Picture: yourhealth.asiaone.com
The past few weeks have been interesting for doctors in Malaysia. One single issue has brought our profession together and everyone was so eager to voice out his or her opinion. The hot debated issue is none other than the “Houseman”.
I have read almost all the blogs and articles, as well as the subsequent comment and discussion among doctors. From my observation, there are two main issues concerning house officers (HO) that were discussed i.e. the long working hours and the non-productive working environment.
To start with, I presume that the majority of doctors would agree that all the complaints are degrading to the profession. Issues that are being raised not only happen in this profession but because of what has been written and published, it portrays a bad image on the profession of doctors as a whole. It is also unfair to the thousands of other HOs out there who perform admirably as doctors without any slightest intention to grumble and whine.
However, lets just be practical and try to see the complaints from a more objective standpoint. Rather than just snubbing what we read by saying those whiners are “babies”, let us examine those issues in a more serious note.
ON-CALL SYSTEM ‘VS’ FLEXI SYSTEM
I did my two-year housemanship training from June 2009 – June 2011. The current Flexi System was first introduced by Ministry of Health (MOH) in September 2011 to replace the On-call System with the initial purpose of reducing the working hours to an average 60 hours with two days off per week.
However, based on feedbacks and series of meetings, final framework of a Modified Flexi System was introduced by MOH Medical Development Division on 23rd October 2013, that stated among others:
- – Duration of working: 65 – 75 hours per week
- – Shall not work continuously for more than 16 hours per session
- – All days are considered as working days INCLUSIVE of Public Holidays and weekend
- – 1 full day off per week, which can fall on any day
- – Post night duty off (afternoon off), which counted as 1 day off even if less than 24 hours
- – Each discipline/hospital is given flexibility to modify the flexi system accordingly to suit its own local environment as long as it conforms with generic framework above
LONG WORKING HOURS
Let me bring you back to the time when we did our housemanship.
Work officially began at 8am and ended at 5pm on weekdays while on weekends, work lasted for half day up until 12 noon. That gives a total of official 53 working hours per week, including lunch hour which was a privilege if we get any.
We came to the hospital every morning since our day off was only after 12 noon on the weekends, provided that we were not on-call. We did an average of two on-calsl per week, and that gives a total of 74 working hours if both on-call falls on weekdays. If we were to on-call on weekend, the total working hours for that week goes up to 88 hours.
We too did the 10-14 days tagging period in which the working hours were extended officially up to 11pm with no day off, resulting in total of 105 hours per week!
All these “official” working hours do not include the unofficial hours that we clocked since majority of days were started well before 8am and finished beyond 5pm. Let just say we work unofficially from 6am – 6pm (12 hours of work every day as some current HO eloquently put it), then our “unofficial” working hour could go as high as 102 hours per week, and worse, up to 119 hours during tagging period!
Now, let us examine the current Flexi System.
House officers in my department are doing flexi-hours with three shifts i.e. AM (6am-6pm), PM (6am-10pm) and ON (9.30pm-12noon the next day). For the record, we let the HO themselves sort out their duty roster and they are the one who comes up with the said working hours.
On average, every HO will do three AM shift, one PM shift followed with an ON shift, and one full day off per week. That gives a total of 66½ working hours. Depending on the roster, one person may get two PM shift per week which is equivalent to 70½ working hours. Even if a person do concurrent AM shift for the whole week, the total duration of work for that week is 72 hours.
The only time it can pass the 75-hour mark is during tagging period, in which it reaches up to 96 hours per week. But even then, every HO is still entitled for a full day off per week.
These figures corroborate that we have complied with the MOH guidelines. So, if the working hours are not that different and definitely better in comparison with the old days, then what is with all the grouses about houseman doing long working hours?
Currently in my department, there will be about 6 – 10 HO for each daily morning round in a single ward and every HO will review about 1 – 4 patients each. On a good day, some of them do not even have to review any patient at all. So, are they currently overworked?
For that reason, I firmly believe that the complaint of HOs being overworked and doing long working hours is mere personal grouses from small group of HO. I do not deny the fact that there may be HOs in certain hospitals who are currently working more than 75 hours per week. Even then, I seriously doubt that it is purposely done just to cause inconvenience to the HO, but rather due to requirement of service e.g. inadequacy of HO; or one’s own personal incapability to perform up to the standard which requires extended tagging period.
We are all human. Any personal story usually highlights only the negative part. How many times do we see a statement in social media telling the entire world how busy someone days have been? But have we ever seen any doctor sharing in social media about their non-busy working day? That on a certain day, they are just sitting around in the ward chit-chatting, walking around in the hospital aimlessly looking for something to do, and occasionally being allowed to leave hospital earlier than the scheduled working hour.
