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 https://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.
Pagalavan's Avatar 
Moh sud take resposibility.too early to make comments
when will MOH and others learn that “pilot” studies should be done at various “size” hospitals .wat about “reliability test”…basic statistics!!!. looks like in our “bolehLand” semua BOLEH..plus the “saya yang menurut perintah” tag line just says “follow” la..your views are not welcomed..then walla ada problem knee jerk reaction…. perhaps MOH and hospital administrators need to attend a course on SYSTEMS THINKING..
I think most HOs who got depressed are not due to the long working hours but the reality doesn’t suit what they expected.
good point…. expectations do not match reality
this is what happen when getting into medical school is easy..passing medical school is even easier..when reality hits the fan..they crumble. if we make going to medical school is hard as possible…only hard truly motivated people will thrive hence we will not have this issue in the first place. dont start on how competent doctors are also susceptible to depressive disorder etc. the fact remains…they are simply too many young doctors out there who are not supposed to be doctors in the first place.
Fully agree with this assessment. It has always been a tough profession, but in the past, only the brightest gets in, and at least their intellect carries them through.
With the current scenario, the majority of medical students enter not because they got academic merit, but because they have money.
I cant understand all the fuss about HO being Bullied
Come on la take it as a challenge and improve yourself
make yourself better to avoid the so called “bullying”
personally I dont mind letting the MO and Specialist point out my mistake and scold me for that…who knows that very mistake can kill a patient…
we are not born genius…kena belasah here and there and learn from it la…
I’m still a HO and i love my job…
Although I agree that it’s okay for MOs and specialist to point out mistakes, it is never okay to shout at anyone. We live in a civilised society where shouting is never the answer to any problems. And ppl wonder why Malaysia is not developed yet. It’s because of these uncivilised people in the country with 3rd world mentality.
I think people are combining 2 separate issues into 1. Being overworked and being bullied is not the same. On the issue of being bullied, I think every junior has to “suck it in” and take it as a challenge to be better.
However, as an employee, every hour at work has to be accounted for. A houseman is not a volunteer. Let’s face it – some hospitals or some departments have bad management. For example, during the “tagging” period, how can you call being in the hospital from 5 am till 12 am reasonable?! And this is supposed to go on for 2 weeks without a day off!
there is a day off after one week and then u have to continue and u’ll get another day off..it’s 7am till 10pm..that is the standard in almost all hospital..u should not just speak whatever u like without knowing anything..that show how stupid you are..
SS was I talking about ALL HOSPITALS? read carefully, don’t be so eager to look smart that you in turn become the stupid one instead.
“that is the standard”.. it is always a “standard” with our government and their regulations. but does every department comply with the “standards”? No!
When you say 7am till 10pm, can the houseman clock in at 7, and then clock out at 10pm? No! He has to come before the MO does, and leave only after the specialist does! Some of my friends even tell me they were afraid to leave because nobody told them they could go, and apparently only the specialist “had the power” to let them go.
All I’m saying is that housemen (and all other medical practitioners) should be allocated their work hours, and they should adhere to it strictly. There should be no reprecussions for coming on time (not early) and going home on time.
Sparks:
Overwork is bad. I have gone through it and do not wish it on any of my juniors.
However, medicine is not an office job. You do not clock in and clock out on the dot on most days. It seems forgotten that the patient is the priority, not the HO, MO or specialist. Patient welfare is the main objective, others are secondary. We need to finish the allotted work for the benefit of the patient. If there are more patients, either work faster or work longer. If a colleague is off sick, you turn up earlier to pick up the slack. If a patient collapses, you stay back to help in resuscitation. There is no option, no excuse.
Huajern:
I totally agree with your point that patients do indeed come first and let’s say a patient came in at 21:59 on our shift, we do have to finish “dealing” with the patient. I’m not saying that we should set up a strict time when everybody should come and go.
I’m only suggesting that all departments be reasonable. The system by MOH seems reasonable, but very poorly implemented and enforced.
