The issue of safety of young doctors in Malaysia has reared its head again in Malaysia. The issue recently resurfaced with an incident involving the unfortunate death of a house officer and the subsequent claims of the hospital “being the worst place to practise”.
As educators and practitioners, we are major stakeholders in any process involving the profession, and it is important that we begin to address this issue holistically and prevent any further incidents of this nature.
I believe that most senior doctors in the service do not subscribe to systematic bullying, and my own experience as a young doctor in the late 1980s and early 1990s bears witness to this.
The Scale Of The Issue
While it is recognised that workplace harassment is a problem internationally, the exact prevalence is hard to pin down, with figures ranging between 30 per cent to 95 per cent of junior doctors across the globe reporting having been bullied.
A local study published in 2021 reported the incidences of bullying among house officers who had completed at least six months of training at 13 per cent.
According to this study, graduating from an Eastern European medical school, working in a surgical (surgery and orthopaedics) discipline, and having poor English language skills increased the risk of being harassed.
Medical officers were most likely to be the perpetrators, followed by nurses and support staff. This could be because they have the most contact with junior doctors, and have enormous workloads as well.
There were no significant differences in age, gender, or ethnicity in the Malaysian study, but many studies indicate that younger doctors, female doctors, and doctors from minority groups are at increased risk.
Defined as a “repetitive process that is intimidating, abusive, and offensive”, systematic harassment can lead to impairment of learning, work, performance, and advancement.
It can lead to increased risk of depression or suicide, with a negative impact on patient safety and an increase in workplace errors and accidents.
The factors that have been identified as promoters of such behaviour are the perceived hierarchical structure in the practice of medicine, the gruelling training process, the passive acceptance of such behaviour as a functional education tool, and the culture of silence in reporting such behaviour for fear of recrimination (Samsudin, Ely Zarina et al. “Workplace Bullying Among Junior Doctors in Malaysia: A Multicentre Cross-Sectional Study.” The Malaysian journal of medical sciences: MJMS vol. 28,2 (2021): 142-156. doi:10.21315/mjms2021.28.2.13).
Combating The Problem
As such, it is crucial to educate young doctors to recognise and call out systematic harassment, increased awareness of what entails bullying, and how to report it.
We should establish clear expectations of what constitutes acceptable behaviour and harassment, either racial, sexual, or online, and there must be mechanisms that educate the workforce on workspace wellness, psychological safety, and overall wellbeing.
Clear, defined, and transparent pathways for intervention and reporting of harassment situations will protect all stakeholders (Smyth, Penelope. “An Institutional Approach to Harassment.” CJC open vol. 3,12 Suppl S118-S129. 25 Aug. 2021, doi:10.1016/j.cjco.2021.08.004).
There should be access to wellbeing resources that emphasise emotional wellbeing, good communication, leadership skills, stress relief, and conflict management.
Accessible mental health services to identify those at greater risk and provide them with the assistance they need would be greatly beneficial.
Programme directors and heads of department play a significant role in ensuring that mechanisms are in place to combat harassment. There must be a distinction between simply attending, teaching, and being taught.
The former is a hierarchical concept, and refers to a one-sided transmission of knowledge, while the latter emphasises a team-based effort, and accepting feedback and a team-based effort in patient care.
This would allow younger doctors to ask for help and break the cycle of hierarchy that has dominated medical education and training (Leisy, H.B., Ahmad, M. Altering workplace attitudes for resident education (A.W.A.R.E.): discovering solutions for medical resident bullying through literature review. BMC Med Educ 16, 127 (2016). https://doi.org/10.1186/s12909-016-0639-8).
We must accept that harassment exists in our workspaces. and that it has largely been ignored or ridiculed when brought to the attention of the authorities.
A larger issue that is even more important is the need to build resilience within young health professionals so that they will be able to call out wrongs and work together for a better working environment.
This must begin as early as possible so that our young doctors have the skills to:
- Build good relationships with their peers and superiors.
- Develop independence while recognising the importance of teamwork.
- Identify, manage, and express their emotions appropriately.
- Take on personal challenges and triumph over adversity.
Assoc Prof Dr Ganesh Ramachandran is the Head of the School of Medicine, Faculty of Health and Medical Sciences, Taylor’s University.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.