More than just train­ing

The Sun (Malaysia) - - SPEAK UP -

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.

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