Abused junior doctors who grow up to become abusive consultants

Abused junior doctors who grow up to become abusive consultants
by Dr. Musa Mohd. Nordin

15th Dec 2006
The Editor NST

Dear sir,

I refer to the Health Minister’s outburst as headlined “Stop your whining, housemen told” ( NST Dec 15, 2006).

Hitherto, many doctors who were “enslaved” in the 24-36 straight call hours of medical apprenticeship due to the paucity of numbers would vouch for the good that it has endowed them in their future medical careers, as reiterated by the Health Minister. Many senior doctors, from the high offices of health ministers, medical directors, deans, consultants down to specialists and registrars would rationalise this as part of the gruelling training process of any wannabe doctor.

Junior doctors are hammered with multiple anecdotes of nightmarish calls including “graveyard shifts” which their seniors have had to endure during their clerkship and yet survived unscathed. Junior doctors continue to suffer in silence and are led to believe by their seniors that this is all part of the tradition of medical training. This “medical tradition” in due time becomes entrenched in the system because the values continue to be perpetuated by “abused junior doctors who grow up to become abusive consultants”.

There is however a major flaw in this premise because there is a world of difference between what is deemed as training and what is downright bullying (for want of a better word) and being inhumane. The latter work culture I am afraid is more prevalent within our local medical circles. One of my paediatrician colleagues even hastened to add that the local medical culture is second only to the military in harshness.

“It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm.” (Nightingale F. Notes on Hospitals. London, England: John W. Parker and Sons; 1859). Florence Nightingale echoed what Hippocrates first said “first do no harm”.

And as alluded to by others, the overworked and fatigued doctor poses a risk to patient care, compromising quality medical care and resulting in errors. The American Academy of Paediatrics demonstrated that the Accreditation Council for Graduate Medical Education (ACGME) imposed limits on resident work hours resulted in less patient errors due to fatigue and less doctors falling asleep whilst driving from work. The paediatric residents in the Neonatal and Paediatric Intensive Care Units ( NICU & PICU ) and their program directors rated residents well being as the factor most enhanced by the work hours limit (Paediatrics 2006;118:e1805-e1811).

It goes without saying that training, internship and residency are fundamental to the nurturing of a medical professional and his preparedness for future clinical responsibilities. Long hours, after office hours and on call hours are part and parcel of this holistic training to ensure an adequately and appropriately trained doctor who will discharge his duties with evidence based medical know how, hands on skills, display and prescribe humanitarian values.

Many who have had the benefit of medical training in the US, UK or Australia at the undergraduate or postgraduate level, would very quickly discern the cultural divide in the Malaysian way of training our junior doctors compared to their own training during their house or registrar jobs.

It would not be too far fetched to suggest that our housemen and junior medical officers, the lowest in the medical tier, are not infrequently harassed, intimidated and humiliated by their senior colleagues ( senior medical officers, registrars, specialists, consultants, head of departments, and deans included ). And this domino effect of psychological harassment goes right up the echelon to those in high office.

The oft echoed clarion call of professionalism and team work remains a loud noise which fails to transform into true deeds in ward rounds, case discussions, journal clubs, audit sessions or mortality reviews. The human and professional value, to quote our PM, “modal insan”, of the junior doctor as an important member of the medical management team is ill recognized and hence unappreciated. It would not be an exaggeration to suggest that their fate is doomed as cliched “yours is not to question why, yours is just to do and die”.

This unhealthy work ambience has somewhat improved over the years but there is much more that needs doing to make the working lives of the junior doctors bearable, enjoyable, a truly learning and meaningful experience.

Those crazy, inhumane call hours should have long been thrashed in the bin of painful medical history never to be repeated. And yet our junior doctors continue to be “enslaved” like their predecessors. Is there truly a lack of “enlightened HODs” who could sort this technicality at their various judicial levels? Maybe they ought to learn a lesson or two about innovative rostering from the good ex-matron in Sungai Buloh (NST 13 Dec, 2006)

A surgeon colleague of mine in his MOH (Ministry of Health) days, who gave the weekend off to all who did calls the preceding 48 hours was ticked off by his HOD because this was against the rules. Many of these ludicrous rules which often burdens the junior doctors most, ought to be scrapped and consigned to the archives of “medical non-sense”

More importantly, those in the highest of office in the Ministry of Health (MOH) and universities ought to address these oft recurring scenarios apart from many other pressing issues which concerns these voiceless and helpless junior doctors.

The tragic death of Dr. Nor Baizura in her course of duty, exposing the lack of insurance cover and compensation for the most junior of doctors in the medical hierarchy, is but one such issue.

It is most unfortunate when senior members of this profession of healing and caring, love and mercy, fail to display this very same compassion and benevolence towards those most junior and most vulnerable in their midst.

Dr. Musa Mohd. Nordin
Damansara Specialist Hospital
119 Jalan SS20/10
Damansara Utama
PJ 47400
Tel : 603-77222692
E-mail : musa@mpf.org.my