Wednesday, December 01, 2010

Improving housemen training

I refer to “Too many new doctors and too few hospitals to train them”(Star,Nov27)

The revelation that about 4,000 medical housemen are joining the government for training every year is alarming but not surprising. At the rate new medical schools are being opened, this problem was expected. What is shocking is that why no remedial steps were taken before we reached this state.

The number of medical housemen undergoing clinical training in government hospitals has increased to an extent that they may not get sufficient experience and training as the hospitals and consultants are not able to cope with such large numbers. In fact the quality of training has indeed declined and there are serious concerns as to what is going to happen soon as medical career continues to attract more Malaysians, often for the wrong reasons.

We should not be surprised that the government would resort to the easy way out by building more hospitals and bring in foreign specialists to train the increasing number of housemen. Will these measures overcome the problem that we have created by our own misjudgment? It may appear to solve the problem in the short-term but it will never provide lasting solutions to an oversupply of doctors. In fact such moves will only create more problems in the future. While we appreciate the government’s efforts to increase the doctor-people ratio but it must be realistic in its targets so as not to compromise the quality in the process.

In the past there used to be about 5 houseman in each clinical department but today it can be as high as 40.We are told that each houseman now looks after just 4 patients in the wards whereas it was 10 about five years ago. On- call duties although may be taxing but is essential part of the training of a young doctor as they provide the experience needed to treat medical and surgical emergencies. In most hospitals today each houseman goes on-call duty about 3 days a month when it used to be more than 10 days ten years ago. In fact in the seventies and eighties housemen had to go on-call almost every day as they were in very short supply. The extremely low number of call duties is hardly sufficient for the houseman as they do not get to see and manage the many medical emergencies that get admitted.

The government must seriously look into the declining standard of training of our housemen as the quality of medical care in the future depends on those being trained today. We do not need large modern hospitals with state of the art equipment and highly qualified experts from overseas to train our housemen. All we need are hospitals adequately equipped with the basic modern facilities and specialists with reasonable qualification but with great zeal to teach the housemen the necessary skills to become good and caring doctors.

We already have these hospitals in the form of our smaller ones in most districts formerly called District Hospitals. Many of these hospitals function as transfer centres which treat only very simple illnesses whereas most serious ones are transferred to the General Hospitals. All we need is to upgrade them, equip them with facilities to cater for the five major disciplines of General Medicine,General Surgery, Obstetricts and Gynecology,Paediatrics and Orthopaedics and post specialists in these basic disciplines to serve in these hospitals. By doing so they become excellent training centre for housemen who just need exposure to total patient care in these disciplines not highly specialized training at the major hospitals in the various sub-specialties. The time has come to upgrade all district hospitals to specialist hospitals which should have facilities to treat the all general specialties.

Recruiting highly qualified people from foreign countries are also not the answer as these outsiders may not have the commitment to train our own doctors. Furthermore the problems created in the training our doctors are our responsibility to overcome which we should not abdicate. There are enough of own local specialists in government and private including retired ones do will do excellent jobs if only they are given the honor to serve the nation. It is a pity that many enthusiastic senior specialists are ignored because of certain prejudicial practices which should be done away with.

While efforts are being made to improve the training of housemen, their numbers must also be regulated. Efforts must also be made to reduce the number resorting to medicine as a career. Only those with good results and aptitude should be allowed to take up medicine. The number of medical schools must be stringently regulated so that mass production of doctors will be discouraged. We have to be more realistic in the number of doctors needed for our people. Definitely we do not need 4,000 additional doctors a year for our nation of 25million people.

The glut of housemen and nurses in the country is our own doing - commercialization of medical education leading to their mass production. It has resulted the rapid mushrooming of many medical schools, nearly 30 in the country, some with questionable standards. It seriously threatens to compromise the quality over quantity of our doctors which will detrimental in the long run.

1 comment:

Anonymous said...

I agree with your respond, Dr. Chris. Even with the existing trainers and specialists, we could not produce good qualities of new doctors.

I hope that the government could give more "hand" to the existing doctors in pursuing their Master and pHD. Since, the higher ranking officer put too much criteria for doctor to do attachment, e.g. we could not do attachment because there is not enough officer in the clinic. However, existing requirement ask for 3-6 months attachment with specialist.So, when is the best time for us?

Of course the interview for scholarship will be difficult to get through since money is the issue. But if there are limitation to utilize money, then there will be less specialist produced. So, when will we get enough specialist in our hospital/clinic?

These are just some of my thought...

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