Sunday, April 12, 2009

Snippets from Suturing workshop with my house officers

This article began to formulate in my mind when I read about some stories on the deteriorating quality of house officers and doctors, especially in civil service, in recent years. When I glanced through MMC report on disciplinary actions against doctors, I realized that as the number of doctors increases in Malaysia, the number of bad apples and black sheep has increased in tandem. It’s a natural law of statistics.

At the same time, I have hope that some of the under-performing doctors will improve and change with time, effort, training and good guidance. It’s very important for us not to be demotivating and derisional, just that it’s natural for some of the senior doctors (especially perfectionist like yours truly) to feel very impatient when faced when people who learns slower (PWLS)

I face a substantial amount of PWLS daily. They could be house officers, staff nurses and even patients. Truthfully, I feel like giving up at times because some of them has skulls as thick as Hitler’s Eagle Nest bunkers.

Yet recently, the house officers in Ipoh seem to give me some hope that they are improving. Maybe it’s because my bosses are very patient and we give massive amount of teaching to them. In fact, I like to think that the surgical house officers face the highest amount of criticism and occasional scolding because surgical-related illnesses are life-threatening. Knowledge, skills and attitude need to be cultivated. I’m really encouraged by how the senior consultants seem to spend time in teaching the juniors in this department. This is a good culture and I wish one day that more surgeons will rise up from the ranks of current batch of house officers.

Some of the house officers, especially those from foreign universities, seem to be at a disadvantage when they first start work. It’s true that local grads have a headstart because they are shadowing house officers and managing patients under supervision even at final year of undergrad studies. Some of the foreign grads are not even allowed to set lines or take blood from patients as they were ‘foreigners’ I sympathize with them as their clinical skills start from almost zero. At the same time, for those who are willing to learn and have a good attitude, their learning curves are very steep and I am proud of some of them. Some of these foreign grads, the non-PWLS are now gaining trust and confidence as they catch up with some of their compatriots.

There are plenty of horror stories regarding how house officers are faring in public hospitals these days. My advice is that there are good doctors and there are bad doctors out there. The sanctity and nobility of the profession might be tarnished slightly by a few, but on the whole, there are still very brilliant, kind and nurturing doctors out there. If we highlight the role models and give them further encouragement, we might offer a glimmer of hope and these exemplary doctors will serve as examples for most of the junior doctors.

Doctors who are inspiring, high-achieving, brilliant and kind should be motivated to progress further in their career. They should not be discouraged by being thrown to the smallest, furthest districts or in departments they do not want. Sometimes, the amount of outwitting and maneuvers we see in the world of medicine is astounding. It rivals even Survivor or the Apprentice. Some of the people with the biggest cables but not necessary the best doctors for the job will get the best ‘postings’ in the hospitals they want.

My point is that transparency and accountability is very important in our daily lives. If we lack integrity, moral and good attitude, even the best education will not get us anywhere. Eventually, whatever wrongdoings we do, whatever mistakes we try to cover up, will get back to us and bite us in the back.

In closing, I do agree with POTS (from regarding the state of house officers from the countries up north when I first started working with them. I almost died of heart attack (!) when one of my house officers gave wrong blood to a patient that I was resuscitating, back in Teluk Intan days. However, I find that as I am exposed to a few more from the same university, I realized that some of them are quite good. I stopped being so judgmental and cynical now, and do put in more effort to help them improved. It's quite liberating when we are freed from no expectations at all. If I find that I cannot help them at all, I just end up doing everything by myself. Although it's tiring, it's safer for my patients in the long run, I guess.....


opkenny said...


Reading your blog gives me a rare insight of the quality of doctors we are having. Reading the horror story of the wrong blood transfusion really gives me the creeps. It would be reassuring to have doctors like you who are passionate and dedicated. Do keep up the good work!


the cili padi doctor said...

hey there

thanx for the encouragement. shall do my best since won't be serving Malaysians for long...with my upcoming plans ahead

opkenny said...


There goes the brain drain again.
Anyway, all the best to ya and keep on blogging!

PS: Whereabouts are you going to??
Furthering your studies or seeking for greener pastures abroad??