KUALA LUMPUR: A 33-year-old doctor woke up in shock after he rammed his sedan into the back of another car.

The gynaecologist had drifted off to sleep at 8am, while making his way back home to Subang Jaya from Kuala Lumpur, after being on-call for 36 hours.



“I do not know what happened and how it happened. I was not speeding or anything, I just drifted off into some weird sleep. The next thing I know, I had rammed my car into another car,” he recounted.

“Thankfully no one was seriously injured. I hit my head on the steering wheel but that uncle was uninjured, just startled.”

He added: “To be fair, that kind of situation doesn’t usually arise. We do have a lot of calls but they are not that crazy. That one time however, things were bad. Two other doctors were on MC and it was during the festive season.”

He also shared that the incident traumatised him, as he was constantly worried about getting into accidents after taking long shifts at work.



Overworked and exhausted, cases of doctors being involved in accidents post-call are not uncommon as many of them are forced to endure long hours.

In fact, there have been cases of medical professionals perishing in traffic accidents after pulling long shifts.

Meanwhile, medical associations are calling for urgent changes to be made as there appears to have been little policy changes so far, despite the loss of life.

The National Heart Institute of Malaysia. (File photo: Bernama)

Malaysian Medical Association’s (MMA) president N. Ganabaskaran, told CNA: “There is an acute problem here. Doctors are severely overworked".

He added that there has been an increase in hospitals and the number of beds in these hospitals, therefore increasing the number of patients attended to by a doctor within a stipulated time.

“With insufficient doctors to stand in and do the work, the existing medical officers are stretched and forced to do more calls and longer shifts to cope with the demands,” he said.

This issue has been in the spotlight, with Deputy Health Minister Lee Boon Chye reportedly saying earlier this month that he has submitted a request to the government for 10,675 additional posts in clinics and hospitals nationwide.



STAFF SHORTAGE AN ACUTE PROBLEM

Doctors interviewed by CNA said that staff shortage is a serious problem, especially in public hospitals and clinics.

A government paediatrician in Sarawak, who requested for anonymity, said: “(Being) short-staffed is an understatement".

She said the clinic, open for three hours daily, can see 100 patients at any one time. These patients are seen by six doctors. This means that a doctor has to see 15 patients in just three hours.

“How do you think the quality of care would be? … Our system sucks,” she said.

Serdang Hospital in Malaysia. (File photo: Bernama)

She added that the government did not know how to prioritise what was important and as a result, the entire body of doctors suffered.

Similarly, an anesthesiologist from Johor Bahru, who also wanted to remain anonymous, shared that the current ratio of patients to nurses far exceeded the recommendations by the World Health Organisation.

“So it certainly does cause a burn out among staff, not to mention compromised medical care. At present, we do have a lot of support staff (and nurses) having to do extra shifts due to lack of personnel.”



PUBLIC OUTCRY AFTER DEATH OF OVERWORKED DOCTORS

There have been past instances of medical professionals who have lost their lives in traffic accidents, after pulling long shifts.

On May 9, 2017, pediatrician Nurul Huda Ahmad met her untimely end in Kuala Terengganu, as she made her way home after being on duty at the Kota Baru hospital for nearly 33 hours. Her home was over 30km away from her workplace.

“It is high time action is taken to prevent the loss of more innocent lives,” said a statement which was jointly released by several medical non-governmental organisations (NGOs) on May 13, 2017.

“In relation to motor-vehicle accidents, we recognise that there are many contributing factors namely vehicle issues, poor road conditions and distraction among others. However, we cannot exclude the fact that fatigue and sleep deprivation is a recognisable and preventable factor in motor-vehicle accidents,” they said.

The joint statement also cited the death of an anesthesiologist Afifah Mohd Ghazi who crashed her car into a tree while she was driving home post-call from Sungai Buloh Hospital on Jul 8, 2015.

The Kuala Lumpur Hospital is located in central KL. (File photo: Bernama)

Following the death Dr Afifah, there was a public outcry for better working conditions for doctors, with many of them coming forward on social media and sharing their post-call fatigue experience.

At that time, Health Director-General Noor Hisham Abdullah had said that the ministry had taken note of all the proposals to improve the working conditions for medical personnel.

After the passing of Dr Nurul in 2017, the medical NGOs which released the statement had met with ministry officials to appeal for better working environments for doctors and nurses.

Their appeal included establishing a “safe working hours” Law or Act to safeguard healthcare workers and the public at large as well as providing compulsory “post-call off” or “day-off” for night-shift healthcare workers or on-call doctors.



On the other hand, there have been reports of oversupply of medical graduates due to scarcity of placements.

Some of the graduates reportedly worked as baristas or Grab drivers while waiting to be posted to government hospitals.



MEDICAL ASSOCIATIONS CALL FOR URGENT CHANGES

Looking ahead, medical associations say that urgent changes are needed to improve the welfare of doctors.

In a statement released on Nov 14, the Islamic Medical Association of Malaysia (IMAM) noted that the country’s healthcare sector is currently operating at the 2012 budget level.

“The consequence is obvious and existential. It causes healthcare understaffing,” said the association’s president Jeffrey Abu Hassan.

“Our healthcare needs more doctors for quality healthcare service delivery, not less and not contractual in nature,” he said adding that many young doctors currently work up to 30 hours or more per week.

Previously, the association had also highlighted that countries like Europe had a time limit on the working hours of doctors, stating that it would usually be a regular 8am to 5pm shift.

“Doctors in Malaysia, on the other hand, often have to be on call and the hours could stretch from 8am to 5pm the following day,” said Dr Munawwar Salim, an executive member of IMAM.

He pointed out that though there was a circular which stated that doctors were allowed to get a day off after an on-call shift, the final decision was up to the discretion of the head of department.

Over the years, there has been an increase in number of hospital beds but not doctors. (File photo: Bernama)

Dr Ganabaskaran of MMA said that doctors sometimes have to go back to work the day after being on call, as the ministry has still not made it compulsory for medical personnel to get the day off.

“The reality is they can’t get the day off, because we do not have enough doctors,” he stressed.



He pointed out that the shortage of staffing was especially prevalent in rural areas.

“At least 30 per cent of the doctors on the ground are stressed out. And this does not include the nurses and laboratory assistants who also pull the long hours.

“Something needs to be done about this immediately as the well being of the health sector would reflect in the well-being of the nation as a whole,” he said.

