How to end the house officer-senior doctor blame game

doctor_housmen_600By Yogarabindranath Swarna Nantha

Let’s face it. The perennial conflict between house officers and senior doctors has existed in our healthcare system for a very long time. What has changed is the mindset of the current generation of doctors, much to the dissatisfaction of senior doctors who choose to remain in the elusive past.

Dr Musa Mohd Nordin, in his article ‘Senior doctors should start with the man in the mirror’, highlights how current doctors, or “millennial” doctors as he calls them, question the norms of the healthcare system.

While this is seen as perfectly healthy, senior doctors often perceive this as a threat to their authority. Perhaps its not our fault to begin with – it is just that we have been conditioned to behave or react in a very myopic manner. Therefore, it is not surprising to see many house officers lose their passion for work, leading them to be categorised as the ‘highest number of civil servants to be served termination notices’ (refer to the article ‘Many Houseman Get Culture Shock’ by Robin Augustin).

It is easy for senior doctors to judge the junior colleagues, but it is clear from scientific reviews that there are very glaring structural problems underlying their behavioural tendencies to do so. In the published article, “Intrinsic motivation: How it can play a pivotal role in changing clinician behaviour”, I have argued that there should be a paradigm shift in the way we motivate clinicians, moving away from prevalent practices that promote tangible rewards.

There is a body of evidence leading to the assertion that there is a neglect in the initiatives to reinforce intrinsic motivation amongst our doctors (Swarna Nantha 2013). This has ultimately resulted in the lack of passion for work, strained doctor-patient communications and overall poor quality of care. The most obvious fact is that there are numerous barriers in domestic and international healthcare culture restricting autonomy/empowerment of clinicians (Swarna Nantha 2013).

In times of rising costs and demanding working hours, the conclusion is that a different approach has to be taken to strike a perfect balance in satisfying the inner needs of all physicians (regardless of seniority) as a way to develop better workplace efficiency and morale.

This can be achieved in two ways:

First, emphasis should be placed on creating a conducive workplace environment that can help doctors deliver greater job commitment and adopt better organisational citizenship; and

Secondly, healthcare workers should be compensated with a balanced remuneration scheme (not solely focusing on extrinsic rewards such as status, authority and financial gains) in order to bring forth any meaningful changes in the morale and psyche of doctors.

Readers may disagree with this opinion, stating that this review is not in sync with local sensitivities and sentiments. Recognising that this could be a stumbling block to truly understanding the influence of intrinsic motivation in Malaysia, I also conducted an in-depth analysis based on domestic opinion, survey and research.

In the review article entitled, “Intrinsic motivation: The case for healthcare systems in Malaysia and globally”, I argue that deterioration in intrinsic motivation levels amongst our clinicians has led to the exodus of healthcare workers from the public healthcare organisations to private practice (Swarna Nantha 2016).

Malaysia is known to have one of the highest levels of power distance in the world (Asian Leadership Index Report 2014). The power distance index measures the extent to which the less powerful members of organisations and institutions accept and expect that power is distributed unequally.

Consequently, most employees in the public sector feel that their superiors should improve their communication skills, empower their colleagues and allow better autonomy to their contemporaries.

Thus, it is not surprising from a national cultural perspective that low motivation among government officials in Malaysia is associated with poor communication skills of employers and employees, separated by a vast power distance (Mahazril’Aini 2012). Also, literature seems to suggest that workplace autonomy is undermined due to societal norms that compel junior employees to avoid disagreeing with their superiors (Ansari, Ahmad, Aafaqi 2014). Therefore, these factors serve as an impediment to the realisation of the core components of intrinsic motivation, namely autonomy and competency.

Policy makers should often examine scientific evidence and translate available research results to uplift the morale of doctors in our country. Hence, a colossal change should take place in the psyche of all healthcare workers and our interactions with each other. This initiative can be approached by (Swarna Nantha 2016):

  1. Implementing structural changes to the inherent job design in the healthcare system;
  2. Incorporating elements of intrinsic motivation in the organisational culture;
  3. Changing the power distance and the manner our national culture has conditioned us to interact with our colleagues;
  4. changing the leadership style to that which focuses on transformational/shared leadership strategies; and
  5. Promoting career-self management.

We can transcend this culture of blaming each other for our own follies if only we cultivate the intention to sincerely do so. The evidence is out there, and once again, we just need to heed the obvious to help give patients’ the best service and protect the sanctity of the medical fraternity.

Yogarabindranath Swarna Nantha is a clinician-researcher and a keen reformist of the healthcare system for greater efficiency.

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