“The majority of them are demeaning, I mean really demeaning,” a houseman told FMT. “They generally degrade you on most days, and the worst part of it is when the specialists and consultants compare you to interns during their times.”
She was commenting on remarks by Chief Secretary to the Government Ali Hamsa that housemen made up the highest number of civil servants served with termination notices. Ali said many housemen would disappear from work, at times for hundreds of days, because they couldn’t take the pressures of working in a public hospital.
The houseman said the stress she and her colleagues suffered came not only from the insults coming from their superiors but also from the expectation that interns should function like real doctors right off the bat.
“On the first day, you have something called tagging, which means you learn how things work by teaming up with someone who is already functional,” she said. “In some places you’re actually observed, but in other places you’re expected to be functional and still report to your superior.
“You’re talking about Day One, and when I say functional, it means you can come out with your own diagnosis and manage the patients you’re assigned to. You have to know how to take blood and do whatever else is needed, including giving medication.”
Another houseman, however, said he was not expected to make important decisions affecting patient care during his first day of tagging.
“Tagging, for me, was basically shadowing senior housemen in wards, knowing your way around and what you’re supposed to do as well as transitioning yourself to become a fully functional cog in the machine,” he said.
“You’re expected to learn on the job while you’re tagging. I agree, though, that close to no training is being given to housemen, but then again there’s not really a standardised training or tagging across the board.”
Although he had not personally faced any problems with his seniors, he said he had heard horror stories from other housemen.
“My experiences with seniors are actually quite okay, to be honest. But I do hear some stories where housemen mess up and their superiors just berate them in front of patients and visitors.”
He said work stress was expected in the profession.
“Housemen just need to learn how to manage the stress. Being a doctor is hard, and if you imagine it to be smooth and plain sailing from the get-go, then you’re not really mentally prepared.”
He acknowledged that it would benefit many housemen if they were treated with a little more respect.
“What needs to change in Malaysia is the hierarchical relationship between housemen and their superiors. I think if everyone just learns to treat each other more like colleagues like they do in the West, then we’ll have a much better working environment.”
According to the Malaysian Medical Council website, a houseman’s duty includes managing cases and performing simple procedures under appropriate supervision.
Housemen would have to take and check a patient’s detailed medical history while ordering and coordinating investigations, liaising with all members of the healthcare team to ensure effective patient management, and maintaining an ongoing record of a patient’s progress.
They are also required to discuss discharge plans with a patient’s general practitioner and other relevant healthcare professionals and, on a patient’s discharge, write a summary of investigations and treatment.