Trainee docs complain of overwork, shoddy treatment

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A group of Malaysian Young Doctors has written an open letter to Dr Ismail Merican complaining of work overload and shoddy treatment. Ultimately, patients suffer too as their care is affected by physician fatigue.

Dear Dr Ismail Merican,

You are either completely oblivious to the fact that — yes, housemen in Malaysia are grossly overworked and inhumanly treated or you are ignoring the obvious.

You need to get your feet down to reality and start taking the physical, mental and social health of Malaysian Housemen (HO) and Medical Officers (MO) seriously. After all, ultimately, all these affect patient care and, as the health DG, it is your 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 is 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. Most of our hospitals are denying the “off day” post call for their HO.

There is research from Europe and the US on non-standard 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 Malaysian HO and MO are serving an average 100-plus hours work per week, including 36 hours straight on-call. The resulting weight loss, social problems, health and safety issues (including a few near post-36 hours on-call car accidents). We aren’t the only ones affected — our patients suffer as well as their care is affected by physician fatigue.

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

Malaysia too needs to establish a regulatory body formed for the Malaysian health care 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 Americans AGCME.

There again, given the attitude and track record of our politicians and the higher-ups in the health ministry, we doubt this will ever materialise in the near future. 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.

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

Malaysian Young Doctors

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