A Concerned Senior Doctor : Standards Of Malaysia Healthcare In Jeopardy – Spoilt, Incompetent, Weak Sum Up Majority Of Housemen

I HAVE read with increasing anxiety the newspaper articles, opinions, and not the least the vitriol from some of our politicians on the recent deaths of two housemen or house officers in Penang.

As a person who spent five years of his life heavily involved in the training of the said house officers, let me give a more balanced view of what is happening and also suggest the solution.

Firstly, let us look at the structure:

  1. Housemen (house officer) – their training used to last a year, but now due to various reasons it has been increased to two years
  2. Medical officer – masters candidates and non-masters candidates
  3. Specialists
  4. Subspecialists

Now if one is to look at the structure, one gets a better idea of things.

The house officer is like a lieutenant in an army. He should be well-trained, prior to him or her being sent to the battlefield. It is not the job of the medical officer or specialist to retrain them if they have not been trained by their respective medical schools.

The path to becoming a specialist and further subspecialists like myself takes much sacrifice and many many more exams. If you are not even competent to complete your housemanship training, then how would you be able to reach the levels of specialist and subspecialist?

Can we compromise on patient care because we want to mollycoddle these young housemen?

There is a huge bottleneck after completing medical officership (housemanship) as the places for specialist training are limited, this being rightly so as the training is very hands-on and intensive.

It takes about four years and many more exams, both written and practical, to make a specialist. For sub-specialists, it is even more difficult. Only one or two per year in each discipline by the Health Ministry.

Even so, our higher-ups are trying to make it easier for them. So we start churning out sub-standard “specialists”!

Until today, I get up at 5am, leave for work at 6am, and am back home by 7pm to 8 pm most days. Can this generation of shift-going housemen maintain that type of discipline and hardwork?

Housemen without basic knowledge, aptitude

Now we go to the moot point: medical schools.

Due to vested interests and questionable policies, we now have the most number of medical schools nationwide, and also recognise more foreign medical schools than any other nation in the world.

The disparity in standards is shocking to say the least!

Some of the new housemen do not even have basic knowledge. Some never wanted to become doctors nor have the aptitude to do so but were forced to by their parents.

Here are a few incidents to illustrate what kind of people are coming into the public healthcare system

  1. There have been instances where specialists or medical officers who scolded a houseman for shoddy work saw the parents lodge a complaint at the Health Ministry. Action is then taken against the specialist, so most specialists nowadays don’t bother about housemen and have as little to do with them as possible.
  2. One ex-minister used to call heads of department to threaten them if her daughter was not passed for every posting.
  3. A member of one royal house even brought a shotgun and threatened a head of department.
  4. One parent tried to follow rounds in the hospital like we were in kindergarten.
  5. A son of a Datuk could not see patients in the clinic, so he only sat at the ward counter the whole day. He had been a house officer for six years and could not be terminated. He got “stressed” if he saw patients. So how did he pass medical school in the first place?

The stories go on.

Good housemen pick up the slack

This problem is only going to get worse if this conveyor belt system is not reviewed!

Housemen work shifts now as there are too many of them. So for the life of me I do not understand the need for housemen to be working 16-20 hours a day. Something is seriously wrong with the postings and scheduling.

When I left the public service in 2014, most positions for medical officers were 150% filled! I believe we need to follow the example of the United States and the United Kingdom in setting an entrance exam for all medical graduates like USMLE in the US or PLAB in the UK.

Once you pass and have the relevant standards then you may proceed to housemanship.

There are quite a number of good housemen who are there for the right reasons, but end up picking up the slack of their lazy, incompetent, and spoilt-brat colleagues. This adds to their workload and demotivates them, especially when these half-baked housemen are so-and-so’s sons or daughters.

Instead of taking them to task, the superiors play it safe and pile more work on the good housemen. And this is why our once-stellar healthcare standards are being compromised by a new generation of doctors who come into the service hoping to relive episodes of Grey’s Anatomy then realise that it is not all glamour and celebrity.

Not heeding the warning signs will only lead to more catastrophes in the future as lives are at stake.

Source : The Vibes




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