KUALA LUMPUR – The headline of this story is not intended to sensationalise, but to highlight the ugly plight of house officers (HOs) working in hospitals throughout the country. Houseman-bashing is a long-standing painful issue – callously ignored for decades by the powers that be.
Here is another potential tabloid-like steamer: “Saya tanya awak soalan klinikal lah, bukan tanya you main dengan siapa semalam” (“I asked you a clinical question, not with whom you had sex with last night”).
Both lines are said to have been uttered by a senior surgeon.
Dr Raj (not his real name), a HO who mustered courage to reveal these behind-the-scenes shocking truths, told The Vibes: “Ask any HO, and he or she will tell you what it is like to be a junior doctor under the Health Ministry’s housemanship programme.
“Take the case of vulgarity. Do we have to be subjected to such sexual innuendos? All the female HOs in that group cried as the surgeon’s ill-flavoured remarks also amounted to sexual harassment. They had no one to turn to for help.
Even if they complain, they will be penalised, like having their grades reduced during assessment and perhaps retained at their posting longer than it is necessary. Is this the language and culture of the medical fraternity which is supposed to be noble and elite?”
HOs are required to complete two years of housemanship. They are expected to get their hands-on practical training over a period of four weeks in each department.
Dr Raj said: “I once stepped into the elevator bumping into my coursemate who was also engaged in the housemanship programme. When I casually asked her how her housemanship was going, she just burst into tears right in front of the people in the elevator.
“The people may not know why she cried, but here we are telling our stories with a strong message to the public to rise up and stand for us. We are your future doctors.
We are suffering physically, emotionally, and mentally. This flawed system is just too much of a ‘rabid malignancy’ that is killing our junior doctors, and all these are happening with the connivance of the Health Ministry and right under their nose,” said Dr Raj.
Another houseman, Dr Palni, told The Vibes that there is a loose slogan bandied about in the wards: “Biar houseman mampus, jangan patient kojol” (“It is okay for the houseman to die, but keep the patients alive”).
“Each time I hear this, I shudder at the thought of physically, mentally, and emotionally strained and overworked HOs who may not be able to withstand the ‘rough and tumble’ in medicine’s most vulnerable hands-on phase in the learning curve. This is what housemanship is all about in hospitals in our country.”
‘Can I date you?’
According to Dr Raj, some of the male medical officers (MOs) will ask female HOs out on a date.
“Nothing wrong in this, but they can be untiringly persistent, and the HO will find it difficult to say ‘no’ for fear of being penalised in one way or another, as it would actually be these same MOs who would be signing off their assessment logbooks.
“If they are not punished by being given a poor assessment at the end of their posting at that department, they can be ‘picked on’ during a group discussion in the ward and made to answer tough questions and humiliated if they do not get their answers right.
“This is definitely some kind of bullying, and the HO has no way of defending herself. She just has to admit to ‘her incompetence’ and apologise!”
Physical humiliation, verbal abuse
Dr Raj said that apart from verbal abuse with vulgarities, HOs are also insulted physically.
“Sometimes files are thrown at our faces by our superiors and specialists. If that is not enough, our case notes are torn to pieces and thrown at our faces or even stuffed into our bags.
“Our housemanship programme is severely flawed. A huge hierarchy system undermines the ones working at the bottom, and we HOs are the lowest of the lows within this toxic and cannibalistic culture.”
HOs from universities in Indonesia, Russia, and Bangladesh are even perceived as unwanted scums and also bear the brunt of such bullying, he added.
He said HOs are expected to work for 13 to 16 hours, most of the time without having food, water, and toilet breaks.
“I remember a time when I worked for 29 hours at a stretch,” he said.
Dr Palni knows what a gastric attack can do to a person’s health, so he packs his own tiffin to the hospital.
“But on most days, I bring my tiffin back home after I finish for the night which can be past midnight. I have to throw away the spoilt food. On some days, I sneak into the ward’s toilet to gobble up a few bites hurriedly and dump the rest. I hide and eat, not wanting to be seen by my superiors and even staff nurses who play big boss.
They will accuse the HOs of taking a break when there is so much to do. So, that is why I eat in the toilet when I get a chance. It is as if HOs are a superhuman breed who can go without food and water endlessly”.
According to him, HOs are pressured by specialists, MOs, staff nurses, and also medical assistants in the wards.
“Just because the HO is present, MOs take it easy, while specialists issue a laundry list of tasks to be completed, and staff nurses conveniently push their menial tasks like emptying the bedpan and replacing urinary bags to the HOs.
The HO’s typical day
Highlighting the HO’s typical day, Dr Palni said: “While I am inserting an IV cannula into a patient’s wrist, the staff nurse will order me to take a urine sample of a patient from the drip bag to be sent to the lab and write a request order after I have finished.
“And if a new patient arrives at about this time, I will be told to take the patient’s case history. Of course, this is my job – but where is the MO to help ease the burden in such a hectic situation?
“I will also have to spend time ordering preliminary tests as well as drawing a blood sample from the newly arrived patient to be sent to the lab.
Drawing blood from a patient can be handled by nurses, but since the HO is present, he is bullied into doing it. Think of the number of times I have to scrub (which is time-consuming) from one errand to another, while the MO is nowhere to be seen.”
If work is shared, it would give more time for HOs to practice hands-on in order to become proficient clinicians, he pointed out.
“Is this not the main objective of the housemanship programme?”
“But here, everything is helter-skelter, boom, and bang. Meanwhile, the earlier tasks given to me by the specialists and MOs are yet to be accomplished.
“Woe to me, if patients are discharged that day. HOs will have to do voluminous documentation and this takes plenty of time.
“That is why when discharge notices are given in the morning after doctors’ rounds, the patient only gets to leave the ward in the late evening, cursing and swearing at the ward staff. Of course, the HO is blamed for this delay.”
Dr Raj said: “We enter our housemanship expecting to do clinical management of patients, but 99% of the work we do is documentation, blood taking, requesting images, scans and referrals, and wheeling patients to the radiology department or elsewhere.
“We do very little to learn about the patients. We are actually supposed to take case histories, examine patients, and make tentative diagnoses. This is called ‘clerking a case’, but we hardly get to do this.
“At the end of the day, when we flop our assessment, we get retained in that department for a longer period. We go through all these, and in the end we are nothing more than contract doctors.”
The Health Ministry has announced the formation of an independent task force to investigate the sudden death of a Penang Hospital houseman, which has triggered an outpouring of complaints of abuse and harassment in the healthcare fraternity.
The task force is expected to also tackle allegations of a bullying culture in government medical facilities, especially targeted at junior doctors. – The Vibes, May 11, 2022
