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Caring for those who Care

"While burnout is not a mental illness, it provides us a way to start a conversation about how clinicians are struggling with psychological stressors at the work place"

Associate Professor Nicholas Chew
Chief Education Officer, National Healthcare Group (NHG)


Healthcare professionals are trained to provide holistic (physical, social and mental) treatment and care to their patients, but who is looking after theirs?

While the signs of physical and social ailments are easier to recognise, mental well-being may not; as it may be concealed due to the fear of stigmatisation, or even manifest as physical and/or social ailments instead.

“There is scant data about the mental wellbeing of clinicians [doctors, nurses and allied health professionals] in Singapore because there is not much conversation going on,” shared Associate Professor Nicholas Chew, Chief Education Officer, National Healthcare Group (NHG), during his talk on ‘Burnout’ at the 14th APMEC (Asia Pacific Medical Education Conference).

Could it be due to the perception that healthcare professionals are considered health role models, hence they would know how to treat themselves? Or could it be due to professional fears such as being stigmatised, that inhibits one from seeking help?

"Interestingly, healthcare professionals are among the last to own up to ill health," said Adjunct Assistant Professor Habeebul Rahman, Senior Consultant (Psychological Medicine), Tan Tock Seng Hospital (TTSH), who leads the TTSH Staff-SupportStaff (3S) programme – a peer support programme that provides emotional first aid to staff facing crisis. “Healthcare professionals in general, make the worse patients!" he quipped.

Dr Habeebul explained that that personality factors such as perfectionism, high standards and expectations, often drive medical staff to brush off early signs of mental issues such as burnout. And the deep seated stigma of being perceived as “weak” also attributes to one’s hesitation to seek help.

A/Prof Chew suggests that burnout is a soft entry point into discussions on mental illness. "While burnout is not a mental illness, it provides us a way to start a conversation about how clinicians are struggling with psychological stressors at the work place," he said.

The NHG Internal Medicine (IM) Residency Programme, led by the programme director Dr Faith Chia is currently doing a study on the prevalence and factors of burnout. Preliminary findings showed a high level of burnout in the IM residents, which is of concern.

She stressed that the effects of burnout is not only detrimental to the healthcare professional but the patient as well. “You [healthcare professional] become distracted, make poor decisions, and slowly lose your ability to engage the patients [emotionally]; and upon realising the lapse in performance, you begin to feel upset with yourself; creating a vicious cycle,” she explained. “This may lead to absenteeism, leave of absence, early 'retirement', health issues or even addiction."

Dr Habeebul explained that “being burnt out isn’t about one’s character or ability”. He defined burnout as a “syndrome” comprising of a collection of various feelings and states that can be felt both psychologically and physically.

Ms Lek Jie Ying, coordinator at 3S, elaborated that the psychological signs include feelings of despair, hopelessness and helplessness. She added that in some instances, "the experience closely resembles depression; and the physical symptoms may include loss of appetite, loss of weight, poor sleep, or even gastric pains".

Using the Maslach Burnout Inventory as a reference, Dr Habeebul noted that three main components of the burnout syndrome include: emotional exhaustion, depersonalisation and reduced personal accomplishment. However, not all components need to be present for burnout to be diagnosed; in his study, he found that 56 per cent of physicians experience at least one component of burnout, and 17 per cent in all three.

“There are numerous causes that contribute to burnout. The incredibly complex and unpredictable aspect of healthcare such as attending to patients who are ill, badly hurt or who do not survive despite the best efforts of the medical staff; coupled with workplace tensions, and the occupational hazards of being in the healthcare industry, may prove to be overwhelming for some professionals [especially the more junior ones] who do not have well-developed coping mechanisms,” said Dr Habeebul.

He stressed that healthcare leaders "should not wait until the time when staff are in a state of learned helplessness where they no longer feel able to effect change in their work environment, before intervening and administering treatment".

Dr Chia echoes this sentiment: “I think we [healthcare leaders or senior practitioners] need to recognise that burnout is a real issue, and not adopt the mindset that the problems are the result of mentally weak ‘strawberries’ [Strawberry Generation], as they are experiencing physical and psychological effects from burnout." “As we in healthcare are expected to help our population prevent the onset of disease(s), we should also adopt the same approach to our healthcare professionals; preventing burnout before it happens,” said Dr Chia.

Both Drs Habeebul and Chia agreed that there is a pressing need to increase the awareness of burnout amongst healthcare professionals, and the social support available to them; so that they would be able to recognise the signs and seek assistance, should either they or their fellow co-professionals experience burnout.

“If we take the perspective of a learning organisation, it is about how we start having conversations about burnout, and the important conversations needed to actually understand what the size of the problem is, and how we deal with it,” said A/Prof Chew.

Adjunct Assistant Professor Habeebul Rahman works at the Tan Tock Seng Department of Psychological Medicine as a Senior Consultant Psychiatrist. He is a member of the Royal College of Psychiatrists, and has a Diploma in Psychotherapy, which is his area of interest. Dr Habeebul has been appointed to the Board of Visitors to The Office of the Public Guardian, and is also an Assistant Professor at YLL School of Medicine and Lee Kong Chian School of Medicine. Prior to attaining specialist accreditation, he completed a thesis on resilience within doctors, and serves as Chairperson of TTSH’s peer support programme (3S).

​Dr Faith Chia is a Senior Consultant in the Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital. Upon completion of her advanced training, she did a fellowship in musculoskeletal ultrasound and inflammatory arthritides in the Centre for Rheumatic Diseases in Glasgow, Scotland. Dr Chia is actively involved in undergraduate and post graduate teaching, and is currently the Programme Director for the NHG Internal Medicine Residency Programme.~

Tan Tock Seng Hospital ‘3S’ (or Staff Support Staff) was set up in 2007 as part of a Ministry of Health’s (MOH) HMDP (Health Manpower Development Plan) initiative to introduce peer support programmes in all the Restructured Hospitals. 3S provides support to staff for most issues, with the exception of financial and/or housing issues. All 3S coordinators and volunteers have received training in Mental Health First Aid, and Critical Incident Stress Management. Staff can either contact 3S directly, or through their supervisors. All sessions will be kept confidential, unless possible harm to self or others is deemed imminent.

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