THIS year marks the 4th year since SK, one of our former HO; had met with an MVA that caused her life. She had just finished ‘on nights’ and was driving back to her house when her car was said to have hit a tree. No one knew what the actual cause of the accident was, some had speculated fatigue after ‘on nights’ shift while some said it may be due to car trouble or the road being slippery.
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Whatever the cause might be, condolences poured in and the department had arranged for her funeral and her body to be flown back to the Peninsular. I think the HOD was questioned (even accused) of ‘overworking’ the poor HO but the system of flexi-hour had just been introduced then and working hours had been cut down. There were other HOs (many in fact) who worked ‘on nights’ together with her and work-load was ‘as usual’.
Recently, we were again shocked by the death of an MO in Selangor, who had met with similar fate as that of SK. The difference was that she was working ‘on call’ in the Anaesthesiology department the day before. Being in anaesthesiology department, she had the whole day off the next day, from 8am (as had been practised by the anaesthesiology departments in this country).
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For certain reasons, she drove back after 2pm (see Ministry of Health Director General’s statement). In SK’s case, even though we were very saddened by her death, we said our condolences and lives moved on. May be because her story was not highlighted much on FB or in the other social media.
But in this MO’s case, many young doctors and even NGOs used the social media to express their sadness and anger for the kind of life a doctor has to endure in our system. Many call for the ministry to relook at the system and be more caring towards the doctors. Many also blame the seniors and HOD for not being compassionate to younger doctors. The popular phrase that they say is that the seniors used to say “during my time…”.
During my time, we had to work 24 hours straight, during my time we had to alone take care of 40 patients in the ward etc…
Even though Ministry of Health is a huge entity, changes for the better is something that ministry and hospitals will continue to strive for.
However, it is NOT that simple. No matter how many doctors we may have now, the work will never get any easier. Housemen doing flexi-hours (shift) now will end up doing ‘on calls’ when they reach MO ship. It is hope when each department have enough MOs, the flexi-hours system can be extended to the MOs too. However, this could vary from one hospital to the other as well as one department to the other, because each hospital or department have their own problems to handle.
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Was fatigue the actual cause of the accident? Should we jump to that conclusion each time we hear of similar incidents. There are many factors that can cause an MVA. I too have my fair share of dozing off at the traffic lights while driving back from work. Praise be to Allah SWT nothing serious happened. And I am sure we all had our so call near misses. PDRM and JPJ statistics showed about 5000 death on Malaysian road yearly. While fatigue could be one of the reasons but other factors like car trouble (malfunction), errors of other road users, poor road conditions etc. could be at fault. (Dr. Syamil wrote a very good article on the issue of ‘defensive-driving’). However, many became emotional, angry and immediately accuse the “on-call” and the system without investigating further.
Doctors are not the only profession who works long hours. Engineers, pilots, accountants even lawyers also come back home late after putting up long hours at work. I have nurses and other hospital staff who leave home at 4 am in the morning to drive to our hospital, just because they stay in Papar or Tuaran. They spend 1 to 2 hours on the road – each way. The difference between our profession and those of other profession (those mentioned above) is that we can’t take our work back home with us. We have to finish our work at workplace. The profession is such that we cannot leave our work unfinished. Emergency happens all the time especially in this field of Obgyn.
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Well, it is us who chose this profession and this is the system we have now. Needless to say, no matter how the system changes, doctor’s workload will not be lesser. Malaysia is not the only country where doctors work long hours. While working in Australia a few years ago, we too put up long hours but the number of hours were limited. Having said that, I too sometimes dozed off, riding on the tram while coming back from the hospital after work. Luckily, we did not own a car then.
While the ministry try their level best to take care of the welfare and health of their staff, one can’t forget our core business which is patients’ care. Nowadays patients demand and expectation are higher, not like ‘during my time…’.
No matter how many extra working hours we put up in the hospital, the workload increase exponentially. In my clinic today, we see close to 120 – 150 patients daily, not like 50 – 60, ‘during my time…’. There are not enough spaces for the doctors to see their patients. Delivery rates have also increase, bringing my hospital of having one of the highest rate in the country. The number of patients will increase year by year especially in the government hospitals and clinics. Complaints from patients will also increase.
