Tuesday, January 26, 2010

malaysiakini-DG Health: 'Housemen not over-worked in hospitals'

'Housemen not over-worked in hospitals'

Aidila Razak & S Pathmawathym, malaysiakini, Jan 26, 10, 11:14am

The Health Ministry has not received formal complaints from any trainee doctor (housemen) about stressful work conditions in government hospitals, said director-general Dr Ismail Merican.

He countered that, to his knowledge, some hospital wards have too many trainees who end up being under-worked.

"I'm surprised (that there are complaints)... if you go to the surgical ward, there will be 20 housemen floating around, and they will be fighting to do an appendectomy," he said in an interview.

He was asked to comment on an issue frequently raised in the 'Letters' forum of newspapers. These have highlighted work shifts for up to 36 hours if the houseman is on call - and there have been claims that call-duty could go on for 15 days a month.
Ismail conceded, though, that he has received complaints
from parents of trainees, describing it as a "problem" that did not exist when he went through the system as a houseman.
"We worked much harder then and we didn't complain to (our) parents...I'm approachable, (the trainees) can e-mail or SMS me or drop by my office, but no one has complained other than the parents," he said.

In Europe, the practice of long shifts has been banned, with doctors allowed to only work a maximum of 12 hours without a break.

Housemen in Malaysia have further claimed that they are affected by bullying and the high-handedness of senior doctors, in a carry-over of treatment they themselves had suffered as trainees.

Interestingly in 2008, Ismail had revealed that many trainees cannot cope with housemanship, succumbing to neuroses (mental disorders) including anxiety, fear and anger, due to the competitive environment.

The long hours and emotional pressure are also a bone of contention, according to some trainees, because of the relatively low pay.
Their counterparts in Singapore earn S$40,000 (approximately RM86,000) a year after tax, which is almost five times more than the pay in Malaysia.

The relatively low pay has also been named as the reason for the number of doctors opting out of public service, a claim that Ismail refuted.

"A lot of government doctors and specialists are staying on because of faster promotions, better career development and perks with the civil service," he said.

In fact, he said, many private general physicians are "complaining" and "accusing (the government) of providing a better deal because (the government pays) RM80 for locum (work)", which can be undertaken in a doctor's free time.

'We won't have too many doctors'

While housemen complain that they are feeling the strain due to a shortage of doctors, Malaysian Medical Association education committee chairperson Dr N Athimulam said the country is headed for a day where doctors will need to "clamour for patients".

johor flood 160107 medical doctor attending to child
He said 1,200 doctors graduate from local institutions annually, with seven more private institutions to offer medical courses in the next few years.

Ismail disagreed to some extent, pointing out that the challenge is that there will not be enough doctors to serve areas in the interior of the country.

"We were thinking that perhaps by 2015 we may reach (a national doctor-patient) ratio of 1:600. But even then, I don't think it will solve the problem because there are states like Sabah, Sarawak and Pahang (which will still face a shortage)," he said.

"In Kuala Lumpur you can get a ratio of 1:300 or 1:400, better than in Britain. But if you go to Sabah, it's about 1:3,000 or 1:2,500. There's a disparity in the doctor-patient ratio," he added.

Fatigued housemen not a good thing for patients
Tan Loh; Jan 26, 10, 5:03pm

I refer to the Malaysiakini report 'Housemen not over-worked in hospitals'.

Based on what I read in my management class (hospitals are a favorite setting for my professor), the health director-general is defending his identity when he says:

'We worked much harder then and we didn't complain' - a classic reason hospital administrators in the USA 'back then' used while defending the long, long on-call hours.

Sleep deprivation is dangerous. Researchers have shown that being awake for 19 hours produces impairments that are comparable to having a blood alcohol concentration (BAC) of .05 percent.

Being awake for 24 hours is comparable to having a BAC of roughly .10 percent. This means that in just five hours — the difference between going without sleep for 19 hours versus 24 hours — the impact essentially doubles.

Depriving housemen of enough rest is like asking a drunkard to take care of my medical needs. Obviously, it is better to break the 36-hour shifts into shifts of 8-12 hours each for the sake of lowering fatigue.

Perhaps its time to stop carrying out old practices because of prior experience 'back then'. After all, the medical profession is all about the patients' well-being and not 'defending the identity of old doctors.

Sorry, I'm not from the medical profession but as I have a sibling midway through his med- school, I hope to see him not killing or hurting patients due to fatigue imposed on him by the system.

Housemen are suffering in hospitals
Concerned Parent, Jan 26, 10, 5:05pm
I refer to the Malaysiakini report 'Housemen not over-worked in hospitals'.

The director-general of health Dr Ismail Merican has denied that housemen serving government hospitals are not overworked and in says in some departments there are already too many housemen.

I know for a fact that at the Hospital Kuala Lumpur (HKL) the housemen are expected to work seven days per week comprising five days of 12-hour days and two days of a 36 hour continuous stretch all totalling about 110 hours per week.

The average working week for all Malaysians is 40 hours per week and the labour laws allow up to 48 hours per week. So a houseman works up to three times more than a normal Malaysian.

When a houseman is on call, he is paid RM100 for 24 hours of work (the other 12 hours is already paid as salary) which is just above RM4 per hour which is a pitiful amount to pay a professional who has to forgo his sleep, family and social life.

Which branch in government service be it nursing, the military, the police, PTD officers, etc have to work such long hours in such a demanding working environment? Housemen have to deal with many sick patients some of whom are alcoholics and drug addicts.

There are also emergencies and trauma patients, etc. No doubt this environment is to be expected in a hospital but coupled with the crazy hours, being always on their feet, the irregular meal times and the low income, I doubt many people will last long as housemen.

The housemanship for these young doctors is two years and during this period they are not allowed to take medical leave- if they fall sick, the leave taken will be deducted from their annual leave. Meanwhile, annual leave can be applied for but there is no assurance that it will be approved.

The DG has mentioned that no housemen has complained to him about being overworked and he also highlighted that during his service as a houseman, there were no complaints. I am appalled that the DG has feigned ignorance of the unacceptable working conditions of housemen in our government hospitals.

These housemen are the frontliners and without them many hospitals would not be able to function properly. Any parent with a son or daughter as a houseman can tell you the suffering that their child is going through.

In fact, during this two-year housemanship, their life is almost non-existent as all they want to do after work is to go to sleep. In fact, some of them have become withdrawn and suffer from depression and anxiety.

There must be a better way of duty roster-ing the housemen. For example, in Australia, housemen work about 40 hours per week and their duty roster comprises of permanent work shifts for each houseman.

I hope the health DG will quickly start finding solutions to this perennial problem instead of saying that there is no problem at all.

1 comment:

Dr. Sanjeev Kumar said...

With the amount of doctors being produced, I suppose there'll be enough manpower to work on shifts?