My first read on the ‘throne’ this morning (besides playing 3 rounds of solitaire on my iPad) was this article by palmdoc, who blogged about a houseman who quit the Ministry of Health and publicly declared the reasons why he did what he did.
That got me thinking as I got ready for work and drove to work. Over the years, I have seen a number of my friends/colleagues/ex-students pre-quit or quit being doctor for various reasons:
1. There’s my dear friend who called me on the phone 3 days after starting housemanship in Klang GH (also known as Purgatory to some). He was in distress and sobbing at the other end, threatening to quit because he could not stand the harsh working condition there. I cajoled/begged/threatened/advised him against quitting and now, although he is out of active clinical service, he is actively going around the nation teaching people ‘A-Z of medical research’.
2. There’s the senior from my college in Manipal who quit after completing his studies to become a chef, a vocation he would have otherwise chosen had he not had to fulfill his parents’ grand ambitions for him.
3. There’s the ex-student who quit HO-ship after 2 months because she realized medicine wasn’t what she wanted to do for the rest of her life. Instead she put herself whole-heartedly into salsa dancing and now runs a salsa school in Bangsar with her very yummy-licious Latino partner.
4. There’s the junior in Manipal who was consistently the top scorer in his batch who completed his MBBS degree and went on to become a grease monkey, something that he truly enjoyed doing.
5. My roommate back in college days quit being a GP after a few years and now is a successful business man who makes more money in a day that what I could make in a month.
And now my fellow blogger has quit and declared his reasons to be:
There is something that I’m rather confused. According to the job description of a houseman given by SPA, we are actually spending more time doing tasks which is out of the description. For example :
1. Sending and tracing blood investigation
2. Tracing files in the record department for the registrar’s CME case presentation
3. Professional telephone operator – informing patient regarding op date, cancelled op, rearrange appointment, etc
4. Data Collectors – doing all data collection, not knowing the end results, whilst the boss gets to present and publish
And one of palmdoc’s colleague wrote in response:
I think his comments about the extra clerical work is not fair. Tracing results, calling up patients are extremely important for patient care. These things, if delegated to someone else may not get the results. I trace results and call my patients regularly. tracing and recording data, when used for publication is acknowledged, sometimes as co authors. Before one does this, one discusses what “rewards” are in store. When you feel things are not fair, there must be an outlet to voice this. Housemanship is part of being a doctor. If all housemen feel it was bad, then change it when you become someone senior. If every one changes just ONE bad thing, things can only improve. Leaving the service does not change the system.
I am not here to point fingers or to condemn because I am sure the causes which led to a person taking such a momentous decision are multifactorial although I must admit I agree with the comment by Palmdoc’s colleague. I have had my fair share of doing all those ‘mundane’ chores detailed by the blogger-who-quit and I remember days when I used to talk wishfully about “dropping everything and going home at 5 pm sharp because that’s the official working hours for Grade A Professionals like me” but reality isn’t always like that. A patient collapses at 4.55 pm and there is no way you can “drop everything and go home”.
To me, doing all the things beyond what was stipulated in the ‘SPA guideline’ is “going the distance” or “the Biblical walking the extra mile” or what these heroic doctors from Gleneagles Hospital did recently:
These surgeons in private practice could have chosen to just stitched up the severed arm of the robbery-victim and then later prescribe him a prosthesis but they chose instead to venture out into the night trolling the streets looking for the severed hand and on finding it, successfully reattached the 2 severed ends together.
The act went beyond the call of duty and this is what makes our profession (still) noble.
Anyway, my own romantic (probably unverifiable if a randomized-control-trial is done) sentiment about doctors who quit is this:
When a doctor quits, the impact of his decision on the society is great. Many lives who may have otherwise be saved in the future would be lost. It’s like the ‘Butterfly Effect‘. Who knows, perhaps one or a few of those whose lives are saved would in turn become people of great significance in changing the course of history for the better. Till this day I still wonder what became of the little baby boy on whom I spent an entire night performing manual exchange transfusion for him in order to save his life – Is he all grown up? Is he successful? Is he contributing significantly to the betterment of society?
I’m not boasting here and I am not proud to say this but during my 9-month attachment in Melbourne last year, quite a number of my regular HIV patients in the clinic here in Malaysia dropped out of follow-up and a few of them passed away. I believe my absence in the clinic may have in some ways contributed to this and it saddens me greatly.
I remember on several occasions, IMU students who have graduated and were about to start work as house officers coming to me for advise on “how to survive housemanship”. My answer has always been consistently this:
“Get a large calendar, paste it on the wall of your hostel room and mark off the days on the calendar as they passed and before you know it, the nightmare would be over”
Coz that’s what I did when I was a house officer 15 years ago. 
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