What you need to know about the Malaysian doctors’ culture

“One HO come to OT now.”

“HO, one patient admitting today, please do the necessities.”

“HO, please postpone all elective list patients.”

The reality of healthcare, for us all at the bottom of the hierarchy is this: we don’t have names. The last I checked, our mothers gave us all names, yet we’re subjected to two letters H-O, not even the entirety of it – house officers, as if our ranks have just been degraded to a mere two letters. Let me be clear, they know who we are and they know who is working for the day. I am sure because I introduced myself to everyone. So why not call us by our name?

“Darien, would you mind postponing all the patients coming in next Tuesday?”

Now, wouldn’t this be a better more polite approach?

Even if they don’t know who’s working today, then…

“Hey, who’s working today? I just need someone to help me with something.”

How’s that?

There is a strong patriarchy culture amongst Malaysian doctors, nobody else matters but you. So far, out of two postings, I have only met two doctors who are so down to earth that they would be willing to do all the discharges while you do all the bloods and all the other pending ward works. This doctor once said “Darien, let’s focus on doing all the discharges.” That day, I was so swamped, I was the only house officer taking care of the whole ward with 14 to 16 patients, 5 discharges and 5 admissions. At some point, I think I teared a little before he eventually came to the rescue. It was a blessed day to have received help. Also, thank you to all my colleagues for lending a helping hand when I needed it.

Once, there was a registrar whom I’ve worked with the past 4 weeks, who would say “What matters is not you or me, what matters is the patient. Your sorry won’t help anyone. So don’t apologise.” It was also a bad day, everybody was stressed. One thing went wrong and all hell broke loose.

What are the odds of working with superiors who don’t consider the type of work, so long as the patient is well and gets discharged, then it really does not matter who does the work. It is awfully rare to be working with people like that. If you are reading this, you know who you are, thank you. I had the opportunity to work with true doctors who didn’t consider the work of a house officer any different than that as a registrar, all work, equally important.

But truthfully, I have only been in two departments.

As I recall, there were days where it was busy and as a house officer, we have to be prepared to handle multiple discharges and admissions coming in, not forgetting active plans, referring and requests. With 15 patients, all with active plans, there comes a minute where you just don’t know where to start or how to even begin. If you work with doctors who would be willing to help you, then you would know, no matter how busy the day gets, you will survive. But a bad day is when you receive no help and you are left to fend for yourself. That happens, and it sucks.

By the way, there is absolutely nothing wrong in asking for help.

But why are MOs and Regs the way that they are?

Depending on the department and the hospital, I suppose, most MOs working for the team for that day, will be juggling both ward and the ED referrals. So it’s not surprising for them to be constantly busy, on their phone, on their feet, moving back and forth. Registrars are mostly only seen during rounds, in our eyes, if not, they are likely either in clinic, OT, ED, teaching or some meetings. So literally, we live up to our titles “house officers”, we take care of the house, i.e the ward.

Sometimes, for the benefit of the doubt, it’s not that our superiors don’t want to help us, it’s just that they are way too busy handling their own work.

But I have also met numerous other bosses who would simply not give a damn about the work. They merely expect you to do what you have been hired to do (slavery).

Just to illustrate a point, on many occasions back in orthopaedics, I had to request for “urgent” MRIs and CTs. The very first time I requested, I was obviously unfit to make any requests (I was day 1 of life). Nobody had helped me. In fact, my MO said “did you say this? you gotta say this -“, then he said “try again”. He hung up the phone and I was left to fend for myself against the very angry, annoyed and intelligent radiologist who would, of course, know better of the indications. I, on the other hand, who just started, would of course, know nothing about making request, or how to even begin. Interestingly that day, I was taught of the word “goreng“.

“Darien, you need to learn how to goreng.”

“Darien, you must goreng goreng so that you can get the request accepted.”

