Houseman shift system (part 2)

There is a lot of talk about the houseman shift system lately, and I heard a lot of feedbacks be it from the mouths of the doctors, the newspapers, social media like facebook, twitter, and blogs. I am one of the lucky few houseman who has got chance to experience housemanship in two ways; first half of my housemanship doing oncalls and second half doing shifts, equally divided three postings each. And I have the privilege to make a comparison between the two.

  A tired doctor = excellent doctor?

Since the beginning of an era, the main complains of doctors anywhere in the world are that they are being overworked and underpaid. Now that houseman are not overworked and underpaid anymore, why do we still complain? We should have been grateful that the whines of the past 50 years have finally realized in 2011! I really really bet you that all those who have been thru housemanship would really wish that their work hours were less back then. Heck even I wished for lesser work hours when I was in 1st till 3rd postings, when the oncall system was in place.

I was quite opposed to the idea of the shift initially. But as I go through it, I don’t think it’s all bad. As I mentioned in my previous post, the number of houseman is increasing. The government cannot possibly increase the number of patients to cater for the increasing number of houseman. To force us do more frequent calls will not increase the frequency of the patients we see as we are forced to do calls with few other houseman, about 3-4 houseman in one ward. Shift system makes us see more patients more frequently albeit in a shorter period of time.

The result of lessening the work hours are inevitable; we shall see much less patients and thus allegedly lacking clinical exposure. The good old consultants may claim that in their olden days they saw much more patients, they did more oncalls, they had more horror experience with their bosses, they managed the ward, the clinic, the operation theater alone as houseman while their bosses came in to work late, some even play golf.

With due respect, in the olden days the mortality rate is much higher, in the olden days you could not possibly be taking care of 40 patients and finish your work perfectly, in the olden days the diagnostic investigations were not as available and lavish as the current days, in the olden days there were not so many treatment options and patient care guidelines, in the olden days the nurses were damn good and efficient not having to call houseman for a simple IV line, in the olden days time is not wasted on petty documentations, in the olden days there is much less medicolegal cases, in the olden days you don’t even know what HIV is, some subspecialties were not known to mankind, some recently classified diseases were not even disease yet. Really, I do not think of anything to be proud of back then. And we do not appreciate horror tyrannic bosses as we do not appreciate a hostile working environment.

I do not mind listening to the tales of the specialists on how it was during their good old days. It actually gives me more inspiration to strive harder. But you can not, really can not, expect things to be as same as the olden days. Things change. So should the working attitude.

This lessening of work hours have implications on houseman clinical exposure as well. Some specialists have been proposing for entrance and exit exam of housemanship, with continuous department level assessments. I do not mind that at all, given that it is somehow true that clinical exposure has been much less and some HOs bring quite the worrying attitude, even to the other HOs. If the higher ups are really keen towards producing safer medical officers at the same time lessening the work hours, they must find a mechanism to assure the public that we are safe doctors.

So yes, we work lesser hours. That gives us more quality rest time and social time, like any other normally functioning human being. Apart from physical health, mental health is also very important. We do not want any doctors to be fatigued or psychotic or depressed. If you think that the current medical officers and specialists are really great with their mental health, try to be more observant. Few of them are really just making other people’s lives more miserable! No, they are not teaching or scolding houseman at a clinical error. They simply swear, they yell, they degrade and humiliate their juniors, they make people feel awful all the time. Do you think a normal human being would do that? I understand that as a houseman in the good old days you were also being constantly harassed and insulted, and claims that made you a better doctor. But does it make you a better human being? Does Allah almighty give you the rights to insult your juniors? I don’t remember He gave those privileges to His prophets.

Previously housemen are just being scorned within the walls of the hospitals, but now they humiliate housemen in newspapers and social media. The reason is they want the public to know how lousy we are, and watch out for the graduates of this and that countries. I do not know what good that can do. They mentioned that housemen are being spoiled and mollycoddled, but in fact the public should be more worried about the mental health of some medical officers and specialists as they are the clinical decision makers who are fatigued and psychotic. Lucky I only met few people like this in my hospital. These people ask respect from us and yet they treat houseman like idiots. And we have to respect them, how??

