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By Nur Natasha Aida Ismail & Ahmad Aidil Syukri Hamzah
The recent death of a medical houseman has triggered a nationwide debate over what critics call a “toxic culture of workplace bullying” at public hospitals. This second of a two-part article on this issue takes a look at the situation overseas.
KUALA LUMPUR (Bernama) – Dr Muhammad Izzuddin Badaruddin, who did six months of housemanship training in Malaysia in 2018 before continuing it in the United Kingdom the same year, finds the UK’s work culture “more civilised”.
“Whether in the UK or Malaysia, I was never bullied, but I must say that the work culture in the UK is more civilised… we are respectful of each other because, ultimately, the patients’ safety is our only goal,” said the Malaysian doctor who is now a general practice specialty trainee at NHS Barnsley Hospital in Barnsley, England.
“I’m lucky I had the opportunity to experience what it’s like to be a junior doctor in Malaysia as well as the UK. To be honest, I won’t say that bullying does not exist in UK hospitals but it is rare because all trainee doctors here are treated fairly and equally, irrespective of rank or seniority, race or gender.
He told Bernama in a telephone interview that at his workplace, he and his colleagues address each other by their first name.
“We don’t use the doctor title or terms like ‘boss’. Only the specialists are addressed as doctor or Mr but even then, they always insist on being called by their first name,” he added.
Relating his experience of working in a government hospital in Malaysia, Dr Muhammad Izzuddin said based on his observations, he found that Malaysian hospitals placed much emphasis on the aspect of seniority, resulting in relatively limited career advancement opportunities.
This, he said, was one of the factors that compelled him to work in the UK which offered a wider scope for young doctors like him to become a specialist.
Over there, trainee doctors are also given the chance to express their views as well as problems, which their superiors are expected to address as soon as possible.
There is no such thing as “closing a case” to safeguard the image of a department or hospital, he said, adding that each junior doctor is monitored by a clinical supervisor and education supervisor who help out in terms of their work and also welfare.
“Even though there is no special committee in the UK to monitor cases of bullying, junior doctors (who face bullying) can bring up the issue with their supervisor or superior and get it resolved. If it’s not resolved, they are encouraged to contact the British Medical Association, which is responsible for safeguarding the welfare of doctors in the UK,” he said.
Dr Muhammad Izzuddin also said some of his friends who were doctors in Malaysia had complained to him about the problems they encountered whilst undergoing housemanship at Ministry of Health (MOH) hospitals.
LONG WORKING HOURS
“I realised that my comrades in Malaysia were overly stressed due to their heavy workloads, to the extent of them losing weight because they just couldn’t find the time to eat or didn’t feel like eating. There were also other doctor friends of mine who were able to hide their feelings despite the pressure they faced at work.
“I’m aware that other jobs can be stressful too but what I am voicing out here is the unnecessary stress doctors face, such as unfair distribution of duties,” he said.
Two months ago, the Hartal Doktor Kontrak movement in Malaysia reported that its findings from a survey involving 150 trainee doctors nationwide showed that 60 percent of them experienced stress due to bullying by senior doctors.
About 20 percent of the respondents reported being so depressed that they had to seek the services of a psychologist.
The Malaysian Society for Occupational Safety and Health (MSOSH) believed that the alleged rampant bullying at public hospitals stemmed from the absence of official guidelines for training house officers or trainee doctors.
On claims that working long hours help young doctors to build their skills and resilience, Dr Muhammad Izzuddin said although long working hours were the norm in the UK previously, it now practices the on-call shift system.
“Previously, the UK’s on-call system was more or less similar to Malaysia’s, where trainee doctors must be on call (be ready to be summoned for duty) for up to 24 hours or even longer.
“But the UK has now shifted to the on-call shift system where doctors can be on call for two to four days/nights continuously but each shift is only up to a maximum of 12 hours,” he explained.
It is understood that a few hospitals in Malaysia have also implemented the on-call shift system.
Dr Muhammad Izzuddin said junior doctors in the UK, or Europe in general, work only a total of 40 hours a week while their counterparts in Malaysia are forced to work a minimum of 75 hours a week.
“To me, such long working hours can endanger the safety of patients and also doctors… there have been many cases of road accidents involving junior doctors who experienced microsleep whilst driving home after completing their on-call duty,” he said.
The media, quoting MOH data, has reported that 554 cases of accidents involving medical professionals going to and fro work were recorded between 2014 and 2016.
Dr Muhammad Izzuddin opined that MOH should consider hiring locums to overcome any shortage of doctors in hospitals, instead of making their doctors work long hours at a stretch.
“This is practiced in the UK and, to some extent, it helps to reduce our workload in case someone takes medical leave and so on,” he said.
LOSS OF MANPOWER
Senior consultant psychiatrist at Universiti Malaya Associate Prof Dr Muhammad Muhsin Ahmad Zahari, meanwhile, urged the government to look into the bullying culture, particularly in the health sector, saying that doctors work in a critical sector and their patients’ lives are at risk if they are forced to work under stress.
He said victims of bullying often experience excessive stress and are not able to perform or focus on their work well.
“When the bullying behavior is deeply rooted in an organisation, there is always the risk of the victims suffering burnout. This can affect their emotional state and lead to a mental disorder such as major depression.
“If a person has major depression and it is left untreated, they are at risk of developing suicidal behaviour if they continue to be bullied,” he said.
Besides depression, the victims can also develop an anxiety disorder, post-traumatic disorder, panic disorder or social anxiety disorder.
This is why, stressed Dr Muhammad Muhsin, there is an urgent need to address the toxic work culture in public hospitals.
Proposing that an independent complaints system be created to enable victims of bully doctors to register their grievances, he said currently trainee doctors were hesitant to come forward for fear that it would affect their competency evaluation process.
MSOSH president Dr Shawaludin Husin concurred with Dr Muhammad Muhsin’s views, saying that if no changes are made to the medical institution and nothing is done to address the bullying culture, brain drain may ensue.
“We are concerned that the nation may lose its medical manpower as no one will be interested in furthering their studies in the field of medicine.
“Or they may only be interested in studying medicine and working in developed countries where such a toxic culture does not exist,” he added.
Translated by Rema Nambiar
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