KUALA LUMPUR, Sept 27 – Dr River (pseudonym) was talking about staff shortages at Selayang Hospital’s emergency department (ED) and an argument they had with a patient’s accompanying relative about toilet facilities.
The Selayang Hospital medical officer lamented to CodeBlue about how many patients’ accompanying family members did not understand just how understaffed the ED was, like how there would often only be one medical officer taking care of the entire Green Zone (non-critical) that’s overwhelmed with 30 to 40 patients.
So when a patient’s accompanying relative demanded access to a patient-only toilet at the public hospital, Dr River lost their patience, admitting to CodeBlue that they were rude with the woman, but only because “she was rude to me first”.
Harassment or verbal abuse from patients and accompanying relatives, according to the government doctor, did not occur on a daily basis, but was getting more frequent these days.
When asked if they felt like they were working in an unsafe working environment, Dr River said: “Certain times when there are a lot of patients and I’m alone in a zone, yes. It feels like a time bomb; anyone can explode anytime.”
Coincidentally, during the recent phone interview, the sound of a man yelling could be heard in the background. Dr River told CodeBlue, “Yes, it’s a patient”, before saying they had to go as they hung up.
Three medical officers at Selayang Hospital in Selangor, including one who quit in August, highlighted the dire shortage of doctors – particularly after the July 31 nationwide relocation exercise of more than 4,000 medical officers – as well as frequent abuse and harassment from patients and accompanying family members frustrated by long waiting hours in an understaffed emergency unit.
CodeBlue understands that at least two police reports were filed by Selayang Hospital staff against patients’ accompanying relatives in the past two years for their own safety, including one this month for verbal abuse. Another police complaint was filed in 2021 in a case of physical assault, where a patient’s relative allegedly grabbed an emergency doctor by the neck and kicked him.
‘I Did Feel Unsafe, Especially Working In The Green Zone’
Dr Cameron (pseudonym) resigned from the Ministry of Health (MOH) last month; the senior medical officer, who worked in the public health service for six years, last worked at Selayang Hospital, where she had been employed since 2021.
Many doctors at the MOH hospital, she claimed, began quitting since last month; resignation rates had spiked after the Covid-19 pandemic, when eight to nine medical officers quit by the end of 2021.
Dr Cameron complained of harassment from patients or patients’ accompanying relatives on an almost daily or weekly basis, such as verbal abuse.
“I did feel unsafe, especially working in the Green Zone, because that’s where the patients and their families wait together. And the ones who usually make a lot of fuss and scold us are the family members. Sometimes patients, but mostly family members,” she said.
“They would scream at us, slam the door in our faces, threaten to even record us, claiming we were not doing our work. So a lot of things and we have to handle all of this calmly as we don’t want to cause a scene. And we want to continue working; that needs mental strength.”Anonymous medical officer, Selayang Hospital
She explained that the waiting time to see a doctor at Selayang Hospital’s emergency department is five to six hours at least. “So the fact that you get to see a doctor in three hours is quite fast.”
Dr Cameron also questioned why blood results at Selayang Hospital – the first paperless tertiary hospital in Malaysia whose electronic medical record (EMR) system has now fallen into disrepair due to the lack of upgrades – take six hours.
“Even at the most ulu-est district hospital, blood [results] come out in an hour,” she said.
“I don’t know why the hospital system at this hospital [Selayang Hospital] is really faulty. We are the ones dealing with patients. We have to explain to them. When that happens, they’re not satisfied; it’ll backfire on us.”
She added that Green Zone (non-critical) cases at Selayang Hospital — the national tertiary referral centre for hepatology — usually come with complications, including post-operative cases or hepatobiliary conditions (diseases of the liver and biliary system), such as gallstones and jaundice. These complex cases – albeit the patient having stable vitals – are not the simple cough and cold problems.
Dr Cameron explained that it takes about 15 to 20 minutes to manage one patient, due to the need to key in all investigations for documentation and medico-legal purposes. “We can’t speed up the process. That’s just how it is.”
Selayang Hospital’s Emergency Doctor Workforce Halved In Two Years
Dr Cameron said the straw that broke the camel’s back was when medical staff couldn’t get leave, doctors were quitting, and there were no housemen at all while staff nurses were insufficient. Medical officers were forced to “do everything” – from taking patients for X-rays to tracing blood investigation results at the lab.
“How many things can one person do?” she told CodeBlue.
She said house officers were only brought in for reinforcement by the time she quit; and it was still insufficient then. “We’re all basically very tired. We’re just exhausted.”
“The patient load kept on increasing and patients demanded a lot. My mental health was going down the drain. Honestly, I couldn’t take it anymore.
“Even though there are very few people at work, no matter what, patients come first. Their life is in your hands. The pressure – when things happen and you can’t save the patient, you have to deal with that, plus the documentation and whatever medico-legal stuff – it’s not easy.”Anonymous medical officer, Selayang Hospital
Dr Cameron pointed out that Selayang Hospital lost doctors to transfers in the recent permanent appointment exercise last July 31, but did not receive any permanent placements for medical officers. CodeBlue reported that nearly 120 medical officers were transferred out of Selayang Hospital.
