For years I have been writing about deteriorating quality of medical graduates. For years I talked about the poor knowledge of housemen and their inability to handle stress. I had also written in this blog the “tidak-apa” attitude of the junior doctors nowadays. We can still tolerate some lack of knowledge as it can be learned but the feedbacks that I get from my friends is the attitudes of the current generation of doctors. Many go missing in action (MIA), SMS their colleagues and even MOs that they are not turning up for work, giving stupid excuses such as car breaking down (can happen even 3 times/month!) etc etc. With the load of housemen in some hospitals and the introduction of shift system, the MOs and Specialist has given up monitoring the housemen. NO one bothers about them anymore. Only the good, hard working ones catches the eyes of the specialist and MOs. The same generations are becoming MOs and the cycle is repeating itself! Unfortunately, the system can’t do anything to kick them out!
Our profession use to be a well-respected profession. People use to look up to us and the staffs in the hospital respected us for whatever we did and said. Most doctor,s up to 10 years ago, use to be the cream of the country. They were the top students and to become a doctor , you need to have a brilliant mind with a lot of hard work. You need not be a ALL A star student but still need certain level of intelligence. We worked tirelessly with only the patient’s safety and life in our minds. Unfortunately, the situation is changing rapidly. Now, anyone can become a doctor as long as you have the money. Everyone who enters a medical school seem to be able to pass after 5 years. No one seem to care for the patient. Many are only interested in the status and salary. Everyone is only thinking on how they can earn money as fast as they can. Everyone is being calculative on the amount of time they are working. Many are becoming “bodoh-sombong”, don’t know anything but don’t bother to find out and give stupid advises to patients! I can go on ranting about it here but the situation will only get worst. Until the entire healthcare structure changes to kick out the “non-functioning” doctors, we are heading for self-destruction.
Doctors had always monitored doctors (apprenticeship). No one interferes. Unfortunately the system seem to be falling apart as specialist are unable to monitor the situation anymore. Thus, MOH has developed a NEW monitoring system for Housemen! Below, I attach a letter from Lembaga Jururawat Malaysia (mind you, NOT MMC!) informing that the Minister has instructed all Sisters of the ward and Matrons to monitor ALL the housemen in the hospital. A “tracking mechanism” is being developed. It will be on trial till December 2015 for feedback.
Well, we brought this upon ourselves. We have come to a stage where nurses aka sisters aka nursing body are being asked to monitor the attitudes and disciplines of housemen aka doctors!. We had lost all the respect that we once had. Soon, they may ask MAs and KK sisters to monitor MOs!!
It is a sad day for medicine………………..
Never do medicine for wrong reasons!
Pagalavan's Avatar 
Sir, with the influx of medical graduates and deteriorating housemanship training, is it wise to do dentistry instead? I will be studying dentistry in australia under jpa and I wonder how the prospects are like….
@confused student..As a dentist..the situation is the same…even right now there r too many dentists n not enough chairs to accommodate the new graduates..can’t imagine what it’s going to be like in 5 years time when ur batch enters our field.. Good luck with ur studies btw..
whether you do medicine or dentistry. do it because of u love and passionate about it. Not because of the “Dr” status that u will be given after u graduated. 🙂
if you are studying dentistry in australia ; don’t come back to malaysia…. please
Confused Student is studying in Australia under JPA sponsorship. He/she MUST come back to serve the bond and the community that paid for his education.
I wonder what kind of scholarship you got under JPA ? I have searched a lot scholarship, but still can’t find one scholarship that can let students further study abroad in critical courses . Or are you a bumi ? (No offence please ! )
Thank you for all the suggestions. I will surely come back to malaysia.
LSY, I was a KPM bursary student and received an unconditional offer for a dental school in aus, therefore I could get a jpa. I am non-bumi.
You’re right, Paga… “we brought this upon ourselves”. It is sad to see this happening.
very true. you hit the point sharply. but thats the current reality
What? really?…. Whose ‘bright idea is this? Surely the Sisters and Matrons going to say:
“Aint Nobody got time for dat”
[img]http://www.salzdummyspit.com/wp-content/uploads/2013/06/Aint+no+body+got+time+fo+dat.jpg[/img]
The sisters can’t even monitor their nurses, which are as bad as, if not worse, than the HOs. They are all of the same generation.
I’m going to be blunt.All these rants are just like the speck of dust in a bustling city.Nobody is going to give a rat’s as* about it. Unless something really big happen ,something that would shock the country to reformation.Until then, we could only wait and see.And im afraid the waiting game that we play would be our own damnation.
I just want to reflect on this article; it is indeed disheartening, shame and plight of our profession. I know the situation is always chaotic, but I wouldn’t have imagined we have stoop so low to such a deplorable state. For those wanted to be doctor, I would rather you fall into depression and rise again and work your ass off or quit the job completely because it is life at stake here. Your negligence will not only kill the patient but also devastating to their family for many generations to come. They will curse you for life. My recommendation is you go to public institutions like UM or Aussie/NZ/UK via IMU because only then you be enlightened and illuminated with what a real medical school is and humbled by their training. Trust me, it is the clinical years tht count, not so much on pre clinical years.
Hello mr very concern…I have seen and worked with graduates from both imu twinning program from uk, ausy, nz..nothing really special to say about them..they are just as equal as other grads from other countries. no extraordinary level of knowledge and skills showed by them!!
good reply vikz
To make nursing staff to monitor medical professionals is indeed an absolute ridiculuous. Period. We need to revoke the proposal. Medics need to come up with a more politically correct quality control measures
Unfortunately we are so disunited and can’t even control the medical schools
Indeed- when quackery introduced by these “esteemed” schools- what can we expect from the students?
https://scontent-a-ams.xx.fbcdn.net/hphotos-xaf1/v/t1.0-9/10628089_10152597824904830_6467875341006147040_n.jpg?oh=3231c2d7c9aaf0cc0d60cca642349b57&oe=54EDD7C9&dl=1
Hahah .. quackery indeed. Though not any better than IMU introducing chiropractic and TCM courses.
