I am a specialist in a surgical department at the Ministry of Health (MOH) and have worked in hospitals in Peninsular Malaysia and Borneo, in university hospitals and MOH hospitals.
A recent circular by the Health DG was written regarding house officers in the internal medicine department. But in my opinion, having worked with house officers for more than a decade, there is a drastic, worrying decline in their training.
Disconnected Administrators
There is a large disconnect between those issuing circulars and the actual day to day work on the ground. Evidently, the health director-general has forgotten what it was like to be a house officer and the type of training that they go through.
Repeating the mantra that “house officers are only for training and not for service provision” takes away the accountability and responsibility that all doctors need to learn in this journey.
How can one expect a house officer to acquire this overnight when he/she comes to work as a medical officer the next day after completing housemanship?
House officers are a vital part of service provision — even more so as manpower deficit are as high as 60 to 70 per cent in certain departments.
Say all you like in a circular, removing house officers from a department that is already short of medical officers and specialists will directly affect the patient care that is delivered.
This is due to the manpower maldistribution that has risen from the poor planning and inefficiencies of the MOH.
Lack Of Empowerment And Flexibility
Allowing house officers the freedom to move between units, and yes, even to join visiting specialist clinics or cluster hospital visits serves to inspire and encourage them.
Every single house officer who has followed me to a visiting clinic in a district hospital comes back with a deeper understanding of our public health care system and a greater appreciation of the resources that we enjoy at a tertiary hospital.
Blanket rules such as stated in the circular that disallow house officers from going on these visits obviously do not realise this. I have worked (and still do) with excellent house officers who function just as well (if not better) than medical officers when they are empowered. Stop restricting them!
Outdated And Inadequate Logbooks
The current logbooks being used for house officer training dates back to the Covid-19 pandemic, where there is a whole section on Covid-19 that is not being practiced anymore.
Because of the “60 per cent passing mark” scoring system, adequacy of medical knowledge and competency have been given very little significance.
House officers are able to pass a posting even after failing the knowledge assessment component, and this may potentially produce unsafe medical officers. Five years after the Covid-19 pandemic is simply too long for the MOH to still be “piloting new logbooks”.
(The charts below can be found in the link to the logbooks)
Weak Leadership And Poor Policies
From the Waktu Bekerja Berlainan (WBB) fiasco, manpower distribution, and now house officer training, it is clear that there is poor decision-making and a lack of direction and leadership at the top administration of the MOH.
Circulars signed by our current director-general have gone from bad to worse–one in particular was the misleading “one year housemanship” that caused confusion among the fraternity.
We need a revamp of our administrators before our health care system falls beyond repair.
The author is a specialist doctor at a government hospital. CodeBlue is giving the author anonymity as 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.
