Shift system for housemen – the lesser of two evils

For the record: I have always been outspoken about things that I really believe in. And I don’t believe in hiding what I believe. If people don’t like it, too bad. I wasn’t born to please anyone else other than Allah, Rasulullah, myself and my family.

So there!

****

I have always wondered whether my superiors in HSB have ever stumbled into my blog and then find out that I have been dissing HSB (and previously the OnG department in specific) all these while. I have always wondered what would I do if they call me out for being TOO BRAZEN and TOO LOUD in my dislike of HSB and the previous department I worked in. I wondered whether when push comes to shove, will I be able to justify whatever it is I have written in my blog.

However, upon further critical pondering, I found out that I don’t really care if anyone finds out about my blog and report on me to my superiors. I have done even more daring things overseas….I complained against the medical faculty to the International Office… and I was a foreigner at that time! And now that I am back in my own country, among my own people where I have always belonged, there’s even less reason for me to hide my claws.

I know that ALMOST all my superiors in the surgical department hate the shift system and they would think less of HO who actually welcome the shift system. I know of one particular specialist who said he is DISGUSTED by anyone who actually likes the shift system.

Fine.

But being me, I did not believe in hiding my opinion simply because the echelon of the health system detest it. If they find out about my stand and find me disgusting, be it. But I have never hidden the fact that I welcome the shift system to anyone. I have spoken about this openly to HOs as well as to some MOs. If any specialist had asked me, I might even let them know what I really think. Sadly, none of the specialist ever asked.

Now, let me be more direct and clear about my stand regarding the House Officer roster.

I give my support to the shift system…not because I think it’s a MUCH MORE superior system than the current system. But because I believe that between the shift system and the current system, the shift system is the lesser of two evils.

Now what do I mean about that?

Read on!

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I am sick!

I am tired!

I am utterly EXHAUSTED of hearing people saying the extreme of two things: They either REALLY love the current system and hate the shift system…. OR they REALLY love the shift system and abhorred the current system.

NO ONE has in their mind the idea of having a middle ground or a win-win/lose-lose situation.

They either want to stay in this sickeningly torturous system ad infiitum…or they would like to have as much holidays as possible as what the shift system seems to promise us.

As a Muslim, I have learned the concept of wasatiah! Sederhana! Equilibrium! You can never go wrong by being Wasatiah and avoid any forms of extremities.

Had HSB been more reasonable and had granted us the usual “HOs are allowed one day off per week and those who are post-call are allowed to go home at 12.00” I would have been more than satisfied with my lot in life. These things are nothing extra than what other HOs are getting in other hospitals! I didn’t ask much! Just what other HOs are getting in other hospitals.

But no! They decided to go on the extreme….and be cruel.

So now, it’s been acknowledged during the meeting in KL that HSB is at the top of the list of hospitals with complaints coming from HOs and their parents. On top of the complaints coming from other regions in Malaysia too!

With all these complaints coming from all over the place (and some of them came from very influential people; anak Dato’, Tan Sri and even Kerabat) , there’s pressure to change the current system into a more relaxed system….aka the shift system.

I acknowledged that the shift system is bad in several ways….the most glaring of them is the fact that our training will be greatly compromised. We may have less chance of doing procedures. Some even said that we would end up becoming an incompetent MOs.

Right.

But I still chose the shift system…simply because no one has thought of suggesting another system, that is the ‘middle-ground, wasatiah’ system. The system I would like to suggest consists of very minor changes to the current system, yet will be able to satisfy both sides if they are willing to compromise.

Let’s do it my way:

1. we all stick to office hours (but we understand that we have to finish our work even if it means staying beyond working hours)

2.Abolish on-calls; Instead, have only a few people working outside office hours. In surgical department, we usually have six HOs on call per day.   These six HOs do not have to come during office hours. They start working from 5 pm until the next morning and passover to the HOs who come working during office hours the next day. We call this system as ‘working nights’.

3.  Let the same six people ‘work nights’ for a week. Next week, another set of six HOs can work nights for the rest of next week. And you keep on rotating the ‘working nights people’ each week while the majority of HOs work office hours; because that’s when MOST things need to be done.

4. All HOs get one day off clinical days per week as is our rights.

A simple but sweet system! Tak pening kepala! I don’t know why anyone did not think of such system! They either want us to work like a slave…or want us to be too relaxed until we are not learning anything.