For example, the public just don’t understand why they have to wait for more than 2 hours to be seen, even though the newspapers keep on reporting that now we have surplus of doctors. Where are all these doctors? Why do I have to wait so long? Do we blame the patients for not understanding?
I always say this when I give lectures to students, don’t enter medicine for the wrong reasons. I hope that the younger generation will understand the life as a doctor is not all that glamourous and one can make a lot of money out of it. No amount of money is enough if you don’t plan your finances properly. Be grateful to Allah SWT that we have a job today, as from this year, JPA has postponed the intakes of new staff. (Recently one of my former MO who’s on contract, was not renewed of her contract.)
The younger doctors of today will become the consultants or HODs of tomorrow. So learn and be prepared for the many challenges ahead as what you learn today will benefit you for the encounters in the years to come. Then, you too can tell your juniors ‘’well, during my time….”
I would like to end by quoting the words written by my sister whom I have the utmost respect, Dr Murizah M Zain.
“During my time…”
Yes during my time…
And I love all that we had done during my time.
If only you had live during my time.
I am very sure you would had loved it too.
It was during my time that I learned the most, where the environment, the teachers, the struggles had shaped me into who I am today, to face all the challenges during my time, to be able to serve to mankind…up to this VERY MINUTE and Insya-Allah…for the future.
Allah knows best
Dr M Hatta Tarmizi
Consultant Obstetrician & Gynaecologist and Reproductive Medicine & Infertility Specialist, Sabah Women’s and Children’s Hospital.
Naib Yang Dipertua Isma Cawangan Kota Kinabalu.
Disclaimer: The views expressed in this article are those of the author and do not necessarily represent the official views of, and should not be attributed to, Isma or Ismaweb.
Stakat ni yg setuju dgn keadaan skrg, long working hours ni specialist, consultant, mereka yg passive call mcm mo opthal.. mereka yg mengalami oncall, still keje long working hours tanpa rehat ni masih mengharapkan perubahan. Still dgn alasan ‘during my time’..sighh
what r u trying to say, is it good or not for long working hours and do you believe even with increasing doctors nowaday there will no changes since patients and demands also increasing, i think u should think throughly this specific things, DURING UR TIME u told us u cover 1-2 ward, u review 40-50 patient, do you know in 2013 i still cover 1-2 ward and review 40-50 patient alone as HO so i think my MO will have more patient than me, what we must look here is the distribution of staff, some place the man source is enough while other have been ignored even total patient are same. The system need to be organised carefully, we hope as junior dont put us in the same situation bcoz u had it before
I think, if u still as MO (or HO) o&g nowadays, u won’t give statement like this. …
Dear juniors, changes are done from time to time by MOH. Of course you cant see the changes overnight, it takes years and it involves a lot of things especially human resources. It is very wrong to say that changes are not done because of ” during my time”..
Number of patients doubles, tripples, so please work smart manage your time wisely and always work in a team. Consultants are not shaking leg at night they have more stressful things to handle and we dont need to share that we the junior drs. The important thing is team work and time management…pointing fingers will not solve the problem, possible solutions should be brought to the moh.
It’s always greener on the other side, isn’t it doctor.
I think we, fellow commentary, should always be thankful of what we have, but also strive to make things better. Start from our own selves, as individual, and those around us as we work our way forward. There is no point in pointing fingers and asking others to change, it should come from ourselves. Most people just run away to escape from the ‘system’ rather than stay behind with the tenacity, hope, and teamwork attitude for better future.
Healthcare system is complex, there is not one country that could proudly say they have the best system overall. May all of us be blessed and be better.
Dr Hatta bincangkan isu secara neutral, bukan tidak mahu berubah tapi kita tidak compromised training utk doktor junior, semuanya utk kebaikan mereka juga, pesakit dan sistem kesihatan negara kerana satu hari nanti mereka akan jadi pakar & consultant. Antara penambahbaikan yang saya fikirkan ialah sistem pengangkutan awam perlu ditambah baik dan quarters kakitangan yang mencukupi.