Apr 16, 2012

The passing of a house officer

Public announcement should not be made out of convenience.
Decision should not be made out of 'knee-jerk' reaction.

Dear Health Minister,
Your statement surrounding the death of late Dr. Lee taken all of us by surprise.
Mainly because a person of your stature and status, we were expecting more professionalism.

None of us were given the accurate information regarding circumstances around the death of late Dr. Lee.
And yet, the reflex statement had successfully labelled all the medical officers, specialists and Consultants as the main source of depression, leading to the unfortunate death of late Dr. Lee.
Is this a fair judgement to all doctors, except house officers, to be falsely accused?

As opposed to what was reported in The Star, late Dr. Lee was not a graduate from Uruguay, but from Ukraine (Crimea State Medical University) and the reason his service was extended to 3 years because he went absence without official leave or MIA for 9 months.

I believe Health Minister should revealed to us what was his reason for the 9 months absence and how was his performance as a medical graduate from Ukraine. The controversy about CSMU in June 2005 should also be given some attention.

It is rather unfortunate that it is an open secret that the medical schools of Russia and Ukraine had always provided slightly inferior medical training, mainly because of the language struggle of our Malaysian students. Yet, more parents were happy to send their children there due to two main reasons. Firstly, the school fees which is just a fraction of price of well-reputed medical school. Secondly, the acceptance grade is never as high as others. The medical students there had to struggle in writing and answering in foreign language that most had failed to grasp the basic in medical knowledge. Nevertheless, those who had diligently overcome this are better doctors, compared to others.

When in the real working world, basic medical knowledge is a strict requirement.
It is similar to any working world.

Here's the analogy.
You want to be a clerk, you will need to have at least basic literacy knowledge.
Because the basic literacy knowledge is what is required in the line of duty.
Or else, you won't be hired. As simple as that.
You don't hire them, then expect the manager or supervisor to start teaching them ABC.
And if the office boy could not perform, he will receive a suggestion of tendering his letter of resignation.
There is no place for depression.
It is also beyond common sense for General Manager to meet all the clerks weekly to make sure they do not have depression.
Yet, Malaysia Boleh, anything also Boleh happen.

Depression is not a joke.
The passing of late Dr.Lee should serve as a warning sign to the Health Ministry and to the nation.

We need to uphold a standard before accepting everyone into the house officers' training and creating house officers' glut.
The Health Ministry should seriously liase with Higher Education Ministry and Public Service Department about this matter urgently.
If you decided to allow primary 6 students straight to University and expect them not to be depressed, you're out of your head. And when there is a death, his blood is all over your hands.

The government should uphold the previous half-baked moratorium on medical schools seriously.
Stop fooling with the medical fraternity. 
Lastly, medical officers, specialists and Consultants all over Malaysia feel like as if we are running medical schools in our hospitals. Yet, we continue our struggle, we continue to strive to make every house officers better doctors for the future.

Public announcement should not be made out of convenience

Thus, it is only appropriate and respectful for the Health Minister to apologize for the baseless generalisation and to refrain from such statement in the future.


Attached: reference articles below

A trainee doctor was found dead in a restroom at Kajang Hospital.

Police believe he had overdosed on an unidentified drug.
Lee Chang Tat, 29, was found dead in the men's room of the paediatric ward at 7am yesterday by hospital staff who went looking for him after they noticed that he was missing.
He was found with a used syringe beside him, which police believe he had used to inject himself with a drug to fight off fatigue.
It is learnt that Lee, who had been working at the hospital for the past three years, had been working on call for five consecutive days.
Selangor health director Datuk Dr Azman Abu Bakar said hospital staff, who found Lee, tried to resuscitate him but were unsuccessful.
“He was rushed to the emergency room but it was too late,” he said.
Lee, he stressed, had no previous medical problems.
A security guard at the hospital said they found him when someone tried calling Lee on his handphone and heard the ringing tone coming from the restroom.
“We broke into the toilet cubicle and found him lying there with the needle,” he said.
Kajang OCPD Asst Comm Abdul Rashid Abdul Wahab said Lee, who studied medicine in Uruguay, had been complaining to his family about the hectic working hours.
“His family said he had also been planning to go on a holiday to Cambodia soon with friends,” he said.
ACP Abdul Rashid confirmed that an initial post-mortem indicated that Lee had died of an overdose, adding that the case was being investigated as sudden death.

