MMA Says Stress Is Part Of Doctor's Job & That Current Training System Should Remain

MMA president Dr Koh Kar Chai said that "harsh words" are expected during housemanship training to ensure trainee doctors perform their jobs competently.

Cover image via Free Malaysia Today & Middlesex University

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The Malaysian Medical Association (MMA) has announced that they are aware and are addressing the issue of bullying of junior doctors within Malaysian hospitals

However, MMA president Dr Koh Kar Chai has also said that "harsh words" are expected during housemanship training to ensure trainee doctors perform their jobs competently, as quoted by Free Malaysia Today.

While acknowledging that there is a culture of fear and bullying of junior doctors within Malaysian hospitals, Koh has also said the current training system should remain to prepare house officers for the hard life of being a doctor.

In a press conference held at the MMA headquarters on Tuesday, 10 May, he asked, "But are we about to declare that houseman training be simplified [so] that there will be no perceived hardship on house officers and that they will be allowed reduced hours, to see fewer patients, and to assist in fewer procedures?"

"What will happen if these housemen move on to be medical doctors? Will they then be able to manage patients on their own with long hours of work when there is a never-ending queue of patients needing their care that they never prepared for?"

MMA president Dr Koh Kar Chai.

Image via Free Malaysia Today

Koh said the competency of such doctors would be questioned if housemanship training did not prepare them for the reality of being a medical practitioner with the stress and long hours of work

He also said that media reports have "misconstrued the reality of the situation" on bullying cases, and that there are only a handful of serious bullying cases experienced by trainee doctors.

"With the bullying cases that have now been reported, many of the press continue to mention the few cases that occurred before," he said during the same press conference.

"But looking back, how many of these cases were severe? The press [is] only mentioning these few cases."

Among his statements, however, Koh also mentioned that there is a high rate of attrition among house officers, of at least 26%.

Image for illustration purposes only.

Image via Oxford Mail

Instead, the MMA president called for bullying within the medical fraternity to be more clearly defined for action to be taken

"From what I've been reading in media reports, bullying can mean anything from harsh words to foul language, to being asked to do an errand from someone who is more senior," he said, as quoted from KiniTV.

"My concern is that even instructions related to work if deemed unacceptable to a junior doctor, it can even be construed as being bullied, which is pretty unfair."

However, he reiterated that MMA does not condone "outright bullying", where he said "there is an obvious misuse of power that is repeatedly done with an effort to drain physical, social, or even mental health".

Image for illustration purposes only.

Image via NPR

The medical association's statements were met with dissent by the Hartal Doktor Kontrak movement, a group of junior doctors fighting for the rights of contract medical officers in the country

"Saying only a handful are bullied greatly downplays the problem and invalidates other people's trauma," said a spokesperson of the group, who asked to be identified only as Dr Syed, to Free Malaysia Today.

Syed said the MMA's statement was troubling as it mentioned only "severe cases" of bullying.

"What about the 'not-so-severe' cases? Does the Ministry of Health (MOH) allow 'mild to moderate' bullying of house officers? If so, what are the cut-off points that separate mild, moderate, and severe cases of bullying?" he questioned.

A group of contract doctors participating in a Hartal Doktor Kontrak protest at Sungai Buloh Hospital in July last year.

Image via Afiq Razali/Utusan

The spokesperson said MMA's use of the word "handful" showed it viewed the abuse suffered by junior doctors as non-existent

"This is why housemen continue to suffer despite repeated reports," Syed said, adding that internal resolutions are of no use as leaks occur, making victims and whistleblowers identifiable, and constantly labelled as "kaki report (simply reporting)".

The group called for probes into the bullying issues by an independent committee.

Syed added that senior doctors should stop "trash talking" house officers, and use kind and supportive words during training.

"We cope with our patients' trauma enough. Let's not cause more [trauma] to our colleagues. You lose nothing by being kind and teaching well. Harsh treatment of housemen should stop."

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For a more thorough directory of resources, head over to the websites of Malaysian Mental Health Association or MINDAKAMI.

MMA made the statements in the wake of a houseman's death at a hospital in Penang last month, which sparked calls for the poor working conditions of junior doctors to be addressed:

Besides the alleged overwork and bullying, Malaysian junior doctors also face poor employment terms within the civil service: