Thursday, January 28, 2010

Malaysiakini: Houseman's work hours, a US perspective

Houseman's work hours, a US perspective

Leong Chuo Ren
Jan 27, 10

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

I am currently completing my surgical residency in the US. Being a Malaysian citizen and having friends who have remained in Malaysia to complete their housemanship training, I have the opportunity to compare the work environment, training atmosphere as well as the issue of work hours in both places.

Health Director-General Dr Ismail Merican is either completely oblivious to the fact that – yes, housemen in Malaysia are grossly overworked and underpaid or he is ignoring the obvious.

He needs to get his feet down to reality and start taking the physical, mental and social health of housemen seriously. After all, ultimately, all these affect patient care and as the health DG, he has an obligation to make sure it is taken care of.

In the US, there exists strict 80 hours per week work rules. It is also illegal to have residents work more than 24 hours without at least a 12-hour break before the next shift. These are strictly regulated by the Accreditation Council for Graduate Medical Education (ACGME) and was implemented in 2003.

The ACGME regularly conducts spot checks on residency programmes to review resident work hours. Any programme which violates these rules are subjected to hefty penalties, including firing of programme directors or having the entire residency programme placed on probation.

In Malaysia, such regulatory bodies do not exist and there is no council that overlooks the welfare, training and education of housemen.

There is research from Europe and the US on nonstandard work hours and sleep deprivation and they found that late-hour workers are subject to higher risks of gastrointestinal disorders, cardiovascular disease, breast cancer, miscarriage, pre-term births, and low birth weight of their newborns.

Chronic sleep deprivation and the resulting fatigue and stress can affect job productivity and the incidence of workplace accidents.There are also social effects such as a significantly higher rate of marital difficulties and divorce among physicians who work long hours.

Almost every single friend of mine who did their housemanship in Malaysia tell me about their 100+ hours work week, poor pay, 36-hour straight on-call, the resulting fatigue, weight loss, social problems, health and safety issues (including a few near post-36 hour on-call car accidents). They aren't the only ones affected - their patients suffer as well as their care is affected by physician fatigue.

Senior physician bullying is also a common problem in Malaysian hospitals and I feel for the housemen because they do not seem to have anyone to turn to for help. In the US, any act of bullying, coercion or harassment is reportable to the ACGME and appropriate investigative and disciplinary actions are undertaken with severe consequences.

I think there needs to be a regulatory body formed for the Malaysian healthcare system which specifically functions to regulate and monitor housemen/medical officers/registrars work hours and well-being as well as provide specific patient-oriented core competencies like the ones endorsed by the American ACGME.

This includes Patient Care, Medical Knowledge, Practice- based Learning and Improvement, Interpersonal and Communication Skills, Professionalism and Systems-based Practice I do not know if the Malaysian Medical Association has provisions for this.

Then again, given the attitude and track record of our politicians and the higher-ups in the health ministry, I doubt this will ever materialise in the near future. However, I do encourage more housemen to continue voicing out their discontent and to fight not only for their right to provide the best healthcare, but to be adequately compensated and their own physical, financial and mental well-being taken care off.

If things continue the way they are, many doctors are going to continue opting out of public service or seek greener pastures overseas. The public health system will continue to suffer a 'brain drain' and we will continue to hire poorly-trained foreign medical graduates.

Taxpayers money will not translate into improvements in health care but on the contrary into worse treatment by tired, disgruntled, poorly trained and underpaid physicians.


He was so tired, houseman slept off at traffic lights
Anne Matthews
Jan 27, 10
I refer to the Malaysiakini report 'Housemen not over-worked in hospitals'.

I have worked in hospitals and these are the comments that I would give concerning housemen in hospitals.

Do not compare housemen of times past who worked without any complaints (a comparison usually made by our so called health directors and our dear health director-general).

Please be aware that we are in the 21st century and not in primitive ages. First and foremost, the health director-general should go down to the ground and meet the housemen personally.

Talk and find out the truth about their complaints Do not just take the words of those you delegate the job to. Each and everyone would like to 'cover' for themselves by being a goody tow-shoes in your record book.

The housemen will not complain for they will be blacklisted by their so called Medical Officers and specialists. This reminds me of one houseman who slept off at a traffic light because of overworking and was exhausted from lack of sleep having worked from 6.30am till 6pm the day after.

Is this what the DG wants? You are answerable and responsible for this problem. You are a DG for the health ministry and not a politician. Go down and see for yourself the conditions and the working hours. All hospitals should be uniformed of the same.

42 hours straight: 'We have to beg our patients to urinate'
Jan 27, 10
I refer to the Malaysiakini report 'Housemen not over-worked in hospitals'.

I am a house officer working at a state general hospital. I thank your readers for all the responses and comments. We really feel appreciated. Many, or shall I say, all the responses were against our health director-general.

I would like to emphasise here that this is not a housemen vs DG issue. It's about understanding a houseman's life. Our DG gave his view based on the feedback he gets. And I believe it;s true that until now he has yet to receive any formal complaint from a houseman or even an ex-houseman who is still in government service.

Why? One obvious reason, it is the PTK . Our yearly 'penilaian tahap kecekapan' is signed by our head of department, verified by the hospital's director Pengarah and evaluated by the ministry. So I don't think any government service doctors who are in their right mind will ever lodge a formal complaint.

I do appreciate my DG's call to us , saying that we can always come to him on any problem. But Tan Sri, I daresay you will never will hear anything from us. That's the reason I am writing this letter anonymously to

Now let's have a look at the issue. Are housemen overworked? I will pen down my view as a house officer, and let you judge. As a houseman, we start our day at work at 6.30 or 7am. And we thereafter have no breakfast or lunch break. At some hospitals, housemen shouldn't be seen at the hospital canteens.

As a health service provider, Malaysian government hospitals give top class service. We will see our patients three times a day via our official 'rounds'. Meaning we will be following and presenting our patients to our bosses three times a day. First at 8am, then 3pm and 8pm.

And its our responsibility to know our patients well prior to the official rounds and to get all the necessary 'jobs' done after the official rounds and be prepared with everything for the next round. We even need to beg our patients to pass urine, bottle it, run to the lab and get the results printed. Don't be shocked, but this is what we are doing and are expected to do.

So we will be done with our work earliest by 6pm in some of the departments. But there are some departments which still demand us to work till 12 midnight. Personally, I don't complain about this because I and many others take this as an opportunity given to us to learn.

But trust me - not many can bear this pressure and they break down. And many fail to give their optimal service to their patient due to exhaustion.

As for the on call scenario, life starts as usual at 6.30am and we will perform our routine responsibilities in addition to fulfilling our on-call duties. This goes on until 7am the next day. And after that, we have to carry on with our normal routines that most of the time extend even until 11 or 12 pm. That is more then 40 hours.

Of course, we get ourselves cleaned, fed and maybe shut our eyes for an hour or so with the mercy of our fellow housemen. But this is 'off the record' and if we ever get caught, we can be considered as 'ponteng' and can be disciplined for that. At least a warning letter or a public humiliation by our bosses.

And for all this, what do we get in return?

• Much lesser pay compared to our counterparts in other countries.

• No weekends off.

• No medical leave. In some departments we must go to work as usual even if we are sick and get ourselves examined by our bosses before getting permission for an MC. Not to mention the hours we have to wait for them.

• Being humiliated by our bosses in front of our patients.

• Getting our tenures extended for three months for minor misdeeds

• Running around doing 'other' people's work. Like those of the ward attendants, staff nurses etc. This because at end of the day, we will be blamed and only we will be blamed if things are not done.

I am writing this letter after 42 straight hours of work, without any sleep and only one meal.

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