House Officer in Malaysia: Are they real doctors?

Does house officer job really tough? I have written about this in my blog before. It may be already lost somewhere in the internet. One of the most memorable time of your life after becoming a doctor is house officer time. The time where you find your true self, your weakness and your strength. It was also the time when you have to decide, whether you need to continue such life, or just leave it and find other job. To tell you the truth, a lot of my friend who dropped out from house officer program are successful nowadays in other field. So what is it like to be a house officer? This will be a part of my chronology of 'Becoming a doctor in Malaysia' post. You can check out the previous post here:

House Officer: Have they eaten their breakfast?

I will start my story here by highlighting that many member of the public, and even some doctor themselves doubt about house officer credibility and competency. That is a normal thing no matter where you work. Does someone become an expert immediately at the first day of work? If they do, that must be  a Godly miracle. People are so afraid of the house officer until they think they will die just by seeing one of them. That's a bit too much, but seriously, a lot of people really afraid of house officer. 

A nurse for example, will always look around for medical officer or specialist to prescribe their child or themselves medication for flu. They afraid that if a house officer prescribe it, they will die of the side effect..of paracetamol... ? They were so afraid to consult house officer, as much as they could, they will keep bothering the busy medical officer and specialist to consult them. 

Not just the nurse, the other staff, all are afraid of house officer. Don't get me started with patient. Patient will feel anxious and nervous when a house officer start interviewing them. It's like a bad luck just step into their cubicle, or something like that. 

The reality is, a house officer is a doctor. A person who learn medicine for 5 years, knows the pathophysiological aspect of a disease, and know the treatment for it. If not, they should not have been graduated from medical school in the first place. What lacking inside a house officer is experience. That experience will be gained through out 2 years house officer program. They will be guided by their senior, medical officer, specialist, consultant, to become a safe doctor in the end. 

Are they not safe in the first place? They should. Any mistake done by a house officer is punishable either via extension of their course or by terminating their career. A lot of house officer who get disciplinary action and warning letter, are given option to resign. Technically, in government sector, option to resign equals to termination. It just a nicer way to fire someone. House officer is safe and a responsible. They were not like kids running around doing anything they want. They do their job according to the standard operating procedure, guidelines and any evidence based medical knowledge available. 

A house officer also will not be put in a hospital without specialist. All house officer will only be assigned to an accredited teaching hospital. This means that every aspect of patient safety is being taken care of not only by that house officer, but the medical officer, specialist, consultant, up to hospital director. What house officer did, is basically applying what have been discussed on a higher level, and deliver them to patient. It is not like they did something just by themselves. 

This is why you can see rounds are being done in a regular basis in a teaching hospital or hospital with house officer. Rounds are basically a meeting, consist of the highest person in the ward (Consultant) down to the lowest person in that ward (house officer?). I do not like to think that house officer is the lowest ranking person there, but let this stereotype thinking be there for a reason. We should not label someone the lowest person, yet we need to assigned someone to be the lowest one. Thus, House officer with proudly took that place. Imagine having a meeting two if not three times daily everyday, 7 days per week. I put one of you in a meeting once a month, you will be already complaining that you have too much meeting. Yes, rounds are meeting. A patient case will be presented to the highest person in the rank, then that highest person will gave order to the lower person below him or her, then down-down-down, to a house officer... WRONG!

That is what you think, but that is not the reality. A medical round is actually a place where everyone will discussed the case. As discussion of this cases is strictly confidential, it is better to discuss it in font of the patient themselves so that they can be involved in the discussion. It's not for the highest person in the rank to make a decision, he is there for other reason which is approving the decision. This is where it get interesting... A house officer is the person that usually present the case to all the members of the meeting, thus if a patient too scared and skeptic about a house officer, think what will be presented there. A lack of information could lead to a disaster. Refusing to answer that stupid question from a house officer could cost you a life. The information then will be digested and circulated around so that everyone will try to chip in and 'vomit' an idea on how to solve patient problem. Someone will suggest doing surgery, another one will suggest to wait and start antibiotic, the pharmacist will suggest the dosage and which antibiotic is better compare to the first suggestion, the nurse will suggest to use other antibiotic as not enough nurse to deliver to frequent dosage, the consultant will nod, give his or her own suggestion, everyone agree...then done. 

