FOR housemen in Malaysia, the shift system has replaced the on-call system. Is this a good thing?
It depends on whom you talk to and what the objective really is. If it is to improve the quality of life of house officers (HOs), it surely is working.
But if it is to provide adequate training for them, then it has failed miserably. Ask anyone. Ask the HOs.
With shift duty, trainers can no longer relate to any particular cohort of HOs; there is no continuity of care or accountability; each day, different faces appear and this is not good for patients and trainers.
Many miss interacting with senior colleagues during the early morning rounds and do not attend tagging or continuing professional development programmes because such programmes are held outside their working hours.
They may attend if their shift duty coincides with the programmes. Otherwise, they would prefer to stay at home and do continuous resting and dreaming rather than continuing medical education (CME).
For example, the attendance for CME at Kuala Lumpur Hospital in February -- 48 out of 393 (12 per cent) -- was appalling and reflected what is happening in most Health Ministry hospitals.
HOs I talked to prefer the previous on-call system as it is becoming more obvious to those who are able to compare both systems that the shift system is inferior in many ways. Doctors who strictly abide by the shift system will end up being under-trained and untested. Patients will become the victims.
Just wait for another few years when they become medical officers, and we will be able to see the products of a decision based on sentiment rather than objectivity.
We are faced with this dilemma of overworked and overburdened housemen. What do we do?
FOCUS on local medical schools. Be selective in sending our students to foreign medical schools. Send them only to Ivy League medical schools and ensure that they come back to serve. Forget about the other mediocre foreign colleges and use the available funds to help local medical schools beef up their facilities and achieve international standards. Local schools which cannot comply, being small, inexperienced and short of resources, should merge with others which have sufficient resources or wind up. This way, we get less for more.
The Public Service Department should start by sending students to local medical schools, provided such schools have the strengths and the reputation of being serious players. This will help the national economy and encourage competitiveness, which will push up the quality of medical training.
AGENCIES, parties or organisations should stop sending students to unrecognised universities.
INTERVIEW aspiring medical students, if possible. Parents should not be the decision-makers. They should just facilitate. Students must know the full score and be physically and mentally prepared. They must learn from Dolly Parton; "If you want the rainbow, you've got to put up with a little rain."
HOUSEMANSHIP training should not have parental or political interference and compromises. Introduce a system that will ensure continuity of care, accountability and adequate training.
The previous on-call system fulfils these criteria, but not the shift system. Training places, in future, should be limited if there are not enough. New HOs can choose where they wish to be trained but must be willing to wait if places are already full. No more short cuts or express entries.
PROVIDE incentives for specialists who train others. Allow them to be continuously upgraded professionally. They need to attend conferences, workshops, undergo speciality and sub-specialty training or learn new skills to remain relevant. Leave the training of HOs to them. If they falter or fail, they will be declassified as trainers and lose all the incentives.
HAVE a clear career pathway for doctors: no surprises and no threats.
MANDATORY rural posting is important but it would be better to enforce it earlier on in a doctor's career. No appeals should be entertained.
LEAVE all matters pertaining to the profession to the professionals and the Malaysian Medical Council.
CREATE a healthy, dynamic, conducive and trusting working environment to get the best out of the doctors and others in the organisation.
INTRODUCE healthcare reforms in stages to accommodate future challenges. Reforms should include strengthening primary healthcare, introducing integrated healthcare, strengthening public healthcare facilities, enhancing patient safety, internalising quality in healthcare delivery and introducing healthcare financing, just to mention a few.
We are at a crossroads. We have to make a decision on the future of medicine in this country.
We can, of course, choose to sit and watch the clouds roll by and accept the imperfections or we can take up the challenge and exert gentle pressure to effect a change for the better: a change that will bring back the glory days of medicine at its best, amid the new and exciting discoveries and innovation of today and tomorrow.
The choice is ours to make. As the saying goes, "Present choices determine future consequences".
The above is an excerpt from the Malaysian Medical Association Oration