FYI, Nursing is part of medical professionals!
Yes but the instructions to do so must come from a HOD and not from nursing board
We’ll have to agree to disagree. Nurses like doctors are in the healthcare profession. But they are not medical professionals. Nor would they ever claim to be as it would be against their own governing body regulations.
that is so last season..our internet dominated zeitgeist would demand electronic tagging of all housemen with smartphones, with data fed directly to our telemedicine unit 😉
Hi sir, as a HO myself i feel very disheartened by this. I acknowledge there r some bad apples in our batch. But is this fair to the rest of us who really work hard? Yes. I agree the older generations had it worst than us but that is a long time ago. When i told my mother (who is a super senior Dr from a long time ago generations) how HO nowadays are bullied, not treated as a fellow colleague or even as a doctor, she felt ashamed. She said last time MO’s HO’s were friends, treated as equal, respect each other. I find it hard to believe. When somone yell at you n making u look like an idiot in front of the staff nurses, the patients or even the bystander. Then there is no more respect left. In my hospital, even the staff nurses can threaten the HO to be extended. After talking with my HO friends, we just want to finish HO quickly. Not sure if we learn anything but hopefully the experience we went through makes us different from the current batch of seniors.
This is just a piece of my mind. I’m sorry if anything i’ve said is wrong or hurtful.
So you’re saying that you’re giving up on the housemen because of their attitude problem?. What about you who are supposed to teach them and not just vending your anger? No wonder the tasks to monitor now is attributed to nurses!.
And you were saying about the cream of cream that were chosen back then. That just got nothing to do with the attitude! They are people who were brilliant enough but still don’t know what to do with their life! And are so bored because they don’t find challenges in life hence the attitude problem.
So don’t double standard people and just look at how much As that were printed on the paper and start to look for the ones who are with enthusiasm!. They are some of them out there who are trying to do their best and to live up to your bloody expectations! No wonder my sisters are having problem it’s because of people like you!. Who keep on searching for their flaw!.
And f.y.i they are the your so called ‘cream of cream’ back then!. You must learned how other senior doctors around the world treat their junior doctors. And even in Singapore they don’t have this kind of bullying episodes from the stupid specialists to the MOs to the junior doctors .
Shame on you guys! Now i wonder why you are having this kind of ‘attitude’ problem. You should look upon yourself first!. People can bare so much lah. We are a civilised developing country so be a modern civilised sophisticated human-being!. It’s not that hard to just use your heart not just your brain and be considerate!.
I disagree with this article!.
Bullying is nothing new. It has been happening for a long time. You will be shocked when you see the same people who are complaining now about bullying will do the same to their juniors. I have seen it many times. That’s why it will never end!
You are absolutely correct. Those days housemens are very lucky as they able to get closer with their superiors. And the training period is just 1 year only with 3 departments! No log book! No assessment! No extension!
Even 20 years ago, there WERE log books, assessments and extensions. Of course since there were very few of us, we were well supervised!
i totally agree with you..everyone talks about changes with time and what we have in the hospital working set up are sometimes inhuman behavior of some senior doctors.i agree and have experienced first hand from mo’s who were bullied and tormented during their housemanship period doing the same tit for tat on their juniors just because they went through it..these are mo’s from not so reputable universities with very minimal knowledge so they protect themselves by being a bully.Mr.pagalavan never fails to mention in his articles about houseman not being up to task and not good enough or complaining about the level of stress as a houseman but he never really bothers finding out whats the reason behind those stress? so if someone does injustice to you in your working place in the name of training you should just keep quiet and shouldnt be stressed out on it as thats part and parcel of housemanship? I have grown old listening to the same rheotic from senior doctors claiming how tough their housemanship period was and all.if we do not want to bring changes to our training and working life than why bother complaining about the system? if someone complains about the stress a houseman is facing you can see warriors coming from all angles to defend the system and blame the houseman for not being competent or choosing the wrong profession..and i agree with you vikz those days housemanship was peanut as it was just 1year program with 3 departments and no extension unless you really do something stupid and everyone becomes a mo regardless because there werent much doctors those days..now the training has been made tougher with much stringnent laws as there are alot of competition out there..those days you do not necessarily need to be a science stream student to be a doctor as long as you come from a rich backgroud who can get a mbbs degree..unlike now where kkm has come up with minimum requirement for medical schools and etc
FYI, no one is defending the system. The system is screwed whether you like it or not. BUT do you see the same housemen who are complaining, changing the system when they become seniors? The answer is NO. They join the system and do the same. That’s why it NEVER ENDS!! Also FYI, I had written about bullies and the reason why it never ends.
So you’re saying that you’re giving up on the housemen because of their attitude problem?. What about you who are supposed to teach them and not just vending your anger? No wonder the tasks to monitor now is attributed to nurses!.
And you were saying about the cream of cream that were chosen back then. That just got nothing to do with the attitude! They are people who were brilliant enough but still don’t know what to do with their life! And are so bored because they don’t find challenges in life hence the attitude problem.
So don’t double standard people and just look at how much As that were printed on the paper and start to thelook for the ones who are with enthusiasm!. They are some of them out there who are trying to do their best and to live up to your bloody expectations! No wonder my sisters are having problem it’s because of people like you!. Who keep on searching their for the flaw!.
And f.y.i they are the your so called ‘cream of cream’ back then!. You must learned how other senior doctors around the world treat their junior doctors. And even in Singapore they don’t have this kind of bullying episodes from the stupid specialists to the MOs to the junior doctors .
Shame on you guys! Now i wonder why you are having this kind of ‘attitude’ problem. You should look upon yourself first!. People can bare so much lah. We are a civilised developing country so be a modern civilised sophisticated human-being!. It’s not that hard to just your heart not just your brain and be considerate!.
I disagree with this article!.
Your very statement tells a lot about you. Please provide your name and proper email address next time.
How do you know that I don’t teach junior doctors? You know nuts about me. If you don’t know me, please refrain yourself from commenting.
