Well, I just returned from my holidays down under. During my holiday, I read a lot of news regarding housemanship situation back home. In fact, before I left to Australia, I did receive few emails and phone calls regarding latest development in housemanship postings. However, I did not have the time to write anything till today.
In my earlier post over HERE and HERE, I wrote about the waiting period for housemanship and the worsening disciplinary problems among housemen. I would not elaborate further on these 2 matters. Before I left for my holidays I received at least 3 emails/blog comments regarding new developments in housemanship employment. We all know that Malaysia do not provide housemanship for foreigners. I had received many queries from foreigners in India, Pakistan etc enquiring about this. However, foreigners who are married to Malaysian can be given housemanship post under contract if your degree is recognised in Malaysia. Unfortunately, the situation seem to be changing rapidly.
About 2 months ago, I received information that a Malaysian PR was told that she will not be given a job by KKM. She is a Singaporean who grew up in Malaysia right from kindergarten days. She graduated from one of the private college here. Following that, I received 2 emails from foreigners ( one from India and another from Indonesia) who are married to locals. Both had degrees which were not recognised by MMC. Thus, they spend almost RM25K going for attachment and sitting for MQE exams. They passed. Unfortunately, when they applied for housemanship, KKM told them that a new rule will be implemented . They will need to sit and pass/get credit for SPM BM paper!! It is very clear that KKM do not have enough post to provide housemanship for foreigners or PR holders. Thus, they are creating “so-called” new rules as an excuse. As I have said many times before, passing MQE do not guarantee you a job. This applies to any country in this world. Every country will give priority to their citizens followed by PR. BTW, even Malaysians who do not have BM credits may not get a job soon!!
Many at times, when graduating students ask me whether they should start their housemanship while planning to sit for USMLE or AMC exams, I had always advised them to do so. This is because, passing AMC or USMLE or PLAB DO NOT mean you will get a job in those countries. Unfortunately, there are students who felt otherwise. They felt that if they start housemanship, they will not have enough time to prepare for these foreign exams. Well, they may be right but life in medicine only gets tougher and never gets easier. As I had mentioned since 2012, Australia is also facing internship crisis. The situation will only get worst from next year, as mentioned over HERE. So, if even their own medical school graduates may not be able to get internship post, what more foreigners, who are sitting for AMC exams. So far, I heard only 5 Monash Malaysia graduates manage to get internship post in Australia for 2015.
I received an email from a local university graduate who wanted to migrate to Australia. She declined housemanship posting in Malaysia mid of this year and decided to sit for AMC exams. She had passed her Part 1 and planning to sit for her Part 2 soon. Then came the bad news. Her senior of 1 year who had already passed her AMC exams is returning to Malaysia to apply for housemanship as she could not get an internship post in Australia. It is the same for USMLE as well. I know many who never manage to get residency of their choice. Thus, I will say this again : NEVER do medicine if your intention is to migrate!!
Over the last few weeks there have been multiple letters to newspapers regarding the working condition of house officers. While I had written many times about these issues before, what interested me most was the letter written to Prime Minister’s office. I received a copy of this letter which I would not publish over here, presumably written by a group of housemen from Klang Valley. The letter states 2 main issues: one on bullying and another on long working hours(supposedly 17-18 hours). Few days after I received the letter, I also saw the letter from PM’s office instructing the state health department to investigate the truth of the matter. It also appeared in the Star. Let me elaborate on both.
2 days before I left to Australia, I received a phone call from a mother whose daughter is doing housemanship for the last 3 months. She informed me that her daughter is very depressed and wants to quit housemanship. She claim that she is being bullied and she is unable to handle it any further. Surprisingly, according to her, the biggest bullies are NOT specialist or even MOs. It is the senior house officers!! Firstly, we need to define what is bullying and what is scolding. Medicine deals with patient’s life and thus certain mistakes have serious repercussions. You go to medical school to learn the basics of medicine and housemanship is to apply those basics in real world clinical medicine. The problem now is the fact that the quality of house officers has deteriorated tremendously to the extend that the senior doctors just throw their tantrum all over the place. Who will not get angry when you do not know how many chambers does a heart has? They should not have graduated in the first place! While I agree that scolding your juniors in front of patients and public should not happen but sometimes, the hectic work life of specialist or MOs just shoots them off the roof.
Bullying on the other hand has nothing to do with scolding for making mistakes.Bullying includes actions such as making threats, spreading rumors, attacking someone physically or verbally, and excluding someone from a group on purpose. Unfortunately, this seem to be an Asian culture. I had said it many times in this blog that the very same person who is complaining about bullying, will become a bully when he becomes a senior. I had personally seen this right in front of my eyes. AND that is exactly what is happening in the case above. The biggest bullies for her daughter were Senior HOs!! As long as these happens, bullying will not end. While KKM do have protocols to make complains on bullying, the line that demarcate bullying and scolding is blurry. The deteriorating quality and the surge in the number of housemen will only make bullying worst.
The second issue was ” working hours”. I had also written about this before over HERE in 2011. While I don’t agree working 32 hours continuously as what we did when we were housemen, being a doctor means we have to work long hours! That is a fact that most students should know before doing medicine. We cannot just let go of our responsibility to the patient before going home. WE must make sure we have done what we need to do. There is NO such thing as office hour job for doctors. In the court of law, patient safety is the most important consideration. These housemen think that they are the only one working 17-18 hours a day. Most doctors do and even people in other profession work long hours. The only difference is in other profession, you can bring your work back home where as in medicine, your work is done in the hospital. Even after 18 years of service, I am still working 24hours a day, 7 days a week. I can be called anytime of the day, even on weekends. Life in medicine will never get any easier. You must learn to work long hours. If you can’t, then leave.
Our DG has given a good reply to those who complain about working hours over HERE(see below). Another reply from a Paediatrician is also worth reading for those who complain about working hours (see below). Interestingly, a recent study in US showed that work hour limit for trainee doctors do not improve patient safety!! I know many who complains about working hours but will be sitting in a clinic doing locum when they are free!.
You chose this path and you need to adapt to what medicine wants you to be. Life’s are at stake and medicine is a life long learning. Even now, I am still learning. The most important teachers are your patients! The more time you spend with your patients, the more you will learn. I may be harsh but my advise to those who complain of long working hours is : please leave if you can’t handle it.
Response to the article Trauma faced by some housemen in hospitals’ by ‘Disgusted Malaysian, Kuala Lumpur’ dated 8th December 2014.
Posted on December 10, 2014 by DG of Health
I refer to the article published in The Star entitled ‘Trauma faced by some housemen in hospitals’ by ‘Disgusted Malaysian, Kuala Lumpur’ dated 8th December 2014.
The Ministry of Health (MOH) appreciates all feedbacks which have been provided on the housemanship training. Housemanship programme emphasises on training rather than merely employment, whereas the medical officers’ main role is to provide medical service, hence their roles are different. The 2-year housemanship has started since 2008. It encompasses training in 6 disciplines namely General Medicine, Paediatrics, Surgery, Orthopedics, Obstetics and Gynaecology, and alternative postings (either Emergency medicine, Psychiatry, Anaesthesia or Primary Care) for a period of 4 months each.
The housemen flexy working system has been implemented since September 2011 and was improved further from January 2014.The introduction of the flexy system is among the continuing efforts by the government to maximise the houseman’s learning process which aims to further improve their working conditions. It provides a chance for them to gain experience and take advantage of the learning opportunities to be competent and safe doctors.The flexy system requires the housemen to work an average of 65-75 hours per week. Housemen are entitled to a one day off per week but it is not necessary for it to fall on weekends. Housemen are doctors under training and they must fully utilise the opportunity given to them to improve their competency. MOH is monitoring closely the housemanship training in government hospitals to ensure the flexy system is successfully implemented.
Feedback pertaining to Housemanship Training need to be chanelled to the Housemanship Training Committee at the hospital and State Health Department. It is worth mentioning here that the doctors’ utmost responsibility and inherent value is providing safe and quality care to the patients. The nature of doctors’ working hours is different than other civil servants because patient care requires continuous services of 24 hours a day or 7 days a week.
In appreciating our doctors’ commitment, the Government has given various incentives such as the critical allowance of RM 750 per month and a special allowance for housemen of RM 600 per month. It is hoped that with all the efforts made by the Government, the aspiration to produce quality and competent doctors for the nation will be achieved.
DATUK DR NOOR HISHAM BIN ABDULLAH
Director-General of Health Malaysia.
HOs must stop griping and learn the job
I REFER to the letter “Trauma faced by some housemen in hospitals” (The Star, Dec 8) on the trauma faced by House Officers (HO) at the hands of seemingly sadistic Medical Officers (MO).
I would like to offer a different view of the matter lest the public gets the wrong impression of how medical supervision is practised here and worldwide.
No MO will willingly traumatise a HO unless the former is extremely overworked or the HO is so hopelessly trained that the MO is so exasperated by the inadequacy of medical knowledge and lack of responsibility.
With the current standard of medical graduates coming back, some of whom with dubious medical training in institutions that have been approved through political means, it is not surprising that the MOs are stressed by these incoming HOs.
The extension of a HO after the stipulated period is the decision of the supervising specialist, and he or she has to justify appropriate reasons for extension.
If the performance is still below par after the extension, the HO’s name will be forwarded to the Health Ministry’s director-general to send him to another specialist for supervision.
Nobody likes to extend a HO because of the paperwork that is involved but due to the maintenance of a respectable standard and the future safety of patients whom the HO will be entrusted with, these MOs and specialists have to maintain these standards of care.
The writer has to understand that getting a paper with MBBS or MD is just the beginning of a lifelong journey of training and retraining.
The initial degree should have taught a basic foundation in medical knowledge, ethics and basic practice to allow the HO to function with further supervision for another one to two years and be trained to be a specialist of his or her choice after that.
Without any further training, the MO can become a general practitioner in this country.
If the HO’s performance and knowledge is below par compared to his peers, it will not be fair to let him “loose” to the general public.
This training of HOs occurs all over the world and it is one way of ensuring that the public will be given safe young doctors to treat them in the future.
Ask any supervising specialist in the profession and one hears of the deteriorating standard and responsibility of new incoming HOs.
There are good ones who perform and never write in the newspapers and there are bad ones who complain about working 32 hours at a stretch. They just have to get used to it!
That’s what they signed up when they chose medicine where the patient is paramount to our sleep, food or toilet habits.
I think the writer exaggerated about the predicament of HOs. There is not a trained specialist who has not slept in the operating theatre, patient’s bed, at the table or in the toilet in his lifetime.
A smart HO should get used to sleeping a few hours in between patients and admissions, wherever.
These complaints are nothing new and the HOs just have to get used to working unlike other workers in the workforce as they will have the lives of their ill patients literally in their hands.
The less they complain and the more they learn from these patients and their superiors, the better doctors they would become.
PAEDIATRICIAN Z
Kuala Lumpur
I don’t understand why is it that the HO’s cannot hand over their duties to the incoming ones for that shift, and leave the workplace (or choose to stay on if no other commitment)? Why is it that it ALWAYS has to be telling the doctors to “stay on long hours” in this era? I mean I understand in the past, there is no shift system, and we have to stay on the whole nite, when on call, till the next morning when all the rest come in; but now, with shift system, why must we continue to force them to stay back? Similarly, why must the specialists come late to the ward for rounds, and then leave early once the round is done? Why not every doctor comes in the same time, and do round together (once) and then all finish the job in the ward? It shows the double standard among the fraternity, and wanting to dominate the hierarchy – with the thought that “I had my quota too in the past”. If it is for the patient’s good, then ALL must stay, and ALL must do the blood taking, and ALL must clerk the case, and ALL must do discharge summary. Because ALL are MBBS. So don’t use MRCP to be different. (Oh btw, just in case you all thought I am a HO…. I am a physician with MRCP)
That’s because the situation is different is different hospital. Frankly, shift system CANNOT be implemented in ALL hospital. Only major state hospitals can do that. Smaller hospital have less number of housemen because the number of housemen taken depends on MMC guideline, which depends on number of consultants. That’s why in certain hospitals, housemen have to do double shift. University hospitals also limits their housemen numbers and usually do not implement shift system. Secondly, it also comes down to attitude. Some bad apples will not do any work and just want to leave sharp on time!
As for specialist, YES, not all specialist are saints! I had written about this before. Why do you think some leave civil service? It is not always because of money. Frustration with the system is a major cause.The hard working and not so hard working gets the same salary and even get promoted earlier!!
As I had always said, it is the system!
If it is just the system, then point our blardy fingers at the SYSTEM, ie the govt and ministry, and the minister. Don’t keep harp on the few bad apples among the HO’s. The funny thing is that most of us know it’s the system, but can’t do much about it; so just easily blame it on those few lazy HO’s. Why not go on strike like in Ireland? But I dare the fraternity here to do… just look at MPCN…haha, you think everyone there really cares about changing the system by sacrificing his or her own future, in case get caught or struck off from MMC? No way… and I am sure if 1-2 bad apples in the team leave sharp on time, but those others so called “SAINTS” specialists, MOs who stay back to help the patients, surely there is no shortage of manpower. If the parents can;t possibly change the attitude of their own children (those bad apples), then what makes you and I think we can change them?! Let them be… better just go on strike, if really want to change the system.
That is what I have been doing all this while! Unfortunately, it is also the system(education) that are producing subpar graduates and making the situation worst.
I don’t usually go into MPCN even though I am their Facebook member. It started of as a unity call but I have worked in MMA since I was a housemen and I can assure you it will not work. Everyone only want to take care of themselves.
The change of the system can only happen from the top. That means politicians! When we have pea size brained politicians, nothing will change.
My HOs are not encouraged to hand over duties as far as possible to the next shift because:
1) when allowed, many things were not settled in the daytime and dumped to the next shift, leading to delays & snowballing.
2) The night shift usually has 1 HO per ward, while the day shifts have 2-4 per shift. He will not be able to cope with new issues, while trying to settle old issues from the previous shifts.
In my department, specialists come latest at 8am for acute rounds, go for clinics, then come back for rounds in the afternoon, finishing off at 4-6pm.
As a specialist may have 2 wards and clinics & being on call, while each HO has 6-10 patients & no clinics, you want the specialist to stay back for blood taking & discharge patients? Then I will be late for the other ward & clinics.
I would love to know which hospital you are working at. Sounds peachy.
I believe he is in Klang valley. I had experienced what he mentioned before when i had a short exposure to a Klang Valley hospital almost 10 years ago.
Pardon me saying, but then if that’s the case, why not go heads-on with the MMC and MOH, to cancel the shift system, and have 40 house officers per ward at any one time? Then the issue of snowballing or delays would not happen! Full of manpower! But then again, I am sure many of us would say “what to do…it’s the policy”, rather than to go on strike and pressure the ministry. And at the same time, we would just continue to harp on HO issue, and it is actually wrong to not allow them to go, when there is already a policy in place!
Some hospitals did not follow the shift system initially BUT MOH insist that it must be done. That is the reason why some housemen in some hospitals end up doing double shift!
Oh but sorry Bro Hua Jern… the moment I put my name as “John Doe”, it just means I won’t be revealing my identity (as for now). But of coz it does not mean I am not one of them. Like I know you are a Neprho in Muar, and Paga in Columbia Nusajaya. Just that I feel a little unfair to keep trying to “implement our own rulings” and complain; while could actually go to the top and get things set right.
And regarding your statement “I know many who complains about working hours but will be sitting in a clinic doing locum when they are free” — TRUE!! I know of a few colleagues, one of them currently interventional cardiologist, who was HO (and then MO) during my time who always gave excuses of health reason, and didn’t want to be on call most days, but quietly did locum elsewhere. Later he boasted that he earned so much extra income that he had finish pay up his house, and also bought a Honda Accord 2.4V!! Well, when this kind of “lead by example” scenario reach the juniors… what do you think they think about us the seniors?! My reflection on this case is that if this cardiologist friend of mine is really caring for his patients? or his own pockets? And the irony is that I heard he is now VERY VERY strict on HO’s attendance, performance etc… HAHA… how irony!!
Exactly!! That is why I said, it is the system!! As long as our system do not change to merit based system and kick out the “incompetent and MIA” ones, this scenario will not change!
john doe what an irony indeed!
It starts with reasonable working hours. Working for over 12 hours in a shift is just not right, and fatigue does impact on learning considerably. Given the glut of interns, it shouldnt be too difficult to impose say a 100hr fortnight cap on interns. That gives crucial time to rest and study. You remember things that you read better when not too stressed. This cannot be overlooked. After seeing things in practice, interns need time to sit and reflect and READ. You will not have the time to do this if you are putting in that many hours in hospital.
It depends on which hospital and the system. Despite the glut, maldistribution is a problem.
12H is long. But MOs work upto 36H a stretch & many specialists work more than 12H too.
Everyone is busy & overworked. That’s life. Just asking everyone to do their part.
Only interns need to learn? Interns are being paid, so they need to work, and gain valuable practical experience. Sitting & reading alone will not make you a good doctor, and the majority of that should be done as a med student.
You have got to be kidding.
The best way to really learn is to read up on things you see in real life. That’s the whole point about having doctors in training.
Working 36 hour shifts goes against a healthy mental state.
Being paid is no excuse. With a glut of interns, there is no real excuse to overwork them. Work life balance is important. YOu cannot study if you are working very long shifts. That’s why a cap is important…. and The shift system, once quirks are ironed out, is really quite a bright idea,
you are leaving in a different country with a different healthcare system. Once you are here then you will realise why the shift system is making the system worst than before.
isnt MOs, when working 36H straight, get some sleeps in between while there is no way for HOs to do the same! it is a big sin to see HOs to sleep in the hospital
HOs can sleep inbetween during the old system. BUT if you are doing shift system, then you should not be sleeping, similar to nurses.
huajern you must be very malignant towards your ho’s all in the name of training…hmmmp
Mr.P you seem to hell bent in blaming the system for everything 😀
Let me ask you a question. For years housemen have been complaining about this, even when i was a houseman. Why nothing has changed? The only thing that has changed was the shift system due to overwhelming number of housemen. What happened to those who complain like you? Why they never do anything to change the system when they became seniors? My housemen have become specialist but why the situation is only getting worst? So go and figure out yourself! What have you done to change the system rather than coming here and calling yourself bodoh sombong!
We need a system that filters out the underperforming doctors at all levels.
Quoting examples in the countries I have worked in :
Eg 1. contract employment for trainees in UK and Australia; future employment will heavily depend on good references by current employers.
Eg 2 No automatic career progression even for those who have completed postgraduate training. Eg in Singapore, I know of a trainee anaesthetist (who had problematic work peer relationships) who completed her training but was unable to secure a specialist job in public restructured hospitals, and finally had to give up her anaesthetic career
Yes, that is what i have been saying
Ha ha ha John Doe
The interventional cardiology fraternity isn’t very large
We’re all looking for the honda accord 2.4
My only 2 cents is this to the people who aspire to be ‘useful’ doctors:
We ain’t running a kindergarten here, if you can’t take the heat you better get out, pronto
Somehow, i felt i knew who he was!! Haha
Ha ha ha Eurick neoh, my point is again to filter out docs like you who love the statement “if you don’t like it, get out” mentality (reminds me of a regime who always ask those who don’t like Bolehland way, to get out or migrate). See the similarity? 🙂
john doe exactly let them eat their own medicine..these are the same goons who complain about politician coming up with the argument of if you dont like or if you cant adjust yourself get out of malaysia..hate when the very same ppl who argues when someone comes up with that statement but would be the first to suggest to a ho if he cant handle stress to leave this noble job.instead of helping that poor ho who struggle to get to that point they crush their little fate they have in the system
I will say it again, doctors work long hours whether you like it or not. So if you can’t handle it, you can find another job
yes doctors work longer hours than other job, but let’s define the long hours, in other country doctors work long hours max 24 hrs, before a must of 8 hrs rest time!
Yes, again it depends on how the healthcare system is
Furthermore, now housemen do shift system
And also, what I was trying to point out is that, despite the sheer “irresponsibility” and lack of team work spirit, that fella still becomes an interventional cardiologist today, and continue to contribute to the society. So is he wrong? or right? A HO now could be snaky and avoiding responsibilty, but who knows he would be another interventional cardio one day too?!
