Housemen have made headlines in the print and social media lately. Some who have cracked under the pressure have been reportedly missing from work, and increasing numbers are leaving the medical service.
We, the baby boomers (1946-1964), were no exception, and were at the mercy of the traditionalists (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.
Undoubtedly, there will always exist problematic individuals in every profession. But, to make sweeping generalisations of the housemen for the irresponsible acts of a few is totally unjust. Instead of playing the blame game, we should focus on the attributable circumstances which 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.
The MMC should also pay particular attention to the “affective domain” of teaching and learning in 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. It is one of three domains of learning, and involves emotions, feelings, attitudes, motivations, values and qualities of character and conscience.
It is 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 upon all medical schools to not graduate, into the healthcare system, doctors who are deficient in their basic medical and surgical knowledge and skills, as well as defective in emotions and motivations to serve and care for the sick and infirm.
Medical schools should be soliciting feedback from the Ministry of Health on the performance of their graduates, which a few are already doing. The ministry should proactively reciprocate this request with objective KPI and should any red flags appear from any particular medical school, the MMC should be immediately alerted.
The working ambience and culture in our hospitals needs to improve. The housemen, the lowest in the medical hierarchy, are frequently harassed, intimidated and humiliated by their senior medical officers, registrars, specialists and consultants. There’s a world of difference between training and houseman bullying.
Except for the Islamic Medical Association of Malaysia (IMAM), I am extremely disappointed that the other health-related NGOs have not come to the rescue of housemen. IMAM and a few health NGOs have plugged the gaps in the medical student and housemen training by involving them in their medical camps, serving the marginalised populations, namely the homeless, Orang Asli and refugees.
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 and survival of your patients, between an intact brain and a vegetative state of mind and between enhancing and damaging the nobility of our profession.
Alan Alda aka Hawkeye in the TV series M*A*S*H, captures my sentiments when he said to the Graduating Class of ’79 Columbia University: “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: The head bone is connected to the heart bone — and don’t let them come apart.”
Datuk Dr Musa Mohd Nordin,
Consultant paediatrician and
neonatologist, Damansara Specialist Hospital