Houseofficer found dead (II)

The Star, like China Press got it wrong as to where the late Dr. Lee was trained. Checks with the MMC website shows that he graduated from Ukraine (CSMU), and not Uruguay. We’ve posted quite a few times in the past about CSMU and given that there are concerns about the training graduates from CSMU receive, and that such training may not adequately prepare them for life as a doctor in Malaysia, one cannot help but wonder if this added to the “stress” the late Dr. Lee endured. Other details emerging from the Dobbs doctors forum are that it was reported in a Chinese daily that he was AWOL for nine months during his training and, after appeal, he was made to repeat his training from scratch. 

Housemen still being overworked and bullied, sending some into depression

KUALA LUMPUR: The Health Ministry will conduct checks on the shift system for housemen in hospitals in the wake of reports that trainee doctors are still being overworked, bullied by seniors as well as suffering from depression.
Under the Graduate Medical Officer Flexi Timetable system, introduced last September, housemen can only work up to 60 hours a week with two days off. But implementation has been reportedly poor at some hospitals.
Health director-general Datuk Seri Dr Hasan Abdul Rahman said the ministry would seek explanations from hospitals found overworking their housemen, adding that the ministry was willing to help them implement the system effectively if they were facing a shortage of housemen.
However, he said he had checked timetables in Kuala Lumpur Hospital, Ampang Hospital, Serdang Hospital, Klang Hospital, Selayang Hospital and Sungai Buloh Hospital but had not seen any houseman made to work for more than five days a week or to do double shifts.
Earlier, Malaysian Medical Association president Dr Mary Cardosa urged the ministry to review the shift system and conduct a study on the mental health of junior doctors.
On the death of Dr Lee Chang Tat, 29, who was found dead in a restroom of the paediatrics ward at Kajang Hospital with a used syringe beside him, she said there was no data to show the number of housemen who suffered from depression due to their long working hours and stress.
“There should be some kind of mechanism to assist troubled doctors, whether they have personal or work-related problems or can't handle the stress.”
The Malaysian Medical Council, meanwhile, reviews an average of five cases of doctors with mental health issues each month. It is learnt that there were 20 cases last October.
“Most of them are housemen, but we have also heard cases on medical officers,” said former Health director-general Tan Sri Dr Ismail Merican.
“The types of issues range from psychiatric problems to anxiety and coping problems,” Dr Ismail said.
Dr Ismail, who is also former MMC chairman, said the working hours for housemen may not be as demanding as before the shift system was implemented, but they were exposed to other sources of stress in their work including demands from patients, their superiors and other colleagues,” he added.

System that’s a burden to many housemen

PETALING JAYA: A 27-year-old houseman lamented that although the shift system was good, it was poorly implemented at his hospital.
He claimed that it was up to each department to implement the system.
The houseman alleged that when he first joined the hospital, he had to work 92 hours a week and on 24-hour shifts for up to one and a half months.
But things improved after someone brought up the issue to the management.
However, for departments that lacked housemen, they had to work long hours and without on-call allowance.
This was because allowances were not provided for in the shift system and housemen were not expected to work more than 72 hours a week, he added.
The houseman said they were paid a fixed RM600 a month but without the RM100 to RM200 allowance for each on-call duty.
He also claimed that eight housemen suffered depression and were under psychiatric observation as they could not take the bullying from senior doctors, whom he said constantly shouted and belittled them.
They were also burdened with a training duration that was extended from four to six or seven months for each department.
“One houseman went into depression after he failed his assessment twice,” he said, adding that some housemen got themselves transferred to another hospital or just resigned.
Another houseman Dr G.M. Pillai, 28, said Ipoh Hospital was trying its best to adhere to the rules set by the Health Ministry.
“We work 60 to 65 hours a week and sometimes up to 70 hours. But if we have to work up to 70 hours, we are given less hours the following week,” he said.
Before the shift system was introduced, he had worked up to 36 hours.
But, after it was implemented, the hours were capped at a maximum of 20 and they get a whole day off the next day, he said.