A good read.
http://mofrust.blogspot.com/2014/12/ho-ho-hohousemen-housemen-housemen.html?m=1
Dear Dr Pagalavan,
Firstly, I am an avid reader of your blog and most of the things you said here are true. But I do beg to differ with respect to the two US studies (Rajaram et al. (2014) and Patel et al (2014) that you quoted and appeared in JAMA:
1)The observational study design (retrospective analysis of prospectively maintained Medicare and ACS-NSQIP databases). The main problems with this type of study design the temporal (time-order) relationship between causes and effects cannot be fully determined. The ascertainment of temporal effect is essential since it will verify whether the exposure and outcome is indeed can be linked by causal association (remember statistical association does not imply causation unless the other criteria for causation such as i) temporal relationship between outcome and association is established, ii) large magnitude of measures of association such as large odds ratio, relative risk, hazard ratios etc). Fortunately, Rajaram et al (2014) admitted this weakness and hopefully the currently ongoing Flexibility in duty hour requirements for surgical trainees (FIRST) trial may able to provide more concrete and definitive answers to this.
2) The statistical analyses used from my own perspective is too obsolete since it denies the incorporation of subjective beliefs into the process of estimating the measures of effects (odds ratio, relative risk , hazard ratio etc). For your information, in current statistical paradigm, there are two different and competing schools of thoughts that have contrasting views on statistical methodologies and the theories of probability in general; frequentist and Bayesian statistics. The current trend of overly depending on rigid statistical significance (p value <0.05) and 95% confidence interval (the interval should not include no effect value to be declared as statistically significant results eg OR or RR shouldnt include 1, mean differences should not include 0 etc) is actually quite obsolete when it comes to obtaining accurate and practical statistical results and inference for population effects. I can draw one fine example from the great Sir Ronald A Fisher himself (the one who proposed the threshold 0.05 as the demarcation line between what truly exists in the population and what is not) who came to the conclusion that rejecting a hypothesis based on such decision-theoretic approach (eg less than 0.05 rejects null, more than 0.05 accepts null) is overly rigid and robotic. Each hypothesis should be examined individually based on their relative theoretical soundness and merits and from there, the threshold for statistical significance can be adopted. In fact the great Sir Ronald A Fisher himself has proposed in his groundbreaking book " Statistical Methods for Research Workers" in 1925 that great caution should be taken when 0.05 is used as the dividing line to separate what is significant and what is not. With respect to 95% confidence interval, its correct frequentist statistical interpretation does not mean that "there is 95% probability that the true measure of effects (OR, RR, HR) will lie between the upper and lower bounds of the intervals". The correct interpretation to 95% CI is "for every n numbers of confidence intervals constructed, 95% of them will contain the true measure of effects". From this new interpretation, there is no way for us to say this one particular CI we constructed has 95% probability of containing the true effect since what we obtained from our usual statistical analysis is just one confidence interval !!!. So if I constructed 100 confidence intervals, I can only say that 95 of them will have the effects but which one that really contains the effect, I am not sure. The only way of constructing A CONFIDENCE BOUND with 95% probability of CAPTURING the true effect can only be obtained through 95% Bayesian Confidence Interval which is constructed from posterior distribution [a combination of prior belief(which we can construct as a distribution from our own subjective belief or prior estimates obtained from previous studies in the literature) and the likelihood of the data given the hypothesis] of our parameters of interest (beta coefficient of regression, OR, HR, RR and whatsoever effects we are interested in)
3) In Rajaram et al (2014) we could clearly see from the abstracts that there is a trend of postreform mortality and morbidity (postreform year 1 ( postreform year 1 (OR, 1.12; 95% CI, 0.98-1.28) or postreform year 2 (OR, 1.00; 95% CI,
0.86-1.17)). This highlights the third weakness of this study that the follow-up period might be a little shorter. Perhaps, in postreform year 3 and postreform year 4, the effects will start to become statistically significant (if we are still interested to adopt the frequentist statistical methodology). I do believe we need a longer follow-up here for the objectives of the reform starts to materialize. And I do believe this is what supposed to be done in our setting with respect to the introduction of flexi hours system for the houseman. The authority should conduct a well-designed study that will shed light to the current dilemma (whether a reduction in working hours will result in the betterment of patient care or the opposite) that we are facing, thus eliminating the state of clinical equipoise in such research question.
4) With respect to Patel et al (2014), I am very much interested to know the adherence rate to the new 2011 ACGME duty reforms since it is useless to compare two interventions (the old system and the new ACGME reform) if the adherence rate to the new reform for each hospital, departments and wards are not fully documented (the effect size would be minimized due to the mixing of effects, making an RCT a better study design to provide such answers).
There are few more points that I would like to add but I don't want this be another CME session on how to criticize a journal. Have to go back to revising for my Phd statistics exams tomorrow. Cheers.
TL;DR – summary?
*reminds me of specialists – particularly in the medical dept. ordering HOs to summarize cases of chronic patients (volumes upon volumes of case notes) + “I want it done by tomorrow”…
😀
Haha, that’s one hell of a statistical jargon!
I actually read it.
It’s not statistical jargon.
It’s non-sequitur.
I simply cannot see how it relates to your post.
It is also very tangential and goes off in odd directions.
I am currently involved in research, and what this guy is blabbering on about is not only unrelated, but contains many simple grammatical errors.
I call bullshit.
I have been reading these complaints to papers about how housemen are treated so badly and wondering what is the problem with these people. When they go for the interview to get a place in medicine, and asked ‘why do you want to pursue this discipline” all say ‘I want to save lives’. This answer says a lot. It encompasses all that they are grumbling about now. Can you save lives without being in the hospital? Can you save lives without having a sound knowledge to do so? Can you save lives by sitting in a locum clinic and not being in the wards even when you are not on call so that you know what is happening to the patients you are taking care of in continuity? Can you save lives without being experienced in emergency procedures? Can you save lives without getting the hands on knowledge to do so from your peers even with all the scolding for your weaknesses? I can go on and on. The surprising thing is that once they get through their finals their understanding of the career as a doctor completely changes and they think it is a nine to five job! with all the added perks so to speak. Fault lies not only in them. I firmly believe that the mollycoddling parents make a huge mistake when they insist their babies become doctors by hook or by crook when they very well know they don’t have the aptitude to do it. I know of parents who rent comfortable hotels (overseas) and sit with their babies through every exam during the five years cooking for them and washing their clothes to make sure they don’t collapse and leave the course. How would they be able to go through the tough life of a doctor when they do not accept the realities of being one. The same kind of parents still influence their lives negatively when they start the housemanship and complain to the media about how disgusted they are instead of educating them about the reality and encouraging them to be excellent doctors. Shame on you. I cannot even start to mention how I went through my housemanship more than twenty years ago when there were only about four housemen per unit in each major discipline in then KL GH (ya, I know, it was crazy) There were times I did not go home for forty eight hours, stood in the OT assisting for six to eight hours at a stretch, and I didn’t know if I was going in or coming out of the hospital, that tired. Food was of course whenever there was a gap of ten minutes with the kind help of the ward staff to buy something. Toilet of course whenever I could. Sleep was quite a luxury. But the brain kept working somehow. That is called will power. But the enormous knowledge and discipline I gathered during this time helped me to go through four exams and do well. Gave the confidence to handle emergencies. In fact when I was working in the emergency, my target each time was to become faster in each tracheostomy time than the one before. Likewise if you don’t aim to do better and better but keep whining, your life as a doctor is going to be an absolute misery and might as well go into another discipline when there is still time and not hold every one around you to ransom. Please stop tarnishing the world’s noblest profession. Enough has been done already. Children, Don’t do medicine if you don’t have an inner call, mental strength and adequate brainpower to do so. First of all come out of the dream state and know yourself. Do not jump into it just because your parents asked you to or just because the neighbor’s child did or because of ego. You are going to get stuck in something you do not enjoy doing, make yourself and poor patients miserable and you can’t blame any one else for that but yourself. Healing comes from the doctor’s heart, not alone with medication and procedures. Life is tough as it is. Don’t make it any tougher by choosing to do some thing you have no idea about the realities of. Do your homework first see yourself in the future being happy or complaining. Talk to those who know about being a dedicated doctor through a lifetime. It is not a joke. Many are laughing at you already. Why take bites you cannot swallow? When there are so many career paths equally prestigious to choose from and in fact less expensive and enjoyable. I am not going to even mention the dog eat dog situation out there in the private sector. It is going to be a very, very, very tough life. If you cant do the simple things as a HO now, please get out of it and do something more relaxing and lucrative now itself when you are still young and have the energy to do so. Be realistic. You don’t know the avalanche that is coming.
