The Icarus Paradox of Indonesian Specialist Doctor Education

FOTO: KRIS-BIRO PERS SEKRETARIAT PRESIDEN

President Joko Widodo gave a speech at the inauguration ceremony of the Specialist Doctor Education Program Based on Main Hosting Hospital (RSPPU) in Jakarta on Monday (6/5/2024).

There is something wrong with our specialist doctor education system. It was hoped that it would eventually enforce health in society, but instead these specialist medical students were plagued by depression.

The Icarus paradox was coined Danny Miller in his 1990 book, and later became popular. This term is used to refer to the metaphor of a company suddenly going bankrupt after experiencing a period of success. Then Miller (1992) observed another company that fell into the brink of collapse precisely because of its own success. The causes include, among other things, overconfidence, feeling great, excessive behavior, and excessive pride.

This paradox refers to the story of Icarus in Greek mythology who flew to the sun. In his flight to freedom, Icarus rose close to the sun (the realm of the gods), the wax on his wings melted, and fell to his death. The consequence of people flying high is bad luck, not because of failure, but because of success with arrogance.

Dowds (2018) in his book, Depression and the Erosion of the Self in Late Modernity: The Lesson of Icarus, concludes the phenomenon of depression (an upset mood) which underlies narcissism (disrespectful, but despised by people) which emerging from self-isolation. Examples of bad parenting practices will create narcissists. Narcissists create and enable individualist societies and individualist caregivers to condition narcissistic children.

In the view of social psychologists regarding the rising narcissism and depression in society, Twenge (2014) observed that children who are shielded from discomfort and unhappiness will be rewarded just for participating. However, despite being pampered by adults, the younger generation is intimidated by each other, as is inevitable in a culture where they are raised with the belief that "I am the only one who is important."

Victims of narcissistic bullying in the form of depression are only one side of the coin. Others concern the people they come into contact with. Bullying of others signals feelings of weakness towards oneself, and contributes to depression in the victim.

Then extreme narcissism is characterized by a feeling of excessive entitlement, which tends to be exploitative, exhibitionistic and authoritarian.

All forms of control can be used by extreme narcissists, including intimidation, isolation, coercion, economic, physical, and mental extortion. The resulting environment leads to low self-esteem, depression, suicidal thoughts, humiliation, and self-blame.

Bullying of specialist doctors

PiskIakov et al. (2013) presented symptoms related to bullying of young doctors. This occurred in a hospital owned by the Ministry of Health and they became "regular" victims of bullying, even leading to depression. Not because of job demands and pressures, but due to various forms of bullying. Starting from junior doctors receiving harsh words from senior doctors, being assigned duties beyond their limits, illegal levies, assignments for the personal interests of the perpetrator, actions of alienation or neglect, to physical violence.

The treatment that junior doctors receive as a result of bullying is not reported due to various threats and concerns for their career future. It is alleged that these incidents occur frequently and have been ongoing for decades. Meanwhile, the perpetrators are increasingly rampant, as if they have the right to determine the fate and future of their victims. This criminal behavior is carried out systematically.

However, currently, the victims of bullying have dared to speak out by reporting incidents of bullying that they have experienced. The Ministry of Health has opened a complaint center for young doctors who are bullied and can file a report provided by the Ministry of Health.

The identity of the reporter is guaranteed confidentiality, making them feel safe. This has been proven by the many cases that have been reported. Since the opening of this complaint center, 91 cases have been reported (until August 15, 2023), including 44 cases in hospitals belonging to the Ministry of Health, 17 cases in RSUD in six provinces, 16 cases in various FK in eight provinces, 6 cases in university hospitals, 1 case in a military/police hospital, and 1 case in a private hospital (Kompas.id, 17/8/2023).

KOMPAS/STEPHANUS ARANDITIO

One of the patients at the Jakarta Fatmawati Central General Hospital, Erixs Gendala (28), was consulting with an orthopedic specialist, Phedy.

Screening results

Kompas (16/4/2024) published the headline "399 Prospective Specialist Doctors Admit They Want to End Their Lives". Citing data from the Ministry of Health, as many as 22.4 percent of specialist medical education program (PPDS) students were suspected of experiencing symptoms of depression. In fact, according to the news above, tragically 3.3 percent (399 people) admitted that they wanted to hurt themselves and intended to end their lives.

In pursuing a residency program, students fund it themselves. Instead of being facilitated to become competent specialist doctors, they end up experiencing symptoms of depression halfway through. The screening results related to these psychological symptoms need to be addressed with a wise and responsible solution.

According to Attree (2006), in evaluation studies medical education, systems and processes also need to be evaluated on four main PPDS stakeholders, namely the relevant collegium, teaching hospitals, leaders of medical faculties, and related senior specialist doctors. PPDS must continue to be monitored and then controlled referring to good and responsible operational standards and procedures.

Avoid the Icarus paradox

The screening results from the Ministry of Health above serve as a strong signal for stakeholders in Indonesian PPDS to change. Various allowance of deviant processes and practices in educating specialist doctor candidates need to be stopped and fixed immediately because it will later result in the health conditions of community members being threatened. At minimum, people will flee to seek treatment abroad, afraid to encounter doctors in the country.

Comprehensive improvements, including upholding the noble values ​​of PPDS, must be maintained and implemented by stakeholders. Otherwise, PPDS's direction in educating and producing specialist doctors will be blurred and it is feared that it will lead to the brink of destruction and fall into the Icarus paradox among society. This situation is contradictory to what has been said that Indonesia's health sector will reach a golden age in 2045.

We believe that there are still many good students, senior lecturers and teachers who support medical education. Even if there is a culture ofbullying, it is hoped that it will only be carried out by a handful of individuals. At this time there needs to be firm action and sanctions. However, who takes the initiative?

Practices such as the above clearly tarnish the field of medical education and become a "thorn" in society's side. Medical faculties and teaching hospitals are expected to make specialist doctor education more transparent and ethical.

ARSIP PRIBADI

Mohammad Hamsal

Mohammad Hamsal, Professor of Strategic Agility at the DRM Program, Binus University and Administrator of the Indonesia Strategic Management Society.

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