Bullying will go on forever. I have seen enough people like you who complain now but will be the same person who become a bully when they are MO and specialist. That’s why it never ends.
Singapore no bullying? Please, I have worked there before!
The first thing in becoming a doctor is to be humble and analytical. Your statement reflects on your attitude.
And instead of saying what have you done to yourself which i know exactly what you meant to say. You should ask the elite group of specialists and those stupid MOs what have they done to this innocent doctors who are working so hard??. One of my sisters now are having problems with the immoral unethical specialist who are always double standardize with the local graduates. Even if she tries to do her bloody best to not get scold or get a phone call to redo her task all the way 45 minutes from her house to the hospital again. So who are actually having some kind of attitude problems?.
I am sure you are aware that there is a mechanism to report bullying. MOH has already issue ed a circular many years ago.
Secondly you must also get both side of the story. What makes you think that your sister is working so hard? Definition of working hard may mean different for different people.
Don’t jump to conclusions before investigating the matter.
This is yet another problem with the system or society these days. Family (parents, siblings, bf/gf, etc) protecting the trainee doctor from learning to become better practitioners.
Don’t be lame. These so called “elite specialists” and “stupid MOs” have wayyyyyy more field experience than you. I’m not saying they are right and there is absolutely no double standards in the fraternity (it exists in every profession and field); I’m saying you have no idea how many times a surgeon is standing 10 hours in the op theatre and a trainee doctor who needs to understand the basic anatomy of the procedure which is going on totally fumbles and screws the case up causing the surgeon to spend another 2 hours cleaning up the mess.
Or, a trainee doctor who inserts a proctoscope up the wrong hole during gynae rounds because he/she just didnt do enough ward work and gets a steaming complaint letter sent to the “elite specialist”.
Or, a trainee doctor who despite being supervised ten times how to insert an intravenous line, still fails to place the line in the right pipe. Sure you have to call that person back from Timbuktu to re-set the bloody IV line.
You know what pisses me off time and time again, Dr P? When some green ass noob comes to this blog to ‘school’ you about ethics, righteousness, and what you should or should not do. I’ll never let that happen because for the past 4 years since I’ve started following your blog, you have pointed all right minded junior practitioners (or would be doctors) in the right direction; telling us to practice for the right reasons.
So ppl like the above ‘melayu jangan layu’, can shove it up where the sun don’t shine.
Very sad! In any profession there will be slackers. But why is the nursing profession called in to “memastikan kecekapan dan disiplin” HO’s. Strange that this came from Post Cabinet meeting. Weren’t any doctors present??
The only doctor in cabinet is the health minister!
A bloody moron one. Sitting on his chair and holding his balls all day long.
mo’s these days need to learn how to use proper language in a forum..it shows your class and attitude at work towards your fellow collegues and staff.
Ward sister to monitor HO attitude has been used in many hospital because they have the most point of contact with the HO. In singapore, we have 360 degree assessment. even the ward clerk can assess you.
Yes but it would not have happened if everyone had behaved themselves. Singapore is a totally different system. Incompetent ones will be kicked out
will the incompetent ones in Malaysia be kicked out as well?
Not at the moment. If the system changes where jobs are given on contract basis and hospitals corporatised, then the incompetent ones will be kicked out
No, the incompetent ones end up doing medical administration or quit government service to become a GP (anyone can be a GP after completing 4 years of government service) or do MLM. Just stating my observation.
Wow this article reeks of biases and lacks objective judgement. You talk of the golden days of medicine, but is that a fact or mere romanticization of the past? Do you have mortality figures and patient satisfaction scores to make a valid comparison between “the good old days” vs now? Your attitude is actually quite common of the “merdeka” generation, you have this unshakeable belief that you were the golden boys, the creme de la creme. Sorry to burst your bubble doc but times have changed. You have observed correctly that the output of our medical system (junior staffs) seem to be inadequately prepared to fill their roles within the system. But is it the product which is deficient (as most hot air specialists would claim, ie, lousy generation), or is it the environment which prepares these young doctors which is to blamed? I for one would be extremely surprised that our new generations are getting dumber despite great advancements in nutrition, basic education and technology.Mind you, it is not the current “lazy generation” that churned out licenses to crony private institutions. Neither is it the fault of the current generation that the sharing arrangements with government hospitals for private medical students are suboptimal. The current generation also didnt decide the specialist to HO ratios. If anything, the quality of the output is a reflection of the people on top, that is the generation from the “good old days”. Stop hacking at the symptoms doc, and start asking hard questions about the root cause of the current predicaments. The boys from the “golden era” brought it on themselves with their sheer incompetence.
Your attitude is common among the Gen Y community. All the issues that you brought up have been discussed in this blog by me for a very long time. Everything is politics in Malaysia. Since I had written enough about this for the last 4 years, I will not repeat again.
If you want to. know whether the system has deteriorated, ask the pensioners.
FYI, please read the title and the whole article again. I said it very clearly that WE ARE To Be Blamed!!
when Medical Assistants became Doctors Assistants itself was demeaning in 1M CLINICS … now this . ?? who is really this person who has given these orders ? Minister ka DG ? Its time Doctors stand up for our Rights and take over MMC / PHFSA . We will monitor the rubbish unlawful medical schools that are springing up and shutting down at their pleasure . We want more respect from our Administrators … Doctors there is nothing wrong for us to fight for our Rights … I dont think our heads will be blown off ! Giving directions to Nursing Profession IS just tooo much to stomach .
Humiliating to the medical profession.This implies at least 3 things; 1.The poor quality (poor attitude and motivation) of medical graduates which many doctors are aware of but which they cannot do anything about it.. 2. Poor quality of senior doctors in the hospitals as supervisors and teachers. 3. Great haste by the Govt do achieve the targeted ratio of 1 doctor to 600 patients.
Nurses are also a part of medical profession, they have their intelligent and medical skill too. I do not agree with the author of this blog writing in this way that sounds insulting or looking down at nursing staff. You must understand, without nurses, doctors can’t even run a hospital by themselves. It has nothing wrong to let nursing staff supervise those HO in our hospital. Accept the facts that doctor is not perfect, please be humble and learn to listen! (P/s: myself is also in medical field).
