August 10, 2022

Doctors need a better assessment system

3 min read

MUCH has been said about medical house officers, permanent government posts and contract offers.

The word criteria is used a lot in reports on this issue – but what exactly is this “criteria” that will be used? Or rather, what tool has been used to assess and evaluate government doctors?

A closer look will reveal the inadequacies, biasedness and non-transparency of the system that has been in place for years. The SKT/LNPT (Sasaran Kerja Tahunan/Laporan Penilaian Prestasi Tahunan) is a performance evaluation tool for government doctors. Every doctor is assessed by two superiors and given a mark indicating his/her performance over the past year.

Much has been said already about the system and how inadequate it is; however, nothing has been done. It was even brought up with the Health Minister during his visit to Hospital Queen Elizabeth in Kota Kinabalu earlier this year but nothing has changed since then.

A recent survey (with multiple options) was conducted among members of the Doctors Only Bulletin Boards (DOBBS) group on Facebook; DOBBS is a platform consisting of 16,000+ Malaysian doctors. The survey results indicate that there is something seriously wrong with the current assessment system. Among the results:

Half, or 58%, of the voters stated that the system is open to abuse, misuse and favouritism.

Of course, many might say that every system is open to abuse/misuse, but this should not be a pathetic excuse that we use to comfort ourselves. As assessments are done by just two superiors, many are assessed based on how well they impress these two superiors. Having a poor attitude and dishonest work ethic can still result in high marks if one is able to butter up your superiors nicely.

Complaints about the work ethics/attitudes of superiors are often greeted with “I will give you low SKT marks”, a threat that is used to suppress subordinates. SKT marks have been used to “punish” those who choose to voice out against injustice and dishonesty.

A third of the voters, or 27%, stated that the system is not transparent and needs a revamp.

The involvement of only two superiors also results in an assessment which is not transparent. More often that not, the second assessor does not even know who the doctor being assessed is, and gives marks based on hearsay or the advice of others.

For example, a hospital director may assess a specialist/head of department despite not having worked with that person or seen how he/she performs clinical duties.

The SKT/LNPT marks are used for salary increments and awards for scholarship for postgraduate studies and so on, with 85% used as the benchmark.

As a result of the system’s weaknesses, many administrators have told assessors, “Just give everyone 85%” to ensure that all have a fair chance. What kind of culture are we promoting?

Is it not obvious that the SKT/LNPT system has failed us? And this is merely the tip of the iceberg of issues plaguing the medical civil service.

We are asking the ministry to create a 360°, bottom up, transparent evaluation system, one that will truly reflect the day to day work ethics and performance of a doctor.

DR TIMOTHY CHENG , Universiti Malaya Medical Centre