Young and promising : Common fears

Recent developments within healthcare has sparked some valid concerns amongst medical students and graduates alike. A recent forum organised by the energetic Malaysian Medics International, drew some common and recurring questions about the state of our healthcare. I shared the stage recently with

  1. Dr Miltom Lum Siew Fah, a prominent Obstetrician & Gynaecologist and a frequent name within the Malaysian Medical Council as well as an avid writer, often with appropriately critical articles in the press
  2. YBhg Dato’ Dr Hj. Azman bin Hj. Abu Bakar, the Deputy Director General of Health (Medical Services) of the Ministry of Health Malaysia

Housemanship

Clearly, we were not going to escape this thorny issue. The days of an automatic position within the Ministry of Health is long gone. With a burgeoning number of new graduates annually, the strain on the Government to provide adequate number of training positions is apparent. As they try to increase the number of positions by gazetting more training hospitals, keeping up with the number of new graduates is clearly a game of catch up. So waiting up to 6 to 9 months for a housemanship position is now clearly expected. There is no quick fix to this and this waiting period is unlikely to reduce anytime soon.

However, it is not the end of the world. There are many opportunities to take up positions and tasks, that will help improve one’s perspective of the world and equip one with more skills. Some of these may or may not be related to healthcare but certainly keeping busy during this period of waiting , now that it is expected, should be part of planning during the final undergraduate years. Be it taking up research positions or delving into entrepreneurship, the variety of choice is there.

Post housemanship

The 5 year contract also does not automatically translate to a permanent government position according to Dato’ Azman and only the brightest will be offered a permanent job. For those who fail to get a position, an alternate path away from public service is the only choice. It is unclear how they will get back into clinical training especially those passionate about clinical medicine or specialist training. Perhaps passing examinations during this period will be wise to up the chances of returning to training positions.

Specialist training is currently the bottleneck in the healthcare system. Masters positions are rather limited. Although a parallel pathway involving examinations conducted by the Royal Colleges in UK and Ireland is accepted, some specialities will require in house training. Post graduate training in public medical universities is extremely limited. Most private medical universities are still unprepared to train post-graduate students.

Bullying

Recent high profile sexual harrassment charges against superiors, has sparked increasing revelations of a culture of bullying and intimidation. Prior to this, most would accept it as part of the process of training and many suffer in silence. While there are certain behaviours that cannot be condoned, there are many others that lie in a gray zone of acceptability.

Horror stories are abundant although not many of them are ever reported. The highly hierarchical structure in medicine, where senior specialists attain almost god-like status, reporting against them will take literally nerves of steel. Current evaluation systems may not be transparent and fair, and at times places too much authority in the hands of senior specialists. This further discourages dissent and encourages abusive behaviours.

It is reassuring to know that the Minister of Health is not mincing his words and is taking the bull by its horns, allowing direct access of reporting cases of abuses to his office.

Solution?

There is so much that requires change in our healthcare system. The fear is that much of this culture has been ingrained into the fabric of the medical fraternity over the decades. It may take drastic measures to address these issues.

Starting from revamping medical education, instilling not just good patient-doctor relationships but doctor-doctor/healthcare professional relationships. Educating doctors on law should also be mandatory in all medical curriculums.

Allow 365 degree evaluations, similar to that practiced in many multinational companies. Allow independent and non-condescending channels for any persons to voice their concerns.

 

Dr Benjamin Cheah

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