I don’t think you are getting the point. I am not insulting the nurse BUT putting the blame on us. Why did we come to this stage where we need to ask the ward sisters to monitor the discipline of HOs!! That is the point raised. Please read the article properly.
I read finish your article and also the attached document before i giving the first comment. I have no interest to argue with you, however, i must let u see clearly the problem we had in medical doctors. In the wad, HO is making a lot trouble to nurses, e.g. they are taking patient as their “experimental trial” and ignoring how this is affect the patient; they simply put those contaminated glove elsewhere in the wad. Sister, as a wad supervisor, they have the right and authority to discipline those young HO. However, the problem is, many HO doesn’t listen to what sister said (maybe they feel that their are “higher ranking” than sister and nurse? they feel that they know much than nurses?). It bring a lot of trouble and headache to wad’s sisters. A lot of wad’s sisters are complaining about this issue – HO not listen to their advice! It is a good sign that government assigning wad’s sister to monitor HO, to correct the error and provide better health care to patient.
Please go to hospital in your wad, and ask your wad’s sister comment about this issue before you reply my comment. Most of the medical doctors are lacking of the altitude of “humble and willing to listen” nowadays.
That is exactly what I am saying!!
If the doctors had behaved themselves right from the beginning, there is NO need for sisters to monitor their discipline. Since the junior doctors nowadays can’t behave themselves, the MOH had no choice but to issue circular to make sisters to become HO discipline supervisors. It should not happen in the first place.
That’s why I said “we have to blame ourselves “
humble is not in the malaysian doctors dictionary especially the senior ones..even patient complains to ho’s and nurses that they would not want to be treated by certain mo’s or specialist not because of incompetency but their sheer lack of respect towards another human being or colleague
Yes, that’s what happens when you do not have the passion to do medicine. When you do medicine for wrong reasons, you treat it as just another job!
Hmm..some sisters and matrons are so incompetent and worse than HO and the MOH ask them to report on HO not to mention they definitely wont do monitor closely instead they will delegate it to the nurses who are well known to bully HO to do whatever they want. Anyone that did housemanship would know that nurses always bully HO and i dont get it why would some specialist and MO tend to believe nurses more than HO sometimes. From my experience this circular is useless and will make the bullying system worse than before expecially the nurses bullying HO’s
Dr Paga, you’re getting a lot of knee-jerk defensive replies & it’s because you’re hitting the nail on the head! Let me reiterate to those on the defensive – Dr Paga is merely making the point (as he has on his entire blog!) that this country (in the interest of making $$$ & to the detriment of the rakyat) has opened the floodgates to allow any Tom, Dick & Harry with money to buy a medical degree. There is no filtering mechanism to weed out the lazy, incompetent ones who will eventually be let loose on the public. Do you want such doctors looking after your health?
Im sorry sir. First of all i disagree with all of these. Ive read through your articles and all i can think of is of how much you hate housemans.
Second of all, theres nothing wrong with sisters or matrons looking over houseman as they are the one who has eyes in the ward.so dont double standard them by saying “we had lost all respect that we once had” just because houseman are being watched by them. I mean come on. Lowers some pride, work still goes on.
Third, all of these houseman, THEY are NOT from YOUR generation. Thing must CHANGE. Even guidelines changes over years, why not CHANGE the way you guys treat/nurture/TEACH them? DONT expect the houseman nowadays to be like how YOU guys were coz that is just plain wrong. Even the new generation now is so outspoken, the opposition has help so much on encouraging this. GENERATION does CHANGE. You and all of you guys seniors doctor have to ACCEPT it. If i were you, instead of blaming it all to the most juniors, i would blame it to the highest authority in the dept, hosp, and ministry.
Houseman are not stupid. If all the consultant/specialist/mo give up monitoring houseman just because of the load of houseman then you guys are just a bunch of failures.
Stop ranting. Find solution.
It is not a sad day for medicine.
Footnotes:
Its funny when we always find the latest evidence based medicine for patients but not the latest evidence based psychological aspect such as human errors after a certain period of long hours calls and applied it to doctors. For example, my western counterpart feels SORRY that i have to work 36hours per call and he is still a good doctor. I hope you guys get what im tryin to say.
Good day.
How much I hate housemen? You seriously got no idea of who am I. Do you know how many housemen I had helped over the years? I was in charge of housemen for 7 years and if there are any housemen that I had hated or bullied, they can come here and comment!! So, if you do not know me, please do not comment as such.
Secondly, again you are missing the point! If the housemen are all well behaved and disciplined, why dro we even need the ward sisters to monitor them?? That is the point. If we had come to this situation, it just tells us one thing for sure! The situation has gone from bad to worst!
This has nothing to do with seniors like us. It is the attitude. Please don’t compare with other countries where their healthcare system is totally different and where Non functioning doctors are kicked out.
actually alot people dont get the point of this. The quality of housemen (be it no matter how u defend or protect the way they are being taught and all etc) has resulted in severe negligence and the end point is death of patients, our very family members. There cannot be a harder end point than this. Our country’s healthcare is gonna implode on its own and many lives will be sacrificed and yet the government and people like BAD HOUSEMAN (so called) cannot and will never see.
How many times have we heard and experience patients being left to die when frantic nurses were calling housemen for resuscitation and when they were either uncontactable, missing or excuses such as “i was busy taking blood for another patient (well, alive and non emergency cases)”.
You know what sir? Not all of the doctors out there are like you. HELP the HOs like you did. I bet you yourself don’t get a chance to see how things going on in ALL HOSPITALS right? So you should as well take into consideration the condition of other places, not only what you see.
The conditions in hospitals has not changed much compared to before. The problem is there are just too many HO for senior doctors to take care. The shift system just made it worst. Thus the ‘bullying ‘ becomes worse.
FYI, I have friends in almost every hospital in this country. IT is a vicious cycle. The quality of housemen deteriorated and thus makes the specialist even more angry, throwing their tantrums around.
