Stresses of being a Houseman in Malaysia

When I was in med school a year ago, I’d say “nahh, I’d survive housemanship, it’s not that hard… Hurdles? Bring it on!” But now that I am in the middle of HO posting, I feel like “enough laaaa…”

So what stresses a houseman?

1. The working hours – All HOs are required to work from 7am till 5pm, if the HO is oncall, the HO must stay in at night till the next day’s 5pm. HOs work 34-40 hours straight. In med school, I didn’t think this should be a problem for me because I am young and I am strong. But imagine doing this in 2 years of housemanship, or if you still wanna continue being a doctor, for the rest of your life till you retire. Just imagine the awesome tiredness. You’ll get old and weak faster than you think!

2. The tagging – Tagging is for department’s newcomers. Usually tagging is about 1-2 weeks. But I have heard people tagging for 2 months. Imagine tagging from 7am till 10pm everyday for 2 months, without weekend off.

3. The oncalls – This isn’t a big problem for me because I am able to sleep about 4 hours whenever I am on-call and I am quite the “anti-jonah” aka not a patient magnet (means not many admissions or problems whenever I am on-call). But imagine you jonah (many admissions when you on-call) with never-ending work and no time to sleep, some more have to do EOD (every other day) calls. Plus have to go back at 5pm the next day after on-call. In other hospitals there is such thing as pm off, but not in the hospital I work in 😦

4. The workload – It’s very tedious. I don’t mind the basic procedures (chest tube, CVP line, LP etc) because that is what we have to learn to do. We HOs actually spend little time clinically but more time on writing and documentations. It is as if we are treating the papers more than the patients. No wonder patients only see doctors writing and poking their veins only. Not to mention the whole documentations for clerking, reviews, referrals, drug prescriptions, discharge summaries etc. Some more the nurses will bug us HOs to sign bureaucratic this and bureaucratic that. To be fair, the HOs few years ago were more overloaded with work that they didn’t have time for lunch, toilet or go home on time.

5. The social life – Read back all the abovementioned stress factors (the working hours, the tagging, the oncalls and the workloads). Do you think you’d have a social life or spend time with family? In hospitals where consultants keep harping on that houseman are too many like in my hospital (400 HOs, thank you!), we do have a little bit of free time. Imagine Sibu Hospital where they only have 7 HOs in one department…

6. The bosses – MOs, specialists and consultants have their own characters and personalities. Some HOs think this boss is “baik”, some think this boss is “cibai”. It’s all subjective to one’s perspective. In the end, they’re still the boss and whatever orders they give, the HOs must carry them out, else trouble awaits. Yes, some of them yell at the HOs (it’s true what the media says). Who isn’t feeling “bengang” when we are yelled at? Of course we do, but we cannot yell back because firstly they are the boss and secondly they’re quite right. It is somewhat true that is how we learn (from the yelling and humiliation) for the next 2 years of housemanship. But imagine the stress.

7. The nurses – This depends on the nurses you work with. I have worked with the good and the bad ones. The good ones help HOs in a lot of things, I did even learn from them. If the nurses are in bad terms with a HO, they will screw the HO hard enough that they will bug the HO to sign all the bureaucratic shits sheets, else they’d report to the sister and sister will report to head of department. Some more during oncall, they’d wake you up at 3 am in the morning in the middle of your sleep just to set a line. I am still convinced the nurse deliberately took off the line just so that I’d set it up again while I was still drowsy. Don’t play with the nurses. They rule the ward. The HOs are far to the bottom of the food chain.

8. The colleagues – this is quite a headache especially for the houseman monitor who does the on-call roster. Some HOs don’t want to on-call this day or that day, especially weekends. It’s quite unfair that other HOs do on-calls on weekends while one or two refuse to do so. Some of HOs take EL (emergency leave) or abscond without informing (for me it’s fine if they wanna go anywhere, but just finish the work and inform lah…) ending up the other HOs have to do his or her job. I don’t mind the slow and incompetent, but I do mind the attitude.

9. The patients – there are some who have poor compliance, there are some who demand many things including AOR (at own risk) discharge, there are some who think they are doctors and say “why not you do like this, you do like that”, there are some who yell and criticize the doctors. There are some with all the things mentioned. And sadly, we still have to treat these people, with passion. Ergh!

10. The assessments – Actually I think it’s weird that a working adult still has to sit for exam. As for HOs, there are at least 2 assessments for every posting. The specialist wants HOs to know in and out of the topic discussed. The stressful part is that when you approach a specialist and got an appointment for assessment, suddenly the specialists cancel at the last minute and postpone to a later date. Furthermore, they will keep postponing the assessments. Imagine you study so hard a few days before with all the hopes to pass the assessment, only to know that the specialist keeps on postponing the assessment. That is the never ending stress. If HOs fail the assessment, they will be extended for another 3 months in that department. That is just for one department, mind you. The housemanship of 2 years is already long enough, adding another 3 months per department is just stressfully demotivating.

11. The breaks – Each department grants 8 days of break in a 4-months posting. Even if a HO is extended till 7 months, the break is still 8 days. Imagine having to work everyday, only to have average of 2 days off in a month (average one day off in a month if extended). Some departments are not so easy to get day off. Don’t ever think you don’t need a break because you really do. Especially if family matters come up or suddenly you got sick.

12. The others – working in a big city like me, other stress factors also count ie the traffic jam, no parking, expensive cost of living, unfriendly people of the city etc.

So, for all the doctors-wannabe, you still wanna be a doctor?

P/S: I am currently finishing my second posting (pediatric) and will move on to third posting (medical) starting tomorrow. Life will be busier, but I am enjoying housemanship despite the stress 😛