Stop racial and other abuse of house officers

The recent case of abuse, which may have caused the death of a house officer who fell from a multi-storey building, has yet again put in the spotlight the unfortunate plight of house officers who face all kinds of pressures during their training, including long hours and atrocious work conditions.

That’s bad enough as it is, but recent reports suggest instances of extreme racial, verbal and even physical abuse at Penang Hospital, which is a strong indication that not only has the situation not improved but has considerably deteriorated. They indicate civil rights violations and racism to boot.

The Vibes report said: “Speaking on condition of anonymity, he (a former houseman) said that those from a particular community enjoy privileges and are treated with kindness by seniors from the same community.

“Housemen who are from the particular community and speak the same language are taken care of by medical officers (MOs) who belong to the same community, '' he added.

“These MOs, who also trained other housemen from different communities, gave negative remarks in their assessment of the ‘others’, even in the reports that were submitted to the specialists.

“He claimed that during ward rounds, the MOs would speak in their own mother tongue, which only a particular group of people understood. The other housemen would need to ask those who understood what transpired to translate for them.”

Reports have tip-toed carefully over the racial identities involved but it is understood that the discrimination in this case stems from senior Chinese doctors. The allegations are shocking and it is good to know that the Health Ministry has set up a task force to fully investigate this.

If found to be true, drastic measures need to be taken to ensure that abuse and racism in the treatment of house officers are snuffed out, those responsible brought to book (including dismissal), a reporting mechanism for abuse put in place and the legitimate rights and aspirations of all house officers are fully protected.

We are a multiracial country and we should ensure that no community engages in systematic discrimination against another community. All assessments of staff everywhere should strictly keep race out of the picture.

Blanket profiling

What is surprising is that there are those, who obviously are senior doctors, who defend this system and blatantly advocate blanket profiling of house officers who in their eyes come from lesser-known institutions and less affluent communities, ignoring the fact that these people qualify from institutions which are recognised by the government.

This letter to The Vibes is an example. Among the things the letter says are the following: “There are quite a number of good housemen who are there for the right reasons, but end up picking up the slack of their lazy, incompetent, and spoilt-brat colleagues. This adds to their workload and demotivates them, especially when these half-baked housemen are so-and-so’s sons or daughters.

“Instead of taking them to task, the superiors play it safe and pile more work on the good housemen. And this is why our once-stellar healthcare standards are being compromised by a new generation of doctors who come into the service hoping to relive episodes of ‘Grey's Anatomy’ then realise that it is not all glamour and celebrity.”

This blanket profiling of the majority of housemen as “lazy, incompetent, and spoilt brats” is at the heart of the problem. Instead, senior doctors need to be taught to address the behaviour of house officers and correct it instead of regarding them as useless even before they are given a chance.

Also hard to understand, of all people, is the president of the Malaysian Medical Association Dr Koh Kar Chai, who said that there are only a handful of serious cases involving house officers who have been bullied.

Even a cursory reading of news reports indicates that is not the case, especially at the Penang Hospital, and the situation warrants serious investigation and rectification. Did Dr Koh do an investigation of his own to ascertain the situation?

But shockingly, this was what Dr Koh said, according to the FMT report: “He called for better screening of prospective students to determine their suitability and prepare them for the hardships of being medical practitioners, stressing that the nature of the job was not a ‘rosebed’.

“He said ‘harsh words’ were expected during housemanship training because of the stress of the job and to ensure trainee doctors perform their duties competently. ‘Many of us do not say it is bullying because it is part and parcel of learning,’ he said, adding that harsh words were expected in any workplace.”

As MMA president, instead of launching an investigation and leading the move towards a reform of the dire predicament facing house officers, Dr Koh is justifying the instances of bullying instead!

Disturbing views

In a letter to FMT in January this year before the latest news reports, Malaysian Medics International (MMI) which represents Malaysian medical students worldwide, said that 80% of house officers experience bullying.

MMI said: “House officers (HOs or housemen) are the first to tend to patients in hospitals. When HOs are poorly treated and denied support, patient care will inevitably be affected. According to surveys by the Malaysian Medical Association and Doctors Only Bulletin Board System (DOBBS), up to 80% of doctors in Malaysia have experienced bullying while serving in the public sector.

“Of these doctors, 71% experienced symptoms such as anxiety, loss of confidence, and hyper vigilance, while 17% considered suicide. These are findings which are indeed disturbing.”

Yes, they are disturbing indeed but equally disturbing if not more is the apparent reluctance by some senior members of the medical fraternity, including the MMA president, to come to terms with it and devise a solution.

This extract from the MMI letter is worth quoting: “Our healthcare system must endeavour to train our junior doctors and retain specialists to protect the wellbeing of the rakyat. Besides that, our HOs are often overworked and underpaid.

“The act of seeking help or advice is often unjustly seen as a sign of incompetence and may come with repercussions, including the possibility of extension.

“These barriers to learning, among many other reasons, make it extremely difficult for housemen to improve. This makes them susceptible to the current culture of humiliation, bullying, and derogative behaviour from superiors that is perpetuated by the acceptance of such acts within the community.”

Well articulated, it is a plea to the profession to do something about the systematic bullying and discrimination of house officers. Even in the so-called good old days, house officers complained about the bullying and the punishing work schedule they had to go through. But if it has changed over the years, it is for the worse.

Now this bullying is exacerbated by an ingrained prejudice against the majority of house officers, with strong racial overtones, by some senior doctors who mistreat them routinely because the house officers are at their mercy and have no recourse to complain without being blacklisted.

Enough is enough - once and for all deal with the house officers’ problem and settle it. Otherwise, see the continued deterioration of the public health system - and the continued rise of racism in the country. - Mkini

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P GUNASEGARAM, a former editor at online and print news publications, and head of equity research, is an independent writer and analyst.

The views expressed here are those of the author/contributor and do not necessarily represent the views of MMKtT.