the chronicles of a House Elf: my 4th month as a House Officer in Singapore + mental health among junior doctors

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This is part of an ongoing monthly series capturing the highs, low (and everything in between) in my working life as a doctor in Singapore. If you’re interested in finding more about medical/non-medical job options or getting answers to doctoring-related questions you’ve always wanted to ask, check out my brand new Chasing Careers series!

Wow. Just like that, we’ve completed 4 months of Housemanship and come to the end of our first ever posting. For those of you who are still reading my monthly posts, thanks for sticking around, 感动++ :’)

It has been tough, both physically and psychologically, but somehow I managed to haul myself past the finish line (well sorta, I still have 2 more races to run/postings to complete). It may be shameless to celebrate such a small milestone, but in the name of self-love, I’m immensely proud of myself for getting through the past 4 months, despite and in spite of its challenges.

In this month’s post, I’ll be touching on mental health among junior doctors and reflecting on my first posting. But before I continue, here’s a legal disclaimer: Any views or opinions represented in this blog are personal and belong solely to the blog owner and do not represent those of people, institutions or organizations that the owner may or may not be associated with in professional or personal capacity.

mental health among junior doctors

This is a topic that higher ups attempt to address but rarely ever succeed in truly understanding. We’ve had countless talks on mindfulness, maintaining good health, lifestyle tips to reduce stress, et cetera, but superficial measures like that are equivalent to sticking a cute Disney princess bandaid over a gaping wound. It might help in the short run and equip us with some skills to better cope in a high-pressure and high-pace working environment/manage stress/live with less-than-ideal mental health, but more significant measures are required to address the various underlying issues.

And at the risk of sounding like an apologist/sympathiser, if we consider the perspective of the various hospitals/government agencies, they probably believe these measures are enough to magically save doctors from burnout and their hands may be tied as well, due to factors like limited manpower (goodbye weekends & hello 90-hour work weeks!), inadequate financing (surely that’s why we’re underpaid ~$5-10/h??), or red tape that prevents any actual change from being effected? I can’t comment further as I haven’t had the chance to speak directly with these stakeholders to understand what’s going on behind the scenes.

Despite things looking decently rosy on the macro level, I’ve heard from and seen so many of my peers/colleagues struggling with mental health & burnout from the demands of working in the public healthcare sector as the ‘lowest form of life’ (as we dub ourselves). We’ve heard anecdotes of doctors committing suicide, others having to quit clinical practice due to various mental health conditions, and a number of my friends have had struggles with mental health directly induced by work.

Some of us have worked for 14-20 days straight (including half-days on Sat & Sun, plus calls on weekends) without a proper off day, despite our employment guidelines stating that we should get ‘1 in 7 days off’ to rest and have a semblance of work-life balance. Personally, my longest working streak was 19 days without a designated off day, but it was unavoidable due to severe manpower issues during that time period (although I eventually did get some weekends off in the following month as compensation).

I just wish speaking out about mental health and wellness won’t be seen as a taboo, and that those struggling with mental wellness won’t be stigmatised or labelled as ‘weak’ by the system. Disappointingly, I’ve met a fair number of doctors (usually more senior ones) who openly disparage those with mental health conditions and brush off mental wellness as a ‘strawberry generation gimmick’. Doctors shouldn’t be ashamed of speaking about health conditions, and mental health conditions are as valid and real as physical conditions.

my personal experience

If I’m being brutally honest, my mental wellness has been on a bit of a rollercoaster ride over the first 4 months of adjusting to this radically different lifestyle, one which I’m going to have to get used to for the next 5-6 years, until I finish serving my bond. Some days have been easier and more joy-filled than others (typically when I’m not at work or on rare weekends), while there were multiple days where my mood was in the metaphorical depths of the Mariana Trench.

The physical demands and ‘10000+ steps a day’ life as a House Officer have caused some old knee injuries to act up, and the pain/constant discomfort made me question whether all these sacrifices were worth it. I confess that I even went as far as speaking to MOHH HR to ask about alternatives* to completing HOship, because there were some days where the thought of having to go through 6-odd years with calls, deal with suboptimal physical health and accept 80-100 hour work weeks as the norm felt simply unjustifiable.

*FYI, such options do exist, in various healthcare-related admin jobs (MOHH, AIC, individual hospital’s admin/planning departments), and you can serve your government bond there as a last resort, but you’ll pretty much never be able to practice as a doctor.

I was confiding in an overseas-based friend about my situation as a junior doctor, and she said this to me: “I really feel bad for you because you are worthy and you should start seeing your value.” That statement struck me to my core. We’ve gotten so used to overworking ourselves, overextending ourselves, not setting clear boundaries between working & non-working hours, that we believe it’s normal. Let’s be clear, this problem isn’t limited to healthcare professions, but either way, it’s a recipe for burnout and making sacrifices that we’ll regret later on in life.

Maybe my memories and pain have been blurred around the edges, so I no longer feel as horrified thinking about it, but I still acutely remember my birthday week in June when I was on call 3 times in 7 days. Let me correct myself – I barely remember that week because it passed in a haze of exhaustion, but I remember reevaluating the life choices that led me here:

  • If I had known (as an 18 year old applying for Med school) that junior doctor life would be like this, would I still have chosen Med? I’m not sure, but I’m determined to make sure prospective med school applicants make a more informed decision about what they’re signing up for.
  • To what extent can ‘passion for Medicine/passion for serving the people’ be used as an excuse to keep pushing ourselves and our colleagues to the point of burnout? You certainly shouldn’t be setting yourself on fire to keep others warm, and would patients feel safe being cared for by a team of doctors who are overworked and near the limit of their physical & mental capacities?
  • Is the sacrifice worth it? I’ve thought this through extensively, and I’ve been vacillating between both sides of the coin. Let me elaborate.
when is it ‘too much sacrifice’?