Does anybody here deny that in SOME (I say some, less some cuckoo goes amok about this) departments, they really do abuse their housemen? No day off for 2 weeks, 5 – 12am etc. (really got lah, I’m not making things up)
Although on paper everything is as it should be, the reality is that those housemen are working more than they should.
Thus, interests and attitude problems aside, housemanship in SOME hospitals seem to be a breeding ground for psychiatric cases.
I have to agree with Sparks. There is no such thing as standards part from being on papers. In my hospital, 7am-10pm is the advisable tagging period with off days subject to the mercy of the HOD/ MO in charge of HO’s. Which, is next to none in most dept. During the early periods, HO in certain dept worked from 6am-2am because of “responsibility”. That is for 2 weeks for 1st posters, with no day off in between.
Being bullied is less of an issue since new HO’s are also very apt in the disappearing act if they want to. Talking purely for the sake of “passion” and “responsibility” will solve nothing towards trying to improve the issue, akin to talking religion into science. It is all about management, and how to prevent increase in mortality rates.
Ss is an example of a typical Malaysian with a third world brain who calls people names. The last sentence was not necessary. It just shows that you are trying to look smart
1st off, not all MOs and specialists are bullies. Same goes to the house officers. Some HOs are genuinely interested in their job and have good attitude that will make them good doctors. I have always stood by my opinion that one need not be smart to be a good doctor, but it is the attitude that counts.
Regarding the issue of overworked HO, I remember there were many comments in Dr Paga’s blog. The shift system itself is flawed, coupled with the fact that most hospital admin people are only interested in going for tea time rather than sit down and properly execute the shift system.I have mentioned this before as well. There are many problems with implementation, mostly due to the fault in the admin department, They have to ensure a steady number of HO and also they have to calculate meticulously the effective strength of HO before starting the shift system. One example is that in a month there might be 50 HO in a particular department(which is sufficient to run a shift system), but then suddenly the number drops to 20 in the next month due to reduction in number of new grads joining the said hospital.(this is also because the admin people suddenly feels that there are too many HOs around and hence decided to tell the state health department to cut down new grads being sent to the hospital!) therefore it is poor implementation that needs to be rectified! Basically the office people looked at numbers and never really bothered to check what is going on in the field. SO when there is a sudden drop in effective men power, the HOs will suffer!
My MOs are working between 96 hours a week and never complain and housemen can only work up to 60 hours and are all over the news.
Hello, can somebody do something?
Oh ya! My houseman will become MO tomorrow and they will be working 96 hours a week without complaint! Thank God!
Mr Pagalavan…
.As an accountant and a parent of 2 would be doctors….i am quite tired of hearing u repeating comments like “dubious medical schools” and ” forced by parents” and “housemen working long hours” etc. Please STOP making stupid comments like that..i have had enough of it ever since i started reading your column about 1-2 yrs ago.
Maybe during your days your parents ‘forced’ you to study medicine. Even then i think most who went into medicine knew what the profession is all about. U tend to make becoming a doctor as something so ‘out of this world’. May i remind you that studying medicine and working as a doctor is no different then studying Accountancy and working as an accountant or studying engineering and working as an engineer. When they choose to study accountancy or engineering they make their decisions on best undertstanding of the profession. Parents do sometimes help children to make the decisions…By no means do parrents FORCE children to study something. Your comments are as old as you, it does not hold water anymore so stop repeating it.
All professions have its share of sheer hard work and long hours…I think your knowledge of other professions is so shallow…for you to talk so great about been a doctor.
Accountants do have to work very late very often….as part of management team their time is not 9-5 although officially it is. They often work late until late nights and weekends WITHOUT BEEN COMPENSATED. Same with engineers, they can be called up any time of the night or weekend…its part of their job and nobody fusses about it. And there are no ministeries to detemine their working hours.
