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Tuesday, 7 April 2009

A doctor’s personal experience as a houseman in a public hospital

The writer just completed his bond with MOH and is celebrating his new found “freedom”. He wishes to remain anonymous.

I thanked Ms Yvonne Chew for her letter on the plight of junior doctors. (read letter here) As a house officer, I had the “honor” of serving in the respiratory unit of one of the biggest public hospitals in Singapore. Local medical graduates will know which hospital I am referring to. It was an experience I will never forget.

A typical day begins with daily ward rounds at 8am. The house officers usually arrive half a hour earlier to prepare the case notes, familiarize themselves with the new cases and to trace results from the previous night.

I am not sure about the workload now, but during my time, the average number of patients under the care of one house officer ranged from twenty to forty.

The ward round which is often intimidating, seldom ends before 11am and sometimes stretches pass 12 noon if the cases are complicated. Then begins a day’s mundane work of drawing blood, doing ECGs (there were no phlebotomists or ECG technicans in those days), typing discharge summaries, arranging for urgent CT scans, talking to patient’s family etc.

If one is lucky to have lunch, it usually means a quick bite at the caferia provided the nurses are kind enough not to interrupt you during the precious few minutes when the new admissions will start to come in at the same time.

The house officers are responsible for clerking, examining the admitted patients, ordering and taking the relevant tests and to present the cases to their MOs or Registrars during the evening round which can sometimes last till 7pm or later.

We had six to eight night calls a month which start at around 6pm and end at 8am the next day after which you are still expected to work till 1pm before you can knock off if there is enough manpower.

I still remembered the Head of Department telling us during the orientation that “post-call” is privilege, not a right. Very often we don’t get to leave early after a hectic night deprived of sleep or if we do, in the late afternoons around 3 to 4pm.

You have to experience it for yourself to know how it feels like to be without sleep for 36 to 48 hours. Your mind gets switched off, your eyelids go drooping all the time and you get irritated very easily. The body craves for sleep and yet you have to force it to be up and running. There was once I dozed off at the bedside of a patient while talking to him!

The long working hours, mental fatigue and emotional distress are not helped by superiors who are not quite empathetic to the problems encountered by doctors fresh out of medical school.

A fellow house officer who broke down crying after being scolded right in front of a patient’s family by a consultant was told straight in her face to “cut the pretence” and stop being a “crybaby”! (I was just besides her) She took two weeks of “emergency leave” a week later and was transferred to another department upon her return.

A Singaporean medical graduate from Australia quitted only after one week in the ward. On her first night call, she was so overwhelmed that she locked herself in the call room and switched off her hospital handphone. She was expectedly haul up the very next day to face the music dished out by the Head of Department who obviously didn’t take kindly to her ”AWOL” . The last I heard of her is that she is now working in a hospital in Melbourne and has settled down there.

The above examples are real life stories and not an exaggeration of some of the challenges or “tortures” encountered by junior doctors in Singapore’s public hospitals.

Why didn’t we bring up our grievances to the attention of the senior doctors then? There is a “macho” culture pervading the local medical fraternity that because medicine is a noble profession, all doctors are expected to put up with sacrifices and hardships which the job entails even at the expense of their own personal well-being.

More than often, the consultants will brush aside the complaints of the juniors with a dose of their own anecdotes:

“In those days when I was a houseman, I worked longer hours than you with half your pay and I have never complained even once!”

“You should be thankful to be serving your housemanship in Singapore instead of Kuala Lumpur or Kuching!”

“Nowadays the load is so light compared to the past and you guys (and girls) still whine so much!”

That’s why consultants working in public hospitals are the creme la crop as they have demonstrated their mettle in surviving and emerging from the system unscathed.

Please do not get me wrong. I am not writing to lash out at anybody. I still have utmost respect and admiration for the consultants whom I have worked with. They are the most dedicated, hardworking and knowledgable clinicians I have encountered and I am indeed honored to be given the opportunity to learn from them.

The long hours and poor working conditions faced by junior doctors are perpetual problems in public hospitals. As long there is a ready supply of “cheap labor” to keep the system running, there is little incentive to improve the welfare of the junior staff as it will lead invariably to higher operating costs.

Under free market conditions, very few local doctors will want to work in public hospitals unless they are training to be specialists which explains why almost all will leave for the public sector upon completion of their bonds. At least 10 of my classmates have broken their bonds during their final years of service.

Recruiting foreign doctors and increasing the number of medical students are only temporalizing measures which will create a bigger problem in the future if the crux of the issue remains inadequately addressed.

While the public sector remains chronically short of doctors, the private sector will be flooded with general practitioners and specialists which will depress the overall wages of doctors.

MOH should do more to keep doctors within the public healthcare system by offering them better working conditions and renumerations which are comparable to that in the private sector.

Keeping more local doctors in the hospitals and polyclinics will obviate the need to recruit more foreign doctors who will have difficulties communicating with elderly patients and understanding our unique Singapore culture.

1 comment:

mz capital said...

Very insightful. Check out this article, which is relevant to what's being discussed here:

Why doctors don't get rich?

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