Reading the grumblings of house officers and reply letters from medical officers, registrars, specialists and even the Director General of Health Ministry made me look back at my own experience during housemanship. It brought about some really great memories throughout those years.

I might write about it later but what I’m going to do now is to write about surviving this two rather difficult training years (which is the beginning of many many long and hard years). I know our colleague Dr Lutfi has written quite a good list of some survival skills:

Idiot’s Guide to Surviving Housemanship

My list is perhaps a little different. We’ll see.

1. The beginning will always be difficult
It is human nature to struggle when we start something. When a baby starts walking, he keeps on falling. But he doesn’t give up. At first he might cry when he falls, but you’d notice that after getting up and falling again, and getting up again, trying to walk, he’d not only start running very soon, but he might also laugh if he falls.
You cannot give up learning. Everyday as a doctor is a learning process – for a house officer, medical officer, registrar, specialist or even a consultant. To start learning is difficult but if you open your mind and heart, you will soon start running.

2. Not only doctors have it difficult. Everyone goes through the same thing too
If you think only junior doctors struggle, you should talk to other people. When my brother started working as an analyst, he worked day and night, with small pay. He had to work weekends and, unlike us, don’t get to claim much “overtime allowances” despite considered a professional.
My grandfather used to complain that my aunt, despite having studied overseas for her accounts degree, worked day and night for the first years in her working life, earning a few hundred ringgit per month!
Another brother of mine started his own business after graduation, working hard weekdays and weekends, and after two years just starting to see some improvements of his income, managed to pay a few workers, and even take university students as interns!
I’m sure you could find lots of other examples. Talk to your parents. Have they gone through difficulties in life? What did those experience teach them?

3. Hard work IS essential
I’m sure you’ve heard the when-I-was-a-houseman story many many times before. But let me tell you this, if you really want to be a successful doctor in the future, look at the consultants. Talk to them. Dato Razak once told me that “you could die standing” if you were a medical officer in his time. You see where he is now. He would never reach his current level of expertise without that much hard work.
Dear parents, please know that all those smart-looking, respectable and/or rich consultants and professors did not reach that level without spending long days and long nights in the hospital. The great quality of care that you feel you may have enjoyed after seeing those consultants in Sime Darby or Gleneagles or KPJ or Prince Court Medical Center could never have been achieved if they have cried to their parents or write a letter to the prime minister saying that work have been really hard on them.

4. However, you DO need a shoulder to cry on
While I believe in hard work, I do believe that we will feel stressed, sad, frustrated or burnt out. As much as we love our jobs, our body would feel it and send some signals. The problem with Asians is we expect too much from each other. We expect doctors to work like superman and judge them when they say “I’m tired.” I saw a snippet of a newspaper article saying that “healthcare workers should not feel tired as they should have been mentally prepared for a busy job.”
I don’t think it’s fair to expect someone to work long hours everyday for weeks without end. However in some situations, it might not be avoidable. It happened to me when I was a house officer in orthopaedics and general medicine.
I was lucky that my early years were not only bearable but enjoyable because I had someone on my side. Someone whom I looked up to and would always guide me whenever I have doubts. Someone who had gone through it all and even more. Someone who was protective enough but at the same time encouraged me to move on. Someone who encouraged me to work hard and was patient with me if I had to leave work late, which happened a lot during housemanship.
You NEED social support. You need it whether you’re sad, happy, stressed or feel like quitting the job altogether. Be it your own colleague, your life partner, or even your parents.
I do sincerely hope that parents, on top of being their shoulders to cry on, would encourage their doctor sons or daughters to stand up straight and carry on learning. I hope parents would motivate their children to become compassionate and responsible doctors, the way they expect their own doctors to be.

5. PLEASE be nice to the support staff
If there’s one thing that could help you survive and enjoy housemanship, that would be to be nice with the support staff. Mainly the nurses. A house officer and the nurses spend the most time in the ward with patients. Please don’t look down on the nurses. Many of them know better than you. There’s so much we could learn from them.
Talk to them with respect, say your please and thanks, be friendly, maybe buy them supper when you work nights with them, even take your short break with them (in turns, of course). Nothing else get Malaysians closer than having a meal together.
The ward attendants and even the cleaners are also great helps when you need them. Just look around, they are there for you.

6. Take a break
This is related to point number 4. It is not always possible, but try to plan some leave, some quality time with family, or just for yourself. Discuss with each other, take turns. If you could ALL learn to do work more efficiently, I think your seniors would not mind having less house officers to work with. The important motto is: “as long as the work is done.”

7. Remember your purpose
I’d say that this is the first principle. It’s the same with everything in life.
First you need to get your purpose right. Then you need to gain the knowledge to achieve your purpose, and you must use the knowledge you have for that matter. In the end, you must reflect on whether or not you’ve achieved your objectives, and are there any collateral damages of not reaching your targets.
Example (1): Your objective: manage atrial fibrillation with rate control, rhythm control and anticoagulation. Knowledge needed: medications, procedures, side effects. Apply knowledge. Reflect: review heart rate, rhythm, symptoms of failure, presence of side effects.
Example (2): You’re a doctor. Purpose: save lives and/or keep them comfortable, maximise quality of life. Knowledge and application: from years of long days and hard work. Not achievable by missing in action and spending energy complaining the whole time. Also not achievable by being calculative with friends and seniors. Reflect: the amount of confidence others have in you. So if you’re not off-tag after two weeks, or extended in the department, please think deeply of what you have not achieved. Your seniors mostly want you to be safe when you finish housemanship. Imagine, if your best friend said he trusts you for his mother’s life, would you be able to trust yourself?
Example (3): As Muslims, we believe that the purpose of this life is to serve Allah as His humble servants, in order to get His blessings for an eternal happiness. It can be achieved by fulfilling specific obligations that He has prescribed, and giving benefit to the mankind. One of those ways is by working hard, helping other people, being kind and friendly, and avoiding things that would distract us from remembering Allah. By being responsible doctors, we ARE fulfilling our purpose. Gain knowledge (ilmu) and apply them (amal). Reflect (muhasabah): Look back on how we treated our patients. Would Prophet Muhammad SAW be happy if he saw us like this? Do we need more knowledge? We will ALWAYS be in need of more knowledge.

Let’s strive to serve our purpose. We have people’s lives in our hands. There is no shortcut to perfection, there is no easy way to succeed. Not many will appreciate our hard work, and they will always complain no matter how hard we try to explain that we are humans. But first, do no harm. That could not be achieved unless you start and continue learning.

Good luck.

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This article is in no way defending abusive attitude of some seniors. By abusive I meant those who shout and swear for no reason (nobody should swear), calling names, and even sexually harassing (directly or indirectly) junior colleagues. These bullies exist in ANY profession. You might run away from this job but others have it hard too.
This article does not defend those unreasonable seniors who extends house officers without valid reason. In the first place you should look into yourself and gain some insights on how you’ve performed so far.
Colleagues please try as much to be honest, even if that person is “somebody’s” son or daughter. It’s sad that such a culture still exist where you don’t “touch” certain doctors just because they are connected. But that’s another story altogether.