Housemen to meet hospital director weekly: Liow

KUALA LUMPUR: Housemen in goverment hospitals nationwide will have a weekly session with the Hospital Director or Deputy Director to iron out issues pertaining to being overworked, bullying and depression, said Health Minister Datuk Seri Liow Tiong Lai on Saturday.
He said they should express their views and complaints during such sessions with a view to improving their training.
"I am very concerned about all the problems faced by housemen including working hours and workload. I will make sure that their welfare will be protected," he told a press conference here.
Earlier, he had opened the Nutrition Month Malaysia 2012 which is jointly organised by the Nutrition Society of Malaysia, the Malaysian Dietitians Association and Malaysian Association for the Study of Obesity.
Noting that the quality of doctors was very important, Liow said the housemen should be given ample time for training and that the ministry may review the current two-year training period.
Malaysian Medical Association (MMA) president Dr Mary Cardosa had recently urged the ministry to review the shift system and conduct a study on the mental health of junior doctors.
The Graduate Medical Officer Flexi Timetable system introduced last year requires housemen to work up to 60 hours a week with two off days.
Elaborating, Liow said the ministry would probe allegations of poor implementation of the new timetable system.
Nevertheless, Liow said he was pleased with the response from housemen on the new system, which allowed them adequate time to learn and rest. Bernama

April 13, 2012
APRIL 13 — “A trainee doctor was found dead after an overdose. He was found dead with a used syringe beside him, with a drug used to fight off fatigue.” The Star, April 12, 2012.
For me, this is an issue close to my heart.
A few years ago, a friend of mine committed suicide by jumping from his apartment on the fourth floor of an apartment complex. He was a jolly good fellow, but faced a few bumps in his years as a medical student.
And throughout the years I worked as a houseman, two of my colleagues broke down and are under psychiatric follow-up, another four quit the profession while two others left for Australia.
My consultant used to call those who break down “collateral damage.”
I had my ups and downs those days. Some days I worked 36 hours straight, no rest, a Snickers bar in between, and was expected to be sharp, smart, alert, and to make the right calls at the same time. At one time, I remembered going home at 7pm, after 36 hours of working, only to be called back to the ward at 10pm because of someone else’s mistake.
No human should be treated this way. Expecting us to make the right decisions, and to treat patients well while depriving us of sleep and rest is ridiculous.
As if that was not bad enough, we were often subjected to verbal abuse in the wards, at times in front of patients and their family members. Some of us were even employed as security guards to chase away family members during non-visiting hours, and as a dispatcher running around searching for old notes.
I’m not sure what it is like now but those were the “good” old days.
Though the system produced good, resilient, disciplined, military-like doctors, there were a few who fell along the way from fatigue and mental breakdown.
Ten years back, we were short of doctors. Now, we have an oversupply of them in the hospitals. I used to take care of 16 patients in the ward and, now, from what I gather each houseman takes care of five to six patients only. And since some of the hospitals are computerised, they are no longer running around dispatching notes and results.
If this applies to most of the government hospitals, it must mean that their workload is markedly reduced.
I suppose the Ministry of Heath has begun to realise that housemen learn, think, respond better when they are well rested. I would rather have a few energetic, well-rested doctors treating me rather than more of those tired, sleep-deprived doctors at my bedside. On that note kudos to the Ministry of Health.
But then, as the working hours become shorter, and workload lighter, the quality of doctors we produce may now be an issue.
The Ministry of Health should conduct stringent tests before these doctors complete their housemanship. If they don’t perform or have an attitude problem, don’t pass them and keep them in the system for as long as it takes.
Revoke their title, bar them from practising if necessary, because what is worse than a tired doctor is one with a bad attitude and knowledge.
As much as housemen deserve better treatment, it should not be at the expense of our patients.
It is a good idea to make compulsory SPM/STPM leavers do community and volunteer work in hospitals, nursing homes, orphanages before applying to take up medicine. Aptitude and attitude tests are also a good way to judge someone’s character, but it is by no means a conclusive test to vet a person.
I mention all this because I do not want houseman to suffer from professional disillusionment. It needs to be addressed before they even step into medical schools or we may end up spending hundreds of thousands of ringgit training doctors, who at the end of the day realise ,”Hey, I do not want to do this for a living.”
Which is what we are beginning to see in our young doctors.
You may have a string of As in your exam but the passion you have in helping a fellow human being is the one that determines how good of a doctor you are.
Patch Adams said, “Our job is improving the quality of life, not just delaying death.”
A good working environment, and attitude is important in any profession especially medicine. And when the government is taking steps to improving their working condition, housemen should learn to count their blessings that they have been given an opportunity to serve humanity.
It is a privilege that not many have.
If all fails, then perhaps our SPM leavers should ponder on this quote by German born American physician Martin Henry Fischer before taking up medicine, “A doctor must work 18 hours a day and seven days a week. If you cannot console yourself to this, get out of the profession.”
Because when the going gets tough, it is the tough who get going.

No comments: