House officer’s survival guide

With all the publicity about “stress” that House officers are facing these days (and even parents writing in), one wonders if what a colleague and facebook friend of mind terms the “Strawberry generation” is an apt description for our current lot of HOs.

The best way to prepare yourself for Housemanship is to
1 ) Have the right attitude. Be humble. Just because you have an MBBS does not mean you can throw your weight around the wards now. HOs are still at the lowest of the low in the medical heirachy. Yes, you have to listen to everyone including the nursing sisters and even the ward attendants who know much more about how things run than you greenhorns.
2 ) Be prepared to work hard. This is a no-brainer. You knew that housemanship is going to be tough, right?
3 ) Be responsible. Do not shirk your duties. This is a serious sin and you are letting down your patients, possibly jeopardising lives and expect to be seriously disciplined (this is NOT the same as bullying)
4 ) Always ask or call for help if you are not sure or in trouble. Do not be a super hero, you are not one. You cannot lose here. Even if your MO is dumb, at least you get someone to share the blame.
5 ) Admit your ignorance and mistakes. Honesty is the best policy.
6 ) Don’t let the case summaries pile up. Work does not go away, it only accumulates.
7 ) Smile. Yes, despite the hardship, a smile will lighten those up around you – colleagues and patients. Always be courteous. Actions get a similar reaction and if you put on a sour face, don’t expect others to behave nicely towards you.
8 ) Learn and never stop enjoying accumulating knowledge. Housemanship is only part of a lifelong career in medicine. We all learn something everyday. If you can strive to just learn something new each day – be it a procedure a new medical fact – appreciate it, cherish it and there will never be a dull day.

Lastly, arm yourself with some tools – smartphones with medical references (especially drugs – never be caught with your pants or panties down not knowing dosages or interactions). If you don’t have a smartphone, get a cheap iPod Touch. Lots of iOS medical apps there to help you. On a related note, I found this House Officers guide (Word format) from Gerald Tan’s site which also contains links to other useful documents for HOs and junior doctors. While written for Singaporeans, I think the scenario is pretty much similar to Malaysia.
Update: If you are equipped with an iOS or Android smartphone, you can also download a free app for House Officers which will help you manage your day to day tasks in the wards. More details here

If you are a HO (hey you got time to read this meh?) so how are you finding housemanship? Is there really any bullying as alleged in the press? Tell us as comments to this post.


Malaysian physician, haematologist, blogger, web and tech enthusiast

8 Comments on “House officer’s survival guide

  1. eat whenever you are have time(like on the way to trace result when you passed canteen. learnt to eat within 5min); bath whenever you have time (in OT changing room, by using OT gaun as towel); sleep whenever u have time (on any empty bed, empty table or chair). I never missed my meal and bath for the whole housemanship, although I have experience doing 72 hours continuos calls & only sleep for 2hours in 90hours. food make u energitic, bath make u fresh, is more important than sleep.

  2. Just to share, a random pick up of letters to broaden our point of view regarding houseman issues;


    First letter from DR T.K. KHOO, Iowa, US in response The Star report in some years ago;

    I READ with interest your recent report quoting the director-general of health as saying that at least five doctors every month are found to be suffering from mental illnesses (Sick doctors – Sunday Star, Nov 30).

    He blames the lack of screening of medical school applicants by medical schools as one of the causes.

    However, I wonder if this is an unfair judgment and if this is indeed warranted.

    Firstly, application to medical school involves paperwork that includes one’s curriculum vitae, scholastic performance, and for some medical schools, an interview, perhaps no more than an hour.

    Nowhere in the application is an applicant asked if he has delusions or hallucinations or other features of a psychotic disorder.

    How then, is a medical school expected to screen for psychiatric issues by those means? Is it even fair, to expect that of the medical school?

    Secondly, while I have never experienced housemanship first hand in Malaysia, I have many close friends and family who have been through the process.

    Extremely long and often unregulated work hours, considered to be inhumane and illegal in the medical system in the United States, coupled with poor pay, lack of respect by superiors (such as public yelling, verbal punishments) seem to be very common.

