The fault of the system

The Star had recently reported that housemen will no longer have to work 16 hours straight. It is perplexing that so much focus is given to housemen when it is critical at this juncture to train them to work under stress. Creating a bubble of comfort is hardly the way to go and makes future physicians lame and unable to take the actual burden of medical work in their future careers.

There are several faults in the system which has led to this misdirected attempt at rectifying the situation.

1. Housemen actually should not be the sole decision makers when they manage cases. All cases clerked must be under the supervision of a more senior staff. Hence, most of the work and responsibilities fall on the shoulders of the medical officers and more senior staff within the team. Afterall, a housemen is still under probation and only possesses a temporary registration from the Malaysian Medical Council.

The reality is that this is not happening and housemen are left pretty much on their own. This is due to a warped mentality of more senior staff, who appear to be deluded that a housemen is competent in all aspects of patient care. Or the more likely scenario is that many senior staff are lazy and view teaching housemen as an absolute waste of their time. Unfortunately, when mistakes occur, they blame the housemen, who would decry this accusation, instead blaming the long working hours which have drained them.

2. Even senior doctors make poor ward managers. From over investigation to a disorganised plan, leads often times to duplication of work. Doctor A comes to do ward rounds and orders a slew of tests at 8 am. Senior doctor B then comes along at 9am and disagrees with the plan and opts for another set of further testing. Consultant C then decides to walk in at 11am and changes the plan again. Housemen are then kept busy poking and repoking patients, on top of having to organise radiological procedures. There is just no organisation at times in the wards.

3. Many hospital systems are inefficient. The failure to adopt technology to advance and simplify workflows has resulted in housemen having to fill up forms after forms. In addition, they have to run to the radiologist to ask for an investigation that could have been ordered remotely or via the telephone. The mess of the radiology departments can make the trip there as arduous as it can be, often sapping precious time.

4. As the meaning of housemen itself is self explanatory, unfortunately, many housemen are actually no longer “in house”. Most housemen were previously actually required to stay within the quarters of the hospital. This is to enable an easy commute and facilitate more rest times by negating the need to travel. Housemanship is a period of intense work and learning which is meant to introduce young doctors to the rigours of medicine, reminding them that it is hard work that gets you to the top. Moreover, more time spent on the wards means better learning experiences, not more classroom type CMEs!

Therefore, housemen can rest quickly when they are off duty or could take a few winks during breaks. Even if they are on call, they could technically go back to their quarters for a quick shower while a colleague holds the fort. This teaches camaraderie amongst housemen, a quality that is glaringly absent in the current shift system.

Unfortunately, many housemen now stay away from hospitals for varying reasons. Perhaps this trend should be checked.

It is not just the housemen that are subjected to long working hours. So what are we going to do the help the medical officers, who are equally burdened with work?? Why are we fixated on only the housemen?

Although it is important to improve on the previous systems, it is feared that the policy makers are barking up the wrong tree and make weaklings out of future doctors. It is the system that needs rectification, otherwise we will just be shifting the problem from one corner to the next.

Similar like piloting, housemen need those hours which can potentially be the difference between life and death in future management of patients. Otherwise, future medical officers will turn up incompetent and unable to cope with the stresses of medical life, which by the way entails long hours uncurtailed by the 16 hour mark!!