Recently, we have seen increasing conversations around house officer and medical officer stress, burnout, and tragically, even suicide. Fingers are pointed everywhere, trying to search for something or someone to pin the responsibility on.
I write this as a specialist who has lived and trained within the Malaysian government health care system and has constantly spoken up over many issues throughout my journey as a doctor.
I write as someone who has gone through the same system, worked the same calls, and seen how different departments can feel like entirely different worlds.
I write about something we can control and shape – our work culture.
It does not guarantee that no one will feel sad, anxious, or maybe even depressed. It will not magically fix laziness or dishonesty, but it will provide a conducive and supportive environment for the healthcare workforce.
Culture is not experienced at the level of policy. It is experienced daily, within departments. And culture is shaped not by circulars, but by people.
We often speak of “corporate culture” and generate nice posters and organise expensive courses to instil it, but how many are truly effective and/or successful?
Comparisons
We often hear the phrase, “Back in my time…”, usually to suggest that things were tougher before, and that the current generation simply needs to be more resilient. But this comparison isn’t always fair.
During my time, for example, I worked shifts. There were structures in place that protected rest in ways that may not exist now. In some ways, life was not necessarily harder, just different. And beyond that, medicine itself has evolved.
There was a time when access to MRI was limited or unavailable in many settings. As a house officer then, you may never even have needed to learn how to request one.
Today’s junior doctors are expected to navigate far more complex systems, technologies, and expectations, often with the same or even fewer resources. So the question is not whose time was harder.
The question is whether we are helping the next generation meet the demands of their time. Experience should guide, but it should not be used to justify poor culture.
Control
We often underestimate how much influence we carry as specialists. Culture is not built in grand gestures. It is built in everyday decisions, often small, often overlooked. Take something as simple as leave.
In many departments, we still hear the familiar refrain: “Cuti bukan hak”, and then some arbitrary rule about “Maximum X number of people can take leave”, regardless of manpower. Oftentimes this is not even applied uniformly across everyone in the department.
While this may be technically defensible within a system trying to balance service needs, the way it is communicated often reflects a culture of control rather than trust.
I like to tell my team this: “Discuss with your colleagues, ensure adequate coverage, and decide how long you need.”
The policy has not changed. But the philosophy has. One approach reinforces hierarchy and restriction. The other builds responsibility, mutual respect, and ownership within the team.
Doctors do not expect unlimited freedom, but they do expect to be treated as professionals. Each interaction leaves an imprint.
Compassion
The same applies when we receive referrals, whether from district hospitals or colleagues from other disciplines. Our first reply matters.
I’ve caught myself thinking before, “Why this also you don’t know?”, and think of a sarcastic reply to fire back at the other person on the line.
But then I remind myself – not everyone is working in the same environment as I am. Some are covering multiple roles, with fewer resources, less support.
Very often, these referrals come from colleagues working in resource-limited settings, with less support, less exposure, and heavier workloads. What may seem basic to us may not be so in their context.
A single response can either shut someone down, or encourage them to seek help again when it truly matters.
And in medicine, creating a culture where people are afraid to ask may be far more dangerous than not knowing.
Cultivate
The Head of Department is directly responsible and accountable to the culture of the department. Every time we stay silent in the face of poor behaviour, we reinforce it.
Every time we excuse it as “That’s how things have always been,” we perpetuate it.
All HODs should be approachable and accessible to allow transparent feedback on pertinent issues. It is often the lack of a grievance mechanism or ombudsman that leads to propagation of a toxic culture.
Choosing Leaders
This brings us to a difficult but necessary question: how do we choose our leaders? Is it through a transparent, election-based process, or just by appointing the “next in line”?
Too often, leadership positions are determined purely by hierarchy or seniority. But leadership is not just a title. It is a function of trust, credibility, and the ability to bring people along.
The person leading a department should be someone the team is willing to follow—not just someone who has been around the longest. Whether formally through structured feedback, or informally through departmental consensus, leadership selection should reflect the confidence of the team—not just tenure.
This applies not only to Heads of Department, but also to unit heads, hospital leadership, and beyond.
Compromise?
While upholding a healthy work culture, there should be no compromise on values and principles that all doctors hold true to.
A harmonious work culture does not mean tolerating incompetency, lack of basic medical knowledge, or anything detrimental to patient safety.
There should be zero tolerance towards issues like dishonesty, bullying, laziness, etc. Corrective action and measures must be taken when necessary to ensure such issues do not propagate.
Conclusion
I hope this has given all of us some food for thought. Over time, little actions accumulate.
Culture is the reason why some postings are actively sought after, while others are avoided, even within the same hospital. Systems, policies and workload may be similar, but the culture is different.
There are departments known for strong teaching, support, and teamwork. And there are those known for fear, hierarchy, and silence.
These reputations are not accidental. They are built over time by the people within them.
Are we building or breaking? Are we teaching or tearing down? Every specialist makes that choice, every single day.
The author is the head of department of orthopaedic surgery at Hospital Duchess of Kent, Sandakan.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
