A Toxic Working Environment

“Berapa kali perlu saya ulang? Saya sudah bagitahu yang ini adalah kanser dan perlu operation!” (“How many times have I told you? This is a cancer and it needs to be operated!”), exclaimed an exasperated specialist, in front of 3 other doctors and 2 medical students, as she explained to the wife of a patient with oesophageal cancer that her husband would need surgical intervention the next day.

The doctor’s obvious lack of empathy and compassion made me wince. But what’s more, my overwhelming pity goes out to the wife when she replied to the doctor feebly, “Maaf doktor, saya cuma tidak faham” (I’m sorry doctor, I just didn’t understand”). 3 years later, that incident still stood out in my mind, clear as day and would always leave me brokenhearted.

Clearly we don’t need an entire subject of Pendidikan Moral to learn about proper virtues?

How often have we encountered this harrowing experience in our day – to – day life? I can assume that this doesn’t only happen in the healthcare industry, but takes place everywhere in our workforce as well.

A toxic working environment has become all too common nowadays. What disgusts me most is the hierarchical system that governs a workplace: senior – junior mentality, sense of entitlement, a demand for respect.

“Familiarity leads to conformity”.

But this is more apparent when it becomes a modus operandi that runs the workplace, and as we all can probably relate, old habits do die hard.

I first came into medical school with a burning desire, like all aspiring doctors — to help others, provide comfort, be a healer, to change the world. But once I entered the medical field, the fire that once burnt with passion, started to dim slowly as I witness the realities and atrocities that struck the hospital setting.

As doctors, most of the procedures we perform on a daily basis are structured and routine. We end up doing the same thing over and over again until our days progressively turn mundane and monotonous, to a point where we feel diminished into life robots — desensitized to our surroundings and our own emotions.

Our sense of integrity starts to chip away gradually: Berating and rude remarks among colleagues become a trend; medical professionals cutting corners when handling with patients; medical students always fearful of their lecturers to never cross the line especially during their bad days, or else students would have to suffer the consequences of being demeaned or degraded. This, in turn, greatly affects the medical students’ self – esteem and performance.

Even during our regular morning ward rounds, I witness doctors ignoring the fundamental ethics of confidentiality, as they broke the news to a female patient — in a ward cubicle, in front of a few other doctors and medical students, with other patients just within earshot — that she had developed Stage 4 Breast Cancer and her odds of survival is minimal. How hard can it be to usher the patient into a closed room, and explain about her condition in private instead? Or maybe with her other family members or caretakers as well, especially regarding a tragic situation like this?

When I look at the new, budding housemen, I wonder when will the numbing effects of hospital bureaucracy, defensive medicine and a toxic working environment start to seep in and take over them?

“As doctors, most of us probably don’t think about our power as much as we should. Like people in any other job, we are preoccupied for much of the time by the constraints of our work: annoying regulations, irritating colleagues or managers, and shortages of time, money and other resources. Yet, power over patients is constantly present in all our work. How we use or abuse this makes as much difference to them as our technical care”.

— John Launer, How Not To Be A Doctor And Other Essays

The French historian and philosopher, Michel Foucault, coined a term ‘the medical gaze’, describing it as ‘looking at other people, not as fellow humans with needs and subjective feelings, but as objects of detached curiosity’. And it’s probably no coincidence how the term is named. Because how many times have we, as doctors, catch ourselves treating our patients likewise?

I’m not trying whine or point fingers at any party. Maybe I’m not qualified to bring this issue up because technically, I’m still not yet a practicing doctor as I have yet to wait for my housemanship. I may not even understand the gargantuan weight that doctors have to carry on their shoulders everyday, or the magnitude of stress exerted on them in the workplace.

But I’m lamenting from the perspective of a victim of the healthcare system, who has experienced her fair share of humiliation and disappointment in the medical profession. All I’m asking is for us all to break the status quo and steer clear from what we have long considered, ‘the norm’. 

I often wondered what had led to bad behaviour in the workplace? I’d always hear news about hospitals being understaffed and doctors being overworked due to lack of manpower. According to the Health Ministry data from 2017, our patient – doctor ratio still stands at 1:625, which is far from the ideal of 1:100 promulgated by the World Health Organisation (WHO). There are rumours about government lacking the financial resources, which forces doctors to be underpaid for the extra workload. Recent announcement proclaimed contract MOs are not guaranteed a permanent placement in the healthcare sector after their contract is over. No wonder doctors are rebelling and performance level is dropping! There is a staggering imbalance between reward and effort, since doctors feel undervalued and drained for being treated merely as the nation’s dispensable tool. And yet, others still question why a large wave of doctors prefer working in private hospitals after their mandatory service in the public sector has ended.

It’s pretty obvious that politics play a huge role in this matter as well, and that both politics and the healthcare system are interrelated with one another in many ways. I personally think that, when it comes to the national financial management, proper governance and radical transparency should be implemented when creating a policy for every individual sector. But with the lack of trust and poor leadership among higher authorities, on top of cases involving money laundering, kleptocracy and corruption that has been spreading like wildfire in the country, how do you expect a nation to redeem itself? However, this is a topic for another day and requires a separate discussion altogether.

“It’s never a ‘team’ problem. It’s always a ‘leadership’ problem”.

I can’t help but also think that a toxic working environment has a lot to do with the leader governing a group or institution. When a leader comes from a lower vibration and possesses a weak character, it sets the tone for the whole organization. Conversely, when a leader is built of strong character and leads with integrity, this somewhat creates a ripple effect that trickles down throughout the entire team.

“Set your house in order before you criticize the world”.

— Jordan B. Peterson, 12 Rules For Life

Probably asking someone else to transform their ways is too much to ask. Instead, I advocate promoting change, first, within ourselves — through our actions, words, thoughts etc. By emulating these virtues, hopefully it will rub off on anyone we associate ourselves with, so that eventually, a community that puts emphasis on kindness, respect and compassion emerges.

Life is already challenging as it is. Thus, isn’t it the more reason for all of us, in our respective workplace, to step up as a team? To lend each other a helping hand and lighten the burden? To cooperate, as oppose to segregate?

Let this be a reminder for us all, and especially for myself, in the future.

#notetoself