By NASA MARIA ENTABAN
alltherage@thestar.com.my

LONG hours, constant stress, irregular diets and an endless stream of patients – this is the reality of a young doctor’s life. Recently, these worrying issues came to light following the death of a young doctor at the hospital where he worked.

An initial post-mortem indicated that trainee doctor Lee Chang Tat, 29, whose body was discovered with a used syringe nearby, died of a drug overdose. This led to in-depth investigations into what goes on in hospitals, resulting in widespread reports of abuse by hospital seniors, and overwhelming work schedules.

Whatever the cause of Lee’s death, there are many issues faced by young doctors in Malaysia, but many remain determined to see their housemanship period through despite the challenges that come their way.

Young doctors are overworked and stressed out

Being left behind

It takes at least five years to complete a medical degree, and graduates who wish to practise medicine in Malaysia must go through a compulsory two-year housemanship process in Government hospitals.

For many young doctors, by the time they are done with their internships they are in their late 20s, and find that many of their friends have moved forward in the professional, financial and social aspects of their lives.

While they spend a good seven years of their 20s studying and going into a workforce that sometimes takes them through 36-hour shifts, their peers have advanced to management levels in their careers and have already begun buying property, settling down and even starting families.

James Michael (not his real name), a second-year house officer working in a hospital in the Klang Valley, sometimes feels frustrated that his peers are progressing in the “game of life” faster than him.

“I have friends who have a more balanced working hours than me, and they get paid equal to me, if not better,” relates Michael, 26. “That can be a bit frustrating when you take into account the number of years spent to attain this degree only to be left behind in the rat race.”

When medical officer Siti Khadijah Abd Rahman, 28, completed her housemanship, she noticed that most of her friends had already gone on to the next stage of their lives.

“There is a gap. Most of my friends had at least one child, while others were already pursuing their masters degrees,” says Siti Khadijah.

Due to his hectic schedule, Michael has also lost touch with many friends as he simply has not had the time to meet up with them.

“I get to hang out with my very close friends once in six months when I’m off, but even then, many of them will be working when I’m not, or I’m just too tired to up,” he says.

Sherlyn Wong, a house officer in her second year of service, rarely gets to go out, let alone go on weekend getaways with friends, due to her schedule.

“My friends talk about relationships, marriage, buying property and so on while

I don’t even have time to catch up on the latest TV series,” says Wong, 26, half-jokingly. “Don’t even talk about partying or going out late. Most of the time it’s not worth it as I will be working late the next day, so I usually opt out.”

Struggling to cope

Working hours for house officers have been capped at 60 hours a week and they work in shifts but often, due to a shortage of personnel in hospitals, they end up working overtime. Sometimes, they work for 36 hours straight, or 10 hours a day for up to seven days in a stretch.

“It’s more stressful because if you mess up in a business deal you lose cash. In the medical line you can actually end up killing someone. Some young doctors don’t get the gravity or the responsibility of the job,” says Angeline  (not her real name), a 30-year-old medical officer.

Adds Michael, “Some adapt well and are able to get through this with no hiccup, but others are unable to cope with the mental and physical stress.”
Amid the stress and fatigue, some have to deal with bullying from seniors and trying to meet unrealistic expectations.

Michael speaks of vulgarities, taunts and insults being thrown at newbies for making errors, which make for low morale among his colleagues.

“Some seniors ridicule house officers to the extent that they need psychiatric treatment. Housemen are expected to get the job done with absolutely no experience, and that’s when it gets tough,” says Michael.

Nurul Ain Mohamad Kamal, 28, had her fair share of being overworked when she was a house officer.

“Our job description was wide. It included taking patients’ blood, doing ward rounds, carrying out orders, checking new admissions, making appointments and so on,” she shares. “But all in all these are things that you are expected to learn and you can only learn them by doing it hands on, not from textbooks.”

Doctors spend so much time worrying about their patients’ health, they often neglect their own in the process.

Some even talk about falling asleep at traffic lights due to the extreme exhaustion.

“When I had a very bad call, I took some time to sleep in the hospital compound before driving home. If we had mild illnesses, we just took some medication and continued working. Some colleagues had asthma attacks and were nebulised between patients!” recalls Siti.

