Tuesday, December 7, 2010

Houseman glut : Who to blame? by Naveen S Pillai

i am sharing one of my colleague's point of view :) spare some time to read it :)

I read with great interest over the recent issue pertaining the glut of houseman in hospitals throughout the country. To make things worse, almost every single Government hospital are now affiliated with medical schools throughout the country, which means the wards in the hospital are not only crowded by housemans, but also with eagerly awaiting medical students who wants to learn procedures. The questions is, how could the students learn when the housemen themselves are deprived with opportunities? It is the students who will soon become the houseman, serving the public. Now, we certainly do not want leave our people getting half-baked treatment. Doctors deal with life, the most precious of it all.

Over the 10 year period i have seen meteoric rise in the number of medical schools in our country.While i agree that the country needs more doctors, that certainly does not equate to mass production.It is sad to say that this was very much a problem that could be fixed,but people were ignorant and medicine is made into business.For centuries, people have viewed the profession of doctors as someone who is noble and caring. I can't guarantee the trend would continue in the upcoming years. Besides needing good grades in the academia, the medical school also develops the professionalism in the student. The first 2 years forms the fundamentals as the student is gradually exposed to wealth of knowledge to prepare for the more challenging clinical years. The next 3 years are most important years as a medical student as they are exposed to clinical settings where they met patient and apply their knowledge to arrive to a diagnosis. There should not be ANY short cut in this. All medical schools employ a similar method. However, what is actually happening is when there a sudden rise of students, we face with various problems such as lack of manpower and facilities, we eventually end up producing doctors who are ill-equipped with the essential skills to treat patients. As a country of mere 28 million in population, we currently have about 30 plus medical schools, one of the highest in the world. When all the institution starts producing their graduates, we are looking into about 4000 to 5000 doctors annually. Mind you, this does not include graduates from Russia, Ukraine, Poland, Czech Republic, and other recognized institution. The total sum many possibly may around 6000. There are more than 200 institution recognized abroad in Malaysia for medical degree. Do we really need so many institution being recognized? What measures are being taken to assess the quality of its graduates?Many of the schools do not even use English as a teaching medium, leaving us a big query pertaining the quality of the its degree.

So, could we blame our politicians for this problem? Everyone wants a moment of fame. In their opinion,by merely increasing the number of doctors, the healthcare industry would undergo a robust change that would translate into better delivery of services and outcome. When we argue, the counterattack would obviously by saying that doctors are wanting to "protect their turf". True enough, we do not want compete among each other. We respect our collegues, and ultimately we want the betterment of the health of our people. Imagine if doctors decide that (I hope not)-to lower the fares and the same time diluting the quality of services. They don't see whole picture, and they will be the ones who will going to New York or our southern neighbour to receive the "best" treatment.Paradoxical? Plus there is establishment of the 1 Malaysia clinic- MAs are already taking some of the jobs of doctors. Numbers are being increased, and now our jobs are going to be deprived? What is the direction that we are heading to?

Government hospitals too should be selective when it comes to choosing the houseman. After all, they do the most work in the hospital. The 2 year period should be maximally utilized. The HODs in each department should constantly keep in track about the underperforming houseman along with their institution. A annual report should be sent to the MMC to assess the standard of the institutions, and it should be made neutral. I was told that some foreign institution uses very simplistic approach even for the final year examination. One collegue even claimed that clinical exposure was very minimal, and only select cases are shown. This is a very wrong approach as we doctors see patients who comes with various types of illness.

It is my sincere hope that everyone involved will look into this matter urgently. We do not want to be labelled as "a mass manufacturer" of doctors by other nations. Worst, we do not want people to pursue medicine as a spectator sport.

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