I was recently asked to comment by “afterschool.com” regarding the problems with the shift system which appeared in NST last weekend (https://pagalavan.com/2012/09/02/for-future-doctors-the-hurricane-is-coming-part-2/). Thus I was obliged to give my comment. It was published yesterday on their website http://afterschool.my/news_details.php?nid=251.
With the current overflow of graduates than what the system can cope, whether it is the old “on-call”system or the new “shift” system, the clinical exposure and training will definitely be compromised. That is for sure. The horror stories that I am being told everywhere really scares me at times. The situation will only get worst within the next few years when the number of graduates reaches an unimaginable level of 7000-8000/year.
The attitudes are another matter. I just heard a JM (Jururawat Masyarakat) who was so disgusted with the attitude of housemen in a general hospital, decided to deliver in my hospital instead. When she went to the hospital for leaking, the housemen were laughing among themselves and was not even paying attention to her. In fact the housemen got guts to even question her on why she went to private hospital to do Ultrasound and why she had so many Ultrasounds being done in private hospital, in a sarcastic manner. FYI, this is a lady who is having her 1st pregnancy after 8 years of sub-fertility! Of course, they did not know that the patient is a JM and her husband is a businessman who was with her when this happened!! I can give you lost of stories like this . I will say this again, if you are not interested in working as a doctor, please leave !
| Too Many Trainee Doctors; Too Little Clinical Exposure |
| The new flexi-hour shift system was supposed to improve the quality of life of medical house officers (HOs) yet it appeared to have its trade-offs.Seventy-five percent of the 908 HOs surveyed felt that they were not getting adequate clinical exposure and were unable to complete enough procedures as required for their training. This came out from the survey results conducted by the Malaysian Medical Association (MMA). Sixty percent felt there was no continuity of care for patients, with 52% saying the previous on-call system was better than the existing system. The former on-call system would take up 24 to 40 hours of a trainee doctor’s time whereas the flexi-hour shift would only require 12 to 15 hours with adequate days off. According to Dr Pagalavan Letchumanan, a renowned consultant physician and rheumatologist, it is not whether the on-call or the shift system is better. “It is about overflow of doctors. We are producing just too many doctors than what the system can cope.” He said that the shift system reduces the number of HOs working at any one time and without it, there will be close to 50 housemen in each department which will also reduce patient exposure time and learning. “The root problem is too many medical schools with too many unqualified graduates,” he emphasised. MMA President, Dr S.R. Manalan said that those interested to learn the skills under the new shift system will have to go the extra distance to attend procedures. “Basically, training is the time for HOs to consolidate and build on both their practical and theoretical knowledge, and sometimes, they need to take the initiative to acquire knowledge for themselves if they are serious about a career in medicine.” |
Pagalavan's Avatar 
http://thestar.com.my/news/story.asp?file=/2012/9/5/nation/11967249&sec=nation
Yah, this guy never fails to amuse me!! We are talking about lack of training and he is talking about “stressed” housemen!! WTH.
Ya, since when HOs make clinical decisions? We now see the declining quality of MOs from the glut of HOs in a department (50-70 HO/department few years ago). MOs who can’t diagnose. Then, what kind of MOs will this shift system soon produce?
it is a vicious cycle of mediocrity. I can already see that happening. There are even MOs who can’t speak proper English nowadays.
I’m not surprised there would be a glut of specialists later too. Whether the quality of the specialists produced will be maintained is another big question mark.
it is possible. When our great health minister finds out that the medical colleges are only producing “general” training doctors and not specialist, he will ask the medical colleges to produce “super” specialists!! I can already see some half cooked specialist being produced nowadays, not because of the glut but because we do not have enough good trainers in MOH and university hospitals.
As I said before, this Health Minister is a nincampoop. He has totally no idea about medical education and doctors job. His only interest is his political career.
Dear Dr,
What can a medical student or a house officer do to acquire proper and enough clinical exposure or experience?? Thank you..
