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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