I really love the way this meeting happen. At the same time, they will ask the patient whether the patient agree or not. It's very interactive. Medical round is the most interactive meeting I ever seen in my entire career. The rest of other meeting was just for tea, coffee, people bashing each other, and no conclusion in the end. The meeting in a medical round will only lasted about 5-10 minutes, but the outcome is always fruitful and the action will be rapid. 

The round will be done usually in the morning, and in the afternoon. Another round will also be done at night but usually consist of those who are on call only. The decision making for a patient, thus, is not simply like a boss ordering something and everyone must follow. Its always a group decision. What will happen if some rogue doctor want to be a hero for himself or herself? You will always see them crying later getting scolded in front of everybody. No..I remember when I was a housemen, my senior told me, don't be a hero. You can save someone's life by not being  a hero... 

So what if in a situation where decision making has to be done quickly. We call them life saving situation. Life and death in the hand of that one doctor that was around? Will then he or she be a hero (or heroin)? 

This is where basic life support or BLS, Advance life support (ALS) or whatever LS, come in. People might think that doctor act like a hero or heroin. Looking at a doctor trying to save a person with cardiac arrest always look dramatic, full of action. If it was a rap music, it must be sound like Busta Rhyme or Tupac Shakur ( oh I am old). It was flowing like that doctor brain is a computer with the latest intel processor installed. Yes, it was cool. I also find it cool to see a doctor trying to revive someone's heart who has stopped. I've have my share of experience as well. 

To tell you the truth, everything done in that life saving situation is already planned. A doctor was 'acting' like they were reading the script. They have to memorised the script, of course, before they can act it. This is what I mentioned above. All the 'LS' that we have. It is basically simple, a normal person can learn that (in fact they did teach to public, but no one bothers). Everything was already being written down, which one to do first, which to do next. Just follow the procedure/ the flow chart, we might end up saving someone's life. House officers are compulsory to attend and get certified on that course..the BLS. They will have their certificate in their filed at home or wherever they keep it. That certification is valid for a certain period of time...3 years..5 years. (I forgot. It has been sometimes since I left clinical work.)

The nurse will also have to attend this course, in fact all hospital staff need to attend. It was one criteria to be fulfilled to get that accreditation or MS ISO certified. So, if you work in hospital, there will always be that one person, likely your superior, that keep nagging you to join that course. You will feel lazy to attend it as there will be exams at the end of the course. It is compulsory nevertheless. An organised chaos.... this is what they call it. Organised chaos as everything will look chaotic and full of drama..but it was actually organised.. Every action was structured long way before it happen. 

Thus, you are pretty much safe now in your stay in a hospital. What else can mess your life up? Certainly not the house officer. Certainly not that nurse you scolded just now. Certainly not that consultant or specialist. Certainly not the medical officer... It must be a bad luck if you mess up in the end. 

No, seriously. Everyone make mistake. Sometimes, a bad decision by a doctor can end up hurting you more. Doctors are human too. No matter how good cops are, there will still crimes on the street. No matter how good teachers are, there will still be a student who failed. No matter how good pilots are, there will still airplane accident in the news. Everywhere, there will be something out of bad luck will happen. This happen because God let it happen. It's beyond our human power. 

So there will still be patient who will end up having more complication from that surgery, or from that medication given.... Medical error can still happen even if you ask a robot to do medicine. We, doctors, are human, and human makes error. However, to minimised the error is what every doctor will be doing everyday. Do no harm. That's our ultimate motto as a doctor. We can't fixed that lungs that someone have been smoked for 10 years that end up with lung cancer. We can't stop that bacterial infection that started since 2 weeks ago, and patient just came to hospital yesterday. We can't stop someone's liver to stop functioning because of those alcohol he drank since he was teenager. We can't. What we do is to minimised the damage and the error. That's what we do. So, if you are in a hospital, you can't put a 100% chances that you will be cured by doctors. But you certainly can rest assure, that all the doctors are trying their best to control the damage of the disease...and save you along the way. 

House officer, is a doctor themselves. They will think like what I have been described. Patient safety will be their utmost priority. I once a house officer myself. Those years in that program teach me the most important lesson in my life. I would never kill anything in this world. Our job is to save life and not to end it. Give that House officer a chance to interview you, be cooperative, and sometime, ask them...

'Have they eaten their breakfast?' ( or lunch)



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