Response to the article Trauma faced by some housemen in hospitals’ by ‘Disgusted Malaysian, Kuala Lumpur’ dated 8th December 2014.

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 flexi working system has been implemented since September 2011 and was improved further from January 2014.The introduction of the flexi 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 flexi 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 flexi 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.

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7 Comments Add yours

  1. musalmane says:

    Sir, we understand the need for proper exposure in training. Thank you for stressing about that. We completely understand the mission of MOH, however the authority of MOH never have gut to emphasize the nature of human resources involving in that particular training. We are working in a streesful environment everyday to face with medical officer and specialist working with no specific level of professionalism, verbal insult is a common practice among them. We wonder what level of authority they have to treat us Houseman, yes of course with the threat of extending the houseman they can play and control us with no specific reason. I wonder the motion by MOH, for HOSPITALiTY treatment, we as junior trainer see no effort made by your senior medical staff

    Sir we really need to control the power you have given to all senior medical staff. They can abuse it and will raise a lot of unsatisfactory in the level of houseman, not to say the raising trend in psychiatric problem arising among junior houseman,

    We really want to have a proper training, we don’t mind to expose to long working hour, we are the cream of society, we have choosed to be our senior medical doctor colleagues, we understand we can have better pay if we use our potential brain to other sector of carrier, but this is us we choosed to be a dignified human being by helping other, so we hope we can be treated as dignified co worker among all our family of MOH.

    We will not create another generation of medical doctor who being abusive to their junior verbally and mentally.

    We need to break this vicious cycle, we may consider this bullying nature of which you may not agree with it.

    We need to control their power, We will not stop and we may pass this motion thru out the nation, we would have proper political patronage to support our motion, by all means we would.

    We really hope we can have a proper channeled to raise our concern

    Thank you and it was a great pleasure for me ,Sir to be able to be in the same lift with you in Hospital Putrajaya.

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  2. ss says:

    It’s really easy to speak so to say when something does not go well ? As a act of defense? I’m not sure but am sure you wouldn’t completely doubt it.

    Being a medical student and passed out, there you go, a house officer. Passing a medical degree doesn’t guarantee that a person will be a good doctor or at least accustomed to being one which is safe, caring etc.

    Unfortunately, there’s no proper mechanism from the selection of a student to know whether they make the cut to become a doctor, apart from their academic achievement in school or colleges. I always tell my juniors, anyone who fulfills the medical entry criteria, and those who successfully undergone the harsh and stressful medical student life, passing exams after exams, you will be a medical doctor. It’s as easy as that and I believe many can do just that. However, like I’ve said earlier, passing out from a medical college still doesn’t mean that one will make the cut of being a safe and caring doctor. Doctor by profession is much more than any academic qualification that a person can ever achieved. It’s something to be nurtured during training as housemanship.

    That’s why I’m sure all would agree, no matter which medical school a person graduated from, be it the premier medical school to the not so well known medical colleges abroad, the training to become a doctor starts during housemanship time. This is the time where some will outshine the others and some would falter, due to various reasons be it inability to cope with the training stress to poor time management.

    A lot of specialist would agree, some house officers are good and mature well during training while some others just are not meant to become a doctor I would say. Some realize the fact and quit the service, some wanted easier life maybe try hard to get into ‘non-critical’ medical services but still wanted to remain as a doctor etc.

    The problem comes, when the not so competent house officers supposedly graduate and became a medical officer. Who sign them off in the first place if the assessment after housemanship training is below par? Probably it’s easy just to sign them off to avoid ‘problematic house officer in their department’? Administrative problems like explanation letter for giving the houseman less than favorable SKT marks? Problems like inviting the wrath of the house officer’s backing from ‘influential people in the society’ be it their parents, uncles, aunties or politicians.

    So, what I am trying to say is that, these houseman are the nation’s priced human resources. They have gone through a lot to be trained to be at least where they are, the house officer, in the many hierarchy of a medical profession. One cannot ignore the fact that they are also human and human comes in many shape, sized, colors and the most important attribute – ones attitude. Some has good qualities but some also are so called perceived as the strawberry generation group.