    I have known some who suffer from situational depression and post-traumatic stress disorder during this trying period of housemanship.

    During several stints as a visiting clinician to my hometown in Malaysia, I have personally witnessed registrars shouting at the poor housemen at the top of their lungs.

    I have seen grown men and women break down in tears, right there in the middle of the packed medical ward, right in front of patients, because of the dressing down they got.

    Therefore, is it not possible as well, that the actual housemanship itself is contributing to many of these cases of mental illnesses?

    Perhaps medical schools should tighten up their screening process.

    After all, I do agree that there are many who go into medicine for the wrong reasons, such as parental pressure and not personal interest.

    But the medical schools alone are certainly not to blame.

    I believe the hardships faced by the new medical graduate deserve some if not most of the blame as well.

    After all, the mind is a fragile thing; any emotional abuse can break even the strongest of minds.

    Second letter by DR WINSTON CHANG, Christchurch, New Zealand;

    “I WOULD like to comment on the report “Sick doctors” (The Star, Nov 25) and the letter “Housemanship can drive you crazy” (The Star, Dec 1). I completely agree with Dr T K Khoo in his letter.

    Better “screening” is not the solution to doctors facing mental health issues.

    Indeed the answer should be better training and better work conditions. If these doctors had severe mental health issues at the start of their training, should this not have been picked up during their years of training?

    If you must persist with pre-entry screening, then screen them for superhuman physical and mental endurance.

    Deprive them sleep for 36 hours and make them do complex decision? Patient safety is a priority for all of us doctors. Please fix the problem at its core.”


    Something to ponder too, improve the working condition for all, mate!

  3. Well, mate, I guess you don’t want to bruise the strawberries. EOD calls, 36 hour work stretches. Hey, that’s all history anyway.
    HOs now work in shifts, and don’t get so physically stressed as they used to be.
    But you are correct, the system has it’s flaws which need an administrative fix.
    Dr. TE Cheah covered it nicely in his post in the MMR, Not solving the problem!

    Problem is now the MOs are left to pick up the pieces, as alluded to by the writer of this letter

    I am glad that the welfare of house officers has improved for the better over the past few years, but I strongly feel that the well-being of the public is sacrificed in the process.
    As the saying goes, the strongest of steel is forged in the hottest fire. The best doctors are those who have undergone vigorous and proper training, and sometimes, training comes with long hours.

  4. Hah. Thanks for quoting me.
    It’s a double edged sword, even here in the US. Restricting the work hours = better and safer pt care (the restrictions here stemmed in part from a 1984 case in which a pt died from a medical mistake felt to be related to overexhaustion). Also, it’s mentally taxing on the doctors as the more senior of us will recall the months of sheer exhaustion and moments when we have a nervous breakdown. So limiting hours will benefit the residents’ (HOs) mental health too.
    The problem is, this will limit the amount of teaching/learning. Also, those harrowing nights teach one of skills we need to succeed; triaging priorities, thinking on our feet, being responsible for MY patient. Indeed, to admit a patient and order/follow that patient’s workup and progress for the next 30 hours, is invaluable. In addition, perhaps this is very old-fashioned of me to say so- the years of training makes one strong, and filters those who are meant to be doctors, from those who go into medicine for the wrong reasons.
    So limiting work hours, especially in a system (from what I understand) as Malaysia’s where there is already a high HO:MO ratio may only cause poorer quality learning experiences, and ultimately a worse doctor.
    Work hours aside, I do agree that the public humiliation as a punitive act to the HOs isn’t a reasonable approach. Here, if an intern really sucks, they fail the rotation (perhaps the year) and need to pass it to get their full license. So, no need to yell and holler at them! 🙂

  5. In my view the best thing is to stop giving permanent jobs. All junior doctors go on contract only. If you don’t perform, then contract not renewed. Period.

  6. Don’t worry, era of HOs applying for permanent job will comes sooner than you thought. This is the next step for KKM as they are already out of options to accommodate the large number of doctors.