More on Training of Young Doctors in Malaysia

Further to my previous post, two opinions in subsequent editions of the Star are given below:

Docs in Good Hands

I WOULD like to refer to comments and SMS messages in response to the report “Sick doctors” (Sunday Star, Nov 30) and the letter by Dr T. K. Khoo from Iowa, US “Housemanship can drive you crazy” (The Star, Dec 1).
The writer’s comments on the working conditions in Malaysia were very unfair. The working system here is totally different from that of the US or any other western country.
In most places in this country, we are still very short of doctors and other health professionals; still lack modern health infrastructure and facilities and have to deal with overcrowding
Therefore, we cannot avoid working long hours. In order to practise the shift system, we need a very large number of doctors from housemen right up to specialists and consultants. The public hospitals and health centres just cannot cope with that.
Despite the working conditions, many improvements have been made to ease the burden of doctors. These include increased renumeration for junior doctors; more allowances; sponsoring of registration to conferences and call allowances etc.
Now, about the “public yelling, abuses and dressing down”. Just because you saw it once, it does not reflect the situation in the whole country.
The working conditions for housemen are now far, far better than what it was 10 to 20 years ago. This so-called inhumane treatment by seniors is mostly a thing of the past.
The majority of housemen receive good guidance and supervision, and now with the new system in which a specialist is specifically assigned to a group of housemen as supervisor/mentor, they will be even better treated and trained.
Of course I do not deny that there are a few bad apples amongst us who treat juniors very badly. But please look at the other side of the coin.
The quality of medical graduates now is definitely on the decline. Nowadays, we have to deal with discipline and attitude-related problems. Some of the housemen have poor work ethics; they come in late, go off early, are very choosy about postings and refuse to do what is expected of them.
We can thus expect them to respond pretty badly like breaking down and crying; there are also those who call in their parents to confront the consultants for giving them a bad time. Some go into depression, even to the level of becoming neurotic.
Those who do well during housemanship rarely have problems with the seniors. Even if they are reprimanded, they can take it in their stride.
Let’s face it; working as a doctor in a public hospital, especially at junior level, is definitely tough and demanding.
I do not advocate training junior doctors in an inhumane manner. But do not tell me that a yell, like a parent reprimanding their kids for making mistakes, is also out of the question.
How else would you train these junior doctors, especially when a patient’s life is in their hands? I would rather yell and rattle them a bit to toughen them up so that they remember their mistakes for life.
GOVERNMENT DOCTOR,
Kuala Lumpur.
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Be aware of challenges facing medical students

I REFER to two recent reports in The Star, in particular the Sunday Star front page headline “Sick doctors – at least five found to suffer from mental woes every month.”
The report may sound alarming, but nevertheless it is a reality that mental health problems affect all strata of society and doctors are no exception.
The sad truth is there is still so much stig­ma attached to mental disorders, resulting in people delaying or not seeking help and getting the appropriate treatment.
The National Mental Health Registry report on schizophrenia for the period 2003-2005 showed that on average, it took a period of 28 months for people suffering from schizophrenia to seek treatment from the onset of first symptoms.
It is believed that many people who suffer from depression, anxiety or other disorders suffer in silence while people around them pretend that there is no problem.
Undetected or untreated, people with mental disorders live with limitations in their mental and social functioning, besides suffering distress in their daily lives.
Schizophrenia, one of the more severe forms of mental disorder, is a chronic dysfunction of the brain which is the result of a combination of psycho-biological and socio-environmental factors.
It is not due to the fault of anyone, just like other chronic diseases such as diabetes mellitus, hypertension or bronchial asthma.
Many mental disorders are often triggered by stress or adaptation difficulties in new environment. Early diagnosis and treatment is essential to limit mental and social dysfunction associated with the disorder.
Medical students are subjected to tremendous stress during their studies, what more in a foreign country and having to learn a foreign language as well as adapting to a new culture.
They are subjected to further stress during housemanship training. Therefore, it is desirable that parents and students themselves be aware of the challenges of a medical course and medical career, and weigh their readiness before embarking on it.
The Malaysian Mental Health Association would also like to urge the public to be aware of, and be supportive of people with mental health problems.
For those who suffer from mental disorders, do not fear or feel ashamed of your problem. Seek help from a counsellor or a doctor, and get early treatment.
DATIN DR ANG KIM TENG,
President,
Malaysian Mental Health Association.

The second opinion should be treated with caution as not all people with depression end up as mental patients.To be depressed for one to two days may be normal but if a person is depressed for longer than 2 months, then there is a problem.

There are other ways to soothe depression before you seek professional help. Maybe you can seek God's help (through Zikir and Quran recitation for Muslims), or have slow talk with close friends and family and people in similar situations. Family and peer support is a great help. After all housemanship does not last forever. Even in the US, interns face the same problems of having to work 30 hours in a stretch.

Doctors have to have passion to help and keep up with the antics of ill people. They must keep the reason and objective to be doctors at the back of their minds and see the challenges as a means for them to be groomed to be great doctors of the future. Anyway, the training of doctors is not like other professions. Life itself is a non tradeable and irreplaceable commodity. Doctors cannot afford to risk making mistakes. That's why we must understand the harsh training they have to go through sometimes.

A tip for young doctors... If you have done well in your training, (in theory and in clinical practice) and you are sincere to serve and learn, you can take all this in your stride. Those with discipline and ethical problems are not cut to be doctors anyway.