Wanted: Positive working culture at public hospitals

 

From Moaz Nair

The general perception is that unlike hospitals in the developed countries, being housemen in Malaysian hospitals can be very stressful.

The stress, according to studies, is partly attributed to an overloaded, understaffed and underfunded public healthcare system.

On the part of the housemen, it is understandable that they must work longer-than-average hours to acquire skills and improve their competence. Nevertheless, their general claim is that there is no balance that protects their wellbeing and mental health.

Of late, claims of the prevalence of a bullying culture in departments in Malaysian hospitals have received wide coverage in the media. Numerous complaints from housemen created a stir in the local newspapers. Even parents chimed in to complain of the stress and anxiety faced by their children working as housemen.

The death of a 25-year-old Penang Hospital houseman from a fall outside his residence on April 17 prompted a debate in the medical fraternity on an alleged noxious culture of the bullying of housemen.

Emotionally drained

Studies have shown that prolonged stress through the hypothalamic‐pituitary‐adrenal (HPA) axis results in suppression of the immune system, thyroid function, deterioration of memory and depression.

Apart from its effect on the physical and mental health, medical personnel can be emotionally drained due to stress and this may affect the quality of care delivered to patients.

Extreme tiredness resulting from mental or physical exertion also exposes housemen to the risk of having hidden psychological stress-related disorders.

When housemen are presented with work demands and pressures that are not matched with their experience, this would challenge their ability to cope. It can affect decision-making while dealing with the needs of the patient in an emergency setting.

Studies have shown that the prevalence of stress that have led to anxiety and depression among housemen were found to be significantly high. The main sources of these symptoms among housemen were attributed to poor work and social life balance, uncooperative non-clinical personnel, the fear of making mistakes, work overload, high patient load, frequent night duties, sleep deprivation, uncooperative colleagues and lack of recognition.

Most housemen were stressed with the high amount of night duties and long working hours they were needed to take charge of. Frequent night duties would naturally deprive housemen of their much-needed sleep. After a tiring schedule with high patient load, sleep deprivation and being under constant stress, housemen are prone to make mistakes. A stressed houseman can be a danger to the patients’ wellbeing.

Some were demoralised when they were rebuked by medical officers in front of patients and this can be seriously hurtful to their esteem and also prevent them from carrying out their duties with confidence. Worse still, this might cast doubts in the patient about the capabilities of a houseman. What more when they are constantly harassed in an abusive manner, rather than guiding them or correcting their mistakes in a professional manner.

It is thus justifiable to perceive that stress, anxiety and depression have demoralised many housemen in public hospitals. Better working hour schedules are suggested to alleviate their stress. Improvement to the Flexi Hours Shift System (FHSS) with less stressful working hours and better scheduling and duty roster system can prevent housemen from being excessively stressed at work.

Be treated with esteem

Understandably, doctors in general are more prone to stress, anxiety and depression, it turns out, than any other profession. But studies have shown that in the hierarchy of a clinical management team, a houseman is found to be suffering from these symptoms the most. Their working conditions are more stressful and demanding than anything others have to deal with in a day at the office. What more, these housemen claim that it is difficult for them to get personal leave or even apply for one.

Stress in the medical profession is just unavoidable. The realities of dealing with another person’s life as a doctor can at times be unnerving. Doctors are expected to be directly responsible for the health of patients under their care. Inevitably, for the housemen, this is a striking difference to years spent in the medical school where they were not responsible for the management of patient’s health.

No matter what, there has to be an effective working of the hospitals and improving the workplace atmosphere for the house officers. These house officers are going to be the future medical officers and consultants and they should be treated with esteem. The country cannot afford to see house officers, after their long medical studies, quitting their jobs due to stress, anxiety and loss of confidence.

There are always ways to teach and motivate housemen without bullying, being abusive or discriminatory. Medical officers and consultants should extend a professional approach towards the junior medical officers. The health ministry, on its part, should adopt and implement firm steps to create a healthy working environment in public hospitals to promote a conducive work culture that encourages learning and growth.

There has to be a positive working culture in public hospitals so as not to demoralise young doctors. The wellbeing and the work quality of healthcare staff in general should not be affected so that patient care is not affected. - FMT

Moaz Nair is an FMT reader.

The views expressed are those of the writer and do not necessarily reflect those of MMKtT.