Actually it is already here.
Ok I have spoken my mind.
That’s the reason I started this blog but many still feel that medicine is luxury!
I feel you. Im an ED registrar. It’s always about pushing yourself and being a better doctor day by day. The learning never stops. Every shift you *will* see something new. What you do after seeing said new thing is up to you. Looking up UpToDate or even Wikipedia makes all the difference, and the knowledge sticks.
I dont eat during a shift (i feed before/after), and pretty much never take a break. Juggling 5+ acute patients at a time is challenging, but fun. That’s how you get quick (and safe!) at clinical decision making and procedural skills. Add in the fact that we do all the paperwork/documentation/scripts if necessary and referrals and you see how crazy it gets.
Organizational support is also critical. I dont know what the Malaysian situation is, but KPI’s are enforced here in Australia. Patients rarely spend over 4 hours on the emergency main floor. Time to referral/bed request is almost always under 2 hours [this is the KPI that gives me grief, because juggling a few acute patients, while trying to discharge the not-so-sickies at a time makes it difficult].
Loving it. I’ll be dead if I didnt. You can tell the ones who like the job… you feel great at the end of a shift…and… critically, have motivation to study for exams.
KPI won’t work in Malaysian hospitals. We get acute cases every 2-5 minutes!!
THat sounds hardcore. What’s the turnaround like?
that depends what you mean by turnaround
Time spent in the department (acute beds or shortstay)
ER departments in Malaysia generally do not have enough space to keep patients for long. They just stabilise the patients and send to ward.
In my hospital, ER are so full till they run out of chair (pt has to be put in floor, no kidding). Medical ward so full till pt on corridor and of course stuck in ER as they can not come up to ward. Bed is 2 feets apart on medical ward. If someone collapse you need to move beds before you can reach the pt.
Hi all..lets look at the bigger picture here. This is not just about quality of younger doctors. This is about quality of younger generations of Malaysian product. This poor working quality is not just seen among doctors ,but it is a very big issue in other profession as well. From my personal opinion, this is a country crisis. Younger generations seems unable to accept negative feedback regarding work, unable to be punctual and badly want things to be their own way. There were raised by parents whom just praised them for beeing good in results, and almost all of them are self centred. They get what they want most of the time. When they entered the workforce they are unable to cope with feedback regarding their work is not good ..etc. as a whole we can see factory workers,police officer, teachers come and see us doctors pretending to he sick and demanded mc. What does that tell you. There is just lack of integrity among this generations..thus it include young doctors. Perhaps we are all are even patient enough to train the younger generations. Dont give up of them. I even known a ho who quit housemanship because unable to work although their parents are doctors too. So lets reflect and fix it together.
hi uz,
Agreed with you that nowadays the younger generations seem unable to accept negative feedback and always think that they are right. I have observed many friends’ children keep changing jobs and keep complaining about jobs.
Yes, it is common and that’s why many are employing foreigners for their business
Some just quit their jobs without any new jobs too. Staying at home doing nothing.
Father mother support mah. Parents are to blamed as well. Many parents nowadays treat their 25 year old son/daughter as small kids!!
Hi, im a houseman in one of our IT hospital, while i agree that disciplinary issue among house officers are worrying, i must say i dont savvy this tds shift/flexi hrs system.
Though i myself have never gone through the oncall system, i did go through the bd shift and i actually enjoyed it. Then KKM decided to implement the tds shift…IMHO, it was a disaster – lack of continuoity of care, multiple passing over between each shifts
(which results in ‘terlepas pandang’ cases), and more ‘opportunities’ for HOs to ‘lepas tgn’ and MIAs.
Yes tds shift is fairly new and there are still room for improvements. But i dont know if KKM is even bother to do any improvements. Many times some respective members of KKM came and asked for feedbacks regarding the new shift system and how can we improve. And many HOs eagerly voice out their opinions, but ended up getting the usual responses such as ‘it was harder during my time but i manage’ OR ‘theres nothing we can do about it’ OR ‘u hv to be more positive and go through this’…these are not the responses that we expect from our beloved KKM! The least we want to hear is ‘we will bring this issue to the next board meeting’…
Hmmm…perhaps this is why many doctors resorted in writing to the newspapers about their conplains?
And may i add that we lack teamwork big time! This is a very sad reality. I’ve gone through my clinical years abroad, where medical personnel (from interns to specialists, doctors of other specialties, and other members of healthcare) work as a team, resulted in better patient’s care and also job satisfaction. I was very eager to finish my medical degree and be part of the team. Then, i came back to serve my beloved country only to find that i’ve lost my passion along the way (but i still have my sense of responsibilty so yes, im still here serving for my country)…though there hv been precious moments where ive been partnered up with some awesome colleagues and despite having a hectic day and heavy workload, we all go home with a tired body but a big smile on our faces. Whats gonna work?Teamwork people! We need more wonderpets moments! (Sorry cant help inserting reference to wonderpets here being a mom of two wonderful kids) 🙂
Sorry for the long post! But i do wish with all my heart that we will have better healthcare system in the near future.
Welcome to Malaysia
I totally agree with MintBerryCrunch. Every case is a medical jigsaw puzzle. Always a unique and interesting one. Analysis , synthesis and integration of data is crucial for proper diagnosis and treatment of any condition. It is through relentless repetition of working up cases that the analytical and critical mind gets sharper and sharper and one ends up being a good doctor. That is why while training, the complete follow up of the patient from beginning to end regardless of the outcome is very important even though the case may be handed over to another doctor. It has to be ones interest to know.This is a life time process. There is definitely no short cut to that. So it is simply what one really wants to be.
Today there are so many avenues of gathering knowledge, referencing, conferencing at the touch of a computer key. The amount of information available and shared is unbelievable. One only has to have the desire to use them for their own betterment.
