Another doctor is dead, and once again the system appears to be following the same familiar answering machine pattern. Statements are taken. Stress factors are being reviewed. Police say there is no criminal element. Internal investigations begin.
But this kind of response may satisfy procedure without delivering truth, justice, or reform. In the recent Kuala Krai case, the trainee doctor was found unresponsive in her hostel room, the death was classified as sudden death, and police recorded statements from more than 10 people. The Kelantan state health department said it was reviewing possible stress factors.
But we cannot keep letting “no criminal element found” become the end of the story. It should be the start of a deep, honest, and fearless examination of what is happening inside our hospitals.
This is not an isolated tragedy. In 2022, a Penang Hospital houseman died after falling from a building of residence. Almost immediately, attention turned to the issue of bullying and the toxic work environment faced by junior doctors.
There were public calls for the hospital management and the Ministry of Health (MOH) to take responsibility and investigate properly. Yet years later, we are still discussing the same fear, the same silence, the same pain, and the same failures. That alone shows how badly the system has failed to learn.
The warning signs did not stop there. In 2023, CodeBlue reported that even after the Health Care Work Culture Improvement Task Force was formed following the Penang death, two more health workers in Selangor died.
During the same period, there were also continued calls to destigmatise mental health within the MOH itself. If doctors and health care workers are afraid to seek help because they worry it may affect their promotion, career path, or reputation, then the system itself has become unsafe. A health care service cannot claim to care for others while failing to care for its own people.
Then came the death of Dr Tay Tien Yaa. Her death shocked many because it once again raised painful questions about workplace bullying, overwork, emotional pressure, and whether complaint channels inside the system have any real meaning at all.
Reports said her family believed she had been made to work extremely long hours, and they openly questioned whether systems like Sispaa were genuinely helping doctors or merely creating the appearance of action.
Later, the task force said there was no evidence of workplace bullying or excessive workload. But when families, colleagues, and the public no longer trust official findings, the problem is no longer only the death itself. The problem is also the collapse of confidence in the very system that claims to investigate and protect.
Enough is enough. If a doctor dies in a department where there were already warning signs such as bullying, repeated shouting, public humiliation, fear, silence, unbearable workload, or ignored complaints, then the head of department (HOD) and the hospital director must not be treated as passive bystanders. They must be held responsible.
Leadership is not just about chairing meetings, signing letters, and giving instructions. Leadership means creating a department where people feel safe, respected, and able to speak without fear.
If junior staff are cut off when they try to explain themselves, if superiors believe it is acceptable to raise their voice, use a humiliating tone, and manage people through fear, then this is not discipline. It is abuse hidden behind rank and hierarchy.
This is why workplace culture must become part of the KPI of every HOD and hospital director. If a department becomes toxic, if bullying complaints are ignored, if staff repeatedly break down, resign, fall sick, or are pushed into despair, then leadership must face consequences in its performance assessment.
A leader should not be judged only by service output, waiting time, bed turnover, or clinic flow. A leader should also be judged by whether staff are psychologically safe, whether complaints are dealt with properly, whether junior doctors are protected from retaliation, and whether struggling staff receive help early instead of being blamed, silenced, or neglected.
The mentor-mentee system must also be honestly re-examined. In too many hospitals, this system is flawed because the role of the mentor is misunderstood. A mentor is supposed to guide, protect, support, and help the mentee survive a difficult environment. A mentor should notice distress, listen with compassion, and help the junior doctor find a safe path forward.
But too often, the mentor becomes part of the problem. Instead of helping the mentee, the mentor stays silent, passes information upwards, joins the pressure, or becomes part of the bully culture. That is not mentorship. That is betrayal.
A false support system can be even more harmful than having no support system at all, because it gives young doctors hope while leaving them exposed and alone.
Hospitals must also understand the meaning of inclusion. A healthy workplace does not protect only the strongest, loudest, or most well-connected people. It must also care for those who are already struggling.
This includes staff with poor physical health, poor mental health, exhaustion, grief, disability, or personal hardship. It includes minority groups, quieter personalities, those from different social or training backgrounds, and those who do not fit neatly into the department’s dominant culture.
These are often the people who suffer first in a harsh and uncaring hierarchy. A decent hospital does not punish people for being vulnerable, different, sick, or in need of help.
It notices them earlier, supports them properly, and treats them with dignity. If the system only works for the loud, the favoured, and the powerful, then it is not a caring system. It is a cruel one.
The truth is that this toxic culture often starts long before housemanship. It has existed for years, even during medical school. Too many new students and junior trainees have been treated as “freshies”, forced to remember seniors’ names, made to perform for the amusement of others, humiliated in public, and at times exposed to obscene or degrading behaviour disguised as tradition.
This is not harmless fun. It is not bonding. It is the early training of submission. It teaches young people that survival in medicine means silence, obedience, and tolerance of humiliation. Later, when they enter hospitals, the same culture continues. The bullied become the next bullies. The silenced become the next silencers.
We must stop pretending that cruelty is good training. We must stop calling humiliation a teaching style. We must stop calling fear respect. We must stop glorifying harshness as professionalism. A system that hurts its junior doctors and then lectures them about resilience is a deeply hypocritical system.
Resilience is not a substitute for justice. Mental health talks are not a substitute for safe staffing, respectful leadership, and real accountability. Mourning dead doctors is not reform. Preventing the next death is reform.
Every doctor’s death that raises concern about stress, overwork, bullying, isolation, toxic work culture, or leadership failure should trigger an external investigation, not a narrow internal review controlled by the same hierarchy that may have failed that doctor.
The HOD and the hospital director should be required to account for the department’s complaint history, staffing pressure, mentoring system, supervision style, and what was done when early warning signs appeared.
If complaints were ignored, if bullies were protected, or if a culture of fear was allowed to continue, then this must affect leadership appraisal, promotion, and tenure. Accountability without consequences is not accountability. It is only performance for the public.
We have already had too many deaths, too many official statements, too many task forces, too many promises, and too much silence. Penang should have been a warning. The deaths reported in 2023 should have been a warning. Dr Tay’s death should have been a warning. Now Kuala Krai is another warning.
How many more warnings does the MOH need before it admits that a workplace can destroy a person even without leaving visible injuries?
Enough is enough. If a department is toxic, its leaders must answer for that toxicity. If a hospital fails to protect staff who are struggling, its HOD and hospital director must answer for that failure. If the mentor-mentee system has become a trap instead of a lifeline, then it must be rebuilt completely.
And if this cruel culture has been normalised from medical school to specialist level, then reform must begin at every stage of medical training, not only after another funeral. The dead cannot speak. The living still can.
The MOH must stop protecting the system and start protecting the people inside it.
The author is a government doctor with first-hand experience who has witnessed enough bullying and toxic culture, from medical school up to the present day. 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.
