Health Ministry circular for doctors unhealthy

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It is every parent's wish for their children to become successful in their careers. My wife and I have gone through the hardship of studying medicine for five years. It was not an easy feat.

At the time, being medical students, we were expected to do a lot of things including clerking, procedures, examine and diagnose as well as to learn to make calculated decisions.

This was part of our training in preparation to become a new doctor or House Officer (HO). You can say that even as students, we were expected to 'work'or at least grasp the concept of 'working life' even before we had to.

We graduated and subsequently became House Officers that we've been helping out during our studies. Being a HO in our government centre is even harder than being a medical student. The working responsibilities and expectations are completely different.

Well, this is where the problems started. Previously, graduate doctors were expected to undergo only one year of compulsory Housemanship which consisted of completing four-month durations in three different postings (General Medicine/Paediatrics, General Surgery/ Orthopaedics and Obstetrics & Gynaecology).

As HOs, we are expected to come in every single day including public holidays with a total of nine days allocated for leave. After completing this grueling one-year period, many can finally breathe again as they will now become Medical Officers (MO).

Being an MO is no easy feat either as they are held fully accountable for any problems that may arise. However, MOs are allowed certain benefits that are not bestowed on HOs, for example having your weekends/public holidays off if you're not on-call.

However, all of these has changed in recent years. Our Ministry of Health (MOH) recently produced a circular addressing the need for doctors to now complete five separate postings in General Medicine, Paediatrics, General Surgery, Orthopaedics and Obstetrics & Gynaecology in that order.

Accordingly, another eight months have been added to the Housemanship period. On top of this, the circular states that doctors are no longer considered House Officers in their 4th and 5th postings but are now Junior Medical Officers (JMO).

Unfortunately, there is no proper implementation of this new rule and most government hospitals are applying it according to their whims and various needs. In most centres, doctors in their 4th/5th postings are asked to remain as HOs until informed otherwise.

This situation would be a common example. Dr K, in her fourth posting, and was asked to remain a HO for the first 2 months before being subsequently 'upgraded' to an MO for the remaining two months. She was then sent to her fifth and final posting where she is 'downgraded' to a HO for the first three months and later on 'upgraded again to an MO until the posting is completed.

Is this not an absurdity? Perhaps most government doctors are just too tired, too over-worked to actually start complaining regarding this ridiculous maltreatment. Maybe these doctors know that complaining about it will not get us anywhere or achieve anything.

If you ask any government doctors, most of them are sick and tired of the MOH creating ridiculous new rules that are supposed to be beneficial. Unfortunately, the welfare of doctors is often left neglected. There are several problems that have been plaguing government doctors namely:

1. The on-call system

It is inhuman for a person to work 36 hours straight and still expect him to make important life-saving decisions. In view of the rising number of medical doctors as well as the rising number of medico-legal cases, it may be time for us to re-evaluate the on-call system.

Changing this system does not mean a doctor will be less experienced or less exposed. As matter of fact, the shift system has already been adopted by several nations including the United Kingdom, Australia and New Zealand.

2. Proper implementation

The circular addressing Housemanship and changes should either be properly enforced or abandoned altogether. Presence of this circular without a proper definition of the roles involved allows various parties to make their own interpretation.

In some centres Junior Medical Officers (JMO) are considered HO/MO (a title which does not exist) and are therefore asked to perform 'double duties'. They are asked to perform HO work as well as MO work especially if there is shortage of personnel.

This flimsy HO/MO title is basically created so that manpower can be pulled and adjusted at the whim of superiors. However certain hospitals allow JMOs to move to other departments and become a full MO in that particular department without having to be a HO/MO first. These are the lucky bunch who would be able to pursue an area of interest ahead of the rest of the pack

3. Keeping doctors

The MOH constantly reports that we have a shortage of doctors, especially specialists. Many specialists are moving out from the government to the private sectors and even overseas because they cannot stand government service where your sweat and effort is not appreciated by the government itself.

The question the MOH should ask itself is: 'Why are our specialists leaving the government service?' and 'If we encourage others to come home and work for the government, how can we ensure they are willing to stay?"

It will not harmful to the MOH if they open their eyes and start to evaluate these areas. Doctors are only human and we, too, would like a little respect from our government.

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