It is human nature to feel important and being noticed by others. With some embellishment, we always tend to make our personal predicament sound like a universal problem. Therefore, I think all the gripe of long working hours should be addressed in that particular department or hospital alone. Writing to the papers will not do anyone, especially you, any favour. So please, I beg you to stop. We should not generalize the issue because it simply does not reflect the entire housemanship training system in this country.
WORKING ENVIRONMENT
Much has been said and discussed regarding mistreatment or alleged bullying of HO by certain MO or specialist. All the complaints published in papers or social media influenced the public to equate this profession to a hostile working environment for the training of young doctors. Senior doctors are reported as people who tend to shout and carry out public humiliation.
Well, every profession has its own Gordon Ramsay and Simon Cowell. All the scolding, shouting, and sneering that make you feel depressed and demoralized was done with the intention of shaping you to be the finest cook and entertainer. Or the best doctor for this matter. Every person has a unique personality and so do those in the medical profession. That is what makes life so colourful. Otherwise, our daily routine will be very dull. One day, you will definitely look back at your encounter with these ‘lovely’ people and share a nice laugh with others by just talking about it.
I believe that apart from few “tyrants”, majority of senior doctors are hardworking and dedicated teachers and trainers, who tirelessly will continue to train juniour doctors on top of carrying their daily routine works.
Some doctors, for reasons of their own, possess very poor work ethics and/or bad personal attitude. Again, this should not reflect the entire medical profession. All problems should be addressed on an individual level rather than to generalize the whole training system as hostile and abusive.
Bad influence can be a great teacher provided that you see things in a positive way. They can mould you to be a complete individual and there can be no other great teacher other than your own life experience. After all, what better way to de-stress from your hectic daily work other than badmouthing all the bad influences over a lunch or dinner with your colleague.
ROOM FOR IMPROVEMENT
I believe that time has changed and we should embrace it. We should look forward to the future and find ways to improve the current training system. To do this, we should start with the understanding of the actual issues. And it is definitely not long working hours or non-productive working environment!
The real issues for me are the capability of current young doctors to be trained and the willingness of the senior doctors to adapt to the changes.
As much as we like to compare current times with our past, the senior doctors should come to realisation that life is not as what it used to be. We ought to stop using the comparison to show how worse our condition was compared to the present moment. We should look forward and see how to improve on that, rather than belittle our juniours that they are not as strong as we were. Why should they suffer as we did before? This country will never progress if all of us have that backward mentality. It will be worse when the current juniour doctors are repeating the same cycle in future.
In discussing the issue, we should also stop being egotistical and self-centred. All comments made in social media were mostly irrelevant apart from to promote oneself as the best. It does not solve any problem nor does it offer any reliable solution. What it only does is to lengthen the never ending discussion since everyone in this profession has their own story to tell.
But ultimately, all of this would never come into discussion if the HO themselves understood the expectation of becoming a doctor and the aim of the training system. It is our intention to make sure that every doctor in Malaysia is competent and safe to the public and community at large. The current training system of house officers is designed to do just that. It all boils down to coping abilities and adapting to your new life as doctors.
The frustration among senior doctors is not with the privilege that the juniour doctors are enjoying now as HO compared to the old days, but rather whether these young doctors are well-equipped to be independent, safe, and competent doctors in future. With the current quality of fresh medical graduates, training of junior doctors is not as easy as it used to be.
Put yourself in the shoes of your MO and specialist. If previously they can review 10 patients every day and remember every single one of them, how do you think they feel when you only do review on 2 patients but still flipping case notes on a simple question like latest haemoglobin level or total days of antibiotics?
At the end of the day, it needs a mutual and collaborative effort from both the trainers and trainees alike. Both parties have to remember that the ultimate priority is towards the patients. Juniour doctors must learn and train hard because one day, they will become MO and make life and death decision. On the other hand, senior doctors must also impart knowledge and experience because we all hope for better colleagues in future.
BEING A DOCTOR IS A PRIVILEGE
Few days ago, I was having a meal at a hawker stall and I found out that my bill has been settled. While I was wondering who would do that, then came a stranger who shook my hand and said, “Doctor, you may not remember me but you did a surgery on me before. And for that, I am truly grateful.”
That, my dear juniour doctors, beats all the hardship and adversity of your life as doctors.
Look past beyond how many hours you work every week and you will see the privilege of carrying a ‘DR’ in front of your name. We touch people’s heart and that is what we do best.
Your housemanship will eventually end, but your training will last forever. Have good attitude and aptitude to continue this journey forward. We all pray that you completed your training as HO and join our family as a fully trained and qualified doctor.
Dr. Aimir Bin Ma’rof is a medical officer working in Sarawak.
This is the personal opinion of the writer and does not necessarily represent the views of The Malaysian Medical Gazette.
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]
9 comments for “Housemanship: The Real Issues – Dr Aimir Ma’rof”