Malaysia Dateline

Junior doctors’ Quandaries

The recent reports of bullying and sexual harassment speak to worrying toxic working conditions in the healthcare system.

Young doctors are ostensibly not getting the protections they need. Given the tragic loss of lives and the litany of reports bandied in the social media, more need to be done urgently.

Soonest I was helming Ministry of Health in the PH Government, these issues, being emotive and perennial, garnered attention. We coined the term “Junior Doctors Quandaries” when we first undertook to address the problems faced by House Officers (HOs).

I told a Post-Cabinet Meeting in MOH, in the early days that we shall get to the bottom this. We needed a deterrent approach for would-be perpetrators and set in place a process for cases.

We worked to create a climate where young doctors could speak out. We visited 3 major hospitals, namely Queen Elizabeth Hospital, Kota Kinabalu, Selayang Hospital and Sultanah Hospital, JB, and had separate engagement or townhall like sessions to the groupings of HOs, MOs and top management of HODs, Specialists etc.

An opportunity came about, when a very serious case of bullying and harassment involving a senior Head of Department (HOD) at a major specialist hospital.

Only then did l suddenly realize of how difficult it was to bring the culprit to book. Firstly, we undertook a preliminary finding and with ‘prima facie evidences’ established, we later instituted a Full Inquiry Committees of very abled, experienced senior staff of MOH, the like of Head of Services, etc. After a concerted attempt, the King has to finally terminate his service.

Arguably, there is a culture of fear that permeates the entire system. Part of this is arguably set by MOH’s top brass, which has repeatedly reprimanded officers for speaking out and raising concerns.

Admittedly it is also systemic, as junior doctors are vulnerable to those in more senior positions who have sweeping powers to control career paths.

1. Their career path (in government service) depends heavily on their yearly appraisal (scored by their immediate superiors);

2. Fear of not getting a permanent position (many are on contract);

3. Fear of not being selected to undergo Master’s training; and

4. Fear of being transferred out of their current place of work or being denied entry to a place of training of their choice.

Many MOH staff are working in fear. Those in senior positions may not agree or like to hear this, but it’s the hard truth. Period. Testimonies by those that have retired sufficed as evidence.

Time for Health Minister to take action

Rather than dismissing the ongoing criticisms and reports, now is the time for the Ministry of Health to take action. The following are some observations and guidelines which can work to address the issues.

1. There should be a zero-tolerance policy on workplace bullying, harassment and intimidation. Be brave and undertake the appropriate actions as per the SOP without fear or favour. The grievances and complaints of the junior staff must be addressed promptly, sensitively and their identities protected jealously. Reinstate processes that allow junior officers to report their senior officers without punishment.

2. Establish a Full Inquiry Committee to review the scope of the issues across the entire health sector

3. Recognize that no system is fool proof. Be humble and be prepared to rectify the faults within the system. Not all faults can’t be fixed at one go, hence requiring continuous work and improvement.

4. In all fairness, the problem is not one sided. Senior doctors too, face challenges from some problematic HOs. These need equal attention too. So arguably, processes put in place need to be at multiple focal points.

5. The Terms of References (TOR) and Standard Operating Procedures (SOP) of a healthy work culture must not be limited to only hospitals but applicable to the entire MOH. Also, it should not only cover junior doctors but all levels of staff. Toxic work cultures can exist even in the offices at the headquarters of MOH at Putrajaya and even at their respective state and district health departments.

6. Leverage on the ‘Let’s TALK Minda Sihat’ program which MOH relentlessly championed to address mental health well-being among the population. It is crucial that the MOH ensures that its own staff are first able to live and benefit from the objectives of that program.

7. Finally, the buck stops at those highest in office, the Minister, the DG, the State Directors and the HODs. As poignantly alluded to by a former senior officer in the MOH. “… appropriate work culture must be championed by all Hospital Directors and HODs on the ground.

Many tend to remain silent even when it’s occurring blatantly. It often starts from the top; the solution will also come from the top

Those at the top need to take a hard look at how they have contributed to the toxic work conditions and work to address these issues.

Trial by the media and social media will only cease or be minimized if the due processes are being done and seen done fairly and justly. These issues cannot continue to fester and worsen.

The solution is in your hands and you have nothing to fear if you are doing your work fairly and righteously.

Those in the health sector have to set the example and assure a healthy work environment, not just for junior doctors, but for all Malaysians.

Dr Dzulkefly Ahmad
Pengerusi JK Kesihatan PH merangkap Ahli Parlimen Kuala Selangor.