Saturday, January 31, 2009

Housemen lack basic know-how

Housemen lack basic know-how

KUALA LUMPUR: Some medical universities, both local and overseas, are churning out doctors who cannot carry out common medical procedures, have no proper clinical exposure, cannot communicate effectively and cannot even take down the history of patients properly for diagnosis and treatment.

Senior medical consultants in government hospitals are now saddled with the task of having to retrain these people to ensure they meet the country's standard of medical practice.

Some of these fresh doctors are retained in their houseman training postings for years, some even up to six years, because they cannot meet the standards. The compulsory housemanship is two years.

In view of this problem, the Malaysian Medical Council has issued letters to all heads of department in government hospitals where housemen are posted to open a file on each of them, containing information on the university they graduated from, their performance and shortcomings.

It is learnt that by the end of the year, the MMC and Health Ministry will nail down the sub-standard medical universities and tell them to buck up.
Kuala Lumpur Hospital's Medical Department head, Datuk Dr Jeyaindran Sinnadurai, said housemen come from 300 medical colleges all over the world. These colleges churn out 1,200 doctors a year and this number is expected to increase to almost 2,000 next year.

"When they come back to work in Malaysia we have been forced to extend the period of housemanship from one year to two years in order to ensure the standard of medical practice is maintained in this country for the safety of our patients," he told the New Straits Times.

Dr Jeyaindran handles about 140 housemen a year and he noticed that some 15 per cent of them do not have enough experience to take down the medical history of patients.

"When they are taught to take the history properly and put the findings and various symptoms in a sequential order they can come to a proper diagnosis very rapidly," he said.

However, he added, this was seriously lacking in many new doctors because they have not been trained during their years in clinical exposure. Thus, during their housemanship training programme they needed to be retrained to do this properly.

"Because they have to be retrained, some of their postings are extended," he said.

Dr Jeyaindran has come up with a syllabus where a house officer must have core knowledge and experience before he leaves for his next posting.

"A houseman who comes in for training should be able to manage hypertension, asthma, diabetes and common medical emergencies appropriately based on current clinical practice guidelines, besides acquiring adequate generic skills," he added.

He said some were never taught this properly during their years in medical school and hence they were taught and assessed in a fair and objective manner during their training.

"We want doctors to examine patients properly and not take notes from the nurses' chart.

"We also do not want doctors to be over-dependent on investigative procedures which is time-consuming and expensive.

"One loses the ability to use clinical acumen to make judgment when he becomes too dependent on procedures for a result and diagnosis," said Dr Jeyaindran.

He also expressed great concern that some house officers were not able to perform even the most common procedures such as setting up an intravenous line, central line, and inserting a chest tube.

There have been complaints from patients that there were housemen who cannot even draw blood for a blood test and had to seek the help of nurses.

"Miscommunication with patients can also lead to a lot of problem and this we have encountered with housemen," he said.

"To be a good doctor it is not how much knowledge you have... it is clinical acumen and the skills developed in treating a patient.

"Medicine is not black and white but lots of grey in between and in order to identify the grey areas the only way is the more you see, the more you do, the more you understand," he added.

Dr Jeyaindran said housemen have become something like a production line.

"They come, they take some history of patients and go away.

"They never come back to check whether their diagnosis of the patient was correct or wrong," he added.

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