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Over the past few days (after the last post) , I’ve received a steady stream of messages from specialists across the country. The tone is consistent. They feel the national conversation around housemanship training has tilted too far in one direction and they want a more balanced discussion.
I want to be upfront: nothing I write here is an endorsement of bullying, harassment or toxic supervision. Those problems are real, well-documented and indefensible. But if we are serious about fixing housemanship in Malaysia, we cannot keep having a one-sided conversation. There are uncomfortable truths on the other side of the table that need to be said out loud.
The competency problem nobody wants to name
A significant number of house officers entering the system are not ready for the real world.
This is not a hot take. This is what supervising clinicians are reporting across specialties and across hospitals, consistently and repeatedly.
Some house officers are barely competent in basic clinical tasks. Some show little interest in learning. Some are physically present but functionally absent, “snaking away” during working hours, disappearing when there is work to be done, reappearing when the heavy lifting is over.
This is not about one or two bad apples. The volume of these complaints suggests something systemic. Whether it’s a problem with undergraduate training, selection, attitude or all three combined is a separate discussion. But the frontline reality is that many supervisors feel they are babysitting rather than teaching.
The transfer carousel
Here is what happens when a house officer is flagged as underperforming or genuinely dangerous to patients.
In theory, there is a process. In practice, the most common outcome is a transfer to another hospital. The problem doesn’t get resolved. It gets relocated. The next department inherits the same house officer with the same deficiencies and the cycle repeats.
Meanwhile, the supervising clinician who raised the flag pays a price. There is paperwork. Mountains of it. Forms to fill, reports to write, documentation to compile. Then comes the meeting where you sit across a panel and explain your assessment, defend your observations and justify why you flagged the issue in the first place. It’s an interrogation dressed up as a review.
The message this sends is clear: raising concerns about a house officer’s performance is more trouble than it’s worth. So many supervisors stop bothering. They sign off, move on and hope the problem sorts itself out downstream. It rarely does.
Mental health is valid. It is not a free pass.
Some house officers have been diagnosed with mental illness. That is a legitimate medical reality and it deserves compassion and proper support.
But here is where the conversation gets difficult.
A diagnosis cannot become an indefinite shield against accountability. If a house officer is consistently going missing from duties, failing to perform basic tasks or putting patients at risk, those problems need to be addressed regardless of the underlying cause. Support and accountability are not opposites. They should work together.
The current approach often treats them as mutually exclusive. A house officer with a mental health diagnosis becomes untouchable. Supervisors are afraid to document poor performance for fear of being accused of insensitivity. The result is a system where genuine illness and strategic weaponisation of that illness become indistinguishable. That helps nobody, least of all house officers who are actually struggling and need real intervention.
The ones who pay the price
The good house officers are absorbing the cost of this broken system.
Every time an incompetent colleague disappears, someone has to cover their patients.
Every time a dangerous house officer gets transferred instead of remediated, the remaining team carries a heavier load. Every time accountability is avoided because the paperwork is too painful, the conscientious ones pick up the slack.
Over the past few days (after the last post) , I’ve received a steady stream of messages from specialists across the country. The tone is consistent. They feel the national conversation around housemanship training has tilted too far in one direction and they want a more balanced discussion.
I want to be upfront: nothing I write here is an endorsement of bullying, harassment or toxic supervision. Those problems are real, well-documented and indefensible. But if we are serious about fixing housemanship in Malaysia, we cannot keep having a one-sided conversation. There are uncomfortable truths on the other side of the table that need to be said out loud.
The competency problem nobody wants to name
A significant number of house officers entering the system are not ready for the real world.
This is not a hot take. This is what supervising clinicians are reporting across specialties and across hospitals, consistently and repeatedly.
Some house officers are barely competent in basic clinical tasks. Some show little interest in learning. Some are physically present but functionally absent, “snaking away” during working hours, disappearing when there is work to be done, reappearing when the heavy lifting is over.
This is not about one or two bad apples. The volume of these complaints suggests something systemic. Whether it’s a problem with undergraduate training, selection, attitude or all three combined is a separate discussion. But the frontline reality is that many supervisors feel they are babysitting rather than teaching.
The transfer carousel
Here is what happens when a house officer is flagged as underperforming or genuinely dangerous to patients.
In theory, there is a process. In practice, the most common outcome is a transfer to another hospital. The problem doesn’t get resolved. It gets relocated. The next department inherits the same house officer with the same deficiencies and the cycle repeats.
Meanwhile, the supervising clinician who raised the flag pays a price. There is paperwork. Mountains of it. Forms to fill, reports to write, documentation to compile. Then comes the meeting where you sit across a panel and explain your assessment, defend your observations and justify why you flagged the issue in the first place. It’s an interrogation dressed up as a review.
The message this sends is clear: raising concerns about a house officer’s performance is more trouble than it’s worth. So many supervisors stop bothering. They sign off, move on and hope the problem sorts itself out downstream. It rarely does.
Mental health is valid. It is not a free pass.
Some house officers have been diagnosed with mental illness. That is a legitimate medical reality and it deserves compassion and proper support.
But here is where the conversation gets difficult.
A diagnosis cannot become an indefinite shield against accountability. If a house officer is consistently going missing from duties, failing to perform basic tasks or putting patients at risk, those problems need to be addressed regardless of the underlying cause. Support and accountability are not opposites. They should work together.
The current approach often treats them as mutually exclusive. A house officer with a mental health diagnosis becomes untouchable. Supervisors are afraid to document poor performance for fear of being accused of insensitivity. The result is a system where genuine illness and strategic weaponisation of that illness become indistinguishable. That helps nobody, least of all house officers who are actually struggling and need real intervention.
The ones who pay the price
The good house officers are absorbing the cost of this broken system.
Every time an incompetent colleague disappears, someone has to cover their patients.
Every time a dangerous house officer gets transferred instead of remediated, the remaining team carries a heavier load. Every time accountability is avoided because the paperwork is too painful, the conscientious ones pick up the slack.
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