Medicine is built on learning, teaching, and growth. Yet in Malaysia, a persistent tension exists between two cultures: mentorship and authoritarianism.
A mentoring culture is essential for a sustainable health care system. It requires seniors who are willing to teach and juniors who are encouraged to learn.
In such an environment, questions are welcomed, mistakes are corrected constructively, and confidence is built over time. This creates not only competent doctors, but future mentors, ensuring continuity and growth within the system.
In contrast, an authoritarian culture relies on hierarchy, fear, and obedience. While structure is necessary in medicine, unchecked authority can suppress learning. Juniors may hesitate to ask questions or admit uncertainty, both of which are critical for safe patient care.
Not all seniors perpetuate this culture. Many are excellent mentors. However, authoritarian systems empower the minority to misuse. This creates space for bullying and intimidation, eroding confidence and potentially compromising patient safety. When today’s juniors become tomorrow’s seniors, the same harmful cycle risks repeating.
As Amy Edmondson, who pioneered the concept of psychological safety, states: “Psychological safety is a belief that one will not be punished or humiliated for speaking up with ideas, questions, concerns, or mistakes.” Without this, even competent teams can fail.
Studies in British Medical Journal have shown that junior doctors often remain silent due to fear of hierarchy, while research in The Lancet links toxic workplace cultures to burnout and increased risk of medical error. The World Health Organization (WHO) similarly emphasises that a non-punitive, open culture is essential for patient safety.
This culture must be addressed at a systemic level. Institutions such as the Ministry of Health (MOH), Malaysian Medical Council (MMC), and Malaysian Medical Association (MMA) have a responsibility to drive change. Intervention through clear policies, structured mentorship, and firm action against bullying are necessary to reshape medical training.
The question is not whether hierarchy should exist, but how it is used. There should be guidance, not domination. If Malaysia is to build a resilient and humane health care system, the shift from authoritarianism to mentorship is not optional but essential.
The author is a houseman. 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.