I am sorry to say looks like we are still far from high level organizational support (especially the speed) and KPIs. If KPI is implemented here I wonder if any doctors will be left in the hospitals, referring to the younger generation we are talking about from what we continuously hear.
I am definitely not referring to all the the new graduates. There are very good ones who have got a good medical education and are in the right path. But they seem to be few and far in between.
My only hope is this whole thing gets rectified and every one realizes the importance of recruiting capable students on merit, provide quality medical education and proper training before the young ones are released into the public arena. And be seriously strict with the present trainee doctors. It has to start now.
By the way all this is a result of education becoming a business just like health care.
Education should never be commercialised
My wife, a Malaysian and has just graduated as a Houseman from Ireland. She however was living overseas since she was 13 years old because her mother was working in the middle east. Hence, she took the GCSEs an equivalent to SPM.
After her interviews in Putrajaya back in September 2014, her offer letter was frozen and she was told that she would still have to sit for SPM Bahasa Malaysia, despite having passed her GCSE BM (which is an equivalent paper to SPM). So this SPM issue also affects Malaysians as well…
The national healthcare system is like a boat with hole going in the wrong direction towards an iceberg. The people on the ship are screaming to ‘change the course’ of the ship to avoid the iceberg. Don’t worry, you will drown anyway unless you patch the hole in the boat.
The real problem is management. There’s not enough money, resources, people, to train junior doctors
You all keep blaming each other about the situation. Meanwhile, public trust in doctors keep eroding to a point of no return.
Forget solidarity, unity, cooperation. Public and private doctors are competing against each other. We should be helping each other. And now, we are killing the younglings.
Before you attack junior doctors, why don’t we ask the question, why are public hospitals bleeding, no, hemorrhaging quality specialists to private hospitals?
With dynamic and capable specialists plying their trade in private hosp, is it any wonder the doctor training systems in public hospitals are collapsing?
You are all doctors. Perception of poorly trained junior doctors are the signs. What’s the aetiology? What’s the risk factors? What’s the management?
Our education system is also going the wrong direction
Did your wife receive an offer letter from SPA?
As i said above, Minister did announce last August that all those who are applying for civil service will need BM credit. Exemption was given for doctors since 2005 but they are reversing it now.
Dr P, gov never said that need to have shift system. They only gave an example of the system use in HKL ( I believe is the system which is running the medical department ). It stated that min requirement is 65 hours. I actually shot down the proposal in my department when they plan to implement and I came up with the new system to cover the 65 hours. Everyone happy, all HOs not on night duty goes back at 6 pm. Department have max man power during day time. Minimum of movement of manpower in ward ( they do not get to change to other ward on daily basis ).
They did. There was a circular issued by the previous DG regarding this. A pilot project was conducted in Temerloh or Mentakab hospital and subsequently in sultan ismail hospital jb. Within 4 months, other hospitals were asked to follow. Nothing to do with HKL.
Sir, if SPA has already offered the horsemanship post to the candidate, will kkm reject the application on this basis?
On what basis? SPA offers a post in civil service. KKM allocates where you will be posted etc. Sometimes miscommunications can occur. In this Bolehland, anything can happen!
On the basis of the lack of SPM Malay.
Sorry bro, GCSE BM is nowhere near equivalent to SPM BM. But I do sympathise with your predicament. Something all the students in international schools will have to think about in they future.
does that means if we have children who want to do medicine and live abroad, we have to send them back to school in malaysia? ridiculous!
To join civil service , the rule is you must have a credit in BM. Unless they corporatised the hospital and internship is NOT a civil service job, this rule will not change.
btw, i know a case last year where one HO who did her O and A level overseas but went back for mbbs in private med school in KL, was offered a HO position, i dont think she has attemped BM july paper…
in this case, do students get exempted from BM SPM requirement if they do their mbbs in malaysia?
Till august this year, BM was exempted for doctors. This was done since 2005 to encourage doctors to come back and join the civil service
When ppl talk abt this current generation of doctors or any other profession, about how weak, indiscipline, unable to accept criticism, not motivated, etc…they often forget that the failure of current generation is in fact the failure of the generation before them in raising and educating them..we have crafted the situation as such and nurture/mould them into what they are today..if u think they are bad, just look at yr own kid/younger siblings of this generation..and think for yourself…did I play any role into getting them to behave in such a way?
On the other hand, look at the brighter side of this generation..all the positive attributes that has been associated with gen-X,Y,Z and so on..and work on those positive attributes..funnily, we are quick to claim credit that those positive attributes but fast to point fingers for their negative attributes.
The change has to come & initiated by previous generation who is now in the position to implement changes.. Yes MOH has to play big role in this, but clinicians too has to change their approach to set this straight..teaching them by humiliating them is not acceptable..period!.. What has MMA done to help? Organising prep course for medical student/HO before starting their HOship is commendable but the approach has to change…stop saying that you HOs just have to be strong, gulp it down and persevere the torture of HOship..why the negativism?
Sharingan I share your views.
We have to take the situation with a pinch of salt. “Inept” junior doctors are part of the family. Our family. This is the type of situations we have to deal with, as a team.
The true secret is among various specialties within the medical field there already exist competition, which sometimes get unhealthy. ENT vs Dentists, Surgeons vs Anesthetists, GPs vs Physicians, Peds vs Obs. So, senior doctors vs junior doctors is nothing new or special.
The problem is, however, in labelling these junior doctors as ‘inept’ as I did in the second line. We are evidence based and absolutely not anecdotal. Whats the evidence that these doctors are underperforming any less than the current senior generation would have done if they were under the same predicament?
The fact is, we are throwing attacks against house officers before truly trying to tackle the problem. The answer is better application of management science. Are specialists in multi-doctor government departments properly trained on human resource management or performance management? Are they backed up by the right people who can help them as consultants?
Look theres an entire discipline dedicated to team-based. Theres an entire body of science, as wide as our cardiology or rheumatology in managing teams whether they are doctors or not. Example –
http://en.wikipedia.org/wiki/Team_management
So whos doing what about this? Why are we not empirically assessing this problem of “suspected underperforming junior doctors” like the scientists that are supposed to be?
Thats the real question to ask.
I’ve said it in a previous post. Get academics involved. Get management specialists, economists, accountants, organizational psychologists, hospital administrators (especially from the examplary IJN) to do their thing. Let them study the hospital structures in our country and come up with a fully referenced set of recommendations. Cut through the bureaucratic red tape and implement a competitive performance based incentive scheme for doctors, implement balanced scorecards, etc.
Unless this happens, we are no different from witches trying to brew a potion, and angry that nothing tangible is happening.
In simpler terms, everyone’s flogging the wrong dead horse.
Chillax, you should become the prime minister!
In an ideal world, Chillax. Our country has so much potential, much more than that little red dot to the south, but all wasted because the powers-that-be are more interested in maintaining their position in order to line their pockets. Attempts at implementing change are usually met with strong resistance.
I can just imagine the dread (and fear) of current malaysian medical students in Australia and in the UK, at the thought of finally graduating and having to come back to work within the system.
