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is it really the house officer’s life so stressful?

few months ago i sent a message to our beloved Health Minister Datok Seri Liow Tiong Lai..

i told him “i think Malaysia should limit the number of medical schools, i’m very surprised that the surgical house officers do not know how to insert a branula”..

he didn’t reply my message.. but few days later in a press conference, he said “the Ministry of Health will look into the issue of the quality of house officers”..

and recently, the Ministry of Higher Education announced “no more new medical schools in the next 5 years”..

to me, this is a great news.. hahaha..

but to those businessmen and money-orientated academicians, this is a shocking news coz they are losing their opportunity to earn easy money…

well, is the quality of the house officers (HO or commonly known as houseman) in our country really that bad..?? emmmm, i think those who are working in the hospital definitely know the answer..

there are few factors contribute to the poor quality of the house officers, one of them is the business-orientated money-digging poor medical education system, both local and abroad; other factors include poor attitude from the house officers themselves, as well as lack of support from the senior staffs (MO and specialists)..

let me draw an analogy how is a doctor being produced in this morden day..

first, you must know the concept of instant noodle..

you can choose vegetarian flavour, or spicy ramen flavour.. similarly you can choose to study medicine in local or abroad..

open up the cap, throw all the seasoning into the cup.. similarly, you attend the medical school and the lecturers throw all the textbooks on you.. (it is very sad to say that when the students approach the lecturers for any doubt in their study, the lecturers most of the time and most likely will answer like this “go back and read your books, come back and tell me the answers tomorrow”.. so basically the doctors nowadays are produced by medical textbooks and not by medical schools.. and this also means that most of the medical lecturers nowadays are makan gaji buta (earning easy money).. surprisingly, some of these lecturers even do not know their subjects well and do not know how to perform a clinical examination in a proper way..!!!!!

then, pour in some boiled water.. similarlly, the students are “floating” in the medical schools.. study just because of assignments, tests, examinations.. but do not know how to link the basic sciences with the clinical problems, do not appreciate the progress of a disease, everything also main hentam and tembak (shooting the answers all around)..

and finally, you get your instant noodle, and instant stethoscope.. :p

so how can we expect these instant noodle doctors to perform their tasks competently and to function as a house officer confidently..?????

here are few examples of the instant noodle house officers that i have met..

# case 1

patient in hypovolemia with hypotension..

MO: pls do fluid resuscitation..

HO doesn’t know what fluid resuscitation is, and malu (shy shy la) to ask the MO.. but he remembers resuscitation is something to do with CPR (cadiopulmonary resuscitation).. so he performs chest compression in a CONSCIOUS patient, causing respiratory distress to the patient, and the patient is looking at him in one kind.. and the smokes come out from the MO’s head..

deserved for HO paling tukul award.. (this HO graduated from Russia, recipient of scholarship from a famous local body)..

# case 2

vital signs stable on a dead body..

the HO did his evening round in the acute bay.. one of the patients was intubated due to head injury.. the family members told him the body became stiff 2 hours ago.. but the monitor still showing pulse rate (patient on ionotropes).. so he documented “patient GCS remains poor, vital signs stable, continue the same management”.. huh..????? how to become a doctor even he/she can’t even differentiate between LIFE and DEATH..????? why do they want to spend the parents and tax payers money to study medicine but the medical knowledge is lousier than a layman..?????

deserved for HO otak ketam award.. (again, this is another HO graduated from Russia)..

# case 3

for MO to resus patient..

i was attending a patient in the female surgical ward..

suddenly another patient in the same ward collapsed and desaturated.. the nurses were shouting and called the surgical house officer who was sitting at the counter doing nothing at that time to attend the patient.. he walked slowly to the bed of that patient but did not examine the patient, he just pointed his finger toward me “neh, doktor dekat sana”.. huh????? what type of houseman is this..????? asking a MO to attend a collapsed patient without examining and doing the initial resuscitation works..?????

deserved for HO ubi kentang award.. (this HO graduated from a local public university, one of the three oldest medical schools in this country)..

# case 4

for MO to insert branula..

during my housemanship time in 2006, when we have problem in inserting a branula, we NEVER called our MO for help (except for neonates).. we would call our senior houseman (most of the time, the captain) to help us to insert the branula.. during my second housemanship posting, i started to insert the femoral line and i did my toes amputation for diabetic patients ALONE while my MO was sleeping the whole night.. i did my first peritoneal dialysis together with my houseman friends without the presence of our MO when i was in the medical posting.. but now, what types of procedures that a houseman can perform..???

recently, during my busy oncall day, suddenly the nurse called me up “doktor, tolong insert branula, houseman dah cuba 2 kali tapi tak dapat”.. huh??? why can’t the houseman call me directly if he/she cannot get the line?? just left the patient and ordered the nurse to call me..?? what tpye of attitude is this..?? no responsibility at all.. when i went to see the patient, i found the vein of the patient was BIGGER than the vein on the manikin..!!!!! how could the HO fail to insert a line into such a huge vein..?????

deserved for HO kurang asam garam award.. (this HO also graduated from a local public university)..

# case 5

in the past, we houseman worked like lembu and donkey.. there was no time for us to sit and rest.. the MO just sat over the counter and monitored what we were doing.. we used to offer ourselves to assist the MO in doing any bedside procedures..

nowadays, the house officers are sitting over the counter and “observing” the MO doing their job.. no greetings, no offer, no initiative to learn..

deserved for HO kurang upaya fizikal award..

# case 6

houseman manja..

a female houseman is a little bit slow in doing her job and her medical knowledge is very poor.. but she likes to come to work late, and goes back home early.. every morning during the ward round, one of the surgeons likes to ask her a lot of questions to test her medical knowlege.. and most of the time she can’t answer.. one day, suddenly the surgeon receives a phone call when he is doing surgery “i’m the mother of @#$%, please stop asking my daughter any questions, or i will make a complain to the state health director..” huh?? like this also can arr..???

deserved for HO lampin pasti tak bocor award.. (this HO graduated from a local private medical school)..

so, is it really a houseman’s life so stressful..?? to me, YES in the past few years.. but NO in these days.. i don’t understand why the HO nowadays like to complain, small small things also complain, even language barrier with patients also become an issue to them.. in my opinion, these HO are too pampered by parents, not competent in clinical skills, too ego, and not taking positive attitude and initiative to improve themselves.. today, there are so many house officers in the ward compared to few years back, the workloads are markedly reduced.. so what are they complaining about..??? the stressfulness is mainly due to their incompetency to function as a house officer.. (of course there are still a lot of hard working, capable and reliable house officers around, but the numbers are not many now)..

as a trainee lecturer, i’m willing to teach and guide the house officers in any aspect, but only if they are really interested to learn.. my advice: don’t become a doctor just because of the title “doctor”, or one may end up like them..