministry )
So…thats what I perceive as the solution to this whole God damned mess. Problem is…it aint achievable.
There’s too much interference from unwanted external factors, too much politics, too much restriction and too much hanky pankies going on in upper management. And not forgetting that there’s a lot of bigshots holding major stakes in commercially privatised medical education.
Boy, do I sound cynical or what. Anyway, feel free to prove me wrong though. I would really like someone to come up with an algorithm to overhaul the system without getting crucified.
Opinion from colleague….
http://www.nst.com.my/opinion/letters-to-the-editor/housemen-experiential-learning-vital-1.32918
Does housemanship mean ur getting educate in nice way or getting bullied for leisure….?
no one should bully for leisure!
when leaders only give reasons and find faults….I guess u can’t expect much from people below =)