Yes, extreme folks!

****

Since no one is suggesting my kind of roster, I am choosing the shift system.

You can say whatever you want….that I am not a dedicated doctor, not passionate, or I shouldn’t be a doctor in the first place yadda yadda yadda.

Say it! And it would not change my opinion one bit.

I still stand with my believe that you are not a good person if you are just a good doctor but a lousy child, a lousy mother, a lousy wife.

Furthermore, you are not a good person if you are a lousy slave of Allah. Part of being a good Muslim is investing the time to continuously learn about your religion…possibly learn arabic, understanding what is it you have been reading in the Quran effortlessly.

Even if you belong in other religions, the same concept applies. If you are a Christian, part of being a good Christian is going to church every Sunday and probably get involved in the Bible study or Bible circle or whatever it is you call them. Just like us Muslims, we have usrah/ Quranic circle.

These things are important too, aren’t they?

One particular specialist was saying “I don’t know where is your passion as a doctor!”

Right.

I happen to be passionate about being a good daughter too. Others happen to be passionate about being a good mother/father and a good wife/husband too. They are forgetting the fact that as a person, we have many roles in life and we have to juggle all these responsibilities. It’s not fair for you to expect a HO to be with patients all day (36 hours!!) while he/she couldn’t even care for his/her own sick parents! The most important person in our lives other than God and his messenger is our parents!

Why are you making us choose between being a good doctor and being a good person?

Is it because you are not exposed to the health system in other countries where they didn’t have to make a choice between being a good doctor and a good mother? They don’t have to choose. They can be both!

Just because you have always been trained that way, you think that is the only way to train! Your lack of imagination is astounding! You seem to think that the current system is the only way to train HOs into being an excellent doctors. As though other interns in other parts of the world with a different system don’t all end up being a good specialist in the end too.

Again, your limited imagination is incredible! If you are disgusted…then, I am nauseated!

It’s very easy to just brush our concerns off by saying, “You cannot complain about lack of family time or whatnots. You chose this life!” It’s a very selfish way of not solving the problem. The fact is, most of our doctors are married or will marry and will have kids…these problems that they face are very real and affect the majority of us. Don’t you care at all? Are the kids of doctors not as important as the kids in the paediatric wards? How do you utilize your mind and your reasonings? How dare you think you sound smart when you said, “You chose this life. Suck it up!” to your fellow colleagues.

You have just successfully demonstrated that you are indeed a good dedicated doctor…

…but nothing else.

***

For the record: I love my time in surgical. MUCH MUCH MORE than the time in O&G.

Most of the specialist are very nice. Some of them are witty and funny! The surgeons are cool ‘buggers’ (to borrow one of my specialist’s favourite word).

I love surgical in ways that I don’t in O&G.  In a lot of ways, I enjoy my surgical rotation very much and I know I would miss my time in surgical. The Head of department likes to teach and I learn a lot during his rounds…he is quite hilarious at times. The MOs are super nice and much, much more reasonable in their scoldings.

However, I cannot agree with my superiors stand regarding HO training, much as I respect them. They keep saying that during their time, they had it worse.

All I want to ask them is “During that time when you had it worse, did you hate it?”

14 thoughts on “Shift system for housemen – the lesser of two evils

  1. Kabilen

    hey Afiza, i really liked ur article n it wouldn’t b a bad idea if dey implemented ur working rooster.i myself have been hoping for the shift system to start as i know how tiresome is the work of a HO. i’m gonna start ma HO soon. Wish me luck.

    Like

  2. Good luck there, Kabilen!

    I too, hope they would implement my roster. It’s not rocket science! Sleep is physiological! Natural! Sunnahtullah! It is tiresome to not sleep after having worked all day and night! Such a simple thing to comprehend…yet they couldn’t seem to compute!