Mr.pagalavan those specialist you claimed to be ranting on bad houseman could be a bad houseman during their time too..everyone forgets their bad side of stories in time and glorify how well they have done and are still doing.
Again, it is subjective. FYI, there were fewer of us 15 years ago and better monitored. Every consultant and even head of departments knows us by our names. There is NO way we can escape their eyes. Those days, HODs do grand rounds every week. My O&G department grand round will be at 7am in the morning, Surgical grand round is on Sundays. Attendance are taken and we have to explain where were we if we do not attend. So, don’t assume that housemanship those days were easier! The only advantage we had was the 1 year housemanship. Unfortunately, those days are gone. The good hard working HODs has left. I had written about this before.
Dear Bad Houseman,
I am a doctor probably from your generation, but not in Malaysia currently.
I agree that things change – guidelines, clinical practice, for good, but I am very sure that some changes that we observe in most(not all) houseman in Malaysia (as you call NEW generation) may not be good for patient care. As you stated in outspoken manner, now is the era of EBM – you can try to pubmed and see if limiting duty hours has done any real good for patient care or human errors – I am very sure you will find very surprising results.
Probably what your western counterpart did not tell you is that with the duty hour restriction/limitation, they have to fill in the knowledge gap when they are not working by some means, doesn’t mean that it will be more effective than seeing a real patient but at least in some methods that people believe it will at least teach interns/residents to be a good doctor when they graduate.
And again, I do believe that somethings are better the way they were, especially attitude of the a doctor. Patients trust their life on your hands, I guess it is fair to say that you owe them everything – including longer working hours, read more, have lesser time with family. We all took Hippocratic oath, and part of that is to be there for patient at anytime, anywhere – or at least I remember clearly that I did.
I am not going to go on ranting – but what you posted just ticked me off – and the most unreasonable statement you have posted is ” If i were you, instead of blaming it all to the most juniors, i would blame it to the highest authority in the dept, hosp, and ministry.” – When you are incompetent, is it really alright to blame others?Who made you incompetent?
Before you say anything further – think of the following question as stated you are the new generation:
When was the last time you feel satisfaction at your work that you helped (not save a life) a patient?
When was the last time you actually read any medical textbook or literature?
And when was the time before that?
Lastly, when was the last time you said “I am sorry it is my fault”?
Outspoken with good knowledge – Opinionated
Outspoken with no knowledge – Ignorance
Cheers
Only a life live for others is a life worthwhile
– Albert Einstein
perhaps the seniors are not keen to personally monitor and manage the housemen.. with the propensity of Gen-Y to complain raucously over all possible channels, it must take a very determined masochistic consultant to continue to be the bad cop, knowing that doing the supervision job properly would only result in more complaints . The nurses and ward sisters may not mind being the bad cop…or may have no choice
Hi there ! i hope i don’t get shot at , just sharing my point of view, if i am wrong please do tell me, after all we learn from our mistakes.So here goes…
to me all this monitoring and evaluation thingy is important as to maintain a standard quality achievement , but at the same time it is not really meant to be taken too seriously, i mean like we are depending on a system to determine our quality ? what happened to self evaluation and self realization of your responsibility ? the nurses, kk, radicare can evaluate me, but that ain’t gonna change your attitude ( at least that’s how i think ) because true glory comes automatically when you work hard at what you do. from yourself.
what i usually do is forget where i am and just do what i do my best ( my best is you don’t stop till you drop dead and not be ashamed to admit “i don’t know but i am willing to learn boss “.as everyone speculating , housemen are useless and not trustable
it may be true , but i think believe this system is divided into two points and has to be balanced , coz lacking each of this would result in failure
1) higher positions ( MO / specialist, etc ) – drag u straight up
2) self realizing and pushing yourself to the max
as we see over here i can assume i guess maybe HOs MOs Specialists ? (excuse me if i am wrong) arguing as to who is right and who is wrong, and saying you have no idea who am i XD
if we all just pause for a moment and look at this post and tell ourselves, we want the glorious days back, and start initiating , i believe those days will come closer 🙂
i know its hard but i guess we shouldn’t stop trying ?
“No one said its easy, but i promise you its worth it ”
sorry if i sound a bit rude but i really don’t mean to offend anyone
HOs self realize and change, you are the main pioneers in making this dream come true
MOs never be stereotype about HOs and try your best to bring them up no matter what the reason or cause , treat them as your sibling (tough love)
Specialist evaluate the whole system i guess ?
and Dr.Pagalavan, thank you for your articles and updates of the current situation 🙂 I am READY TO RUN THE WARD
btw im a final year med student 🙂 i’ll see you guys in the fields next year and i hope i can play a role too in changing this nightmare 🙂 cheers , see you in the field 🙂
Only people with genuine interest and passion will have self improvement and evaluation. Unfortunately, these group seem to becoming a minority.
I think medicine is a tough field no matter where you are. With resilience, humble, hard work, genuine care, life-long learning, we will succeed as a safe doctor. Working with difficult people so called bad MO, HO or malignant specialist, is just a path to make you a better team member, better communicator, and patient care is all about team work. Looking forward to see you next year. I am a final year too.
haha jack like the part you wrote you have no idea who I am..lolol
Dr. Pagalavan, i truly agree to your observation. Im a nurse who graduated frm IMU and i stopped serving in just 1 year of service as a nurse. The truth is the same for the nursing profession. The young nurses are no different. The medical service in Malaysia is going down the drain. Poor patients. Too much of negligence. Healthcare professionals are more motivated by money. Its getting harder to see people who serve from heart nowadays. Im not generalising my views to all the healthcare professionals. Sadly, this thing is really happening whether we like it or not. If the government is trying to intervene, then we must admit that there is an issue there. I hv read some really biased comments above about the sisters being called upon to intervene the issue. Malaysian health standards can only improve if a doctor stop seeing their profession to be superior to the nursing profession and embrace the fact that both are parallel profession. Hope MMC & LJM can work in hand to overcome or at least improve this situation.