Some of medical officers are not without irresponsible attitudes. I remembered there was one patient who was seen by neuromed in Emergency Department the day before, but I mistakenly referred to another neuromedical MO as a new case. After she did her 3 page review, she yelled at me “Why are you refering this case to me? This case was refered yesterday to another MO! Why didn’t you call him? Why do you waste my time doing all this useless shit?!”… Excuse me, a patient is a useless shit?? I admit my mistake for the wrong referral, but to say that a patient is a useless shit??? Some other MOs did not even come when called for help or opinion. Some even said “ask your houseman friend lah how to manage.” Some MOs become over-apprehensive when a case is refered to them. They specialists mentioned about a lot of houseman with lackadaisical attitude, but what about your MOs? Irresponsible MOs with attitudes are far more dangerous, don’t you know that?  Some of them are just psychotic beyond borders because they are allegedly stressed out.

I have worked with some MOs and specialists who really teach houseman. It is long and tiring rounds but the rounds are brain stimulating. The problem is some of them prefer resting time or doing administrative works over bedside teaching, and scorn us for being low in quality. Ironically they work in a teaching hospital. Yes it’s annoying if a houseman doesn’t know the basics, but if you do not even teach, you can’t put blame on them. I am not proposing breastfeeding, I am proposing tighter supervision. Some houseman even get the basics wrong that you must really correct. If you are concerned that housemen are of low clinical quality, then you should do something about it. If not concerned, please take your rest time, and make peace about our quality.

I do feel shame that my bosses (the medical officers and specialists) are working harder than me. There should be a mechanism to limit their working hours as well. A fatigued medical officer and specialists are more dangerous than a fatigued houseman. A fatigued houseman after an overnight call can still function like a robot, following orders from the superior. But a fatigued medical officer and specialists will endanger patients as they are the ones giving orders and supervising the juniors, and they are bound medicolegally.

I am two postings away from becoming a medical officer. I do not mind doing oncalls all over again as I had done it before and I enjoyed doing oncalls. But as more of my batch of houseman are becoming medical officers, I hope that the government revises the working hours for medical officers as they are currently the most hardworking group of doctors, covering the houseman’s works especially when the housemen go home after their shifts. As I mentioned, I do feel embarassed that my medical officers are working harder than me.

Why am I writing this? Because I find it true, to myself at least. When I started my first posting as a houseman in surgical department, I always dreaded coming to work everyday. There was once I had a sleepless call due to multiple emergency operations. I couldn’t help my colleague at 4am to take morning bloods in the ward as I was still in Operation theater till 7am. The next morning rounds, I was so screwed by the specialist for not taking LFT of a patient post op. He pulled my tie to him and threatened me with extension, in front of patients, nurses and my colleague. I explained to him I was in operation that time, but he just said you houseman are making lame excuses, so stayback till 11pm tonight. Mind you I was postcall and it was a weekend! And that kind of things did not happen just once.

My temper back then was very unimaginable. I honked on the roads all the time, I was really a reckless and fast driver, I yelled at waiters and customer services, and I was swearing curses like I don’t care, even to my parents. I slept dreaming of my dreadful bosses. I look tired even when I am not oncall or postcall. After starting shift system at my fourth posting, I found out that I have been much less stressful, even I forgave a driver who accidentally hit my honda city quite easily. And frankly, I feel happier coming to work each morning, and I do not feel like quitting medicine as much as I have posted in this blog before.

I now love my job as a doctor. I want to brush up on my clinical skills, though I know it takes some time. And I do care about my own health, physically and mentally. Change in the working attitude really needs a paradigm shift. Few specialists already on board for lessening work hours. We hope the other majority follow suit. Please take note that a physician burnout is no small issue. I am sure those who are medical officers and specialists now wished their housemanship in the past to be less tedious and less dreadful.

