Ever since a houseman fell to his death at Penang Hospital last month, there have been more and more reports of junior and trainee doctors allegedly being mistreated at their workplace.
Accounts such as Hartal Doktor Kontrak on Twitter have been sharing tales of bullying as well as suicidal ideation amongst junior doctors. At this point, such news has become so common that it almost seems as though the alleged workplace abuse is normalised.
To those who are outside of the system, this might just sound like the current news cycle, one that might dwindle soon and be eventually forgotten.
But for medical professionals, the housemanship experience is a core aspect of their careers and lives, a reality that will continue on even after the news forgets about it.
Curious to learn what housemen really go through, Vulcan Post reached out to various individuals in different stages of their medical careers.
We requested that they provide their contact details to us for verification and assured them that they would be anonymous in the article, but ultimately, only three replied to us.
Thus, we acknowledge that this is just a small sample size, but hope that these are still genuine experiences shared with us in good faith.
These individuals will be referred to as:
- E: A fifth posting houseman, a senior who is about to finish their training before becoming a medical officer;
- J: A house officer;
- S: A medical doctor in Australia with 4 months of experience in Malaysia.
Expecting the worst
It’s not the first time that allegations of poor work environments in the medical field have made the headlines. Just last year, there were cases of junior doctors staging walkouts and threatening resignation. In fact, there are allegations that date all the way back to 2014, and perhaps even earlier.
Naturally, E, J, and S all expected their housemanship experience to be tough.
“I already knew it was going to be bad in terms of lifestyle and hardships,” E admitted. “But it was a whole different ball game. It was much worse.”
In between that though, E acknowledged that she was able to meet, and learn from, a good share of humble and talented doctors, nurses, and medical assistants.
J’s positive housemanship memories included seeing the health of patients under her care improve, and when her bosses agreed with her proposed treatment and management of the patients. There were also times when she was allowed to perform minor operations under supervision. Such details have become the highlights of her housemanship experience.
As for S, her most positive experiences came from supportive seniors and patients. In particular, she recalled moments when patients, bosses, nurses, or colleagues would thank her or tell her that she was doing a good job.
“For us who were working long hours and trudging through the immense workload, these little compliments mean a lot to us,” S said.
However, their housemanship programmes might only be the tip of the iceberg.
“Everyone says once you finish housemanship that things will get better,” E said. “Nope. 200% untrue. You earn lesser, you still work like a dog, you have to do things your house officer doesn’t do, and think like a specialist as well.”
Many junior doctors have reported on social media that their intensive workloads have resulted in fatigue and stress, allegedly to the point where they contemplated suicide.
Thankfully, our sources were never driven to that edge. However, S did witness peers dropping out because of the lack of support they received from their seniors.
“Almost every house officer would have experienced mental stress and fatigue when performing houseman duties,” she said. “You are expected to work at least 12 hours or more per day, six days per week, and on top of that if you’re on call, your sleep-wake cycle is completely interrupted.”
To her, the issue is that there’s no proper mental health support for house officers, and bosses may not empathise. She also shared that some bosses think that current house officers shouldn’t complain because their own training experience was worse.
J has a different perspective, as she believes mental stress exists in all sectors. She herself has experienced depression and claimed that mental health is taken as a joke at her workplace by bosses and even among her peers.
But she also believes that there are those who use mental health as an excuse to take frequent leaves, letting the workload fall onto the rest of the cohort.
“As time goes by and they frequently gave the same reason, it’s really hard to empathise with them,” she shared. “There are colleagues who really put in their effort to work their way through despite their illness. But there are also a number of them who likes to use it as an excuse to get away with work and things.”
On the other hand, E thinks that things have at least gotten a little better.
“Compared to our seniors years ago, when one houseman had to take care of three wards by themselves and do 36-hour shifts, I think we’re pretty damn lucky to have a shift system,” she said.
With that said, she doesn’t think that the current generation of housemen are “brats” for complaining, as she believes they do have a right to speak up about their experiences.
A hierarchical culture
According to S (and articles over the years), housemanship bullying has been an ongoing issue for a long time. From what she has heard, there have been many instances when bullying incidents were reported too, but no actions were taken against the bully. Instead, whistle-blowers tend to be implicated.
“A healthcare system that doesn’t protect its workers’ welfare is a dangerous one that compromises patient care and healthcare workers’ mental health,” S said.
As such, she believes senior doctors should call out colleagues that are being bullies. Junior doctors should also help each other in these difficult situations. Of course, the complaints must be followed up with proper action and support.
But making complaints isn’t as easy as it sounds. Some juniors might not feel comfortable or even safe speaking up about their experiences. As shared by E and J, medical spaces are often ingrained with hierarchical structures that make speaking up difficult.
“As a houseman, we are treated as the lowest,” J said. “No one respects us, and when things happen, we are made the scapegoats. Even nurses, PPK (healthcare assistants), and patients don’t respect us.”
J believes that the strong sense of hierarchy means bullies in the system get away very easily. Due to this culture, junior doctors cannot question what seniors or bosses say.
She reported that her seniors have recently been throwing around sarcastic and insensitive remarks such as, “This is not bullying ah”, or “Don’t go and jump off the floor”. Another comment was, “Doktor sekarang tak guna, sikit sikit dah stress, nak terjun bangunan” (doctors today are useless, they get stressed easily and want to jump off buildings).
Similarly, E said that being a house officer means being at the end of the food chain, claiming that even cleaners are spoken to with more respect.
Changing the industry
Despite calls for change in the industry, Malaysian Medical Association’s president, Dr Koh Kar Chai, said the system should remain in a press conference on May 10.
“But are we about to declare that the houseman training be simplified in order that there will be no perceived hardship on house officers and that they will be allowed reduced hours, to see fewer patients and to assist in fewer procedures?” he asked.
According to him, such a system would lead to incompetency. Free Malaysia Today reported that Dr Koh also said “harsh words” are expected during housemanship to ensure competence.
S, who experienced further medical training in Australia, believes otherwise.
“Working in the overseas environment now has taught me that harsh words are not needed during housemanship training,” she said. “We are all adults, so we have to learn to respect each other.”
“The entire medical industry needs a change,” J said. “It should be a truly merit-based system. The current system we have rewards the mediocre but punishes the hardworking. If KKM is really keen on avoiding brain drain, then something has to be done urgently. The ugly truth is: no one wants to work in Malaysia anymore.”
S also believes that change is needed, particularly when it comes to working hours. “Tired doctors make more mistakes, which is harmful to patient care,” S said.
According to her, the official KKM circular is that house officers should work about 60-65 hours per week. In reality, they’re working about 70-96 hours per week.
E agreed, noting that the current training program is too mentally and physically taxing. She hopes the system will change in the future, whereby junior doctors’ general health is prioritised better.
Though the older generation tends to complain that youth today are “too soft”, she believes that times have changed, and being harsh and physically abusive is no longer effective.
“I think there is a change,” she said. “Young specialists are slowly changing as well. It’s just the malignant, ancient ones that need to retire.”
While these individuals agree that change is necessary in this climate, it ultimately comes down to the decision-makers in organisations such as KKM, MMC, and MMA. With MMA already believing that the current system should stand, is change in the near future even possible?
- Read other articles we’ve written about company culture here.
Featured Image Credit: Noor Hisham Abdullah, Director-General of Health