[WARNING: RANT BLOG POST]
As many of you know, I have passed my finals in medical school after 5 long years, and in July this year inshaAllah (God willing) I will be graduating with my medical degree. Hurrah! Now all should be rainbows and unicorns as I enter my brilliantly glowing career as a doctor right?
As a scholar from a certain government's department, I am bound by contract to return to my country after graduating to serve the government as a doctor for 10 years. That in itself is not a problem. I love my country, I miss it and would love to return and serve my people.
The problem is: everyone else back home keep telling me NOT TO COME BACK.
And by everyone else, I mean everyone. But most importantly, doctors who are in the early two years of training just after graduating medical school, which in Malaysia is called housemanship training (in the UK they call it the Foundation years). These housemen (HOs) are all my seniors and friends, and I value and trust their opinions. So when they tell me I'm better off staying in the UK, I'm obviously worried by this. Some of them were previously medical students trained in the UK or Ireland, others did their degree in Malaysia, but all agreed the working conditions as a HO in Malaysia is bad enough that they are actively encouraging me to abandon ship.
This is old news to you, if you're Malaysian and you are/know a doctor, or even if you just read the news/FB enough. They work extremely long hours and very few breaks (sometimes 24-25 hour shifts), they get bullied/insulted/humiliated by their senior colleagues publicly, and they get villified by patients who don't want to be the "guinea pigs" for these "inexperienced" doctors to "experiment" on.
Contrast that with the more humane working hours here (the longest shift I've seen is 13 hours) thanks to the European Working Hours Directive, no bullying culture, and patients who are always willing to let even medical students practice on them and saying "well you've got to learn". I can definitely see why staying in the UK seems like an obvious decision.
But what I don't understand is: WHY IS NO ONE DOING ANYTHING ABOUT IT IN MALAYSIA?
Everyone knows these conditions are not fair, not safe for both doctors and patients, and not conducive to attracting talented doctors to train in Malaysia and retain them in training. Everyone complains and rants about it. This has been going on for as long as I can remember (which due to my crap memory, is till high school).
But nothing's changed. Sure, they said they've made some changes ( read this Press Statement by the DG of Health: https://kpkesihatan.com/2016/03/09/press-statement-dg-of-health-9-march-2016-strengthening-the-housemanship-training-programme/ ) but on the ground, it seems it is not enough.
Before I move on, note that this is a rant piece, where I am using this medium to just pour out my frustrations. However, if you have any advice or opinions, or know of any improvements in these issues, or if any of my information is incorrect, please comment or contact me to let me know.
Ok, here goes the rant:
1. Working hours
According to the Modified Flexi system introduced in 2013, HOs are expected to work 65-75 hours per week. However from the people I have spoken to working in different states, often they work longer hours than these. The problem is not just the total hours, but the length of each shift. If doctors are working 24 hour shifts, this is obviously not safe for patient care, nor for the doctors' wellbeing.
In what other high risk jobs would you get people working 24 hour shifts? Would you let a pilot who hasn't slept in 24 hours fly a plane, especially if they've been working those shifts for the past 3 days? But you'd let a doctor who hasn't gone home or had a good sleep for a whole day hold people's lives in their hand. Where's the logic in that?
And do not tell me: Oh but the older generation did that, and they were fine, doctors now are just pampered spoiled brats.
My mum used to walk to school for miles, sometimes barefoot. Did she expect me to do the same? Would anyone expect me to do the same? NO. There was a time people used to perform surgery and circumcisions without anaesthetics, would you like doctors to do that now? Obviously not. The older generation didn't have a choice, there were fewer doctors back then. We have a choice now.
The reason we strive for change and advancement is for our children and future generations to enjoy what we did not have, for them to enjoy a better quality of life. Why is it different then for doctors? Isn't the reason we try to send so many students on medical scholarships because we want more doctors, to improve the ratio of doctors to patients so we can improve medical care? Then why, despite INCREASING numbers of doctors graduating each year (apparently too many medical students) why are the working hours not improving? Surely we should be striving to maintain a workforce that is large enough to maintain humane working hours and yet still achieve quality patient care? And yet they complain we have too many graduates and not enough jobs to go around. Pah.