My next issue is on your often stated comments about “dubious medical schools’. I dare you to name a few that you think are dubious. U keep repeating that in mnay of your comments . I hope you take my challenge….or forever shut your mouth. All medical schools teach students the theoretical aspects and as much of practicals as possible. For your info it is the same with Accountancy or Engineering. When they start working they have to accquire the working experience. Are u saying that when your graduated from medical school…you were so good ?? Next time stop saying housemen are incompetent etc…there are incompetent people in all professions.
the shit must had hit in the face spending all your hard earn cash to send your children to these “dubious med school” because maybe your children are just not good enough for proper med school. i dont blame you man, being a parent these days…challenging i must say but if you really care about your children make sure they meet the grades and send to them to medical school where at least they can work abroad. information assymetry man..im sure you learned this at accounting school…owh by they way are you an accountant or a certified accountant? is the same like saying whether you are a medical graduate or a licensed- doctor..very different indeed.
Ashrafkhan,
I still know parents who ‘force’ their students to study medicine. Maybe coerce is a better word to use, I’m not sure. They think they are doing it for their child’s benefit, but in reality, they are doing their child a disservice. A close friend of mine studied in the UK, got his degree, worked for 6 months and then quit. He had never wanted to do medicine in the first place but was ‘forced’ by his parents.
The difference about long working hours in medicine is that when doctors make mistakes, patients die or suffer other forms of injury (some permanent). The consequences are not so dire when accountants get 2+2 wrong at 4am.
In terms of dubious medical schools, I would gladly state that 75% of the private medical schools in Malaysia do not teach their students to the required standard and/or take in very mediocre students who should not be studying medicine. We should aim to emulate UK, Aus, etc in this respect – not India, Ukraine or Indonesia. 30 years ago, our medical schools were among the best in the Commonwealth but that is not the case anymore. So while others have progressed, we have stayed stagnant or regressed. The other problem is that the medical council has recognised too many substandard medical schools from eastern europe, middle east, Indonesia, etc. Not all are bad, but the many stories of lecturers accepting bribes to pass students, cheating being tolerated during exams, parallel courses run in English where students are not taught well, graduates not performing to standard expected of them – surely all of this warrants a good look at the problem! I have a background in medical education and would like to think I am well-placed to make these comments.
You may tolerate incompetence in your profession, but I won’t in mine. If there are incompetent doctors around, they will eventually cause harm to their patients. I would not want my family members to be treated by these individuals – would you?
If you do not like what Dr Paga writes on HIS blog, you are free not to read it. Better yet, start your own blog extolling the virtues of parents spending lots of money to send their children with mediocre SPM results to study medicine. Keep us updated on how it goes. Would like to know how these new doctors handle the oversupply situation in 5 years time. 7,000 new grads per year (and increasing), only 1,000 Masters places per year. You’re an accountant, you do the math.
Accepting bribe: Once a Russian medical students told us that in his school, the difficulty of questions asked in viva is based on the amount of ‘Ang Pow’ given.
An accountant’s post bad investment denial reaction.
Mr. Ashrafkhan,
I guess Dr. Pagalavan will not name the dubious medical schools he mentions, but let me state some, generally speaking from experience working with houseofficers from various universities (to generalise is bad but you have to see it to believe me).
Ranking from the best to the worse of them lot…
1. UM/UKM/USM graduates are amongst the best I’ve seen, good work ethics, good knowledge, maybe a little poor on presentation skills, probably only 1 out of 100 will pull a disappearing act or get extended by the department
2. Local twinning graduates i.e. PMC/IMU/MMMC, these are the so-called kids of rich parents or what you people would label them as, but knowledge and attitude-wise, probably on par or slightly lacking behind the UM/UKM/USM bunch. Maybe 5-10 out of 100 are bad, lets face it every medical school produces bad apples
3. Graduates from UK/Australia/New Zealand, sometimes I wonder why on earth do they even come back from where they graduated (1st world country practices are not applicable to Malaysia!). Knowledge-wise excellent, but usually takes a while to pick up the necessary clinical skills compared to our local graduates, interns are not expected to do much in 1st world countries and if so only under SUPERVISION.