Yes, only people who are in the system and have genuine passion will realise this.
even MAs dont like nurses/sister/matron.. they have done many ridiculous things to show that they are the one and only good profession in KKM… the new issue is at a&e selayang and a&e kajang…
It is disheartening to know how we have come to this stage. It is a humiliation at its highest form for the profession.
Why do we even come to this stage?
Medical profession is a well respected and highly sought for in the eyes of the public. In order for the profession to maintain its high level of dignity and respect, it requires input from all levels – the higher management team, the sub specialists, specialists, MOs, and HOs. All has to work together as a team, rather than trying to point fingers at each other. Everyone has a role to play. Everyone contributes in their own way to what it is today.
There are definitely both good and bad products (here refers to medical graduates, housemen, MOs, specialists) in any system (here refers to education system, training & monitoring in hospital setting) in any generation. It does not matter which era we come from. It just looks like the bad ones are more prevalent now because the n-value of such products being manufactured in sub-standard institutions & sub-standard student selection process are more compared to the past, but whether it is statistically significant is another story. The perception of the public that focuses on the bad ones rather than the good ones is another thing.
The issue is, there is no method to remove the bad products from the market. When the bad ones are being protected and retained, the bad reputation of the few poor performing folks will soon tarnish the good name of the profession as a whole. The good ones will be dragged down at the same time.
The few poor performing folks have to leave the profession – stop hurting the reputation of the profession and risk the life of a patient. Then only the credibility, dignity and respect towards the profession that we once had be preserved and be improved over time. Until the efforts from all level are there, there will continue to be brain drain and it will be harder to move up.
If anyone who is not competent enough to be a doctor, just leave. Just be honest to yourself and your patients. Are you really competent, or just taking chances?
Plenty of opportunities out there. Doctor is just another occupation to make ends meet. If there is no passion in what you do, why do it? It does not mean after getting a medical degree you have to be a doctor. There are plenty of medical degree holders venturing into a whole different field and still do very well.
Good luck and all the best to all.
From the perspective of a practising pharmacist.
It is disheartening to know how we have come to this stage. It is a humiliation at its highest form for the profession.
Why do we even come to this stage?
Medical profession is a well respected and highly sought for in the eyes of the public. In order for the profession to maintain its high level of dignity and respect, it requires input from all levels – the higher management team, the sub specialists, specialists, MOs, and HOs. All has to work together as a team, rather than trying to point fingers at each other. Everyone has a role to play. Everyone contributes in their own way to what it is today.
There are definitely both good and bad products (here refers to medical graduates, housemen, MOs, specialists) in any system (here refers to education system, training & monitoring in hospital setting) in any generation. It does not matter which era we come from. It just looks like the bad ones are more prevalent now because the n-value of such products being manufactured in sub-standard institutions & sub-standard student selection process are more compared to the past, but whether it is statistically significant is another story. The perception of the public that focuses on the bad ones rather than the good ones is another thing.
The issue is, there is no method to remove the bad products from the market. When the bad ones are being protected and retained, the bad reputation of the few poor performing folks will soon tarnish the good name of the profession as a whole. The good ones will be dragged down at the same time.
The few poor performing folks have to leave the profession – stop hurting the reputation of the profession and risk the life of a patient. Then only the credibility, dignity and respect towards the profession that we once had be preserved and be improved over time. Until the efforts from all level are there, there will continue to be brain drain and it will be harder to move up.
If anyone who is not competent enough to be a doctor, just leave. Just be honest to yourself and your patients. Are you really competent, or just taking chances?
Plenty of opportunities out there. Doctor is just another occupation to make ends meet. If there is no passion in what you do, why do it? It does not mean after getting a medical degree you have to be a doctor. There are plenty of medical degree holders venturing into a whole different field and still do very well.
Good luck and all the best to all.
From the perspective of a practising pharmacist.
dr, keep calm always
sbgai ma sy bersimpati dengan hal ini
Sir does your kids studying medicne or they doing something else?
My kids are still schooling. I got no intention to make them a doctor unless they want to do it with their own passion. So far, both my sons are not interested in medicine.
Sir thats an honest answer i appreciate .Well sir DR tharmaseelan have written lots of article on on newspapers stating that over supply of medical students in malaysia i’m sure you have read some of his article, ironicly his own sons doing medicine one of them did in indonesia entering using foundation cert obiviously not a scholar,well i dont need to mention futher about the quality. i’m just wondering why such a hypocrisy by a person who held a position in MAA?
You have to ask him!
If i get a chance i will ask him regarding his articles of oversupplies of doctors and his sons doing medicine.Everyother parents also will have that same ambition to send theirs kids to do medicine, its ok for his own sons to do medicine but not ok for others parents to do so.Anyway cheers sir
Oversupply is definately true.
Dear Dr Sir, your frustration and disappointment comes thru in yr post. I wish I could disagree with you as some have here but unfortunately I can’t. Most recently a friend experienced a rude encounter with an HO. Investigations were done and it was clearly the doctor who was on the wrong for speaking so rudely to the patient. The doctor had behaved similarly to others in the past. The upset patient seeked professional advice and finally lodged an official complaint. No matter how tired you are, you do not disrespect a patient. The same goes for teachers lawyers engineers etc. You are professionals. You are taught ethics in your profession. What comes across in the comments is that its not an isolated incident to the medical profession. It is a virus that has infected us. One that removes empathy compassion respect honour from our makeup. I will not restrict it to any age group for I do not judge. I merely state my observations that many people today are less patient than they were before. We can use the law politics ministers MS whomever as a reason for our lack of manners but it does not remove the fact that at the end of the day – I Choose The Words I Speak, The Action I Take. Nobody else. Michael got it right when he said you start with the man in the mirror. Dr Sir, pls don’t give up writing and sharing and illuminating. And dont give up hope.