Just work and learn whenever possible. Commit to your patient from the start to e end amd not just pass on your patient when your shift emds. Work when others don’t want to and don’t expect compensation. You should have the passion not lust for money. The more time you spend clinically the more you will learn and the more your superior will appreciate you and this the better for your career advancement
work hard and learn as much as possible by being in the ward. Follow-up the patients till they get discharged. Go back and read about the disease when you are not sure. Ask seniors questions which you are not sure. Remember, always do what is best for the patient even when you need to push their troly!
If working in ED, the most important thing you could do to enhance your learning is to keep track of all the patients you see.
Personally I keep the discharge summaries of patients I see… and follow up on them later.
Was your diagnosis correct? What happened after they were admitted to the ward? Did the initial management you started them on get changed? What did the admitting registrar notice in their review that you didnt.
Simple things like that.
You learn on tangents. It’s amazing and it really works.
Learn from patients FTW!
hi dear Dr.
my name is ray had graduated (diploma in medical lab tech + attachment in kuala lumpur General Hospital 6 month ) just enrolled 2yr biomedical sc ,MSU ….Intend to do attachment at laboratory esp in columbia asia hospitals
mainly puchong branch . my intention is to constant practice my skill that i had learn and acquire during my attachment ..and make use semester break , ….so what can i do …or shall i seek for assistant on it ?..tq for your time
pls contact the relevant hospital.
Hi drive paga, thanks for yet another insightful post. My question is, what can a genuinely interested and passionate new doctor do to receive adequate training? I hear that now they also say that they no longer allow housemen to do certain procedures alone because of legal risks. Perhaps you could also write a few posts on how can a houseman circumvent the current issues to receive proper training.
Also, does the houseman have a right to learn? Sometimes I hear that the problem is not the houseman but with the MO s and specialists not wanting to teach.
Yes, the litigation rate is going up in an exponential manner. I heard some GH are getting few legal letters almost on a monthly basis. The situation is serious enough that some Pengarah’s have asked the specialist to stay in and see all cases that are being admitted. So, the specialists have become MOs and the MOs have become HOs. The HOs have become clerks! I always believe that housemen should be given some independence to manage patients and do procedures. However, it MUST be supervised by MOs for atleast the first few procedures. I did my first CVP line at 4am in the morning , supervised by an MO. It all depends on how interested you are in doing these procedures.
Saying that, I must agree that the teaching and supervising culture is slowly dying! I know many MOs who are now not interested in teaching the HOs. The specialist can only teach the theory and management of the patients. The MOs are the best in teaching procedures. Unfortunately, it has become “blind leading the blind” where poorly trained HOs are becoming MOs!!
Hi Dr. Pagalavan,
I’m an avid reader of your blog, and truly appreciate the effort you take. I do, however, have a question I was hoping you could answer regarding the housemanship process…
If one was to defer the start of housemanship for a year, would said person be able to resume his duties as usual after he returns?
Thank you in advance & Best regards
Careful, defer to start your housemanship may be viewed as rejection of the offer of the job! Better sart your job and then find some reason to have unpaid leave
Careful, defer to start your housemanship may be viewed as rejection of the offer of the job! Better start your job and then find some reason to have unpaid leave
Are you talking about deferring, after joining or before joining? If before joining, you need to write to SPA for deferment. However, at the most they will only allow 1 month. If after reporting, you can’t defer unless on medical grounds. Housemen are not entitled for unpaid leave either as you are not confirmed in service.
The best would be “don’t apply for horsemanship” yet
Thank you both for the advice.
In my case, it would be a deferral before joining. I wasn’t aware that graduates were allowed not to apply for housemanship – it does seem like the best option for me right now.
Thank you again, and all the best.
Application for Housemanship is not compulsory and you can apply whenever you want to. BUT without completing housemanship, you can’t work as a doctor.
I understand Sir. I was hoping, instead, to obtain residency in North America during that period i.e. seek local externships, work on my CV etc.
