Junior Doctors’ Quandaries – Dzulkefly Ahmad

Many MOH staff members are working in fear. Those in senior positions may not agree, but it is the truth.

The recent reports of bullying and sexual harassment speak of toxic working conditions in the health care system.

Young doctors are ostensibly not getting the protection they need. Given the tragic loss of lives and the litany of complaints on social media, more needs to be done urgently.

Shortly after I became the health minister in the Pakatan Harapan government, these issues immediately grabbed my attention. We coined the term “Junior Doctors’ Quandaries” when we first undertook to address the problems faced by house officers (HOs).

I told a post-Cabinet meeting involving Ministry of Health (MOH) staff during the early days that we will get to the bottom of this. We needed a deterrent approach to handle would-be perpetrators, and set in place a process for cases.

We worked to create a climate where young doctors could speak out. We visited three major hospitals, namely Queen Elizabeth Hospital in Kota Kinabalu, Selayang Hospital, and Sultanah Aminah Hospital in Johor Bahru, and had separate engagements with the HOs, medical officers (MOs), heads of department (HODs), and specialists.

It was then when a serious case of bullying and harassment emerged, involving a senior HOD at a major specialist hospital.

Only then did l suddenly realise how difficult it was to bring the culprit to book. Firstly, we undertook a preliminary finding, and with prima facie evidence established, we then formed a full inquiry committee of abled and experienced senior MOH staff. After a through investigation, the Yang di-Pertuan Agong can terminate his service.

Arguably, there is a culture of fear that permeates the entire system. Part of this is arguably set by the MOH’s top brass, which have repeatedly reprimanded officers for speaking out and raising concerns.

Admittedly, it is also systemic, as junior doctors are vulnerable to be bullied by those in more senior positions, who have sweeping powers to control career paths:

  • Junior doctors’ career paths (in government service) depend heavily on their yearly appraisal (scored by their immediate superiors).
  • There is always a fear of not getting permanent positions (many are on contract).
  • There is also the fear of not being selected to undergo specialisation training.
  • Junior doctors can also be transferred out of their current workplaces, or be denied entry to a place of training of their choice.

Many MOH staff members are working in fear. Those in senior positions may not agree, but it is the truth. Testimonies by those that have retired speak volumes.

Rather than dismissing the ongoing criticism, now is the time for the MOH to take action. The following are some observations and guidelines which can be used to address the issues.

There should be a zero-tolerance policy on workplace bullying, harassment and intimidation. Be brave and undertake appropriate action as per the standard operating procedures (SOPs) if one is bullied. The grievances and complaints of junior doctors must be addressed promptly, sensitively, and their identities protected. Reinstate processes that allow junior officers to report on their senior officers, without fear of punishment.

Establish a full inquiry committee to review the issues in the public health care sector.

Recognise that no system is foolproof. Be humble and be prepared to rectify the faults within the system. Not all faults can be fixed at one go, hence continuous improvements are needed.

In all fairness, the problem is not one-sided. Senior doctors also face challenges caused by problematic HOs. These need equal attention. Therefore, processes put in place need to function at multiple focal points.

The Terms of References (TOR) and SOPs of a healthy work culture must not be limited to only hospitals, but also be applicable to the entire MOH. It should not only cover junior doctors, but all levels of staff. A toxic work culture can exist even at the MOH headquarters at Putrajaya, and even at the respective state and district health departments.

Leverage on the “Let’s Talk Minda Sihat” programme which the MOH has relentlessly championed to address mental wellbeing of Malaysians. It is crucial that the MOH ensures that its own staff are able to benefit from the objectives of this programme.

Finally, the buck stops at the highest levels in office, namely the health minister, the director-general, the state directors, and the HODs. As stated by a former MOH senior officer: “Appropriate work culture must be championed by all hospital directors and HODs on the ground.”

Many tend to remain silent, even when bullying is occurring blatantly. It often starts from the top, but the solution can also come from the top.

Those at the top need to take a hard look at how they have contributed to toxic work conditions and work to address these issues.

Trial by media and social media will only cease or be minimised if due processes are followed fairly. These issues cannot continue to be allowed to worsen.

The solution is in your hands, and you have nothing to fear if you are doing your work fairly and righteously.

Those in the health care sector must set an example and assure a healthy work environment, not just for junior doctors, but for all Malaysians.

Dzulkefly Ahmad is the current Member of Parliament for Kuala Selangor and a former health minister.

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.

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