Set up a special committee to investigate the alleged grievances of trainee doctors

The Consumers Association of Penang (CAP) is concerned about the recent report about a Hospital Pulau Pinang houseman who committed suicide, the second case in two years. While healthcare professionals’ psychologically toxic working environment is much highlighted, the investigation of the doctor’s suicide case should be comprehensive as bullying of trainee and junior medical staff may likely be the tip of the iceberg. It should not be handled on a piecemeal basis or as a kneejerk response whenever a problem arises.

We call upon the Health Ministry (MoH) to conduct a nationwide study as bullying of housemen and junior doctors should not be confined to Penang and doctors alone. It should include other healthcare professionals such as nurses because they are in the same system and working environment.

Studies in countries such as Finland, Norway, Australia, Singapore, and China show an increase in anxiety, depression, and suicidal thoughts among medical students and medical professionals. Being prevalent does not mean that the issues can be overlooked or normalised.

There are more than 300,000 studies available online on the subject of doctors’ suicide and mental illness. It was shown that the suicide rate among doctors is among the highest of any profession in the U.S. Doctor suicide cases range between 28 to 40 per 100,000 which is more than twice that of the general population which is 12.3 per 100,000.

Bullying and the long working hours of doctors are also factors that cannot be ignored. Doctors often worked longer than their official duty schedule because they may have to complete their reports after their working hours and pass on their duty to those on the next shift.

Many fatal and non-fatal road crash involved medical professionals and this is because of the long working hours with minimal rest in between the shifts that they are subjected to. MoH data showed that between 2014 and 2016, there were 554 commuting accidents involving medical professionals and these are only the reported cases. It is pertinent to point out that traffic accidents involving medical professionals happen in other countries as well and are often associated with sleep deprivation.

Stress and depression are also associated with how doctors are treated and how their professional and institutional systems handle their complaints.

A medical professional job places the person in a uniquely vulnerable position as they are under constant stress with a sense of responsibility of having people’s lives in their hands. The person may have a sense of failure when a patient under his charge passes away despite trying his very best. It is not only the lives that are lost but the agony to see the despair of the deceased family members losing their loved ones.

Another stressful and depressing possibility is that a doctor might be sued for medical negligence and that may spell the end of his professional career.

In a survey of housemen in Penang, 88.5 per cent of them rated their stress levels between three and five on a scale of one to five. An astonishingly 15.4 per cent rated their stress level at a maximum of five on the scale. However, we wish to point to a study concluding that “the overwhelming majority of people who might be viewed as high risk for suicide will not kill themselves, and about half of all suicides will occur among people viewed as low risk”. Thus, it must be noted that low-stress levels do not mean that a person cannot have suicidal ideation.

The lack of permanent posts and the opportunity to go for specialist training in Malaysia were the main reasons for doctors to quit and experience the stress due to the elements of uncertainty they create. This has been a persistent issue and worry for doctors because, without a permanent post, they find it difficult to plan their career path besides losing out on benefits that permanent doctors enjoy.

Without solving the outstanding issues involving doctors, the increased number of medical schools and medical programmes over the years will continue to churn out medical graduates, exceeding MoH’s capacity to absorb them into permanent posts. The Ministry of Higher Education (MOHE) should help MoH to address this issue as government service job vacancies for doctors have been frozen since 2015.

According to MOHE, an average of 4,000 new doctors are needed every year for Malaysia to achieve the target of one doctor for every 400 population by 2025, noting that local institutes of higher learning have a current total intake capacity of 4,820 students.  What this means is that we are still in need of doctors but just a dire shortage of permanent posts, a setback that will continue to plague the medical profession for years to come if there is no concerted effort to solve it.

We call on the government to set up a special committee with representations from doctors, nurses, and civil society to enquire into the alleged ill-treatment of trainee doctors, their workload and working conditions. The committee should publish a report with recommendations to improve their working conditions and restore a sensible work-life balance.

Mohideen Abdul Kader
President
Consumers Association of Penang (CAP)

Letters to the Editor,  10 May 2022

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