4. Graduates from Indonesia/Middle East, mind you some are JPA scholars, some are sponsored by parents, I’d say 50 out of 100 are good.
5. Graduates from Russia/Ukraine – What do you have to say, I have countless stories accumulated from just over 4 years as these graduates are rare/unheard of before 2008. 95 out of 100 are BAD to the core, no knowledge, doesn’t know how to take a history/examine a patient (some probably did Accountancy), never held a needle/syringe or touch a patient! Last but not least, disappear or try to pretend to be busy so that others will do extra work. How on earth do they graduate from these dubious medical schools?
Why are graduates from Russia/Ukraine being looked down upon? To the extent that they usually exclude from their Rubber Stamp where they graduated. Useless unless proven otherwise as mentioned by some senior doctors.
I hope Mr. Ashrafkhan, that you have not sent your children to some Eastern European country to pursue Medicine. If you did, I sorry to say that your money has gone to waste. Sometimes I do wonder if our politicians are involved with the recognition of such dubious medical schools, maybe they do get a cut of the tuition fees after all.
I am a ho who graduates from Australia. The only reason I came back to Malaysia is that I was sponsored by jpa. No one in their right state of mind would want to work in a third world health care system like malaysia”‘s after graduating from a first world country.
“When they start working they have to accquire the working experience.” I like this phrase but in reality the problem is (especially for those who came from the Russian dobious medical college) the correct phrase should be ” When they start working they have to acquire BASIC MEDICAL KNOWLEDGE”. These medical graduates from these dobious medical schools often starts with little or even NO basic medical knowledge. The MOs and specialists have often need to teach them again like fresh medical students rather than letting them practice what they learn in medical schools or learn to do basic medical procedures. I had even seen some medical graduate who finish a clinical posting without seeing any real patient. I don’t blame them, they may be a good student but just the medical schools system is real bad and not suitable for Malaysian system.
My comment apply mainly on Russian graduates. Indeed they are useless unless proven otherwise.
Great idea Poor Doc! Now try maintaining that same attitude, and replace “Russian Grads” with any certain race or nationality and see… why, you’ll probably lose your family jewels faster than you can shriek. =)
Dear Mr Accountant,
Firstly, if you want to make any comment, please do so intelligently rather than emotionally. If you read my blog carefully including each and every comment, all the answers are there. Pls don’t read bits and pieces and throw your tantrum.
No one forced me to do medicine. I beg to differ when you said that all students know what they are getting into when they decied to do medicine. Even in this blog, if you do read all the comments you will realise that that there are many students who did not realise anything about medicine till they start to work. I have been in service for more than 15 years and I can TELL YOU FOR SURE that you are wrong !! Please check you facts first before commenting. I have been incharge of housemen for almost 10 years before I left to private and I can tell you that most housemen who can’t cope, need psychiatric help etc have few things in common:
1) never interested in medicine but parents forced
2) never realised that being a doctor is this tough
3) poor qualifications before entering medical school
4) no one explained to them about life as a doctor.
This blog is to educate the public and future doctors on the reality of being a doctor. Oh, BTW, this is a comment from a psychiatrsit who posted in my blog few weeks ago:
Dear all
Can I suggest something. I am a psychiatrist and received few houseman who do not want to be a doctor and referred to us because of “missing in action”. There are intelligent but force to be a doctor . The have No way out unless to finish their HO. Some of them do go to Putrajaya and begged to be transfer to other discipline other than medicine
Pitty them also , become the victim of authoritarian parenting . I suggest MOH channel some of them to become a researcher, scientist , allied health specialist , lecturer and etc by creating a path for them to join university or other allied health department.
So, you see Mr Accountant that I know exactly what I am talking about. If you can proof me wrong then I will shut my mouth!! Pls also read all the comments in my entire blog before that!