Reason #2 I keep hearing about why we need these ridiculous hours is: they need to work loads to gain enough experience.
Excuse me, that is NOT a valid reason. Yes, as is with all skilled occupations, practice makes perfect. The more hours worked, the more experience gained. That does not equal working people to beyond their limits, and beyond their rights to having a life outside work. The hours you need are naturally accumulated over years as you progress in your training. Those hours do not need to be accumulated in crazy marathon shifts, where you gain experience but you lose concentration and motivation (and lose having a LIFE). The experience gained should be in safe increments, and cannot be justified by doctors losing their passion and burning out, and patients suffering from errors due to fatigued doctors.
2. Bullying culture
It completely escapes me why this is even still around. Not just in any profession, but among doctors? It seems so absurd it's almost laughable. When I explain this culture to my non-Malaysian friends, they seem astounded by it, like it doesn't even make sense. And it really doesn't, considering doctors are supposed to be intelligent, compassionate and professional people.
Even medical students doing electives in hospitals have seen this, and my HO friends have sadly experienced it too. When your seniors who are the ones supposed to guide you and support you in your training, the ones you're supposed to turn to when you're lost, are the ones insulting and humiliating you in front of patients, tearing your confidence and patients' trust in you into pieces, how are you supposed to grow? I'm not saying there aren't any mean or harsh seniors in the UK, but I personally have never seen or heard it being done in front of patients. It is simply unprofessional to act like that, there are proper ways and adab of correcting or criticizing someone's weakness or mistakes. In Islam, our religion teaches us that humiliating or revealing someone's weakness in public is not acceptable, that you should always try and protect someone's honor and dignity. Don't even get me started on doctors who actually physically lay a hand (or a book) on their juniors. Even if it's a light smack and doesn't hurt physically, it is absolutely unacceptable! They are not your children to hit or scold like little kids, they are your grown up colleagues, and should be treated as such.
And whenever someone says that "oh we went through the same thing, so we're just teaching them the way we were taught, it'll make them tough", THAT JUST GETS ME SO MAD. If you went through such horrible times, why on earth would you want to inflict that on someone else?
As a person who chose to go into a career of saving lives and should be caring in nature, why would you choose to make someone else suffer when you have the choice of making it better and easier for them? It's the same thing as how our parents work hard to give us what they didn't have growing up, so should senior doctors be as nurturing and supportive to junior doctors to provide them with what they didn't have when they were training. It's repulsive how some people think just because they had a hard time, the juniors should suffer the same way too. That kind of mindset leads to stagnation and repressive working conditions, when we should be aiming for progress and development.
It's a sad situation when my friends at home are telling me to stay away, while my Singaporean friend has her seniors telling her confidently to come back home, that they've got better pay and conditions than the UK. Here in the UK this week, junior doctors are doing a full walkout strike for two days in protest of a new contract that will change Saturdays into normal hours (instead of antisocial hours with its accompanying premium pay) and also will stretch the workforce thinner to create a so-called "7 day service". In Malaysia, junior doctors have been labouring under even worse conditions, but no significant improvements have been made, and policymakers have not even involved HOs in their negotiations and discussions.
I'm not saying doctors in Malaysia should go on a full walkout strike too (perhaps eventually :P), but it's time that something more concrete is done at the level of policymaking (and implementation), and this time it should be decisions made with the junior doctors, as well as integrating the ideas and solutions from those directly impacted: the HOs themselves.
It's time for doctors to save themselves now.
P.S I'm really hoping for loads of heartwarming stories where people have had nice experiences being a doctor, but that doesn't mean the ugly stories aren't there too. Also, please please do let me know if it really isn't this bad or there has been loads of improvements but I'm just ignorant about it. I have never worked in Malaysia yet, so fellow Malaysians please share your stories with me.
[ Disclaimer: I have never worked/trained in Malaysia, everything here is based on what my trusted friends/seniors have told me. Thus they are technically hearsay/stories/personal experiences, and I know they may not be representative of everyone. However, they are from my trusted sources and they are experiences that I believe no one should have, hence the rant.]
Oh yeah I post. Long ranting posts.
