I STUDIED locally and did my housemanship in Malaysia. I am the head of a department in a hospital and also a member of the Academy of Medicine of Malaysia.
I am involved in the training of housemen. By virtue of this, I am not only qualified to comment on housemen, but more so about housemen in the Malaysian context.
I am writing this in the hope that the issue of the working hours and conditions of housemen will stop being a topic of public discussion or criticism. I will explain why.
I hope that if anyone still insists on commenting in the media, they will qualify themselves first to enable the public to adjudicate their comments or criticism.
There is a common misconception, even among housemen, that because housemen are being paid, they are working. This is not true.
Firstly, they are in training and have limited privileges and responsibilities.
Only after satisfactorily completing their training are they allowed to work as a doctor.
Secondly, the training of housemen, including duration of duty, should be decided by technocrats and professionals and not by the public or politicians.
This is because, as with other professions, fellow professionals will know best the requirements to develop the skills, knowledge and attitude to enter the realm of unsupervised practice of medicine.
Let me give a background information about housemanship training, which involves not just cognitive and psychomotor skills development, but also requires exposure to situations and extremes.
The American Graduate Medical Education's statement reinforces this point: "Residency is an essential dimension of the transformation of the medical student to the independent practitioner along the continuum of medical education. It is physically, emotionally and intellectually demanding, and requires longitudinally-concentrated effort on the part of the resident."
This form of training is best summed up as "experiential learning".
It means that learning and development are achieved through experience and involvement, by observation, listening, study of theory, or some other transfer of skills or knowledge.
In short, the training of doctors from students to housemen to doctors is a complicated process and should not be discussed publicly.
An analogy would be the training of airline pilots: the training hours or training conditions are debated by the public because it is considered a complex subject.
If I may boldly say, the training of doctors is far more complicated with more complex variables.
Thirdly, the negative implication of such comments is that it encourages housemen to work according to a fixed schedule, which is against the spirit of experiential learning.
It also causes doctors involved in training housemen to generalise and presume that the current generation of housemen is lazy, dispassionate or even calculative about its profession.
It also makes these doctors dispirited in teaching housemen.
The public -- in voicing their displeasure to the press, ministry or the government -- exert pressure on the profession to conform to public demands and not to professional demands.
I know that such generalisations are untrue because I have been fortunate to have had dedicated housemen who do not work to rule, but stay on even when they are off-duty.
They are guided by their desire to learn new cases or apply newly learnt skills, or to see the evolution and outcome of diseases in patients.
They realise that the opportunity for doing so is unpredictable and may not appear during the times they are supposed to be on duty.
They also have a sense of responsibility to ensure continuity of care to patients they are assigned to and with whom they have bonded. They exemplify the desired patient-doctor relationship, which is the hallmark of good doctors.
Because of differences that exist between hospitals, most of them will tailor the training of housemen to suit their situations.
The guidelines from the Health Ministry on housemen training serve only as an assist, which is what guidelines are supposed to do, but this is poorly understood by many people. This reinforces the fact that training is best decided by professionals, especially those working at that particular place.
The training hours of housemen in my hospital in Kajang has been quoted negatively in a letter to the media.
I would like to clarify that the duty schedule of housemen in my department of surgery is determined primarily by the housemen themselves, guided by goals and training requirements given to them by me.
The other doctors and I try to be involved in housemen training to ensure that their training is adequate because we believe this is an important aspect of experiential learning, too.
I must also salute the specialist and medical officers who are much fewer in number compared with the housemen.
They are true professionals and they are the ones bearing the responsibility for the housemen on top of their main duty: taking care of patients.
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