Secondly, you do not have any authority to comment about medicine. I will say this again that medicine is different than any other profession. If you don’t know then it is you who should keep quiet!! Yes, in every profession you need to work hard in the early stages. I don’t deny that and I have said that in my blog as well. BUT there is one difference. A mistake made by an accountant can be corrected. A mistake made by an engineer can be rectified BUT a mistake made by a doctor WILL cost a life!!! A lawyers letter will await you after that. I am sure you don’t see any lawyers letter awaiting to sue you at your doorstep everyday, right!! And why do you think there is a medical council in each country monitoring the standards of medical education and practise of doctors??
Now, coming to dubious medical schools. I challenge you to do this: go and pay a visit to some establisehd medical schools like UM, UKM, USM and then to NUS , UK , Australia and US. After that, come back home and visit all the medical schools in Malaysia ( 36 of them). After doing all this if you can tell me that our medical schools are of equivalent standards with these countries, then I will shut up!! If not, you should just shut yourself up! We have medical schools in Malaysia with less then 10 full time lecturers but can run a 5 years medical programme!! By any international standards, 70% of our 36 medical schools are NOT FIT to be called a medical school. I don’t need to name them but if you do read all my comments in this blog, you will know the answer. Oh, and don’t forget to compare the russian wing and english wing of the medical schools in Russia!!
Lastly, I hope when you get admitted into a hospital, you will be happy to be treated by incompetent junior doctors. If you do so then I salute you BUT if you run to a private hospital and only want to see a specialist, then again pls shut up! You can only train someone when they have basic medical knowledge BUT when the graduate can’t even name me the valves of the heart then what do you expect the specialist to do? When they do not even know what basic drugs to be given for an emergency, would you tolerate this when you are the patient they are treating? would you? We don’t expect you to have a knowedge equivalent to a specilist BUT BASIC KNOWLEDGE to be a save doctor.
Oh, how do you know how old am I? Intersting. Finally, if you don’t know anything about medicine then you do not have any right to make comments about it, same like how I do not make any comments about other profession. You will only make a fool out of yourself.
I will probably second whoever that has had experience where they have seen parent that force their children to do medicine.
“All medical schools teach students the theoretical aspects and as much of practicals as possible.” – The true fact is – medical schools nowadays do not teach theory like they used to.Most of them just to shove all the textbooks to medical students and tell them to read but applying what you learn should start as early as possible and NOT during internship.
as for overwork – 80 hour/week rule applies to most of the world now and no one is complaining about it other than HO in Malaysia I guess. And it is not uncommon to see residents working 2 week(max) stretch especially after starting shift system. We have to accept the fact that there is NO perfect system as long as someone keeps complaining about it.
Just in-case if any parent wants to bring up reducing work hour to improve patient safety and doctor’s safety – there is still no data after changing the work hours from 100/wk -> 80/wk, on call -> shift work that shows improvement in safety for both patients and doctors.
Relax, if indeed your kids are into medicine, there is nothing stopping them from becoming leaders in their field (med). It boils down to the individual – interest, drive and dedication to lifelong learning.
If it is indeed their calling, then they will find it a very rewarding profession.
Housemen are incompetent by definition. A competent houseman is an oxymoron. They dont exist.
Because we learn by treating patients based on our knowledge…and textbook knowledge means shit all when it comes to actually dealing with a patient in front of you. (*mind the swearing)
That said, medicine without adequate knowledge is dangerous. As in life and limb dangerous.
Internship is a very very crucial time. The dedicated/interested doctors will flourish, absorbing skills and mental processes like a sponge…while those who are not inclined to medicine will falter.
ashrafkhan
quote from your post:
Mr Pagalavan…
.As an accountant and a parent of 2 would be doctors….i am quite tired of hearing u repeating comments like “dubious medical schools” and ” forced by parents” and “housemen working long hours” etc. Please STOP making stupid comments like that..<<>>
dear ashrafkhan,
if you have had enough of this blog, why on earth did you continue reading it for 1-2 years? nobody forced you to read this blog! go get a life man!
