NUMEROUS news articles and the results of multiple surveys and studies have detailed myriad issues in Malaysia’s housemanship training programme. The problems are causing unfair terminations, loss of talent, mental health issues, and multiple cases of suicide among doctors.
House officers (HOs) are the first to tend to patients in hospitals. When HOs are poorly treated and denied support, patient care will inevitably be affected. According to surveys by the Malaysian Medical Association and Doctors Only Bulletin Board System, up to 80% of doctors in Malaysia have experienced bullying while serving in the public sector. Of these doctors, 71% experienced symptoms such as anxiety, loss of confidence and hypervigilance, while 17% considered suicide as a result of being bullied.
HOs are often overworked and underpaid. The act of seeking help or advice is often unjustly seen as a sign of incompetence and may come with repercussions, including the possibility of housemanship extension. These barriers to learning, among many other reasons, make it extremely difficult for housemen to improve, making them even more susceptible to the current culture of humiliation, bullying and derogative behaviours from superiors that is perpetuated by the acceptance of such acts within the community.
Furthermore, as per the latest available data in Malaysia, the current ratio of hospital-based specialists to HOs was 1:3.13 in 2011, resulting in inadequate supervision of HOs. This often leads to psychological challenges and insecurities among junior doctors when they apply medical knowledge or perform clinical procedures on patients, especially without supervision or guidance. Appropriate mentorship with sufficient motivation and fair assessments during houseman training had been postulated by a study to be key approaches to preventing emotional burnout among HOs.
Malaysian Medics International (MMI) thereby urges the government to carry out the following actions to improve the quality of houseman training in Malaysia.
> Increase funding for public hospitals to improve training and available vacancies in the housemanship training programme – In 2018, Malaysia’s health expenditure was 3.76% of the country’s GDP, significantly lower than our South-East Asian counterparts such as Myanmar at 4.79%, Singapore at 4.46% and the Philippines at 4.40%.
An increase in funding from the government is necessary to increase vacancies in the housemanship training programme and improve the current wages and welfare of housemen. These include entitlement to leave and reducing unhealthy working hours. We strongly urge the Health Ministry to devise a sustainable and achievable plan to improve, protect, and safeguard the welfare of our HOs.
> Create a conducive environment for healthcare professionals to speak out and report negative culture – Support groups and existing feedback channels must be reinforced to better deal with further reports and feedback. Relevant organisations or support groups must protect the reporters by either keeping their identities confidential or keeping them safe from abusive behaviours when reports are received, preventing power abuse from superiors and allowing for prompt action.
It is also of utmost importance for the involved hospitals to assess the situation and take immediate action and further steps to prevent similar incidents.
Concurrently, the Health Ministry must develop nationwide policies to prevent such incidents from occurring in all hospitals. This not only will create a safe space where healthcare workers can speak up about hostile work culture, but will also propagate positive changes towards the future of our healthcare system.
Additionally, nationwide audits and surveys measuring the extent and acts of bullying in hospitals will also be a means towards developing policies to safeguard the welfare of our HOs.
MMI urges the government and all relevant stakeholders to come together and devise strategies to improve the dire conditions faced by many junior doctors. We call upon the medical fraternity to propagate kindness and uphold a positive work culture to create a conducive working environment for all medical practitioners.
MMI understands the government has been actively identifying the concerns of various parties involved in the issues and challenges to the housemanship training programme. However, these pressing issues in the programme must be magnified to improve the welfare of young doctors now. Junior doctors today are the leaders of healthcare tomorrow. MMI strongly believes that a change is necessary for our junior doctors, for our healthcare system, and for our rakyat.
MALAYSIAN MEDICS INTERNATIONAL
Note: Malaysian Medics International is a medical-student led organisation based locally.
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