As many of you know, I have passed my finals in medical school after 5 long years, and in July this year inshaAllah (God willing) I will be graduating with my medical degree. Hurrah! Now all should be rainbows and unicorns as I enter my brilliantly glowing career as a doctor right?
As a scholar from a certain government's department, I am bound by contract to return to my country after graduating to serve the government as a doctor for 10 years. That in itself is not a problem. I love my country, I miss it and would love to return and serve my people.
The problem is: everyone else back home keep telling me NOT TO COME BACK.
And by everyone else, I mean everyone. But most importantly, doctors who are in the early two years of training just after graduating medical school, which in Malaysia is called housemanship training (in the UK they call it the Foundation years). These housemen (HOs) are all my seniors and friends, and I value and trust their opinions. So when they tell me I'm better off staying in the UK, I'm obviously worried by this. Some of them were previously medical students trained in the UK or Ireland, others did their degree in Malaysia, but all agreed the working conditions as a HO in Malaysia is bad enough that they are actively encouraging me to abandon ship.
This is old news to you, if you're Malaysian and you are/know a doctor, or even if you just read the news/FB enough. They work extremely long hours and very few breaks (sometimes 24-25 hour shifts), they get bullied/insulted/humiliated by their senior colleagues publicly, and they get villified by patients who don't want to be the "guinea pigs" for these "inexperienced" doctors to "experiment" on.
Contrast that with the more humane working hours here (the longest shift I've seen is 13 hours) thanks to the European Working Hours Directive, no bullying culture, and patients who are always willing to let even medical students practice on them and saying "well you've got to learn". I can definitely see why staying in the UK seems like an obvious decision.
But what I don't understand is: WHY IS NO ONE DOING ANYTHING ABOUT IT IN MALAYSIA?
Everyone knows these conditions are not fair, not safe for both doctors and patients, and not conducive to attracting talented doctors to train in Malaysia and retain them in training. Everyone complains and rants about it. This has been going on for as long as I can remember (which due to my crap memory, is till high school).
But nothing's changed. Sure, they said they've made some changes ( read this Press Statement by the DG of Health: https://kpkesihatan.com/2016/03/09/press-statement-dg-of-health-9-march-2016-strengthening-the-housemanship-training-programme/ ) but on the ground, it seems it is not enough.
Before I move on, note that this is a rant piece, where I am using this medium to just pour out my frustrations. However, if you have any advice or opinions, or know of any improvements in these issues, or if any of my information is incorrect, please comment or contact me to let me know.
Ok, here goes the rant:
1. Working hours
According to the Modified Flexi system introduced in 2013, HOs are expected to work 65-75 hours per week. However from the people I have spoken to working in different states, often they work longer hours than these. The problem is not just the total hours, but the length of each shift. If doctors are working 24 hour shifts, this is obviously not safe for patient care, nor for the doctors' wellbeing.
In what other high risk jobs would you get people working 24 hour shifts? Would you let a pilot who hasn't slept in 24 hours fly a plane, especially if they've been working those shifts for the past 3 days? But you'd let a doctor who hasn't gone home or had a good sleep for a whole day hold people's lives in their hand. Where's the logic in that?
And do not tell me: Oh but the older generation did that, and they were fine, doctors now are just pampered spoiled brats.
My mum used to walk to school for miles, sometimes barefoot. Did she expect me to do the same? Would anyone expect me to do the same? NO. There was a time people used to perform surgery and circumcisions without anaesthetics, would you like doctors to do that now? Obviously not. The older generation didn't have a choice, there were fewer doctors back then. We have a choice now.
The reason we strive for change and advancement is for our children and future generations to enjoy what we did not have, for them to enjoy a better quality of life. Why is it different then for doctors? Isn't the reason we try to send so many students on medical scholarships because we want more doctors, to improve the ratio of doctors to patients so we can improve medical care? Then why, despite INCREASING numbers of doctors graduating each year (apparently too many medical students) why are the working hours not improving? Surely we should be striving to maintain a workforce that is large enough to maintain humane working hours and yet still achieve quality patient care? And yet they complain we have too many graduates and not enough jobs to go around. Pah.
