More than just training
of what the problem at stake is and which specialist to refer the problem to.
Surely, the general public would not be willing to pay hundreds of ringgit per consultation only to find out that the problem is being passed on to someone else, with another three-figure sum waiting for them when they get to the next clinic. This is, surely, incompetence at best and probity of practice at worse, and is certainly not what so many of us took the Hippocratic oath to do.
A degree, a stepping stone But even for my junior medical colleagues, a career with medicine barely begins with a degree, let alone end with one. There is so much to medicine that most medical schools hardly ever cover in their syllabus. Being a good communicator, but more importantly a great listener, is just one of the many skills we honed over many years of practice. How can we be expected to learn all there is in the textbooks in five short years?
As doctors it is our role to, first and foremost, make and take responsibility for those clinical decisions. It takes many years of experience, education and exams to ensure we are not just “safe” but can provide an excellent level of care to our patients. That requires a formalised training pathway, and to ensure that such training pathways are in place to accept, support and educate all my future junior colleagues in their respective specialty choices, both permanent and “contract” medics.
There is simply no benefit in making splashing headlines to ensure all doctors are employed but putting no plans in place to ensure that they continue to be able to serve the government and continue to improve their skills and knowledge with adequate training pathways.
The NHS in Britain is far from being the perfect model. A recent UK government announcement of wanting to train an extra 1,500 doctors to plug the severe shortage of doctors within the system at the moment is similarly a poorly thought out, short-term solution, with no plans made to ensure funding for further training of those doctors.
Because, the basic tenet of the argument is this, no medical student graduates to just become a doctor. Every doctor has a clear vision of a career pathway, and how they intend to get down that path. This may not happen immediately after graduation, but certainly further down in their career path.
A doctor may start out putting in lines and putting up drips, or prescribing medication, or writing discharge summaries. And yes, these are the basic jobs that house officers provide as both a service and, more importantly, part of their early training. But no medical graduate will aspire to do just that for the rest of his or her career.
Medicine is a career where we are taught the knowledge and to use our head; to process and apply those knowledge and skills to cure diseases, not to carry out routine, repetitive jobs on a daily basis.
If that is what the government’s idea of being a doctor is, by offering them employment contracts on an ad-hoc basis, to provide a service and not training, then it is severely mistaken and in fact undermining the profession as a whole.
A way forward? The recent announcement by the health director-general that the total number of accredited teaching hospitals has been increased to 44 hospitals in 2015 is welcome news. But unfortunately, I fear that does not go far enough. Because, what is the definition of a teaching/training hospital?
As far as I am concerned, a hospital with patients and diseases to treat is training in itself for a fresh graduate.
I am not advocating allowing thousands of “inexperienced” doctors to start practising independently but, as any junior medic will know at the beginning of their careers, when in doubt – which is more often than not – we speak to a senior, and I am certain that all hospitals will have senior consultants and specialists who will be around to offer advice and guidance to any junior starting their first job, whether it be in a large teaching hospital in Kuala Lumpur or a small rural clinic in Kulai.
So rather than cramming 5,000 medical graduates annually into a few accredited hospitals or employing them on an ad-hoc contract, wouldn’t it be better if house officers are rotated annually as they do in the UK, to work in both a city/major teaching hospitals and rural hospitals, to provide better training experiences and an improved service to the local community? This too can encompass the six main domains in medicine that the government mandates some experience off.
Sure, I agree that not all senior doctors or consultants will be great trainers or mentors, and the rationale behind the government’s self-imposed limit on house officer training hospitals is probably to ensure an equitable training in all posts.
But surely, having to learn to cope on the job, with senior support, will provide more of an experience to our junior medics rather than having to follow and listen to a consultant on a ward round, with 20 other house officers, with plenty of opportunities to practise our listening skills, and very little chance to actually apply it and, most importantly, learn from our mistakes in our individual practice.
The training of our doctors probably doesn’t cross most of our minds, but it definitely will when we find ourselves engaged within the health service.
Until then, we need to ensure that doctors are not just taught and trained well, but equally given the opportunity to have a decent social/work life balance. The logistical nightmare that is the governmental allocation of doctors is not even a subject I will delve anymore into!
After all, a nation is only as wealthy as its citizens are healthy. It’s time the Health Ministry review its training of doctors, before it’s too late, just as we approach the hallowed age of Wawasan 2020!
The writer is a UK-trained Malaysian working in England. He is currently an Orthopedic Surgeon practising with the UK’s National Health Service.