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29 November 2010

Aku dan Houseman Zaman Sekarang



Zaman 90-an dulu, 2 housemen jaga 28 patients. On call selang 3 hari tidak termasuk passive calls. Bermakna hampir setiap masa aku berada di hospital. Kalau di universiti dulu aku belajar sebanyak teori yang mungkin, semasa houseman aku belajar hampir semua prosedur. Bila aku dicampak ke hospital daerah, hampir semua kes aku kena handle sendiri. Aku antara doktor yang berani buat Vacuum dan Forcep Delivery di hospital daerah. Aku juga antara doktor yang berani buat D+C under sedation di hospital daerah. Aku juga antara yang berani buat suprapubic catheterization kat Unit Kecemasan.

Doktor sekarang? Aku hantar kes Paraphimosis pun disuruhnya patient balik rumah. Compound Fracture pun suruh balik rumah dulu. Dan yang paling tragis ialah bila mereka misdiagnosed Acute Leukemia walaupun White Cell count mencecah 45 ooo. Dah arwah dah adik tu.

Siapa yang patut dipersalahkan? Doktor? Ibubapa? Kerajaan? Aku pilih kerajaan. Mereka menukar dasar untuk kepentingan jangka pendek sahaja. Konon nak ikut ratio negara2 maju bila nisbah doktor:pesakit cuba dikurangkan tapi apa yang apa pada kuantiti jika kualiti tiada? Bila kurang pakar, sibuk nak ambik pakar daripada luar negara. Bagaimana dengan doktor2 baru yang nak sambung belajar? Adakah mereka mendapat layanan yang sewajarnya?

Satu hari nanti aku cerita...

Too many new doctors and too few hospitals to train them

By LOH FOON FONG
foonfong@thestar.com.my

PETALING JAYA: The number of medical housemen undergoing clinical training in most government hospitals has increased and this has given rise to concern that they may not get sufficient experience. With new medical schools opening up locally and lower fees being offered at new institutions abroad, around 4,000 Malaysian medical students are expected to graduate annually from 350 universities all over the world in the coming years. Senior Hospital Kuala Lumpur (HKL) consultant physician Datuk Dr S. Jeyaindran said each specialist was supervising four times as many housemen compared to a decade ago.

“Five years ago, one houseman looked after 10 patients in hospital wards at any one time but now it is one to four patients,” said Dr Jeyaindran, who is HKL department of medicine head and national head for medicine at the Health Ministry.

“The concern is that these interns are seeing fewer patients and hence, have fewer opportunities to carry out adequate procedures. In some hospitals, there are more housemen than patients.”

Dr Jeyaindran said they were not only concerned about the increase in numbers but also their attitude.

“Some lack responsibility towards their patients,” he said, adding that there were also those who did not know how to give an accurate diagnosis and relied too much on investigative tools instead of clinical skills and getting the proper patient history.

Malaysian Medical Council ethics committee chairman Datuk Dr Abdul Hamid Abdul Kadir said several specialists had expressed concern about the large numbers and training hospitals were finding it difficult to cope.

“In the past, it was five housemen in each department but now it could be 20 to 30 for each department,” he said, adding that some specialists were overburdened by the workload.

Health Minister Datuk Seri Liow Tiong Lai said the ministry was aware of the issue and would be increasing the number of training hospitals. He said the ideal ratio should be one specialist supervising five housemen with one houseman taking care of 14 hospital beds depending on discipline. There were 38 hospitals providing training to more than 3,058 housemen last year. However, the number increased to the current 6,253 housemen since the ministry increased the duration of housemanship from one year to two.

“This led to most hospitals, including those in Sabah and Sarawak, having an excess of housemen,” he said.

Hospitals that were chosen must be able to cater to six areas in which housemen need training – medical, surgical, paediatrics, obstetrics and gynaecology, orthopaedic and accident, and emergency, he said. Liow also said that they would be getting 58 contract specialists from Egypt, India and Pakistan next month to help supervise housemen and reduce the burden of the specialists now. He also said that the ministry had taken steps to overcome the lack of experience among housemen by making training compulsory for two years instead of one.


3 ulasan:

  1. saya rasa memang patut pihak kerajaan dipersalahkan....dasar-dasar tersebut tidak patut dilaksanakan. Mereka sepatutnya buat dasar yang lebih komprehensif dan terbaik untuk pesakit....

    BalasPadam
  2. lagi 10-15 tahun, melambak doctor kat malaysia, macam org yang ada Master in Business Admin...kualiti wise, sendiri boleh fikir.

    BalasPadam
  3. big toe dah badly infected and uncontrolled diabetic pun disuruh balik dulu..dressing dulu kat klinik aku...
    mau tak mengamuk aku!!

    BalasPadam