Another Selayang Hospital doctor told CodeBlue that nearly 20 medical officers were transferred out of the ED alone, leaving just 30 there, half of the 61 medical officers that the emergency room used to have two years ago when she joined the government tertiary hospital. Yet, patient load remains the same or seems even heavier.
Currently, Dr Cameron is happy working at a private general practitioner clinic, after previously suffering sleep problems and anxiety when she worked at Selayang Hospital, to the point that she was crying whenever she went to work, especially for on-call duty. She now plans to go into aesthetics.
“I tried to be strong, but I was not one of the strong ones. I’m hoping my [former] colleagues can make it.”
The Main Problem Is Manpower Shortage
Dr Carter (pseudonym), a medical officer at Selayang Hospital, stressed that the main problem at the hospital’s emergency department was the severe staff shortage leading to long waiting hours that triggers harassment or abuse of medical staff.
“We doctors face harassment from patients and their relatives every day and in return, more medical officers have decided to quit MOH,” Dr Carter told CodeBlue.
“From a doctor’s point of view, we are trying our best to give our best to all patients, but we are only human; there’s only so much we can do. But patients and their relatives don’t seem to understand the lack of manpower, so they always harass doctors to work faster.”Anonymous medical officer, Selayang Hospital
Dr Carter said the Red Zone (critical) with two medical officers gets about 10 to 12 new patients per shift. In the Green Zone (non-critical), one doctor sees around 20 to 25 patients per shift. There are usually only one or two medical officers in the Green Zone.
There are three Yellow Zones (semi-critical) at Selayang Hospital, one of which usually has two medical officers stationed, while the other two zones have one doctor each. The Yellow Zone gets around 25 to 40 new patients per shift.
These staffing figures are on a “good day” if no one takes medical leave, Dr Carter pointed out. The patient figure estimates also exclude patients carried over from a previous shift. Compared to 2021, one doctor now handles the workload of three.
Dr River claimed it was extremely difficult for medical officers at Selayang Hospital to take leave, even medical leave – without a “really really valid reason, not beg per se” – and without finding a replacement first.
‘Why Are We Getting Pulled Into Some Family Drama?’
Dr Carter said most of the abuse by patients and accompanying relatives towards doctors at Selayang Hospital was in verbal form.
“Sometimes they keep knocking on consultation doors, sometimes they confront us in the zones. In some cases, they shout at us regarding the system being late.
“The situation gets very tense, where you just have to walk out of the room. It’s very sad – to think you’re a doctor, you’re a professional, and people are just, like, abusing you – but in return, you get paid so little.”Anonymous medical officer, Selayang Hospital
Dr Carter highlighted how doctors even get caught up in patients’ family conflict at the emergency department, such as when multiple family members demand updates for one patient, even though the doctor has already briefed one accompanying relative.
“For example, the patient’s first son will come and ask, then you update fully. Suddenly, the patient’s second child will come and ask for an update. If we say, ‘why don’t you get the update from your elder brother?’, they will say, ‘why don’t you want to tell me?’ or even worse, ‘I’m not talking to my brother’.
“Why are we getting pulled into some family drama? We have, like, 20 patients in that one small zone. If it’s one to two patients, I don’t mind updating the whole family.”
Dr Carter added that patients were also impatient despite the severe lack of manpower in the ED, who said things like: “I’ve got other work to do after this”, which, to Dr Carter, showed the lack of importance Malaysians placed on their own health. “If you’ve made other plans and all, and you’re coming to get treatment, it’s not fair.”
“I’m not saying like, oh they have to wait two to three days to get proper care. I’m not saying that. I understand their point of view — everyone wants fast service — but it’s so impractical.”
Dr Carter claimed that staff nurses and medical assistants at Selayang Hospital are also working double shifts. “So everyone is tired.”
A cross-sectional study published last May in the IIUM Medical Journal Malaysia by Kavita-Jetly, Arvinder-Singh HS, and Amar-Singh HSS – which was conducted among 316 doctors at all EDs of 14 major state tertiary government hospitals throughout Malaysia – found that a whopping 98.7 per cent experienced some kind of bullying (98.1 per cent faced verbal abuse).
Among those bullied, 83.7 per cent of doctors reported verbal abuse to be the most distressing event. Most of the preparators of the distressing incident were by accompanying relatives of patients (62.1 per cent). The study was conducted in the emergency department because the ED was deemed to have the maximum number of patient encounters.
Health Minister Dr Zaliha Mustafa, Selangor state health director Dr Shaari Ngadiman, Selayang Hospital director Dr Afidah Ali, and MOH Putrajaya did not respond to CodeBlue’s requests for comment at the time of writing.
CodeBlue is providing anonymity to Dr River and Dr Carter as civil servants are prohibited from speaking to the press without prior authorisation. Dr Cameron is also not identified in this story because she fears reprisal against her former colleagues at Selayang Hospital if she were to go on the record.