“However, the situation improved when new house officers joined the hospital.”

With stories like this circulating, it’s no wonder many medical students studying overseas choose not to return to Malaysia to practice as they are probably worried about how it might affect them.
Medical student Aaron Yee is three years away from his housemanship and is already worrying about it.

“So far, I haven’t heard many positive things about doing our housemanship.

But one thing doctors have told me is that you’re going to be learning a lot, and that’s the only thing that’s positive to me at the moment,” says Yee, 21.

He adds that he is concerned about bringing accidental harm to the patients.

“Mistakes are made everyday by everyone but in the case of a doctor, one mistake could mean the death of a patient.”

Part of the job

The long hours and stress are a given in the medical profession, and doctors who have gone through the process say all the obstacles are what train you to become a better doctor.

“Yes, the working hours are long, you come back home just to sleep and wake up next day to continue working. But as a houseman, we need to accept that we are not going to have a luxury life, and it is only two years.

“The aim is to produce safe doctors, so it is part and parcel of a housemanship to be scolded by superiors, and it is better to take these scoldings as a learning experience than to harbour ill feelings,” says Siti Khadijah.

Nurul Ain believes the best training ground for a doctor is a Government hospital.

“It all depends on your effort and eagerness to learn. I’m glad I took the opportunity to do so during my housemanship as it made me what I am today – passionate and patient,” she says.

R. Jeyanthi, 29, who completed her housemanship several years ago believes many house officers just have to toughen up, but agrees that seniors and juniors need to start communicating better.

“Not only did my generation of house officers have a heavier workload than today’s generation, now we have to babysit these house officers who are a bunch of whiners. Our specialists have to entertain their complaints, please the directors to ensure the shift system is a success, while at the same time ensure patients’ safety and continuity of care,” says Jeyanthi.

While most young doctors are resilient enough to deal with the pressures of the job, they do have a “wishlist” that they say will improve their situation.

“First of all we need to constantly remind ourselves that we have to focus on the patients’ best interests. We need to foster good camaraderie and have a good support system. Maybe a buddy system or support group to help us overcome our hardships together,” Jeyanthi continues.

While the number of doctors is picking up, she also hopes that they will be distributed evenly.

“In many hospitals, everyone from the medical officers to the house officers and even nurses are overworked as numbers are inadequate. For us to be able to function better, we need a good work-life balance, and that can only happen when there are enough resources,” she says.

The bigger picture

Every job has its challenges, and according to doctors who have been through the housemanship process, you just have to grin and bear it.
Siti Khadijah constantly reminds herself that she is one of the lucky ones.

“As doctors, we encounter people from different backgrounds, and their lives enrich ours. When one sees a Down Syndrome patient, or a 20-year-old man who has lost both his legs, we ask ourselves ‘aren’t we lucky?’.

“It’s important to be thankful, to be able to appreciate every small thing in life,” says Siti Khadijah.

In medicine, only the strongest survive, and according to the young doctors we spoke to, only real passion for the job will pull you through your formative years in a hospital.

“I’m still green in this field, but honestly, it’s my patients that keep me going. When we are able to help improve patient’s conditions, that makes us happy,” Siti Khadijah shares.

Even the slightest improvement in a patient gives doctors the motivation to set aside the fatigue and stress and focus on what really matters.

“Last year a 64-year-old man came to see me to thank me for sending him for a scan, which revealed he had early stage renal cancer,” relates Siti Khadijah.

“That was one of the best days in my life, to know that I was able to aid in early diagnosis.”

Wong, too, has moments when she realises all the late nights and junk-food dinners have paid off.

“You get your fair share of patients who are ungrateful, you experience guilt and also grief when a patient doesn’t make it, but even a ‘thank you’ or a grateful smile from a patient or relative can brighten up your day,” she says.
Nurul Ain always goes back to the reason why she got into medicine – to help people.

“It is simply my passion. Seeing a patient get better gives you this indescribable feeling of happiness and satisfaction. We need to be reminded that every profession has their hardship. If it is too big a hassle, maybe it is not for you?”

*Worried about how doctors-in-training are being treated? Or do you think they need to toughen up and just get on with it? Tell us what you think by joining our #RAGEchat discussion today, 3:30pm, at @thestar_rage!