Insight to a life of a housemen

My brief stint at the Kuala Lumpur General Hospital has given me a lasting impression as to how the government healthcare system works in Malaysia. I was attached to the general medical wards for 4 weeks. There, I had a taste into how life is like as a junior medical officer. If ever asked to describe their working environment in a word, it would have definitely been ‘exhausting’. Imagine waking up at 5.45am, and then consequently be present at the wards by 6.00am, then, meticulously going through all the work-up of your patients in the cubicle of the wards by yourself including finding the blood results from a pile of papers stacked up in the ‘blood results tray’ until around 6.45am. After all these are done, you will then have to present your findings and proposed management plans to the medical officers or your specialists (depending on who is there earlier), and go through the whole patient list again. Right through the ward rounds, depending on their mood, you will either get a pat on your back for a job well-done (a rare sight), or risk having public humiliation; i.e., scolding in front of all your patients and fellow healthcare professionals. At times, the specialists even threaten to extend their postings for an indeterminate period of time. Every so often, you could even discern remorsefulness from the patients towards the junior doctors.

Trust me, the day does not end there just yet, in fact it has only begun. Following all that, you spend the whole day drawing bloods from the patients, arranging review appointments with other departments for second opinions, going for second (or third) ward rounds with your beloved superiors, and finishing up discharge summaries, manually; all while religiously wearing a white coat and neck tie under the blazing tropical heat. After all that is done, you’d be lucky to go back at 5.00pm. Even if you do, you would still be stuck in the ever congested Malaysian traffic. By the time you do get back home, the only sane thing left to do is sleep. Your mind and body is just too exhausted to do anything else, especially knowing that you have to go through the same torturous road again the dreadful minute your alarm clock rings. Even dinner is optional. It makes me ponder; perhaps even the military training has some tolerable degree of leniency and laxity compared to this industry. I guess the Malaysian government health system was set up with one primary aim; to outwork the poor souls of the junior doctors. If truth be told, I think a considerable amount of them would have opted out; had they known how much work and public humiliation they had to put up with as junior doctors. I suppose you don’t know how deep the water is until you start swimming in it. I cannot help but feel sorry for these junior professionals.

Judging from the personal experiences I have witnessed so far, I can safely express the hostile learning environment in the hospital. I dare not over-generalize in this context as I do not know what it’s like being in other hospitals in Malaysia. In this particular hospital however, the specialists expect their juniors to learn, but they never pave any room for mistakes. To err is human some might say; but not for us health professionals. To them, it seems, the juniors have to get it right even at their first attempt. It is a good practice to implement, as patient lives are at risk when errors are made, but how can one truly learn without making any mistakes? It is such an idealistic perception. From what I can discern from all the castigation I have witnessed, it seems that every mistake; whether major or minor deserves an outright public humiliation. Constructive criticism and mutual respect is somewhat non-existent in their living dictionary.

With regards to the infrastructure as well as the design of the medical ward, I personally believe that they are not exposed to the layout of a modern hospital. I may not have the right credentials to comment on the architectural aspect of the ward per se, but it does not take a genius to figure out that patients who are under anti-tuberculosis medications as well as those with chicken pox should be placed in an isolated ward to prevent spread to others. It is alarming to note that these patients who are clustered into one cubicle are just physically separated from other patients by a half-length wall that stretches vertically to 1 meter high. Imagine the state of nosocomial infections arising from these hospitals! There is an obvious state of over-crowdedness with roughly 10-12 patients being located in the same cubicle together. With 6 cubicles per ward, you can estimate the number of patients being from as little as 60 to as many as 72. There is hardly enough space for the medical team to fit in between the beds let alone the visiting family members.

However, despite all the negativity, cynicism and pessimism one can extract out of what is said so far, there are a number of glittering goodness in the public health system. Firstly, the patients are given unprecedented treatment by the medical teams caring for them. Despite the endless stream of work to be done by the professionals, patients’ needs and complaints are always heard. There is no preferential treatment whether you are placed in the 3^rd class or 1^st class wards. The doctors will spend the appropriate amount of time with you and will make sure that you understand the management plan regardless of which ward you are placed in. In some cases, even phone calls are made to family members to set up a family meeting to discuss the progress as well as the future management plans of a particular patient. In terms of best evidence medicine, they are also not trailing far behind 1^st world countries. Many of the pharmacological interventions are in line with the latest guidelines as published in distinguished medical journals. Even the imaging technology is at par with most Western countries, but there is an obvious gap in terms of resources. They for one do not routinely screen patients using CT scans as what is practiced in the U.S.A for example. CT scan is just reserved for those who they think might benefit from its use. This hospital even has its own centre for continuous medical education; and holds medical conferences and seminars almost on a daily basis. With regards to the scolding, I suppose the specialist acted the way did towards the junior doctors because they were duty bound to train their apprentices so that they would match; if not, supersede their level of expertise in the years to come. Perhaps this is just an act to toughen them up in order to prepare them for the ups and downs in their upcoming medical careers.