Housemanship can drive you crazy
Posted on December 1, 2008 by tunaung
COMMENT: Many consultants are arrogant and used to bully the housemen. Consultants, esp. in third word countries like Malaysia, almost always used to bully housemen till they are almost crazy.
Instead of current 36 ++hour duty, should consider shift duties. Some consultants are lazy and their super ego drive them to shout and blame the younger doctors. Look even last health minister went to see medical students and bullied them.
Better working conditions, please
The conditions that Malaysian junior doctors have to work in are ridiculous and frankly dangerous to patients.
Long working hours, sometimes exceeding 100 hours a week,
36-hour continuous shifts and stressful working environments, don’t you feel this might cause mental health issues in any normal human being?
I WOULD like to comment on the report “Sick doctors” (The Star, Nov 25) and the letter “Housemanship can drive you crazy” (The Star, Dec 1). I completely agree with Dr T K Khoo in his letter.
Better “screening” is not the solution to doctors facing mental health issues.
Indeed the answer should be better training and better work conditions. If these doctors had severe mental health issues at the start of their training, should this not have been picked up during their years of training?
If you must persist with pre-entry screening, then screen them for superhuman physical and mental endurance.
Deprive them sleep for 36 hours and make them do complex decision? Patient safety is a priority for all of us doctors. Please fix the problem at its core.
DR WINSTON CHANG,
Christchurch, New Zealand.
I READ with interest your recent report quoting the director-general of health as saying that at least five doctors every month are found to be suffering from mental illnesses (Sick doctors – Sunday Star, Nov 30).
He blames the lack of screening of medical school applicants by medical schools as one of the causes.
However, I wonder if this is an unfair judgment and if this is indeed warranted.
Firstly, application to medical school involves paperwork that includes one’s curriculum vitae, scholastic performance, and for some medical schools, an interview, perhaps no more than an hour.
Nowhere in the application is an applicant asked if he has delusions or hallucinations or other features of a psychotic disorder.
How then, is a medical school expected to screen for psychiatric issues by those means? Is it even fair, to expect that of the medical school?
Secondly, while I have never experienced housemanship first hand in Malaysia, I have many close friends and family who have been through the process.
Extremely long and often unregulated work hours, considered to be inhumane and illegal in the medical system in the United States, coupled with poor pay, lack of respect by superiors (such as public yelling, verbal punishments) seem to be very common.
I have known some who suffer from situational depression and post-traumatic stress disorder during this trying period of housemanship.
During several stints as a visiting clinician to my hometown in Malaysia, I have personally witnessed registrars shouting at the poor housemen at the top of their lungs.
I have seen grown men and women break down in tears, right there in the middle of the packed medical ward, right in front of patients, because of the dressing down they got.
Therefore, is it not possible as well, that the actual housemanship itself is contributing to many of these cases of mental illnesses?
Perhaps medical schools should tighten up their screening process.
After all, I do agree that there are many who go into medicine for the wrong reasons, such as parental pressure and not personal interest.
But the medical schools alone are certainly not to blame.
I believe the hardships faced by the new medical graduate deserve some if not most of the blame as well.
After all, the mind is a fragile thing; any emotional abuse can break even the strongest of minds.
DR T.K. KHOO,
Finally, let’s look at the structure of housemanship. Although doctors doing housemanship are thoroughly supervised and given professional guidance by senior doctors and surgeons, they are definitely learning under a lot of pressure.
It is very common to see them being assigned to all types of duties at one go. These young doctors should be given enough space to put theory into practice.
While those with passion and the right attitude for the profession will prevail, what about those who are there because of their parents?
It should also be noted that doctors doing housemanship are practically forced to work more than 24 hours.
As a patient who has been warded at government hospitals a number of times, my sympathy goes to these doctors who tirelessly and relentlessly work through the clock.
I simply cannot imagine the risk of patients under the care of these tired and exhausted doctors.
We all know that there is a serious shortage of doctors at government hospitals and the Health Ministry should address this problem first. It should liaise with the Higher Education Ministry to extend the medical degree programme to all stuents who are qualifed, regardless of race, creed and colour.
It should be noted that there are poor students who are academically qualified but are not given a place at local universities. Where do these students go?
I sincerely urge the Health Ministry and the Higher Education Ministry to seriously look into problems in the medical profession so as to be fair to the aspiring doctors, parents and society.
Lend young doctors more support
I write in response to the report “At least five doctors to suffer from mental woes every month” (The Star, Nov 30).
I was surprised that it was suggested, somewhat simplistically, that the increase in mental illnesses in young doctors was due to “pressure by their parents to take up medicine” and the “inefficient selection process”.
It makes it seem that the focus is not on helping young doctors achieve holistic, balanced lives and careers in the midst of an already acknowledged stressful work environment, but instead on weeding out and further stigmatising those who cannot perform because of a mental illness.
Instead of planning an extra examination to “check their attitude, knowledge and experience”, how about addressing the root of the issue and planning more support services and stress-relieving measures for doctors?
Housemen do not have it easy
I REFER to Dr T. K. Khoo’s letter entitled “Housemanship can drive you crazy” (The Star, Dec 1) and wish to share my view.
Ever since 2001, doctors have been a part of my life. I have been treated by housemen and also specialists.
I have an appointment with a specialist clinic once a week on Thursdays. The number of specialists in this field is limited in the country, and thus I know of patients coming from other states to Kuala Lumpur for such treatment.
Each time I am at the clinic, there would be at least 150 patients, a third of them with some form of disability. They would usually come alone or with a caregiver.
The patients would wait for long hours to see the doctor, suffering the physical pain of disability and also the unbearable cold of the air-conditioned room.
The typical scenario for the past few years has been me meeting a “tired” doctor at about 6pm or even 7pm, telling him or her about my condition and the medication I am taking and its reaction.
There is very little that the doctor can do in listening to a patient’s medical history within a few minutes, followed by a brief examination. My heart goes out for these doctors. They do their best for their sick and depressed patients, bearing the long hours and listening to a list of ailments that never ends.
How motivated can a doctor be at the end of the day? Has anyone looked at their workload, work environment, the hours they put in and the mental and emotional strains they go through? It is so typical of human nature to comment on others but how many people think of what it is like to be in a doctor’s shoes?
This year I have changed my approach. I have decided to walk in with a cheerful face and cheerfully give them whatever information they want and wish them a nice day. I hope I would help a doctor be a better doctor to the patients waiting out there.
I have changed my approach because when I was warded in 2006, a houseman came to draw blood from me. I was bloated due to liver dysfunction, so the houseman could not find my vein. He punctured me so many times that I could not stand the pain and cried uncontrollably.
The poor houseman was alone, and he apologised profusely. Nobody was there to see whether what he did was right or wrong but I knew that he was depressed to see me in that state.
A couple of days later, another houseman came to draw blood at night. I saw her in the ward from the morning rounds until evening and there she was at close to midnight attending to me. She told me she was working for the past 24 hours. May I ask why is this happening?
If I as a patient can think of the welfare of a doctor, how much more should their employers do in recognition of their services? How can a doctor think and act fast when he does not get enough rest?
I have also witnessed the degrading treatment given to housemen by specialists when I was warded.
How can a patient respect or have confidence in a houseman when he is condemned in front of the patient by his superiors?
A human being has self-worth. To become a houseman, that person has put up with lot of hardship. Why is there no other approach to practical training? Must the superiors play God?
Seri Kembangan, Selangor.