Practicing Medicine In The Age of Doom and Gloom

Recently I attended a talk by MMA Kedah held at my hospital auditorium. The topic of the talk basically revolved around the future direction of our health system with the major part of the talk consisted of the speaker’s derision towards the quality of junior doctors and our future problems due to the same.

 

The talk had also said that the minimal requirement for doctors are now below than that of teachers (seriously, I found that hard to believe. I listened hard for the speaker’s source of facts but alas, he didn’t mention it).  He also said that we are having too many junior doctors who are not exposed to some of the common procedures that they had performed during their time, and the voice of doom and gloom echoed throughout the talk. It was relentless, I assure you.

 

I had wanted to ask some questions at the end of the talk but they did not open the floor for questioning due to the time constraint. However they did invite the audience to talk to the speaker personally afterwards. I did not have the opportunity for the personal talk with the speaker because I had PSY Liaison Round to attend to with my specialist immediately after.

 

I would love to know his source of reference when he said that the minimum requirement for taking medicine these days are below that of teachers. Are we talking about private med schools or what?

And I would like to know the SOLUTION to the alleged low-quality junior doctors that he had so gloomily presented. Listening to junior doctors getting the bad rep is counter-productive without presenting us with effective solutions, n’est ce pas?

 

***

 

I am a realist.

I am not by nature, an optimistic person. However, I too don’t like to be around people whose regular utterance consists of consistent ‘doom and gloom’. And this ‘doom and gloom’ only come about when they talk about others…never themselves.

Or rather, it comes about when they talk about other generation; never their own.

How thoroughly exasperating, don’t you think?

Is it possible that it has escaped their notice that it was THEIR generation who had come up with all sorts of asinine policies that shaped our generation into its current form? Did they suppose that our generation come about magically with nary the touch nor the influence of the past generation?

When they talk about the current generation of doctors, their voice with just the right touch of arrogance and self-righteousness, it is positively nauseating. They went on and on about how OUR generation is the most spoiled, most entitled generation in the history of humankind, failing to appreciate that they were the one who brought us up!

 

Our failure – if it is a failure – is theirs as much as ours.

 

So rather than going around feeling unnecessarily self-satisfied with themselves while looking down at others, they should take the problem-solving approach rather than the finger-pointing approach. Stop badmouthing our generation, and start coming up with better policies to fix the problem that THEY started, in the first place.

 

***

Let me elaborate on some of the asinine policies that result in us having the bad rep:

• Russian-grad doctors are not competent, they say.

Whose wonderful policy was it to send our brilliant students to Russia, in the first place? That ‘dazzlingly bright policy’ did not originate from OUR generation, surely you know that.

Please know that when you train students overseas – not only in Russia – the students are shaped according to the needs and the system in THAT country, whose needs and system may or may not be compatible to our country.

It was YOUR policy to train students overseas, and this is the result. Deal with it in a mature manner by helping them and shaping them into what YOU want them to be, and that cannot be done by belittling them during your rounds or in public forums.

 

Furthermore, let me enlighten you that people are biased against the Russian grads without really knowing the situation at that time.
I went to Australia, scored straight As in my SPM.

But my SPM 2002 batchmates who went to Russia were more brilliant than I ever was. They went there based on their SPM TRIAL results (everybody knows that trials are much harder than SPM; I didn’t get straight As in my trial). 

Almost all my SPM 2002 batchmates who went to Russia scored straight As in their SPM, just as their trial results had predicted they would.

It was the government policy at that time to send brilliant students to Russia based on their trials – while us less brilliant students didn’t get any offer yet until we get our real SPM results and applied through a much delayed process (some of us spent/wasted two years in IB and A-level before we got to fly).
Thus, it is quite common for those who graduated from UK, Australia and Ireland, to have our batchmates who grad from Russia being our MO or JMO – they get to save 2 years of their age.

The point is: Contrary to populour ‘specialist’ opinion, MOST Russian grads who are on government sponsor to Russia were among the best in their batch in SPM. They were crème de la crème.
FACTS.
Do some research.

