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Tuesday, July 31, 2018

Bullying helps build doctors' characters


Junior doctors (I shall assume house officers) are in a period of training where they need to learn as much as they can in as little a time as possible before they become medical officers. In many hospitals in the country, medical officers are required to make life-death decisions and are expected to have a decent amount of surgical skill. This is the development of a doctor's character and this inevitably comes with some amount of correction from colleagues and superiors.
Navy Seals are subjected to rigorous training due to the nature of their job - they do not complain of bullying. Doctors may not need such high physical requirements but the mental focus and drive for excellence is similar to that of a Navy Seal.
There must be a clear distinction between bullying and discipline in that senior doctors who physically/mentally/sexually/emotionally abuse others should be disciplined heavily.
If you choose to pamper and pander to the whims and fancies of these people who feel "bullied", you have yourself to blame if you suffer in the hands of an ill-trained doctor.
I will now list down some issues that I feel are way more significant.
Ombudsman - besides the public, our own members of the health ministry also need an ombudsman to speak up for us. The reason for Facebook polls is simply because this ombudsman system is non-existent. The reason for the anonymity of this letter is because I have been threatened with disciplinary action and pay-cuts over any more letters.
The recent report of the sex predator that has been preying on junior doctors over the past few years is an example of the lack of a proper whistle-blowing system.
Now many are going to say - use official channels. "Listen to both sides of the story" and all that. Well, please wake up! When police reports are useless and reports to the ministry are useless what do you expect victims to do?
And why shouldn't the juniors be scared when the accused used to wave his phone around with ex-PM Najib Abdul Razak's number on it? There was no other way but to turn to the media under the cover of anonymity, of course. And even this is not a sure way of ensuring the perpetrator is brought to justice.
Imagine if it was your sister or daughter that was groped/molested and then told you but refused to reveal her identity. Imagine the hopelessness the victims are going through.
My challenge to you, the honourable minister is this - formulate a transparent yet protected system where anyone, any member of the ministry is able to write a complaint or a suggestion which will be taken seriously yet with confidentiality so as not to jeopardise his or her career.
Heads of service/departments/units - even the director general himself. The current unspoken rule/trend is that the most senior member in that unit becomes the head. This is an outdated and ridiculous policy. It has resulted in long-timers being "untouchable" in certain hospitals in the country.
Some hospital directors have been doing poorly but are not replaced simply because no one else of that pay grade is able to fulfil the position there.
Heads of departments/services are usually the most senior members there - it is very unusual to have a young doctor lead the unit/department. Is that not disempowerment and bullying?
My challenge is - establish a transparent, democratic system of choosing all your heads of services, units, departments, etc. For example, let all the orthopaedic surgeons in the country sit down and vote for their head of service. Let all the permanent staff (yes, including allied health staff) members of a hospital sit down and vote for their director.
SKT/LNPT is the Sasaran Kerja Tahunan/Laporan Nilaian Prestasi Tahunan which is basically a yearly review done for all ministry members by their seniors. This has caused juniors members to suffer from favouritism and low-performance marks simply because they are not favoured by their seniors. Is this not another form of bullying?
These low-performance marks translate into delayed promotion, delayed entrance into post-graduate programmes and affect the service of the ministry.
My challenge is this - revamp the yearly review system and allow assessment of each ministry staff by everyone in their unit, regardless of seniority. This would mean that a house officer is allowed to assess and write their opinions of a senior consultant. A junior nurse would also be able to assess and grade the senior matron of her unit. Marks are only given out after a fair consideration of all the assessments given.
Broken hospitals - are all over the country. A few letters were written over the past months about suboptimal infrastructure but little has been done about it. Falling operating theatre lights in a Hospital Likas still have not been replaced, Hospital Serdang is still waiting for the replacement of some equipment which is beyond economic repair, the list is endless.
Antibiotics often run out, forcing us to use alternative antibiotics for certain cases - resulting in suboptimal treatment of patients. Consumables such as disposable gloves, plaster of Paris etc. have been known to run out of supply.
My challenge is this - be willing to cancel the contracts and tenders of these companies/suppliers that have been failing the ministry. Award tenders to companies based on their ability to deliver and provide quality service and not on their connections. Set up a transparent and effective way of submitting feedback regarding their service.
My dear health minister - it is time to open the doors of your closed door meetings and listen not only to the junior doctors but the whole ministry.
There are many other more pertinent issues that actually make a difference to the service of the ministry that need looking at. Please do not waste too much time finding out why someone felt anxious after being scolded for causing a patient's death. Please realign your priorities and take appropriate action. - Mkini

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