For more reading

The Life of a Medical Resident in Mexico 

Burnout in doctors hurt patients 

8 thoughts on “Houseman shift system (part 2)

  1. I feel you, my friend. I really do. Me too, did my first 3 postings doing oncalls before they started the new system during my 4th posting. Life indeed has been brighter. I remember the days when I couldn’t even recognize and hated myself secondary to working like crazy from early morning to late night apart from being shouted and blamed at everyday without avail. Man, I really don’t know how I managed to survive those gloomy days when I was doing medical if not because of Allah. I feel you.

    • We are not alone. There is no use of overworking the houseman till 90 hours a week when the numbers keep increasing. Shift system, though still in trial mode, is a brave move.

      • Today is my 2nd day of tagging in my 5th posting – A&E. And in support with your statements above, I do believe that housemen trainings are better nowadays with the introduction of A&E and anaest as the 6th posting. I still remember one of my surgical MO purposedly called the anaest MO oncall late at night to attend an impending collapse patient because he NEVER INTUBATE ANYONE BEFORE and he DON’T KNOW HOW TO INTUBATE. Mind you, he’s a senior MO. Another MO never inserted a CVL short line before. Another MO (just another simple example that crossed my mind) don’t know how to close an exp lap using mattress technique and the HO is the one who taught her. Trust me, those are true stories. I don’t know about others, but for us, those are among the things that we HAVE TO DO and at least HAVE TO KNOW before we “graduated” from housemanship. And some people are just dare enough to do oncalls as the “trusted MO” and shout to the HOs in between without knowing those vital things. Just because some people are more senior does not mean they know more.

  2. i agree with u..coz i’ve gone through that 2 systems also..this shift system,although it’s not that good,but it’s not bad view of we have lesser working hours n more rest..but that lack of clinical exposure,we’ll have to have our own initiative..well said! 😉

  3. This is a cool post. I am already nauseated to listen to how the specialists were very hardworking in their good old days. It just irritates me alot….

  4. We indeed need to prove ourselves to others to be able to adapt into the new shift system, though less exposure, but at least as good as the old time doctors. But issue now is this possible? Old time doctors really work much more harder than us. I guess shift system is good for better mental health and physical health, produce a more smiling and polite doctors, but it is really true that there are too many houseman now. I heard some enter medical program easily despite poor performance in their A levels. It is of course quite true that in older days, a person could enter medical program only if he/ she did well in their academic. Therefore i doubt the quality control of some medical schools which get the licence to do medical program. And therefore, it is no surprise our seniors think that our houseman quality is below par. At the end, someone who approve the permit for those medical schools must be responsible as well. Sorry if what i think is wrong.

    • “I do feel shame that my bosses (the medical officers and specialists) are working harder than me. There should be a mechanism to limit their working hours as well. A fatigued medical officer and specialists are more dangerous than a fatigued houseman. A fatigued houseman after an overnight call can still function like a robot, following orders from the superior. But a fatigued medical officer and specialists will endanger patients as they are the ones giving orders and supervising the juniors, and they are bound medicolegally.”
      hi i’m an MO from a district hospital,after completing my housemanship i was shipped to a district hospital with 4 other HOs..i am a graduate of the old system prior to the shift i dun find 36hr calls 8x a month a burden d/t my training previously.stressed?u bet!whats worse is we dun have d luxury of specialists and when we refer to referral hospitals d MOs give us crap and treat us like s^&T.we are faced with much problems than u can imaginei like ur outlook on the issue, but how many houseman these days think like u do?sad to say not many..what will d current crop of HO’s do if they were sent to district hospital such as mine?working hours suddenly x3 d normal hours and u dun have ppl to fall back to?its gud u guys have rest now but i hope u prepare for these type of problems later on..gud luck

      • Hi District MO, I think the issue of oversupply of HOs will eventually became an oversupply of MO in the near future. So you MOs will very soon be on shift system too.

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