 

• Too many doctors as a result of having too many medical schools

How is it our fault that YOUR generation allow too much medical schools in the country? Now you have a problem of adequately training junior doctors, deal with it without blaming us! YOUR generation DO NOT have the right attitude in dealing with the problem that YOU caused. If you are interested to know what is the right attitude in dealing with this, please read on because I DO have an example of how the Australian older generation deal with the problem of current generation without finger-pointing at us.

***

 

The adage that ‘History repeats itself’ is true, you know. Not just in the issue of current generation of doctors, but also in other aspects of mundane daily lives. We just LOVE to make comparison, especially when that comparison results in us being the more superior. Isn’t it laughable?

Let me give you several scenarios to demonstrate just exactly what I mean.

 

Scenario 1:
“Ala…zaman sekarang SPM straight As pun macam nothing. Tak sama macam zaman dulu. Pangkat 1 dah kira hebat dulu.”

Scenario 2:
“houseman nowadays…” sambil geleng kepala.

Scenario 3:
“Ala…zaman aku buat MRCP dulu lagi susah …. specialist yang dah pass MRCP sekarang belum tentu bagus”

 

Scenario 4:

“Tok Wan dulu umur 12 tahun dah kerja, dah ada pendapatan. Bukan macam hangpa la ni. Tok hang dulu umur 10 tahun dah masuk ceruk dapur….cekap segala. Hang ni pula, nak pegang senduk pun tak reti….”
This is CLASSIC standard predictable generation snobbery where each generation think themselves as better than the generation after them. Nothing so phenomenal and surprising here.

They are only saying what other generation had said about them once.

How about realizing that it is YOUR generation that shaped the policy and the environment for the next generation. Our failure is YOUR failure. Our success is YOUR success.

So next time a student get straight As, just congratulate her nicely. No need to reminisce on your good old days because frankly speaking, your time has passed.

 

***

When I was a 5^th year medical student, I was attached to a kind palliative care specialist at a rural hospital in Tamworth. He is a religious Christian, full with empathy towards his patients, very humorous and humble towards everyone. Some arrogant Muslim specialist should really learn how to talk towards their subordinates. Just in case you don’t know, there are ways to teach others without making them feel stupid, knowing that doing so would make you feel more clever and self-satisfied with yourself. Feeding your ego at the expense of others is the behaviour of someone with self-esteem issues, in my opinion.

 

When he talked about his training more than 25 years ago in Australia, it was always with humility and a sense of gratitude that some things have changed. He talked about how little supervision he’d had back then when he was desperate for a guiding hand. He talked about how much he wished he had not unknowingly caused any harm towards his patients just because he’d had to do what he had no idea to do at that time. He thanked God that back then the public did not go around questioning their doctors. He talked about how little medicolegal issues there were back then. He talked about how there were no high-end, sophisticated and discerning imaging technologies that would make it absolutely unacceptable to not have the right diagnosis.

 

Thus, comparing your time and our time – when other variables have changed – is not exactly fair, is it? I still remember how a houseman in my batch was extended after a surgeon’s FAVOURITE VIP patient had complained about her brannula setting. Hmmm…

 

Back then, staff nurses were not burdened with reports that need to be done in the computer. Back then, discharge summaries could be done by hand, as the round was taking place. There were no time-consuming computer-based documentation that took the time away from our patients. Paperwork was much less than now. Doctors back then focused more on patients than documentation. Subspecialties were a rare luxury. Defensive medicine was unheard of.

 

So please, adopt the paternalistic attitude in guiding our young. Not the attitude of US against THEM. It does NOT serve any good purpose whatsoever other than exacerbating public anxiety of going to the government hospital (for fear of being subjected as guinea pigs for Housemen, thus compounding the problem of their lack of training), and trampling the morale of our junior doctors.  At the end of the day, everyone will suffer if this lambasting of junior doctors continue.