Reason #2 I keep hearing about why we need these ridiculous hours is: they need to work loads to gain enough experience.
Excuse me, that is NOT a valid reason. Yes, as is with all skilled occupations, practice makes perfect. The more hours worked, the more experience gained. That does not equal working people to beyond their limits, and beyond their rights to having a life outside work. The hours you need are naturally accumulated over years as you progress in your training. Those hours do not need to be accumulated in crazy marathon shifts, where you gain experience but you lose concentration and motivation (and lose having a LIFE). The experience gained should be in safe increments, and cannot be justified by doctors losing their passion and burning out, and patients suffering from errors due to fatigued doctors.
2. Bullying culture
It completely escapes me why this is even still around. Not just in any profession, but among doctors? It seems so absurd it's almost laughable. When I explain this culture to my non-Malaysian friends, they seem astounded by it, like it doesn't even make sense. And it really doesn't, considering doctors are supposed to be intelligent, compassionate and professional people.
Even medical students doing electives in hospitals have seen this, and my HO friends have sadly experienced it too. When your seniors who are the ones supposed to guide you and support you in your training, the ones you're supposed to turn to when you're lost, are the ones insulting and humiliating you in front of patients, tearing your confidence and patients' trust in you into pieces, how are you supposed to grow? I'm not saying there aren't any mean or harsh seniors in the UK, but I personally have never seen or heard it being done in front of patients. It is simply unprofessional to act like that, there are proper ways and adab of correcting or criticizing someone's weakness or mistakes. In Islam, our religion teaches us that humiliating or revealing someone's weakness in public is not acceptable, that you should always try and protect someone's honor and dignity. Don't even get me started on doctors who actually physically lay a hand (or a book) on their juniors. Even if it's a light smack and doesn't hurt physically, it is absolutely unacceptable! They are not your children to hit or scold like little kids, they are your grown up colleagues, and should be treated as such.
And whenever someone says that "oh we went through the same thing, so we're just teaching them the way we were taught, it'll make them tough", THAT JUST GETS ME SO MAD. If you went through such horrible times, why on earth would you want to inflict that on someone else?
As a person who chose to go into a career of saving lives and should be caring in nature, why would you choose to make someone else suffer when you have the choice of making it better and easier for them? It's the same thing as how our parents work hard to give us what they didn't have growing up, so should senior doctors be as nurturing and supportive to junior doctors to provide them with what they didn't have when they were training. It's repulsive how some people think just because they had a hard time, the juniors should suffer the same way too. That kind of mindset leads to stagnation and repressive working conditions, when we should be aiming for progress and development.
It's a sad situation when my friends at home are telling me to stay away, while my Singaporean friend has her seniors telling her confidently to come back home, that they've got better pay and conditions than the UK. Here in the UK this week, junior doctors are doing a full walkout strike for two days in protest of a new contract that will change Saturdays into normal hours (instead of antisocial hours with its accompanying premium pay) and also will stretch the workforce thinner to create a so-called "7 day service". In Malaysia, junior doctors have been labouring under even worse conditions, but no significant improvements have been made, and policymakers have not even involved HOs in their negotiations and discussions.
I'm not saying doctors in Malaysia should go on a full walkout strike too (perhaps eventually :P), but it's time that something more concrete is done at the level of policymaking (and implementation), and this time it should be decisions made with the junior doctors, as well as integrating the ideas and solutions from those directly impacted: the HOs themselves.
It's time for doctors to save themselves now.
P.S I'm really hoping for loads of heartwarming stories where people have had nice experiences being a doctor, but that doesn't mean the ugly stories aren't there too. Also, please please do let me know if it really isn't this bad or there has been loads of improvements but I'm just ignorant about it. I have never worked in Malaysia yet, so fellow Malaysians please share your stories with me.
[ Disclaimer: I have never worked/trained in Malaysia, everything here is based on what my trusted friends/seniors have told me. Thus they are technically hearsay/stories/personal experiences, and I know they may not be representative of everyone. However, they are from my trusted sources and they are experiences that I believe no one should have, hence the rant.]
Oh yeah I post. Long ranting posts.
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