FOR years, there have been students joining the medical profession for the wrong reasons.
Some wanted to become doctors because of the prestige involved, while others did so because their parents wanted them to.
For such students, some dropped out halfway through their studies when they could not sustain the interest or cope with the rigours of medical school.
Others who went on to become housemen then discovered the less glamorous aspect of the calling and the high pressures that come with it.
There have also been graduates who eventually gave up their medical careers after they found an alternative that they preferred.
Much time and resources go into the education of a medical graduate, along with the hopes and expectations of healthcare providers and their clients.
While every dropout from the profession is regrettable, an increasing number who are doing so threatens to undermine the future of Malaysia’s healthcare delivery system.
It was partly with this in mind that Vikkineshwaran Siva Subramaniam, the chief convener and chairperson of the student-led Malaysian Medics International (MMI), gathered medical students for a summit with senior members of the profession.
“I connect medical students from various schools both locally and overseas,” said Vikkineshwaran.
“I get to educate medics on the current happenings in the Malaysian healthcare system which concerns us.
“I also help medics work towards cultivating their ambitions by organising events which can help improve students knowledge on specialisation opportunities, planning research, and providing pre-meds with guidelines on applying for med school and shadowing opportunities.”
The Malaysian Medical Students Summit (MMSS), held recently in Kuala Lumpur with the theme Future of Malaysian Medicine, turned out to be the country’s largest annual international summit for medical undergraduates.
Seventy-six medical schools from around the world were represented, while medical students from five countries were involved in the planning.
Vikkineshwaran said that MMSS 2016 aimed to provide medical undergraduates an effective platform to dialogue with medical experts on the future of healthcare in the country.
“We want to encourage medical students to challenge themselves to be more proactive and to speak out on critical issues,” he said.
Datuk Dr Jeyaindran Sinnadurai, the Health Ministry deputy director-general (medical), lauded the aims and actions of the MMI.
“Bringing together medical students from all over the world serves to give them clearer expectations of what lies ahead and also a better sense of direction and belonging,” he said.
In his keynote address, Dr Jeyaindran highlighted two problems faced by Malaysia’s healthcare system.
One is that of an ageing population beset with diseases such as diabetes, cancer and hypertension, and the other being too many patients dependent on public facilities.
“By monitoring the changing pattern of diseases in the country and adapting to the future needs, the medical students of today have to be ready to treat the diseases expected to be found in the majority of patients in 30 to 40 years’ time,” he said.
“The transformation of healthcare delivery is a dynamic process.
“We need to ensure adequate number of specialists who are able to address the diseases of our aging population.
“We must also produce more trained caregivers for those patients who do not require the attention of nurses.
“At the same time, the onus should be moved to the patients for them to focus on their health and not just their wealth, so that their lives can be lived to the fullest.”
In his keynote address, Mercy Malaysia president Datuk Dr Ahmad Faizal Mohd Perdaus listed seven reasons why doctors quit practising.
These included lack of passion, lack of postgraduate opportunities, financial remuneration, unrealistic expectations, long working hours, prevailing hopelessness and lack of career counselling platforms.
Elaborating on the first point, Vikkineshwaran, a final-year medical student from MAHSA University, said that some students were compelled by their parents to study medicine even though they lacked the interest and passion.
“For these students, it does not get easier over time,” he said.
“Not only are their expectations not met, they have to deal with competition within the workplace.”
Vikkineshwaran said that there is a risk of doctor burnout if there is no channel for addressing mental and emotional health.
“Once you become a houseman, especially in local hospitals, you can expect to face issues like longer working hours, higher patient load, instances of being overworked, demanding patients and insecurity over position,” he said.
“Some overseas graduates also suffer from unwarranted low self-esteem, based on the misguided perception that they are less qualified when the fact is that they are being taken by the hospitals.”
Vikkineshwaran added that there is also a lack of career and specialising opportunities.
“However, those who do not like working with patients can always do research, work in administration or teach,” he said.
Dr Wan Abdul Hannan Wan Ibadullah, a medical officer at the Institute of Medical Research in Kuala Lumpur as well as co-founder and chief operating officer of Hospital Beyond Boundaries, agreed with the general view that being houseman in Malaysia is tough and energy-consuming.
“Being a doctor itself is a form of pressure as you are dealing with fellow humans’ lives,” he said.
“Doctors will treat their patients like their own family members, doing their best to avoid mistakes that involve another person’s life.”
After five years of medical school, there will be two years of housemanship under specialist supervision.
“During this period, you are expected to learn to manage patients accordingly. Your clinical skills are the most important during this period,” said Dr Wan Abdul Hannan.
“And you are not treating one patient in a day. Usually you have to take care of seven to 14 patients or even more during the day and at least (if you are lucky) one ward with 40-plus patients during night shift or when on call.
“The stressful environment, the skills you need to gain, the knowledge you need to build, makes this period ‘living hell’ but this is for your own good.
“Housemanship training elsewhere usually lasts just one year. Less time in ‘hell’, so the pressure is not that overwhelming.
“But we should always find ways to handle and manage our stress.
“If you are lost and exhausted, try to look back and remember why you choose this career in the first place.
“There are reasons why your superiors are training you hard. One reason is definitely for the benefit of our patients.”
Lim Mao Fong, who will be starting his third year at King’s College London in September, said that transitioning from being a fresh graduate to starting out as a medical practitioner involves a difficult learning curve that includes not just being effective but also safety issues.
“There will be a lot of stressors from the nature of the work itself, as well as pressure from superiors to perform well,” said Lim.
“The perception I get is that the top-down hierarchy in Malaysia is much more evident, whereas the UK is going for a more egalitarian, more flat kind of approach.
“Most foundation doctors (as housemen are called in the UK) that I have spoken to generally feel well-supported, professionally and emotionally.
“We hear our fair share of horror stories but I think it’s a fair point to be weighed in the larger scheme of things, and whether or not to take up the study and profession of medicine.
“However, just because ‘it’s always been that way’ isn’t a justification to continue perpetuating the negative aspects of training as a doctor in Malaysia.”
Kharthik Deepan Murugesu, MMI head of sponsorship, underwent his pre-clinical study in Ireland.
“Although personally I have not experienced being an houseman in either Malaysia nor Ireland, I do believe that housemen in Malaysia suffer more than fresh medical graduates from other countries, from talking to quite a number of junior doctors from both countries,” he said.
“I believe the core issue is not quality of training housemen receive in Malaysia, but the level of preparation they have before joining the work force.
“The standard of competency expected from a houseman in Malaysia is higher than overseas.
“In Malaysia, housemen are expected to have the set of skills essential for a junior doctor the moment they start work and usually without a guidance.
“However, I still do not think this as the root of the problem. The readiness of fresh graduates to perform the tasks of a houseman is determined by the level of training they receive in their respective medical school.
“A medical school with outdated curriculum and training will not be able to produce competent graduates.
“When these graduates enter the workforce, they are unable to cope with expectations of their senior colleague thus feel pressured.
“I believe that to solve the current crisis of incompetent housemen or those stressed out by pressure, the Health Ministry together with the Higher Education Ministry should push for revamp of medical education in Malaysia and implement stricter criteria in giving recognition to local private and foreign medical schools.
“When a fresh graduate feels sufficiently prepared, he or she won’t feel the pressure.”