Why so? I thought UK has no problem in placing their graduate in hospital at least for the time being and that the glut in Aus is going to lessen in a few years time? Mind clarifying?
In UK the number of intakes are monitored based on the number of internship post. So gradutes will be given internship post but no guarantee that you will get employment after that. Australia is also the same but due to increase in the number of medical schools over the last 10 years, they miscalculated. The issue above is concerning those who intend to migrate to these countries by graduating from elsewhere.
I wrote “having to come back”, as in those who are bonded on scholarships. Those not bonded will most likely continue their training in these countries.
From this website: https://www.amsa.org.au/advocacy/internship-crisis/
“The Audit of Applications for 2015 internship has been completed before any offers have been made. The audit identified that there were 3676 applicants for internships: 3004 domestic medical graduates, 480 international full fee paying medical graduates of Australian universities and 192 other applicants. NB: Based on experience from previous intern recruitment it is anticipated that the number of applicants able to accept and commence an internship may be less than those who applied due to failure to complete their course.
As at June 2014 there are approximately 3210 state and territory intern positions available for 2015 (some positions still subject to accreditation) and up to 100 Commonwealth funded intern positions.”
Essentially, more graduates than there are spaces, but enough spaces to absorb all local graduates. Some international students will miss out on spaces. I don’t know if the 480 number quoted included Monash Malaysia but I suspect it might not.
Also, I believe the Aus govt is axing a GP placement programme for interns, which will decrease the number of intern places by 180. The Aus economy is undergoing a dip due to a drop in commodity prices. The expansion of public health services seen 5-10 years has stopped. This is all cyclical of course, and money will be poured back in eventually as they struggle to keep up with population growth.
Most will not come home unless under scholarship
I do know of a few who were given overseas scholarships to do medicine in uk and aus several years ago, but never came back to fulfil their moral and legal obligation… Any new measure taken by govt or jpa to make them return or pay back the full amount spent on them? I heard the authorities are stricter these few years but I don’t know how true it is.
Firstly, JPA has stopped sending students for medicine overseas except for selected top 50 students or so.Last few years, if you don’t come back, you will need to pay the full scholarship amount compared to RM 25oK before.
Hi Dr. P
I just want to know is it possible to join private healthcare after completing ho? Is there any loopholes that we can use to get out of gov system?
Still need to complete the compulsory service. If not you will not get the APC
Case 1: A registrar threw her shoe in front of her house officer and hit the door. Hurling abuse and non comprehensible nonsense. Found out registrar was actually under intense pressure under her tyrannical boss.
Case 2: Another senior doctor threaten to smack the face of a house officer. Turns out he despises new HO pay scale & grade where he is still stuck in his old pay scale equivalent to a HO
Case 3: Consultant privy to private life of woman house officers with children. Claiming about hardship & need to survive. Found out she send her children to her parents house in the village. She doesn’t have time for a husband (divorced) and a children.
Case 4: House officer consulted with her superiors about the verbal abuse, threats, unnecessary insults received by her superiors. Got turned down and downplayed. “This will not be your first time being treated this way. You have to man up.”
Good people, bad culture turning them into the worst version of themselves. Vicious cycle that won’t get fix. Bye Malaysia. House officer has migrated to another country and works happily in another country. Treated with respect and have a pleasant working hours and paid very well and fair. Also to note, seeing a lot of Malaysians taking up the courage to migrate and leave the sinking ship that is Malaysia.
Now you see why it will never change. The system is such that no action can be taken to anyone. That is the problem with the entire civil service. Thus it has become a culture. The only way this will change is when hospitals are corporatised and doctors work on contract basis.
Yes, many will migrate ONLY if your degree is recognised elsewhere. Many who migrate from this sinking ship are not doctors.
my wife did her HO in malaysia and 2 yrs of MO before left her job and moved with me to middle east..passed usmle and secured a residency position here. she is very surprised with her new working enviroment, wayy different than her previous. specialist and consultant are very nice, helpful, and teaching is often. no yelling, no humiliating belittling residents and intern. ppl respect each other and are happy working there, no full 36 hrs of working, max oncall 24 hrs with a must gap for rest/ sleep in the hospital,.. and yes better pay too!
It has become the culture here. No one wants to change it and the same people who are complaining now will do it to their juniors. Secondly, how the oncalls are done depends on the healthcare structure of the country. Every country have their own structure. Unfortunately we are still running the same system which the British left us in 1950s.
ppl like you who have more expereience with the system, seen different system, should do something to change the culture, maybe should encourage more doctors to do elective/ attachment abroad then they will see the difference and more civilised hospital working environment. as for my wife, being done everything in malaysia including mbbs from ipta, that’s when the surprise comes!
it is no longer 1950s, ppl change, the system should change too.. stop mentioning ‘during our time’! the british who introduced the system to us has changed/ improved alottt too!
I have done my part but as long as it still remains as a civil service, no one can change the system.
“A smart HO should get used to sleeping a few hours in between patients and admissions, wherever.
These complaints are nothing new and the HOs just have to get used to working unlike other workers in the workforce as they will have the lives of their ill patients literally in their hands.
The less they complain and the more they learn from these patients and their superiors, the better doctors they would become.”
ain’t paediatrician Z a funny guy? talking bollocks when clearly housemen has legitimate reasons to complain..why can’t specialists such as paediatrician Z put aside their ego and stop dismissing every complaints by self-glorifying and reminiscing on what they had gone through in the past. it serves no good other than boasting your ego. there are many remaining specialists in the system, but we all know better what sort of doctor paediatrician Z really is…
and during ‘their’ time.. it was only a one year torture, not two years!
With only 2 housemen per ward whole day, everyday!!
dear doc, what pathway I should do if I intend to open my own clinic in the future (GP)? mrcp? family medicine? a must?
At the moment, anyone can open a clinic as long as he has finished his compulsory service.
Hello sir, I have a question or two.
Will a tattoo on my wrist effect the results of my interview ?
Also , let’s say I cover it up by wearing a watch, is there anything said about a houseman not allowed to have a tattoo.? ( if they eventually find out )
Generally, you must be well dressed. I have not seen any one with a visible tattoo becoming a doctor. So, I got no idea what the reaction would be.
Dear Dr. Pagalavan,
Just to share my story.
I am a graduate from a reputable local university. I was not the brightest back in medical school, neither was I the smartest HO around. I didn’t really have a problem with my job, in the beginning. I know the basics, I can grasp new knowledge quite fast and handle simple cases well.
I had completed two postings, and I was excited to move on to the next. I saw a clear pathway for me to become an MO (I have always wanted to do Radiology or Psychiatry) before I was stucked in the 3rd posting.
I can only say that I survived my first 2 postings because of highly supportive colleagues, seniors, and very inspiring superiors – MO and specialists. Whenever I asked a question or did not understand a management plan, they would patiently explain and in some circumstances, helped us when we were so overwhelmed with tasks especially on busier days. I still remember an MO who taught me how to properly read the CVP, the MO who patiently sat next to me to supervise my first lumbar puncture, a consultant physician who taught me how to check the level of oxygenation in a ventimask, the Mos who came at 8am and can remember their cases very well despite of going through the notes on the PC for just a few minutes (and I came to work at 6am and still had to check my notes every now and then.) They all motivated me to become better day by day, because someday, I want to be as good as they are! I believe I was not the best, but I received good feedback from a few of them.