    Like

  3. angryhouseman

    do you actually think that the new shift system they are implementing is all that you have ever dreamt of to be?? it is not the well planned UK 8 hour shift system my dear.. the shift system that we will be facing are TWELVE HOUR shifts! 7am – 7pm, 11am – 11pm, 10pm – 10am. with the morning/afternoon shifts, you barely have time for anything besides dinner/breakfast, and for the night shift you need to allocate time to sleep before/after the shift, effectively reducing the hours left to do daytime activities to nearly ZERO! and on top of that we are forced to take randomly arranged leave, and leave will be deducted for public holidays and weekends! our off days will end up being random and singular, making it pointless and short. it will be very difficult for us to even arrange a short trip or ‘balik kampung’, let alone long trips overseas and such! and to swap shifts with your colleage is totally out of the question! the overlap is incredibly long and stupid, you wont be able to swap shifts or get your colleague to cover for you by doing a double shift (e.g. how the staff nurses are doing). the timetable is going to be rigid, and we will all suffer even more.

    to the housemen who have been complaining so much about the current system, i wish they could take a step back and realize what their foolishness have caused. and to the DG! please understand that the shift system cant properly be implemented unless the manpower increases! i suggest that the easiest and best option right now is for post-call HOs to get PM off!

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    1. Waalaikumussalam!

      Aimi Rahayu! I am soooo happy to hear from you. Long time no see and no news, INDEED!!

      I am very well, ALhamdulillah. Getting used to being a houseman in HSB.

      Where are you now? And how are you? Bila kita nak buat Mafia reunion, do you think? Nak cukup 10 tahun dulu ke? heh.

      Like

      1. aimi

        Daku masih di perantauan lg. Dah nak dkt 10 tahun dah ni. Huhu. Bestla buat reunion 10 tahun for sure. Nanti kita tengok mcm mn. Entry ni yg menarik daku ke blog ni😉 . Emel aku (__________@yahoo.com) : 2 patah perkataan nama aku.😉

        Like

  4. bahari

    I think one forget the basic of training. the opportunity to learn. the problem at present is too many ho at a time that this opportunity is loss. people say cases alot during office hr but there are many HO too. so;ution present id 1. reduce HO (so most of ur friend will bw out of work), distribute HO to cases evenly during the day. case in point, at present there is 1 HO to 6/8 pt. if this HO cannot finish his/her work ? beg to ask ?? competency. we are currently monitoring HO to pt and work load the next 2 week and see time taken to finish job. ? would u let a surgeon that take 2 hr to operate a simple appendic operate on u. I believe this is a way forward for the coming future. run the system, adjust and maximize the output.
    bahari

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  5. syafiqa

    i’m not sure if i’m agree with this shift system. I love my job as a HO. i Hate people who keep complaining that they ‘re having too much work, hv to work 36Hrs, didnt have time to eat, crying and make a complant to parents. euwww…
    hello guys, we only have 2 years..what is so hard to finish these 2 years. with shift system, we didnt have our weekend off, we cant take a long holiday, we cant even plan our holiday. and one more thing, i love oncall not because of money but because that’s the time u really have to be independent, fast ,effective and can learn a lot of things. and one more, please la dont complaint anymore to ur parents or DG.. this kind of people make us look weak and stupid and ‘cengeng’. hihi peace no war!.

    Like

  6. azni

    salam.im, azni. i would like to apply as ho at hsb later. but, once i read ur article, i feel that i will get trouble plus shock maybe.ngeh3…. may i know, how “severe” was there??it’s too bad??what do u think about being ho at hsb??

    Like

  7. Be grateful of what you have.. Be it shift or on call, there’s always a chance to learn… if you want to learn more, then come during your extra time.. Even though i only manage to work through on call system for 1 month only, but i feel it more better than shift system simply because of man power. i was in O&G posting as well at that time. In old system, we have 13 houseman per day to cover 2 maternity/postnatal wards, 3 to cover gynae, 2 in labour room and 2 in alternative birth center. Since we also need to cover the OT and clinic as well, no matter how tired you are after the post call, it’s still ok..with shift system, only 8 houseman working and need to cover everything. we come at work at 5.30 am and sometimes come back as late as 10 PM… everything need to be done by ourself. even preparing for chemo patient. you have to start from beginning till end. setting those damn terrible line, calculating the chemo dose and discuss with specialist, indent the drug, you need to dilute your own chemo drug and run it by yourself from the first drop of chemo till end.. this not include what happen in labour room and ABC.. as compared with my seniors who undergone old system, they are a LOT better than me. they work super duper fast and efficient

    then, come to ortho.. u have all the luxury of time. probably because n0othing much we can do in ortho that’s why we are quite free. too bad, it makes us to be a LAZY person including me… it’s really bad

    but to compare shift vs on-call, of course i would say that you will have more time for your own. it’s kind of relief actually. at least you can have time to sit back and relax.

    Like

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