I supposed the most intriguing bit of this entire conversation was that, there was a need to ram up the issue, make it so severe that it must have warranted an MRI. That day, I was not taught of the indications, instead I was taught that I needed to do better, to “goreng” better. Truth is, it does not matter how sick your patient is, so long as your boss wants it, you got to get it. Most people don’t think, but if you try too hard, you might just land yourself in trouble. To the radiologist if you are reading this, this is the sad unfortunate truth that happens everyday. Your time and energy is wasted because these people exist to take up your time and energy for non-emergent cases, that are already occupying bed spaces, of which patients who really need them, aren’t getting it. Sorry for the time you have wasted. And to the world, the reality is we are understaffed, under-resourced and we simply don’t have the capacity to treat the population coming to us, we are simply overloaded with patients.

Day 1 of life, the most important lesson, apparently I needed to know was “how to goreng 101″. It wasn’t about writing reviews or managing chest pains or SOBs, but instead it was how to have your request granted urgently.

That’s the culture of it all. Truth is, sometimes, bosses don’t care. As long as you get the job done, then they are happy with you. That is, also unfortunately the sad truth. Because this also translates to nobody really cares about your learning and whether you are on track, what matters is you get the job done.

The jist of it all is when you have very busy superiors, they tend to treat you less. When you have superiors who are more free and able to help, they would if they wanted to.

But of course, I have heard worst in other hospitals. Literally, one house officer to 20 patients? Lack of MOs and registrars in other hospitals.

Then the questions remains – can we blame our superior for being mean, annoyed and angry all the time? Are they simply just tired and fed up of the system that they can’t be bother dealing with us? I think there’s always two sides of a coin and therefore two sides of a story.

Our system is overloaded with patient, coupled with inefficiency in the way the healthcare system is managed. Lack of resources and lack of manpower does not help at all, unfortunately, if at all, it exponentially makes everything worse. Say if I had 20 patients to juggle today, and suddenly my colleague decided to take a leave, I would be alone managing everyone. Imagine the time I have to be there before my registrar is, imagine the amount of patients I have to review in that morning, and the active plans I have to carry out throughout the day, all alone. As a house officer, we can only pray that the world doesn’t hit us hard, on a daily basis, and that it comes at a pace, at a rate that we can handle. To our superiors, we hope that they treat us well and we in turn can learn and do our work better.

So, the Malaysian doctors’ culture is this

  1. Depending on your hospital and your department, there will inevitably be some superiors who are arrogant, selfish, difficult to work with, vulgar, intentionally make your life difficult, lazy, unreliable and undependable.
  2. Lazy is a common aspect where superiors may simply rely on your finding and come up with a management plan. ALWAYS get them to double check unless you are confident.
  3. The “apa-apa sahaja”, “sesuka hati kau”, “do whatever you want” culture certainly exist. Remember if this was your father or your mother, you wouldn’t do whatever you want. But believe me, cultures like this exist. As house officers, all the more reason to be stern and professional and do the needful for your patient’s sake.
  4. Mean doctors are everywhere but never let them get the better of you. Somebody once told me that even mean doctors have something to teach us. They teach us to be better than them. But just because we have experienced such culture, doesn’t mean we can go boomer about it to our juniors in the future. “Last time ah.. we used to…” (You know what I mean.”
  5. Harassment. Big big issue, hardly ever address. But it exist. Sexual harassment exist. And I would say report them, you won’t lose your job, so no worries. Why would you lose your job after getting molested by your superior? It simply does not make any sense. But if at all, remember our generation have the willpower as strong as social media. That’s our strength, utilise it, go all out. Nobody will judge you, only the perpetrators will be judged. Doctors are notoriously known to protect their reputation, so what better than tarnish them altogether? My point is harassment is a big deal, and if doctors cannot understand that, they don’t deserve to have a spot at service.

The culture exists in many form. Some good, some bad. It takes one bad apple to rot the entire department’s reputation, e.g O&G. But for the most parts, I am optimistic that most doctors remain good, and true to their work and passion.

Even though in the last decade, the image the doctors have portrayed hasn’t been all good, most doctors I have worked with are still kind at heart. Keep an open mind, dear juniors.

P.S I hope not to offend anyone with this article. Merely stating my experience and offering a perspective most might not have heard. To the doctors who may be reading this, I hope this provides an insight you wouldn’t have imagined/known.

Darien Liew

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