COMMENT It would seem that bashing of medical houseman is the unsavoury flavour of the day, and trending voluminously in the print and social media. These doctors described by consultants of the past as the “lowest form of life, even lower than the amoeba” must surely be going through some agonising times.

Some who have cracked under the pressure have been reportedly missing from work and increasing numbers are leaving the medical service. Both being major losses to our national “modal insan”.

The young has been perennially censured and lambasted by the older generation for being weak, lazy, spoilt and not up to the mark. Socrates complained of the young writing; “the children now love luxury; they have bad manners, contempt for authority, they show disrespect for elders”

Us baby boomers (1946 - 1964) were no exception and were at the mercy of the traditionalist or silent generation (pre-1946). Yet, it was the succeeding and younger generation who have trail blazed the art and science of innovation and created the brave new world that is today.

Perhaps, it is the “older generation” that ought to undergo a paradigm shift in their thinking of young people, their work culture, aspirations and dreams. Perhaps, the senior doctors in the medical service needs a radical transformation of their outmoded training strategies to embrace “star wars medicine” and deal with the millennial psyche of the Gen Y.

Hammering them with anecdotes of graveyard shifts and similar no longer sounds smart, let alone inspiring to the millennial doctor.

Sweeping generalisations

Undoubtedly, there will always exist problematic individuals in every profession. But to make sweeping and scathing generalisations of the housemen rank and file for the act of the irresponsible few is totally unjust and uncalled for. Instead of playing the blame game, we should focus on the attributable circumstances that might direct the various stakeholders to potential solutions.

The Malaysian Medical Council (MMC) moratorium on new medical schools should probably stay indefinitely and the current ones monitored closely to ensure no compromise in the quality of medical graduates. Medical schools should be strictly and regularly credentialed and those not meeting the minimum standards should be struck off the list of accredited medical schools.

Among the many other credentialing criteria, the MMC should pay particular attention to the affective domain of teaching and learning in the medical schools. Most medical educators are familiar with Benjamin Bloom’s 'Cognitive Domain Taxonomy', but few are familiar with the affective domain, which was first published in 1965.

One of the three domains of learning, it involves emotions, feelings, attitudes, motivations, values and qualities of character and conscience which should be similarly mainstreamed and emphasised.

It is therefore not surprising that the cognitive and psychomotor domains have been overwhelmingly stressed in the medical school curriculum at the expense of the affective domain, thus failing in the holistic development of the medical student.

The onus rests entirely upon all medical schools to not graduate and unleash into the healthcare system, doctors who are not only deficient in their basic medical and surgical knowledge and skills, but also defective in the emotions and motivations to serve and care for the sick and infirmed. Kudos to the few medical schools who would not qualify any one student who fails in the affective domain!

Harassed, intimidated and humiliated

The medical schools should be soliciting feedback from the Health Ministry on the performance of their graduates, which a few are already doing. The ministry should proactively reciprocate this request with objective key performance indicators (KPI) and should any red flags appear from any particular medical school, the MMC should be immediately alerted for further investigations.

The working ambience and culture in our hospitals needs to improve. Some of us who have had the benefit of undergraduate and postgraduate medical training in the UK, US or Australia, would very quickly discern our work experience with the 'Health Ministry style' of training of our junior doctors.

The housemen, the lowest in the medical hierarchy are not infrequently harassed, intimidated and humiliated by their senior medical officers, registrars, specialists and consultants. It is not too far-fetched to suggest that the local medical work culture is second only to the military in harshness and regimentation.

This unhealthy training tradition has since become entrenched in the health system, because the work ethos continues to be perpetuated by abused junior doctors who become abusive consultants.

There is a world of difference between what is considered as training and what is houseman bullying. Senior doctors need to exude more understanding, compassion and due care towards the most vulnerable in the medical tier and make the housemanship training period a genuinely learning and meaningful experience, if not enjoyable at the very least bearable working lives.

Except for the Islamic Medical Association of Malaysia (IMAM), I am extremely disturbed and disappointed that the other health related NGOs have not come to the rescue of the bruised and battered housemen. Congratulations to IMAM and the few health NGOs who have plugged the gaps in the medical student and housemen training by involving them in their medical camps, serving the marginalized populations, namely the homeless, Orang Asli and refugees.

It contributes towards character building, enhancing self-esteem, and unleashes the spirit of volunteerism, which is the bedrock of our noble vocation.

All other health NGOs and maybe even the ministry, should emulate IMAM’s series of Housemen Preparatory Courses, which goes beyond a houseman’s survival guide, preparing them for their future career pathways with active mentoring from IMAM’s alumni of distinguished consultants. Instead of complaining ad libitum about the lousy traits of the millennial doctors, they have taken it upon themselves to be part of the solution and not be part of the problem.

Housemen, persevere

At the end of the day, the buck stops with you, the houseman. You bear the ultimate responsibility, which in some circumstances may decide between death or survival of your patients, between an intact brain or a vegetative state of mind and between enhancing or damaging the nobility of our profession.

Many of my peers and senior colleagues have reflected nostalgically on their housemanship experience and narrated that those were among the best times of their professional lives and made them what they are today. Even the doctors (now big time consultants themselves) who were earlier described as the “lowest form of life” by their boss, wrote “we just take in one ear and out the other, we never felt humiliated, we even laugh it off afterwards” (I think they were just scared stiff and not assertive, ambitious and autonomous as today’s Gen Y)

Allow me to congratulate the overwhelming majority of the millennial doctors who have persevered despite the unrelenting battering and bashing from all quarters. Alan Alda aka Hawkeye in the TV series 'M*A*S*H', captures my very sentiments when he said to the Graduating Class of ’79 Columbia University;

“I congratulate you, and please let me thank you for taking on the enormous responsibility that you have – and for having the strength to have made it to this day. I don’t know how you’ve managed to learn it all. But there is one more thing you can learn about the body that only a non-doctor would tell you – and I hope you’ll always remember this: The head bone is connected to the heart bone – and don’t let them come apart.”

DR MUSA MOHD NORDIN is a consultant paediatrician & neonatologist at Damansara Specialist Hospital.

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