Hi and a very good bidding to all,
Just leaving my two cents, after reading your article, i can only hope that most of my specialist and consultants are as caring as you are. Truthfully, when i hear “during my time , it was…” one more time, i try so hard not to lose respect to my seniors. Because in the end, it is your guidance that we need, not to compare times and experience. How to care for patients, how to learn their backgroud, how to ease their sickness and suffering. If seniors are good examples, then im sure that you are inspiring the housemen to be the same. What i think the reason of the problem you are adressing is that, most of the HOs are not inspired anymore, lack of motivation and being bullied to no end. But tiredness is nothing if you go back and feel like, “yes ive learned something today, or im inspired to do something today. Sadly we dont get that feeling when we go back, so we dread of having to work the next day, worse is scolding a houseman till they break and tear is a norm. Not to mention some of my consultant is so arrogant that they actually say that ” HO must not talk to me straight, have to through MO, through specialist, or you will get extended” and im typing word for word..
So that is the reason being. It is guidance that we sought. And openess to accept HO might not know something but we want to learn.
To all my seniors, please dont lose hope in your HOs. Because you know, the kindness you show them now is what would make our future.
Honestly, im not a bad student or i can say im not stupid or lack of knowledge or ignorant whatever you want to call my generation. I didnt choose the fast track program to Russia of all places to do medicine. Toughness doesnt mean my spirit of wanting to learn will wither away, but being dispirited by my working environment and the feeling of selflimiting from my seniors make me feel im losing hope of wanting to care. “As long as i dont get scolded, i can sleep at night and come to work again tomorrow”. Nobody wants to be this demotivated of a doctor. So dont demotivate others.
And if the sisters hv to check up on us, by all means, i hv nothing agaisnt it, that doesnt effect the way good HO are working, it will just help the admin to identify the ones they will need to take action against. I hv no problem as long as they dont treat us like children or retarded. Myself, i feel the sisters and staff nurses are the ones most helpful in the ward and every doctor should respect them.
Im in geriatrics posting now, so there is nothing more than how i feel i really want to help my patients. So i better be good at what im doing. Plus my consultants and specialist are super duper talented and inspiring.
Although I am a doc prac overseas, yes, I encountered bullies everyway from charge nurse to superior. To be fair we doctors need to prac evidence base medicine and refute even the superior ( in a polite non aggressive way) if they do not prac tht. But if you do not know ur stuff or not up to the level, please suck it up and learn more, apologize even to nurses or medical assistant and move on. If you are pure at heart and prac wht I have said just now, it does not matter ur mentor is specialist or nurse. But one thing my fellow doc out there, you guys have extra training and should be the leader in managing the patient in consultation with appropriate consultant, don’t let your role taken over by nurses or others, why ?it is simple, not the issues of arrogant or narcissism, but you are ultimately responsible in court and you have to stand on your feet, you cnt drag the nurses down as they are not trained for that. It is you ,doctors, had earned your doctor tittle through hard work. It is not undermining nurses or other position, but your self worth as doctor
For those houseman out there I suggest you listen to Dr P because you guys are not up to the mark to refute him and your point is not valid and only dispose how immature you guys are. Unless you guys come with Phd /basic degree prior to enter medical school like in the west, be humble, it is for your good,we the SMO out there has nothing to loose.
If you’re a new houseman and feel ‘insulted’ or ‘affected’ by this article or any talk that ‘housemen these days are etc etc’, let me tell you something.
Dont take it too hardly. Improve, improve, improve.
This is nothing compared to some of the stuff you will face practicing medicine. If anything, it will toughen you up. As a doctor, take every criticism constructively regardless of whether its fair or not.
Remember, 10-15 years from now, you will be a 40 yr old doctor, and we need good 40 year old doctors to hold the fort. Who is going to replace the legends? Someone has to. And that person will be you. And you will reminisce the past when your generation were called lousy doctors.
Your generation use technology, memes, innovative apps, and a heck lot of mental toughness to do what the previous generation could not. As the cohort of practitioners born out of the 2010-2020 years, you developed your own way to become better doctors, being able to tease out improved health outcomes from your patients compared to the previous generation doctors.
How did you all do that? That’s the challenge.
I am not a doctor but upon reading this article and all of the comments (it was shared on a social media by a friend of mine who is a doctor) I feel it is more of a wake up call to everyone affected by it. What’s done is done, what lies in the future is what could be changed and it is up to you to act upon it. I wish you all doctors and professionals related to this all the very best in improving the situation.
My point of view is nurses bear no responsibilities. They take orders from doctor, when anything goes wrong, or they didn’t do their job properly, doctors are going to responsible it or take the blame. When sisters are more superior than HOs, HOs are going to do their jobs and take the blame. Are u going to monitor the junior staff nurse too? Most of the nurses just want to finish their work and go back home on time, they don’t really give a damn to the patients because they will not take the blame. When junior doctors are under them, it is ridiculous that HOs have to take orders from them and responsible if anything goes wrong. I think instead of solving a problem but creating another new problem. I think everybody has to responsible for it but not only HOs. It would be so nice for doctors to supervise junior staff nurse too. Why always HOs take the blame?
Yes… doctors to ‘supervise’ junior nurses… 😀
Agree with you Dr Paga.
After almost 15 years in this profession, I think the attitude is the main problem. I rather have a poor knowledge HO with good attitude then distinction HO with bad attitude. Poor knowledge and bad attitude is worst.
Anyway, as long as the decision making is dictate/ interfere by politicians, I do not see any good solution in near future. Just my 2 cents opinion.
I think this memo on “tracking mechanism” has been blown out of proportion by the writer. I read it many times over….the memo does not in anyway pass judgement on HOs…It is meant to IMPROVE the monitoring mechanism…as these days there are so many HOs and Specialists cant alone be expected to keep an eye on their attendance etc. Specialists have more important jobs i am sure. I dont see anything wrong in the Administration delegating this simple tracking mechanism of HOs attendance… to the Nursing level.
The writer seem to have chosen to interpret the memo …to serve his own purpose…ie passing his own judgement and discrediting HOs in general. and worst still …as you can see from the reaction of some readers….now pitting the doctors against the nursing profession.
