Housemen not over-worked in hospitals

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

Malaysiakini

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".

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.

1MALAYSIA CLINICS: Lift our nurses' standards

2010/01/15

DATIN HATIJAH YUSOF, Honorary General Secretary, Malaysian Nurses Association

I REFER to the letter "Rethink 1Malaysia clinic move" by the Malaysian Medical Association (MMA) (NST, Dec 25). The Malaysian Nurses Association (MNA) supports Prime Minister Datuk Seri Najib Razak's choice of registered nurses (RNs) and medical assistants -- now known as assistant medical officers (AMOs) -- to run 1Malaysia clinics.

These clinics are to offer treatment for common illnesses, attend to minor ailments, and do follow-up treatment for well-controlled diabetes, hypertension and asthma, which RNs and AMOs have been doing for decades in rural and urban areas.

The public should be aware that RNs and AMOs have been the main providers of primary healthcare. There are simply not enough medical officers to provide healthcare to millions of Malaysians.

The MMA has expressed concern over the quality of medical care at 1Malaysia clinics. Nurses have been providing healthcare for decades, particularly in maternal and child healthcare.

They are all well-qualified public health nurses who have undergone a year's training in midwifery and another year in public health, apart from their three-year training as nurses.

The public should be aware that from day one in Malaysia, nurses and assistant medical officers have been the main providers of primary healthcare in the country for a long time. — Bernama picture

These nurses have five years of education and training and several years of experience before they take the public health course. Since 1996, nurses have not only been providing healthcare to mothers and children but also to the elderly, children with special needs, women and adolescents. We also provide mental healthcare.

As a doctorate candidate (PhD), I did field observation of RNs and AMOs in six states on their roles in early 2000.

It was obvious that RNs and AMOs were the main healthcare providers in all these clinics. While the nurses are champions in maternal and child healthcare, health education, prevention and promotion, the AMOs treat the general outpatients.

In most of the clinics, AMOs saw 90 to 100 per cent of the patients. The MMA can easily check such data at any health clinic. There are far too many patients for one or two doctors to cope without the help of these AMOs.

A morbidity survey of community health then and retrospective data of six months collected from each clinic showed that the diseases they sought treatment for were just common illnesses.

It is unbecoming of the MMA to run down nurses by saying that allowing nurses and AMOs to run 1Malaysia clinics would place "the standard of these clinics at the level of Third World countries".

The MMA is ignorant of the fact that in developed countries such as the USA, Canada, the UK and Australia, community clinics are run by nurses independently.

These nurses are known as "nurse practitioners" who are advanced-practice nurses with master's degree education or degree nurses with specialisation.

Is the MMA aware that we have several RNs who are PhD holders and that many have a master's degree? We have also quite a number with degrees and specific specialisation.

We also wish to inform that we are advocating that all RN training should now be at tertiary level. We want to be under the "professional group", not in the "supportive group".

We feel that diploma-level training is no longer suitable for RNs. Nursing colleges here should offer degree courses instead.

To give quality care, the MNA has recognised four areas of basic nursing competencies that RNs should possess.

These are problem-solving, knowledge-based practice, clinical competence, and accountability and ethical practice.

In the area of clinical practice, nurses should have clinical skills in physical assessment to detect medical abnormalities, skills in auscultation, palpation and percussion, just like the AMOs who have this special training.

Even though nurses lack clinical skills, experienced nurses would have no problem running a 1Malaysia clinic.

On the MMA's remark that we have sufficient doctors and that "2,000 to 3,000 new doctors are returning to our shores annually", I would like to ask: where are they?

The truth is, medical officers have to work very hard to meet patient care demand and are frequently on call due to a shortage of medical officers. They work straight on for 34 hours, which is inhuman. Also, apparently MOs are not keen to work in semi-urban or rural areas.

We predict that there will never be enough MOs in the Health Ministry as it is a hard life and less lucrative than working in the private sector or setting up private practice.

NST Online