Although I had to work alone on a night shift in an overloaded dengue ward with FBC QID, or had to take care of multiple wards at the same time, alone, and only had post-PM (postcall) for a break before starting work as usual the next day, I did not really feel depressed/stressed because of the anticipation of the new things to learn, the new cases to see the next day.
Of course there were bad apples around, such as a physician who goes around calling people “mangkuk” every now and then, who told me he has problems with me and I should have quit and worked as a clerk instead, but he is too knowledgeable that I ended up having respect for him despite of how much we all hate him (and his attitude towards the patients).
However, the current posting I am stucked in is filled with destructive air, led by toxic people from head-to-toe. I was told by my seniors that in this department, EVERYTHING needs to be consulted with an MO, even simple things like sending FBC/ABG, doing ECG or giving nebs to patients with SOB. Unnecessary bloods will be fined from our own pockets. Unlike my previous posting. I still remember being so afraid to disturb my MO during my night calls because I know they were so busy since they had to look after multiple wards, so I tried my best to manage simple cases before informing them. Like, running fast an IV drip in a dehydrated patient with low BP, putting high flow mask and ordering ECG for a patient who complaints of chest pain and having spo2 drop, recognized SVT on ECG, took ABG stat, called MO, and send the ABG to the lab so that when the Mos come, we finally discovered that his blood gases and electrolytes were deranged.
In this particular department, things are different. When I reconfirm management plans, I was told I wasn’t focused during the rounds. When I asked about insulin dosages, I was told I was not proactive enough to figure it out myself. I caught a patient who was discharged and thanking me with branula still on his hand. The CBD from morning plan was still not removed at 2 pm. The nurses were so sure they don’t really have to do their work because if anything happens, the Hos will be blamed. Ultimately, we, the Hos, besides having to do houseman work like running to the blood bank to take pre-op GSH, send it to the OT, make sure pt names are on the list, carry out morning plans, put in notes on PC, take bloods, set branulas, clerk new admission, attend to pts on resus, update latest investigation and medication charts, do 2-hourly turning, WE also was blamed for not doing nurses’ jobs, like removing branula, or for Radicare’s job… like we got a scold in the morning for not wiping a small speck of blood on the floor.
I am not saying that we cannot work together in completing these tasks, after all these are all for patient care. But I have to say we have so many things on our shoulders, like referring cases to other teams, call anaes team for pre-op review, fetch reports from other hospitals, and so on. Those are OUR job, and we can’t pass this to nurses and Radicare. I still see bloods taken by my colleagues the previous day in the same basket where I place my morning bloods. They are supposed to be sent by PPK the previous day. Then, all the dramas about the rejected bloods, clots and lyses begun.
My motivation was destroyed from day 1 in the department. I have forgotten my long-term vision to become a specialist, I have lost my motivation. I am now numb, with no ambition. I went to work for a month in that department without any anticipation to learn anymore. Everything I did, good or bad, will be wrong in their eyes. In fact, I don’t really learn much in that department. Nobody really cares to teach, because they are so busy thinking about whose mistakes to blame and avoiding blames. That is the result of having a crooked departmental system from head to toe – this particular HOD does not want to talk/face HOs personally. I believe we don’t exist in his eyes. Or maybe we are just walking pests in the ward.
Yes, I am an HO who was used to having no meals until 11pm, and I am not the kind of person who wakes up early to take breakfast. But I believe we Hos have to be smart. On the way to request a CT scan, I stopped by the hospimart to buy bread and milk. While waiting for my turn to talk to the radiologist, I munched on the bread and sipped on the milk. On the way back from the lab, I made a stop at the washroom to pee. Those things. We have to continuously ‘steal’ time. I still remember carrying currypuffs in my white coat pockets, and munched them while taking the elevator. Or at least, I always make sure I have a bar of chocolate in my pocket in case I go hypo during a busy day.
But those were the good old days.
I am one of those “manja-litis”, vulnerable, fragile Hos, who collapsed and fall into the trap of depression at the first hint of destruction (or intimidation) and (don’t worry), I’m already out of the system.
I have quit, 6 months ago.
Bravo to my colleagues who are strong and striving. Keep up the good work.
P/S: The weird thing is, I still have got night dreams of patients collapsing in an airplane, encountering an MVA and I was the only person who could attend to the victims. I literally encountered an old man who happened to be an asthmatic who stopped by the roadside for SOB, looking for his MDI.
Sadly, I am not a doctor anymore. I could only make sure his MDI technique was correct and he was fine.
you should have just ignored the ricidulous comments made by your 3rd posting mo/specialist, never give up! that’s exactly what i told my sister. just go with the flow, learn as much as you can, and forget any derogatory remarks made on you. anyway, you are not gonna work with/ for them after you finish your rotation, or just pray that KKM wont put you in that specific department in the same hospital.
anyway it is never too late, you can still try a different career path, usmle is one of them.
I could not ignore them, they had gone overboard.
I still remember being scolded harshly for not clerking a patient who presented himself for elective admission DURING the rounds. Well I could’ve chosen to run to him to clerk him, but I had an experience running to the washroom during the rounds for emergency evacuation of my bowels and was scolded for “not following rounds”, so running to the pt to clerk was not an option.
I was yelled at on day 4 of tagging for apparently “ignoring” a pt’s particular condition, when in fact, I had told 2 different MOs on-call who attended to the pt and didn’t order any investigation or referral and only instructed to withhold one of his medications (to which the condition then responded). How was I supposed to know that those 2 MOs were not the seniors’ favorites and were not really trusted by them? I was only told that HOs couldn’t simply order Ix or make referrals without MOs’ consent in that department.
Oh I don’t know. I’m writing this with anger and frustration shooting down my nerves and veins.
I love medicine and I still want to know more, but at that particular point of time, I was so frustrated with that particular medical fraternity that I have became anhedonic and apathic.
Life is never easy or smooth sailing. There will be times when you will face situation like above. You just have to endure. Ups and downs are common in life. You just have to take it as part and parcel of life and just close an eye and move on.
If you want to truly make a difference, the best way is to lead from the front. Which essentially means that you need to get to a point where you have sufficient independent ability and authority to effect meaningful change, at least within aspects of medical practice over which you have control.
In giving up, you have also given up any potential opportunity of inspiring the next generation of doctors whom you would have trained. The system in overall compass may be broken, but outstanding individuals still exist within it. Be one of these. This is one of the key motivations which got me through difficult times in my training years.
After you have quit MOH, what are you doing currently? Just out of curiosity. 🙂
Dr, I am a third year medical student about to start my clinical years. What are the things which I must learn outside the textbook? Can I have your thoughts on this matter?
See and clerk as many patients possible!
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