Sure…in every profession there are bad apples….but they are far and few. It is bad to generalise as if a very large number are bad. If anything the responsibility for poor performance has to lie witht he system…ie from the top.
(Ironically i think this is exactly what the Memo is trying to address….ie relief the specialist off the “tracking jobs”….and IMPROVE THE SYSTEM).
Those who are working in hospitals are very much aware how bad the situation has gone to. So much so that such an instruction has be made OFFICIAL via a circular. Those who are not in medical field and not working in a hospital will NOT be aware of the gravity of the situation.
The very purpose of the circular and the need to ask the sisters to monitor the discipline of the HO tells us how bad the situation is. Doctors should be a disciplined person.
This has nothing to do with the nursing profession. It is everything to do with the medical profession.
Oh my god i can’t belief this is happening.
A good nurse is one that alerts the doctor if they are worried. They are also very good advocates for patients when we have busy doctors who are too busy to be overly attentive to every patient. They provide warmth and care in a different way to doctors. Each profession complements each other for good patient care.
But a nurse can never be expected to perform, or completely understand the rigours of being a doctor. Medicine is complex, and requires an understanding of basic science, good clinical acumen and off course good communication skills. Asking a nurse to supervise houseman???
Imagine if one of the airlines were to come up with a directive asking the senior air stewardess to supervise the junior pilot.
Doctors must regain their self respect. Imagine the day when you need the ward matron to sign you off after your housemenship. A person who has not even went through medical school, giving their piece of mind on whether you are a good doctor. You will need to bring loads of chocolates for the nursing staff from now on. Good luck guys!!
We,the medics will fight back for our own rights,we refuse to be monitored by the nurses! No offence.
Is there plastic surgeon shortage in Malaysia ?
Yes, of course
The answer depends on what you exactly mean by the term “plastic surgeon”.
Hi! Have sent you en email!
Don’t you think part of the reason doctors are currently in the mess we are in is because the MMC has never been a truly independent body that represents the medical profession and and it’s practitioners unlike, for example, the Bar Council?
Yup, exactly!
What is your opinion on the USM-KLE International Medical Programme?
Let’s not get too worked up over this.
Nurses alerting admin to dangerous practice is standard in the developed world.
Nurses have a very important role in any ward. It’s their responsibility to ensure meds are given promptly etc.
If a nurse thinks a patient is deteriorating, even if she is junior and couldnt tell you anything other than “I think my patient in Bed 21 is getting worse” based on a gut feeling she couldnt explain… ITS ALMOST A RED FLAG as far as I am concerned.
This is more critical in ED and ICU. If a nurse thinks something is wrong, you damn well better review the patient quickly. It will be documented: “Dr MintBerryCrunch notified re patients increasing tachypnoea” (for example) at 0020 hours. They can crash and you better have a good reason for not being able to attend in a timely manner.
This is standard practice. Nurses form a very good second line against junior doctor’s mistakes and failure to recognize sick patients. Also all the misspellings and drug doses done wrong (especially in paeds).
This is why I see this as a positive development.
Dr Crunch.
Unfortunately the nurses here are not comparable to the nurses in developed countries. You will know what I mean if you work here. Majority are just SPM Leavers with 3-5 credits in SPM. Many can’t even speak English npowadays.
FYI, you can have a patient who had died for 4 hours but the nurse do not even know!
Doctor…This is another mindset that you have to change. It is not necessary that they need to speak English to do a good job. In this country Bahasa is the national language and official language. Everyone speaks (or should be able to converse in Bahasa in Malaysia). The patient and the DOCTOR too should be fluent in Bahasa. Understandable the OLD doctors are not good in Bahasa…its they who should be improving their Bahasa.
NB: In Japan even the professionals dont speak English but they are a developed nation. In Indonesia too.
And what is wrong with nurses with SPM…is that the minimum qualifications required? You want nurses with a Degree in Science? You willing to pay them? They probably will need to be paid more than doctors.
Again, you will know what I am talking about if you are in the system. All doctors notes are in English. If they don’t understand English, how will they follow the orders?
As for SPM, I am comparing to other developed countries. In developed countries, nurses are degree holders. With the standard of our SPM nowadays, where thousands of students can get straight As, what do you expect from 3 credits??
ashraf spot on!!!!!!
Is there orthopedic surgeon shortage in Malaysia ?
Not in private sector
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Yeah I wonder why our admin department prefers Kulim rather than sg petani hospital? are they out of their mind or they don’t know the tiredness of the students? Seriously they are freaking stupid, they thought the students are too free and simply make decision…
[…] my earlier post over HERE and HERE, I wrote about the waiting period for housemanship and the worsening disciplinary problems among […]
this guy never stops complaining about current houseman and mo’s..everyone does their work to their best of ability..its always those people who had reached to that point where others are aspiring to reach who makes the most noise..live and let live if they were so bad they would never finish medical school in the first place.
Haha, definitely you don’t know anything! Do you know there are housemen who do not even know what history taking is all about but have passed their medical school? Do you know that the passing rate for medical schools in Malaysia is almost 100% with lower entry qualification than developed countries? Please go and do your own survey!
why blame the poor housemans who were accepted by the government to do their training in our hospitals?
The scenario of government accepting ALL will CHANGE soon. The incompetent ones will be kicked out!
Why blame? who is blaming? It is the scenario nowadays and I HAD WRITTEN why it is happening. Please read my blog entries since 2010. The root of the problem had been mentioned right from the beginning. The issue is, the incompetent ones CANNOT be removed at the moment due to civil service structure and regulations.
so long as the government are accepting the houseman into their houseman-ship program they should not be picked at just because they do not come from the list of university claimed to be reputable..these students all go there with the same aspiration as the one goes to some of the best medical colleges..not all can gain entry into those university or colleges so should they not find other ways to achieve that legally? students will only learn what is being thought to them in the university..
Who is picking? Even MOH knows who are the gradutes who are weak and should not have graduated in the first place. Aspiration? Do you know that most surveys shows that close to 30% never wanted to be a doctor?