Stop Reacting And Start Giving Real Solutions! — Dr DoGood

A doctor at a Klang Valley public hospital says redeploying HOs to district hospitals isn’t a solution; there’s no alternative but to centralise HOs in tertiary hospitals. “We need to propose serious solutions and stop making reactionary stopgap measures.”

I read with interest the recent announcement by YBMK Dzulkefly Ahmad regarding the immediate redeployment of housemen to district hospitals, following multiple Facebook posts highlighting the current plight faced by medical officers there.

The number of housemen halved from around 6,000 in 2019 to 3,000 in 2023. During the same period, our population grew from 27 million to 34 million, while the number of hospitals remained largely unchanged.

Each hospital is facing an increasing number of patients. Coupled with a drastic reduction in manpower, this further stretches our health care system.

I believe there is no alternative other than to centralise housemen in tertiary hospitals to optimise workforce and education of housemen. When the cake has shrunk, one must find ways to rationalise resources.

Either the whole system suffers or part of the system must be sacrificed, however unfortunate the circumstances are.

Given that tertiary hospitals are major referral centres with the most numbers of beds and treating more complex conditions, I’m not surprised that district hospitals and clinics were the first to go in this rational calculation.

I’m afraid the current reversal forced by YBMK will do little to solve the problem, other than to placate the victims of this current debacle.

Imagine 3,000 house officers (HOs) stretched across 30 training hospitals, with tertiary hospitals getting the lion share – the amount of help trickling down to district hospitals would be paltry.

If the manpower were to be equally divided or to omit university hospitals from the list of training hospitals – as suggested by a certain high-ranking official – this could seriously impair provision of subspecialty services and training of specialists, as the Master students would be forced to do more scut work, instead of acquiring specialist knowledge and skills.

The dwindling number of HOs is just part of the problem. The mass resignation of medical officers (MOs) is just as concerning, as they are running the majority of services currently.

As the saying goes, a lack of HOs leads to lack of MOs, and a lack of MOs leads to lack of specialists in the future. Our health care system is indeed heading towards a titanic collision.

YBMK has often spoken about short-term and long-term solutions to these problems in all his comments, yet concrete points were not included, as if this were another Manhattan Project.

Real and tangible solutions must be spelt out as soon as possible to stem the current tide of doctors’ resignations. In an increasingly fast-paced, competitive, and globalised world, we need to propose serious solutions and stop making reactionary stopgap measures.

To avoid any confusion, I will address two controversial points head-on:

‘Sacrificing District Hospitals and Clinics’

District hospitals and clinics are vital to the public health care ecosystem. They serve as critical gatekeepers and community hospitals.

They provide easy access to locals, without which, locals would have to travel some distances and the workload would overwhelm any tertiary hospital, crippling their bed availability and harming care.

Given the twin threat of mass resignations among MOs and dwindling numbers of HOs, this is a Catch-22 situation for which there is no good solution.

We need to stem the tide of resignations and inject new workforces rapidly. Otherwise, cutting services will become the only viable option.

‘Scut Work’

Scut work is paperwork, calling patients, escorting patients, sending labs, taking bloods etc – basically uninteresting but important work.

In the past, housemen would be doing it, as medical officers who were once housemen “graduated” from that role and are now upskilling by running clinics, and performing more complex procedures and operations.

This graduated responsibility is ubiquitous in most countries, but developed countries have made it more bearable with a higher number of ancillary staff, i.e. health care assistants (PPKs), phlebotomists, physiotherapists, and clerks.

We need to employ more of such people to help alleviate the load for doctors and nurses.

Dr DoGood (pseudonym) is a doctor at a public hospital in the Klang Valley. CodeBlue is providing the author anonymity because civil servants are prohibited from writing to the press.

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

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