Well said
https://polldaddy.com/js/rating/rating.js
http://www.nst.com.my/opinion/letters-to-the-editor/medical-profession-public-s-well-being-matters-too-1.74797
This is the situation that an accountant never take into his account – public’s well being.
Mr. Ashrafkhan,
Perhaps this is not applicable to your children, but there are always exceptions to every general rule. You may be an understanding parent who never forced your children into medicine, but that does not mean all parents are as enlightened. There are those whose parents forced them into it, those who have been cajoled into it, and simply those who have been “built” into it by society. The society portrays an image of a wealthy and well-respected general practitioner sitting behind his desk and making prescriptions all day long – this is a misconception that thrives in the hearts of the general populace. There will always be children forced into careers they do not have a passion for. Many people out there are working in careers that are completely different from what they had actually studied. The question here is, why is it so? Force – by parents or society, directly or impliedly? It is a fact that a huge number of people attribute their choice of career to influence from their parents.
As for the medical field itself, as clearly mentioned by others above, it is distinguished from other professions because it is directly related to life and death situations, even more so than other professions. We are not a “suicide club” and the basic aim of humanity is to survive, and unfortunately, human vulnerability is a fact. Being directly responsible for lives at all times would probably impose a little pressure as opposed to other professions, don’t you think? Sure, a lawyer’s mistake could cost his client’s life. But a lawyer doesn’t deal with life-and-death cases all the time. There are simple matters like will-drafting, conveyancing, etc, where you are not on “red alert” condition. A slip of the pen when filling in an income tax return is easily amended. A slip of the scalpel could mean life and death. What is more important than life? A conscientious man would be able to realize the constant great pressure involved in being responsible for so many lives. This is precisely why it is so important for our medical force to be competent and passionate in what they do – it is undeniable that without passion, you can only go so far!
Imagine a job in which mental concentration is of the utmost importance, and being conscientious, having the pressure of so many lives in your hands. True, accountants have to work late nights and weekends without being compensated. Doctors work throughout the night, on weekends, and public holidays. Let us assume it is of an equivalent nature. However, surely you must agree that accounts don’t work like that every day, year in year out. What you refer to is something that occurs “sometimes”, not always. You are especially busy at the end of the year, but doctors are especially busy year in year out. Have you tried playing midwife to 100 births within 36 hours? That is incidentally, not an analogy, but reality – real numbers. At the end of those 100 births, you can barely move your sore hands anymore. Have you tried working 36 hours in a row, having a 12 hour break in between to go home, eat, bathe, rest, and then returning immediately for another 36 hours? And having the cycle repeat day in, day out? 36 hour continuous shifts used to be the norm before the shift system – no weekends, public holidays etc. Even now, I doubt accountants work in 15 hour shifts day in day out.
It might also be a good idea to read the newspapers for a bit. This recent letter for example, raises an instance of a “dubious” medical school: http://www.thesundaily.my/news/351299. Dr. Pagal already mentioned this quite some time ago. Look around a little, pull out some pen and paper, and consider the statistics. Why can some medical schools have an almost 100% passing rate? If it is not lax standards, this generation must have brilliant minds that are strangely unable to name the valves of the heart when even someone who is not in the medical field is able to do so.
Try doing some research – why are there so many reported cases of doctors, housemen or not, having mental issues? If as you claim, 1) they are not forced, 2) the education they received was excellent, 3) long hours are normal 4) the field is no different from any other – then it seems strange then our doctors are “suddenly and mysteriously” taken ill mentally.