Being a doctor entails so much sacrifice, and let me make a disclaimer that this statement is not meant to make any comparisons with other professions or allude to any BS like ‘wow doctors are so noble’. All sacrifices are valid, in any profession or life choice, and we just have to decide if we’re willing to accept and live with the consequences/opportunity cost.

We’ve had to devote so many years of our life to med school, sacrifice precious hours/months/years of our youth to the hospital, miss out on so many important events in our own personal lives (time with elderly grandparents, skipping family gatherings, being late/cancelling on friends because of sudden work commitments, reaching home late and not having the mental bandwidth to spend quality time with our family, etc.).

And it’s a sacrifice I’m willing to make for now, because hospitals can’t function without House Officers to run the wards, assist our senior doctors, or churn out essential paperwork. The work is menial but meaningful, and it’s part of our training to become full-fledged doctors next year, so it’s a worthy tradeoff in the short run.

Earlier this month, in a conversation with a senior doctor who’s been toiling away for ~30 years, she told me in all earnestness that ‘work doesn’t end even after you leave work’. And she indeed lives by that belief, often appearing in the wards at 10pm or even in the wee hours of the morning (I’ve seen her at 2am!), after finishing a late surgery or some paperwork.

I certainly respect/admire her commitment to her work & devotion to her patients, but different strokes for different folks; I definitely do not see myself devoting most of my waking hours to work/my career, no matter what career path I eventually choose. Such choices just boil down to each individual’s life priorities, and I hope everyone finds a rhythm/pace of work that fulfils them and suits their goals (but I’m clearly not a workaholic, so you won’t catch me living that kind of life).

the way forward (and memes as a coping mechanism)

I personally feel it’s not sustainable or reasonable to overwork junior doctors to the point of breaking either their minds or bodies, and it’s tragically comical at how we bond over memes about how underpaid we are or how poor our mental health is. Nevertheless, it’s a coping mechanism and is pretty entertaining to boot; at least we’ll burnout with a smile on our faces?

Here are some of my favourite and painfully relatable posts from my favourite local medical meme account @updatemeprn:

It sucks that we’re pretty powerless when it comes to making concrete change and trying to be heard by a massive corporation, but not all hope is lost. The owner of that Instagram account runs a website and is actively advocating for & working with other junior doctors behind the scenes to advocate for better welfare and rights for our community. Hopefully these baby steps now will translate to us having more of a voice and being able to effect bigger changes in the future, for the benefit of future generations of junior doctors (because it’ll be too late for us). And maybe we won’t be asked to lie to auditors about our working hours…(click the link above for context/this is a true story that I verified with my friends working in a certain hospital department)

Let’s not give up hope that there will someday be better manpower and a healthier working culture for junior doctors in Singapore, and even though it’s tough for all of us right now, let’s just stay alive and push on together. And please remember to check in on your friends (even if they may look like they have it all together on the surface), because a simple “How are you?” might save a life.

looking back on my first HO posting

Overall, I’d say I had an…okay first posting. In terms of working hours and work-life balance, things were as good as they’re ever gonna get, with a manageable day-to-day workload, and being able to show up comfortably late at 6.30am and reliably leave work around 5.30pm each day. And yes, 11 hour days are considered ‘excellent working hours’ for House Officers, especially when compared to my friends who pulled 13-15-hour work days with alarming regularity.

Another massive plus point was that I had to work relatively fewer weekends than other postings. While weekend rounds (half-days) and weekend calls are inevitable, my department put the bare minimum manpower on weekends to allow the rest of us to have some precious rest and a social life on weekends, which I was immensely thankful for. I’ll admit that I’m envious when I hear my non-doctor friends complain about being bored and having nothing to do on weekends, and I can’t wait for the day that I finally have full weekends off to just ??enjoy life??…but that’s tragically still many years away. 😦

The most challenging parts of my first 4 months of working life were:

  • The transition from chill med student life to overwhelming work hours/calls. From being able to leave hospital and head home to study at whatever time we chose (as a student), to the sudden loss of freedom and relative schedule flexibility, and being rostered on weekends, which we used to take for granted.
  • Adjusting to work culture and department politics. This varies greatly from hospital to hospital, and department to department, but I shan’t comment further out of propriety.
  • Not being interested in the specialty I was posted to, as it wasn’t a posting I selected nor a specialty I was remotely interested in as a medical student. Nevertheless, I’m grateful to have had exposure to women’s health; I’m sure the knowledge I gained will be useful once I become a GP. (I’m sorry this point sounds so half-hearted and fake LMAO)
  • Balancing my hobbies, social life, sleep and family commitments with work. I would say I’ve been able to juggle these with relative success (due to the decent work-life balance afforded by my first posting), and I’m praying I’ll be able to keep it up for the rest of this year, even as work gets busier.

Things got progressively better and easier as time passed, as most things in life do, and before I knew it, 4 months had whizzed by and my very first posting was done and dusted. I’m just very glad it’s over, and I’m excited to start my next posting (in a different hospital, thank goodness) tomorrow!

And as usual, here’s my song rec for the month – In Case You Don’t Live Forever by Ben Platt:

In case you don’t live forever, let me tell you now
I love you more than you’ll ever wrap your head around
In case you don’t live forever, let me tell you the truth
I’m everything that I am because of you

I apologise if this month’s blogpost was more serious and nihilistic than usual, but these are issues I feel very strongly for and have a fervent desire to speak up about. Anyway, I’ll continue sharing my journey as a House Officer/junior doctor and wherever life takes me after Housemanship year, so be sure to follow my Insta or Facebook page to stay up to date with my latest posts and life updates!

xoxo,
Faith

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