 

***

This is the section where we focus more on solutions rather than the enumeration of our problems and frustrations.

 

So the MMA speaker was saying that our junior doctors are going to be incompetent as they are no longer exposed to some of the common procedures that the older doctors were exposed to during their time.

 

However, this is not only happening in Malaysia. We all know that. This is happening all over the world especially in the developed, Western countries. Time has changed. And we need to adapt to it.

 

In Australia, interns are glorified clerks. They did not even perform brannula setting or venopuncture during office hours, let alone other common procedures like peritoneal tapping, plural tapping, peritoneal dialysis (which was done under GA at the operation theatre in the West,hahha. Unlike here.), chest tube insertion, intubation, bone marrow aspiration, ray’s amputation, desloughing, etc etc.

Forget doing episiotomy because O&G rotation is optional ONLY, and very difficult to get into as an intern.

When do they get to do venopuncture and brannula setting? When they are working the night shift or anytime outside the office hours when there were no phlebotomists around.

How about attending patients with impending cardiorespiratory arrest? The intern’s job consists of pushing a button at the bedside that would activate the MET call  (I think now, they call the system as RRT a.k.a Rapid Response Team) and at the push of the button, a team consisting of an ED physician, an ICU resident, an ICU SN, and medical registrar will run to the bed with a trolley bag to attend to the patient, while you perform mostly the redundant minor role.

So in terms of exposure, theirs were so much less than ours and this is not a recent development. It has been going on for more than ten years.

So, following the logic of our older physicians, the current specialist in Australia now must be way more mediocre compared to our own specialist in Malaysia, right? Are we arrogant enough to actually say that? On what basis?

So, since the interns in Australia are very underexposed of the most common procedures that we were exposed to in varying degrees as Malaysian Housemen, how do they train their specialist over there to become as good as they are? Because believe me, their interns ended up becoming good specialist anyway, regardless of their earlier internship training.

 

So, how do they get to produce good specialists despite of the highly-disadvantaged internship training?

The answer is, they do MORE than just badmouthing their young interns. That’s for sure.

 

We need to look at how they design their rotations and training, so that their underexposure during their internship would not compromise their quality as specialists. Since I did not hang around long enough in Australia to look at their specialty training system for a thorough analysis, I am unable to answer that. But I am just saying that, they did MORE than presenting the voice of doom and gloom.

 

Furthermore, even though the interns are based at a tertiary hospital, but every few months they will have a rural posting or regional posting to go to. This is where they get exposed with some of the basic procedures.

So, knowing that not all district hospitals in Malaysia are good enough for housemanship training, we should however consider the district hospitals as a place for rural rotation, where they get to learn how to manage patients with only very basic rudimentary facilities. The district hospital as a rotation basis is good exposure and most interns look forward to it.

 

***

I have the utmost respect towards the older generation of any field; make no mistake.

I am just tired of listening to them making the junior doctors feel like we are never going to be good enough and never going to measure up. I am tired of their failure to comprehend that time has changed.

There are days when I just take it philosophically, telling myself that they are merely doing what their own previous generation had done towards them. I told myself that this is merely a rite of passage that all junior doctors will go through, being made to feel like their older generation is always going to be better than them.

Maybe, we should just let them have their fun and tolerate their criticism – no matter how unjust –  the way we tolerate our old relatives who love to reminisce on their good old days.

But then, maybe once in a while, we should correct their own delusion of doom and gloom because remaining with that worrying outlook about life must be stressful for them. We don’t want them all stressful now, do we? So let’s lift them out of their ‘doom and gloom’ overview by correcting their delusion.Take it as an act of kindness from the new generation to their respected elders.

 

So, relax! We’re all going to be okay.

***

Dear respected elders,

We thank you for everything you have done to enable us to practice medicine in this current outlook of ‘doom and gloom’.

Please accept the extension of our profuse gratitude for all the policies you have made that result in this current situation we find ourselves in.

We try not to complaint at you. So, I hope, are you.

 

Yours sincerely,

The Current Generation.