Nevertheless the matching process is becoming increasingly competitive and I was worried that I might lose the standing offer if I took a time off to do those things and do not succeed.
sylvian fissure.. cool name
ok the places for housemanship might not be easy to get after the next 1-2 years… we are very close to having a threshold limit and for the first time in Malaysia, new grads may not get a housemanship post by 2014/2015.
deal your cards wisely.
Indeed, Chillax. Which is why this whole process seems trickier than defusing a bomb right now. Too many variables…
But as always, I appreciate the input!
Just realize ur blog. I am glad u r in malaysia not singapore. The way u disclose unseen side in the medical field is quite unprofessional. Be prepared get sued. The proper way is to bring up to the authority. It is ethical issue to misguide public as I am sure not all people behave like what you have said. To be honest, money orientated guy like you who practises in private and at the same time chide your competitors.
What is so unprofessional about what I disclose? Please enlighten! I am talking about reality which each and every doctor knows. Did I mention any names ? Did I say which hospital and which doctor? BTW, don’t think it has not been brought up with the authorities. Most of the issues that I write here have been brought up to the authority.
If you don’t know me , how do you know that I am money orientated? Many leave government service NOT because of money. Please ask everyone in private sector. many are willing to return to government sector if only the government treats the doctors well.
AND what competitor are you talking about?
if u r not the one, u shudn’t care wat i have said.
i was one of ur pity patient who received substandard care.
what do you mean “if you’re not the one”? pls clarify. I am giving a general statement based on your general remark.Please provide evidence to whatever you say. IF it is true you were my patient, I would have probably asked you to see a psychiatrist. Since you also said that I should serve the poor people, why did you go to see a private doctor? contradictory statement, aren’t they?
@aaron – accusatory statements like yours on a public forum without legally backed evidence against a clearly identifiable individual constitutes libel.
In all the years Dr Pagal has run this blog, he has never taken down any postings to allow free discourse. Libel is a different matter. Your post should rightly be given the credibility it deserves, which is to say none, and be removed.
If on the short chance you have hard legal evidence, then you have my apologies.
Is there such a thing as ‘unseen side’ in the medical field? If there is, shouldn’t it be made ‘seen’ instead of secrecy?
And all this will NOT happen in Singapore, so a blog like this will not exist.
Send housemans to klang gh or revert back to on call system…… shift system is ridiculously stupid…….quality drops even worst!
You mean ALL to Klang GH? Why only Klang GH?
[…] it is not always a good news when your names appear in the newspaper. Few days ago, I received a comment in this blog accusing me of being unprofessional for exposing the unseen side of medical field. This […]
There are people that I know that did not meet the minimum entry requirement for medicine for Malaysian universities and they go to Indonesia to do their medical degree. Is that acceptable? Shouldn’t there be some standard at least for a prospective doctor? I have also heard many horrible stories about housemen with terrible attitude. Could it be because of these below par students who still enter into the medical field anyway?
yes, exactly. There is something known as NOC certificate before going overseas but it is not compulsory. You can still go overseas without NOC, however when the glut gets worst, the government may not provide job to this guys when they come back.
Health DG fined RM3,000 for committing khalwat.
comments invited.Setting examples to follow
As our ex minister
He’s a doctor, not a saint. He’s a widower, she’s in the process of divorce. That’s their private life. Have these two somehow committed some crime against humanity by acting on their their passions?
It is a shame that such an event between consenting adults has to be dragged into the public eye on account of subscription to archaic laws where mature adults of intelligence and insight have their virtues decided upon by another adult who is deemed to know better and therefore dispenses judgement.
Agreed but one of the reason why this has become a hot issue is because of what he did to many people in the ministry. Many wanted to resign from MOH because of his unilateral decision making attitude.
what do you think about endless extension for HO in our latest system? do more harm or more good? does not exist in those days.
as far as I am concerned, if the HOD feels that the HO is not competent to work as a doctor, the HO should be subjected to an enquiry or review committee which should then decide whether the HO should be sacked. The incompetent ones should be removed from the system but it should be done in a proper structured manner by MOH and MMC.