We undoubtedly have passionate and competent bright scholars who are diligent, humble, and responsible in every way. But that does not mean all are so. The fact remains that there are many misconceptions of the medical field and Dr. Pagal is merely bringing them to light by his blog. It is knowledge of his experience that he is so kindly sharing with others. You may choose to disagree with Dr. Pagal, and I, in turn, would choose to disagree with you. When one disagrees, it is perhaps more prudent to voice such disagreement through rational arguments using facts, logics, and yes, NUMBERS so favoured of accountants, instead of crudely telling people to shut up – which brings to mind an obstinate child refusing to listen to reason. Maybe I should put it more plainly – if you feel you are right, invite civilized discussions instead of trying to shut out everything you disagree with.
just a note.. i kinda agree that when doctors make mistakes its not the same as accountants/engineers due to the perceived cost of a life. however, take note that
1. accountants are making inroads in healthcare performance management and creating new forms of metrics to measure physicians outcomes which are not clinically related. in fact, its expected than in the next ten years, the major medical blockbuster wont be a drug, but performance accounting.
2. the recent japanese nuclear meltdown which costs thousands of lives was due to engineers’ fault… so..
hahah, chillax you will be a good businessman! BTW, i don’t think anyone died in Japan nuclear meltdown, just got radiated!
I would argue that the nuclear meltdown was due to the earthquake rather than the fault of the engineers. Just another example of man underestimating the forces of nature.
Not that there haven’t been other catastrophes due to human error: Chernobyl for example, and some plane crashes have been due to pilot error. But that is going a bit off-topic here 🙂
Everyone is indirectly responsible for everyone. As I sit on my chair, shoddy workmanship could cause the chair to suddenly fall apart and I might fall at an angle that cracks my skull. As I reach out for a bottle of mineral water, the workers responsible could have accidentally caused it to be contaminated – when I drink H2O, I don’t expect to be drinking H2O2! My point is that doctors are more -directly- involved with lives at all times. But as Nav pointed out, I digress. If our dear accountant up there makes a mistake and discovers it immediately after, he can either rectify it or worse comes to worse, redo it. As a client, I would be more ready to accept a second and more accurate version of a balancing sheet, but I doubt I’d be at all happy about accepting a second operation if the first didn’t work out (assuming the first mess up didn’t make the second operation impossible in the first place). On a smaller scale, I’d hate to be given a wrong dose of medicine or receive an injection for nothing – to be informed of the fact two minutes later. Side note: Dr. Pagal is right, chillax, you show promise as a businessman. 😉 Cheers!
Dear houseman friend,
Working under flexi-hour system with RM600 is already a luxury, let say you have 4 double shift ( night duty) a month, so, u want extra RM100- RM 200 per day, making your extra salary of RM1000 every month? Is it what you want?
Had you experience 36sleepless hours? Houseman used to have oncall claim when they are really oncall,it means they work 36 hours at a row. Average working hours now for HO is 60 hours, not exceed 70 hours, but most of your MO worked about 90-100 hours a week.
Maybe HO complain that too many assessment, they feel it so stressful, and get depressed when they fail the assessment. But I had encounter HO that who do not know grading of murmur ( they dunno that murmur had systolic type and diastolic type, grade 1 to 6), dunno about GCS charting, when the specialist say that a patient had GCS of E5 ( simply test the HO), the HO can agree on that!, they will write in BHT: Patent foramen ovale secondary to atrial septum defect, Down syndrome secondary to AVSD…So, can a HOD extent a person when he did such a mistake? even it is just one mistake. It show that this HO had extremely poor knowledge, can you release a doctor to district when he dunno about mUrmur, too bad , he is not a first poster, he is a fifth poster! But, with the extension period, specialist do take out a paper, explain everything about murmur- systolic , diastolic, grading, bring him to ausculate some murmur that patient had in ward.
We all know that HO cant take MC it will be deducted from their leave ( it is unfair, actually), but my HO friend tell me that if they want to take unrecorded leave for maybe 1 month, they still can do it easily, They just go to psychiatry department saying that they are depress, get 1 month MC, which some of them just miss -use it for some other reason, they dun mind that they had extended 1 month for that, since they can had 1 month leave. Last time, it would be a shame if you tell people that you are get extended, so, old days HO worked hard, so that not get extended, but, nowadays, most of the HO don’t mind they are extended, some will tell, nevermind, i can relax 3 more months in ortho! Thing change. Some HO say, i dun mind to be a forever HO, i get my paid yet no responsibility, oh my goodness!
