Sunday, August 09, 2009

Choosing the right candidate for medical training

Housemen extension not the solution to houseman problems

The report “Longer training” (theSun,August 4)revealed a number of rather intriguing facts regarding the training of our medical house offcers. Firstly it was rather surprising that about 4,000 new doctors are recruited into the health ministry every year. This is indeed a very large number,to be adequately trained in all the major disciplines before being sent out to serve in the various hospitals. The job is a formidable one considering the number and the health ministry must be commendable for the great job it is undertaking.

However despite the addition of this large number of new doctors every year, we are still told to be acutely short of doctors and specialists in the various disciplines in hospitals all over the country. It takes weeks, even months for patients to be seen by a specialist in government hospitals. Wonder where do all these doctors go on completion of their training?If they are leaving the government service,why are they doing so in droves?

It is rather alarming that the recent study in 28 general Hospitals
revealed that67.8% trainee doctors found their training stressful,53% had thought of quitting due to the stress,21.8% required counseling,5.8% needed specific treatment. This is a very unsatisfactory state of affairs that needs further in depth scrutiny to prevent any repercussions on our health care in the future. How can we expect to have committed, dedicated and capable doctors and specialists when more than half of them had chosen the wrong profession and considered quitting in the first place?

The high ‘morbidity’ of our trainee doctors is an indication that most of them have wrongly chosen their career in medicine. Many of them opted because of the perceived glamour, the respect it commanded in society and the material gains that it could bring. Others chose medicine due to parental pressure although they did not have much interest in the job. I was surprised to know of many medical students who don’t like the sight of sick people let alone deal with them. How can you expect to become a good doctor when you don’t like the company of patients?

It is timely for the ministry to select medical students who have the right aptitude for being a doctor.It may be difficult but it must come up with some guiding principles so that the right people get selected to do medicine. Although academic credentials are important the system of selection must give equal importance to the overall attitude and aptitude of the individual to take up medicine as a career.The least we could do is to avoid choosing the wrong individual for the job.It is extremely sad these days that financial capabilities to pay the high cost of training is becoming an important criteria for the selection of candidates for medical studies,especially in private institutions.

Providing a more comprehensive training to include all six major disciplines is good but has this to be done by doubling the duration of housemanship? Medicine is a rapidly developing field and we cannot keep increasing the period of housemenship to cope with the increasing influx of new knowledge and technology. What is important is to provide the basic training in the important disciplines to make them caring and safe doctors.

They should be given their due promotion after a year of housemanship and may be retained slightly longer in the major hospitals for training in other critical disciplines as needed. After five to six years of strenuous undergraduate training It would be unfair to maintain them as house officers for another two long years as that would only exaggerate the already severe stress they are being subjected to.

The Director General of Health Tan Sri Mohd Ismail Merican should be commended for directing his specialists to be more professional and train and teach their housemen with extra care and civility. Stress is not only inevitable but necessary in medical training especially when treating the critically ill but it could be greatly alleviated if the specialists training them are considerate, humane and fair to those under their care. They should not just impart knowledge and skills unselfishly but also instill the right attitude towards the patients by their own exemplary and caring behaviour.

Dr.Chris Anthony

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