I am a UK graduate and I’ve been working in Malaysia for almost a year. On my first day, I called my MO by her first name (respectfully) to ask her a question, and she did not answer, so I asked again, and she said to me ‘I would like to be addressed as Dr xxx’. For someone who has been calling all doctors, even my consultants in medical school by their first name, how lame that is, I thought. But I’m used to that now. Just because I am addressing them by their title doesn’t mean that I respect them all of them, especially ones who are obviously empty tins. If I disagree with something, I will say it out.

In Malaysia there is this thing that HO should round early in the morning first, then the MO will round again (which we are suppose to follow and write), then again with the reg and the specialist. I have never encountered anything like this where I studied. There is just so much repetition here. What is the problem with everyone just arriving at the same time and then we do ONE single round together? Are consultants too mighty high to be asking questions or examining patients? Yes, the juniors should know and present the cases, but so should the specialists and the consultants. Here, we come at 6:00-6:30am in the morning to see all the patients, then there will be another 2 or 3 rounds with people more senior than us so we can ‘update’ them patient condition so that they are able to add on their own management plan. Most of the specialist/consultant would just stand at the bedside listen to the juniors present, bombard lots of question, dictate some plans then move on, without even saying a word or looking at the patient. Then when the intimidating boss-like figure is finished, the patient would rush to ask me what had he just muttered before I had to rush off to tail ward round. In the UK, junior doctors come half an hour earlier than the consultant to get the investigations results ready and find out if anything happened overnight/over the weekend, then wait for the consultant to turn up to start the round. If it is a non-consultant round, everyone would get on with the round as a team. There is no such thing as HO to see the patients before the reg. There, the registrars, SHO and HO help each other out so they finish their work as quickly as possible. Isn’t that a much more efficient use of everybody’s time? Once, my nice MO was helping me with a particularly difficult IV line, and another MO asked him ‘why are you doing HO’s work?’ You see the attitude? Don’t get me started on the TDS round. Yes, they do rounds three times a day here (in most specialties), sometimes x 3 due to the hierarchical arrangement as I have mentioned above.
The worst part is having to play the servant for MO/reg/specialist/consultants. In my hospital, 

HOs have to regularly to go the record department to trace files for the reg’s case presentation/ write up. Last week, my friend had to go to my specialist’s car to fetch a stack of photo frames to her office. In departmental census, the HOs does all the data collection (trawling through the case records) not knowing the end results whilst the boss gets to present and publish. We call patient up to inform op date, cancelled op, rearrange op so often I thought we sounded like a professional telephone operator. You can’t blame me for cursing under my breath whilst performing these stupid errants.

In Malaysia, HOs are unappreciated slaves. Everyone, senior and junior figures in the medical profession, should rethink the way we are doing things here. You may say the practice has stood the test of time but is it really worth wasting so many hours for sometimes so unproductive as three morning ward rounds in a day just because of hierarchy? Is it fair to treat HO as your servant doing your secretarial job? Are MO/Reg/Specialist incapable of occasionally helping your new HO make some referrals or write a prescription or ask for a CT scan, or God forbids, take blood? Are we not in the same boat to make patient better? I foresee that it will take another 10-20 years for us to change the culture, if it ever will. The seniors always have their ‘back in those days’ or ‘you have to learn’ excuses.

 

This is an article i copied from here. I thought of it too when i was doing my hospital attachment in paediatric ward last holiday. we have 3x ward round each morning which last for almost 5 HOURS!!! and yes, according to the HIERARCHY!!! If the HOD or someone very 'BIG' come in later, then we will have 4x!!! Just that i never know it actually happens to each MOH hospital. I thought only that stupid hospital i went will do like this. It's really a waste of time undoubtedly.

My life is damn hectic now. Honestly i can rarely spend my own time for other things like jogging or even sleeping. I have to rush to another hospital in town every morning. However, i am actually kinda lost when i am there. Nobody comes and tells us what we should do to learn more effectively from the patient (or patient's folder?). The chances for doctors there to teach us are like once in a blue moon. Even if i follow them for ward round, i can just stand aside and listen to what they discuss. If i don't ask questions, then i will be just like a walking dog doll following them blindly, and with my mouth shut. That's why i HATE following doctors for ward rounds. I don't know how the others feel. Maybe they like it.

So? I just try to clerk a case every morning and copy down the investigations & management done for that patient. If i got more time left, i will just go to other wards to see if got any other interesting cases or physical findings on patients or go to library there to study or...just sleep at the counter so that i can study better later at my own hostel room without yawning lol.

life is simple, but ain't easy. But being a medical student in clinical years or doctor in Malaysia, it's not merely "ain't easy", it's CRAZY!