Imagine, HO now are so calculative,make sure that they only work 60 hours per week. More than that, they will complain, 2 years later, can they adapt to 36 hours sleepless oncall? I am waiting them become MO, start to complain, then MO life become easy. But, i guess it is still long way to go for MO have flexi-shift system…because, MO will be send to a lot of district hospital, KK, so far i never see an hospital having 50 MO in a department. ( correct me if i am wrong).
It doesn’t mean that i am anti-HO, i do gone through 2 years of HO, i do know they are victim from bullying like really get extended because HOD simply doesn’t like a person. MO/senior HO bullying the HO… i mean the real bullying, example, HO in my hospital are not suppose to set branula for a child who will undergo elective surgery, then, there is incident that new HO in surgical posting ( not a first poster), it is someone who had gone through paeds posting, dunno about this rule and set a branulla on a child, end up with the HO( those involve) being punished to set branulla among themselves, and walk around in the ward like animal show. It become a big issue until KKM know about it, but that HO not smart enough to write it in newspaper. so, quickly, KKM people come to my hospital, and everything was covered. that MO, nothing happen to him. He say, HO are adult, they are the one who set branulla on themselves, i did touch them at all. He is the one who was emotional imbalance, when he oncall, he will make all HO in the department to come to hospital middle of night simply wait for his scolding. ( for an excuse of 1 HO do a mistake)…Ho being punish for night round everyday, extension of shift…. But, things had happen. If there is this kind of MO/specialist/HOD, yet they escape from MMC/KKM action, you no need to be frustrated of that, god know, they will had their punishment in their lives.
I believe that the one complaining is minority, most of the HO still worked well and will become good MO. lets say, you come from a medical school that never teach you about murmur, you still can learn it the hard way during the HO…just a bit tough, maybe some extension will happen, but, eventually, you can proceed, and become a good MO/specialist if you want to learn and want to improve.Just, you had waste 5 years in medical school, which you will be far behind from those graduate from a medical school that teach well. But, it doesn’t mean you had no hope at all.
Unfortunately, the previously underperforming HO’s had already joined as MO’s as well. These chronic MO’s always complain about HO’s, but they themselves had all the disappearing act. Going back home 1 or 2 hours of journey away from hospital the whole night when they were supposed to be doing active call at night and admit patients without seeing them. Or missing from clinic duty while screwing HO’s to replace their duty. Or did not attend to patients who collapsed in the middle of the night! And their knowledge is sometimes as good as a HO albeit being in the department for a year! Unfortunately, as I can say, these were also mostly grads from dubious universities…Of course also some from local universities, as there are always bad apples everywhere.
I’m not saying that these dubious uni definitely produce incompetent HO, as I do see some who can persevere and thrive to be competent MO after the completion of training. Perhaps it’s the attitude as well. The reason why local grads could do better is because they work harder, not because they are smarter, to achieve what they had to get into local Uni admission.
Just to quote an example of a possible poor attitude, there is even one local grad HO who had been in a department for a year plus as a 1st poster houseman. I know the duration limit in each posting is 1 year with a maximum of 6 years in total of all postings, but perhaps I don’t know the full story why he is still around.
blind leading the blind. it is just downhill from now on. a full reset is required.
It’s simple really, being in orthopaedics as a medical officer and having whiny, selfish houseofficer under my care, it comes to how much the houseman brings after graduating. A good houseman would be able to tell the names of most important bones in the body while a hopeless one would be totally clueless or worst bluff. Teach? For something that they should have learnt during the undergrads? Nah, that’s why extension and the supposed shift system exist.
If anyone is interested there is an interesting article that I received from a friend of mine regarding problems with housemen. The link is below
http://www.theborneopost.com/2012/05/17/50-of-housemen-in-sabah-cant-cope-need-retraining/