    Am sure the MOH is trying many ways to best rectify current problems and continuing to provide the best training and to mould these young doctors to be competent and caring as who knows, the doctor you once trained, would be the doctor who would be treating ourselves or our loved ones.

    Melentur buluh, biarlar dari rebungnya. To start rectifying the problems, maybe the short listened medical students to undergo a selection process by some experts, to screen through if the applicants make the cut to be trained as a doctor. It’s crucial to identify whether a student is trainable and sustained in the training and can mix with others from different cultural background easily and collaborate with each other as in to foster good team work. Those shortlisted candidate, must be given a trial to be attached to an on call doctors in order to have a first hand experience about a real doctor’s life. No point sending those candidate to be attached to a doctor who is not on call, and merely be attached during office hours where we all know it’s not the real deal.

    Secondly, as we all know that the ‘churning’ out of doctors problem that we are facing now as a result of mushrooming of medical schools in and outside twinning schools over the past few years. We would have too many doctors to trained from the limited hospitals, in fact we already have problems. Do we think that the houseman would get adequate exposure or training? With the introduction of shif systems, we hope to accommodate and better distribute them for training purposes. Unfortunately, i found that the house officer distributions to various hospitals throughout the country is somehow not even. While mostly wanted to stay in the urban hospitals in the peninsular, those hospitals in Sabah & Sarawak are obviously not a popular choice. So the issue here is, the placement and distributions of house officers are not done fairly, and that would somehow affect the implementation of shif system due to inadequate numbers of doctors placed here as one of the problems. Problem comes when everybody seemed to have valid reasons to stay close to their family or comfort zone to defy the placement order. Maybe a more stringent rules to be applied? We are helping to provide training to make them a better doctor and with the additional perks given to them to be posted far, they should not be in any position to demand and choose their placement as to be fair to other doctors as well unless they have a real good reason to do so. In the end those who got sent to hospitals far away would be the yes man doctor or those without any cable to pull. Perhaps a more refined mechanism that balanced between perks and career opportunities which must be made known to the doctors before hand and most importantly their promised incentives must be taken into account in due time. To strengthened the mechanisms, the authority must be able to make decision without interference – independent. Humbly speaking, in order to do great things in healthcare as well as in education, there should not be any political influences involved.

    Thirdly, during housemanship training, the mentor or specialist in charge must make it a point to take charge to properly access the level of competency of a supervised house officer. Get to know them, identify their strength and perhaps give them due recognition, as well as try to rectify their weakness. Having said that, some house officer are really difficult. Those are the one that must be reported to the in charge ie. to the hospital director for further remedial action if there is. The in charged specialist should not sign them out just to get rid of them from their department just to close the matter. Those who are caught doing so must be dealt with. A lot of problems comes when a specialist encounter such scenario. They have to write a report as to why to extend the house officer and lots of administrative and clerical work for that, probably attending counseling session together with the house officer as well as the director. Probably things are easier to just sign off the house officer.

    Only those house officer who completed training satisfactorily, could be made a medical officer. At this time, the responsibility is a lot higher and whatever mistake made can be accountable. So what to do to those house officer who are not competent enough to carry out a responsibility of a doctor? One thing for sure, the medical officer post in all the hospitals are almost full. The MOH is doing all they could to weed out those ‘shadow’ medical officer who occupies the post but are not there physically – those who somehow left for studies without the knowledge of the government, or those who overstayed their study leaves.

    There will come the time where the house officer would be offered a contract to work as medical officer. Only those who are capable can call themself a doctor and work on and secure a contract with the MOH. It’s something brutal I suppose to some, but I’m sure the authority will not pull their punches in order to provide better healthcare services to the Rakyat.

    Just a thought.

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  3. I agree with the DG. Whe proper channels are available dont go splashing thing all over the place. There is nothing new in what all these doctors are complaining about. Hey I complained too when I had to do a week’ s call till I had to turn my under wears inside and reuse them!

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