the chronicles of a House Elf: my 5th month as a House Officer in Singapore + recovering from burnout + a welcome change in environment :)

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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!

As the smiley face in the title suggests, I’m glad to start this month’s post with an optimistic declaration that things have been looking up ever since I rotated to a new hospital & department, and for the first time in 5 months, I’m actually liking my work. This past month spent in my 2nd Housemanship posting has been nothing short of enjoyable, fulfilling and with sufficient ‘work-life balance integration’ (more on that later).

(For legal reasons, I will refrain from writing the names of any hospitals or departments on this blog, but you can just stalk my LinkedIn if you’re curious :P)

Gone are the days where I woke up with a sense of dread & anxiety in the pit of my stomach and dragged myself down yellow linoleum corridors to my ward, before the sun had even risen. Maybe it was the culture/politics at my previous workplace, maybe it was the excessive administrative work that House Officers were made to do in that posting, maybe it was me having close to zero interest in that specialty; maybe it was the amalgamation of all these factors that led to a massive episode of burnout and me very nearly handing in my resignation letter.

I came so close to quitting, but I’m so glad I didn’t quit.

As mentioned in my post last month, I had actually emailed M0HH about quitting and serving out my bond in a non-clinical posting, because I felt loath to imagine spending the next 5-6 years feeling so unfulfilled, apathetic and sad at work. This is the raw and brutally honest story about how I got out of that rut and onto the road to recovering from burnout.

Legal disclaimer: This is a personal blog. 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, unless explicitly stated. Any views or opinions are not intended to malign any religion, ethnic group, club, organization, company, or individual. (but if you were a former colleague from the aforementioned posting, then please don’t read on.)

my experience with burnout (in my previous posting)

I believe I wouldn’t have burnt out so quickly if I had started my Housemanship journey in a different place, but alas, fate led me down that path to enable me to share my story with you today. Hopefully you’ll be able to avoid the same pitfalls I did, and take active steps to delay burn out. (I said delay, not prevent or reduce, because I honestly don’t believe the current healthcare system in Singapore is well-staffed or well-equipped enough to stave off burnout among public healthcare workers.)

Burnout is a slow and insidious process. It begins as a feeling of ‘sianness’* when you start up the PC at your workstation at 6.30am, sigh deeply, and begin typing your morning entries mindlessly, manually clicking around and keying in your 10-20 patients’ vital signs/pee/poo charts, etc. Day in and day out, you pre-round all the patients, then round them all again with the resident (trainee in that specialty/your immediate boss), and then a third time with the registrar and consultant (bigger bosses).

*’Sianness’ is the state of being ‘sian’. It’s a Hokkien word that means to be sick and tired of something or bored or being caught in bothersome situations you can’t do anything about. (Source: BBC, because they taught us in school to always cite our sources)

And then the feeling builds. Small but consistent sources of exhaustion & frustration add up: slow computers, having to document every case according to a fixed template (something unique to that previous department), ordering the exact same set of medications for all your patients according to yet another template, menial manual data entry, and discharging double-digits of patients daily, with another 10+ flooding right in.

And then after a few weeks of this mindlessly repetitive work, it starts to feel like you’re trapped in Groundhog Day, and you stare at the clock, practically praying for the seconds to pass by quicker and for the day to end. You start to wonder if the rest of Housemanship will feel this menial, purposeless and unstimulating. (Unfortunately, it might be, depending on the postings you select.)

And then one fine day, some asinine and seemingly minor thing just tips you over the edge. You’re on call, 21 hours in and severely sleep-deprived, you get a phone call at 3am asking you to order skin lotion – and they casually mention that it’s not urgent at all. It was not a fun feeling at all: being a glorified secretary, paperwork monkey and slave being pulled in all directions.

I remember reaching home and just feeling completely drained on most days, even though I had only worked a measly ~10/11 hours (my job was largely 7am-5/6pm) and had really fun co-HOs (fellow House Officers). It clearly wasn’t the hours that were killing me, because I was certainly working a lot less than my friends in other postings. But on the bright side, I learnt how to multitask – crying while watching Netflix over dinner, because there simply wasn’t enough time to get home/eat dinner/cry/unwind/sleep at 10pm before yet another day of waking up before 6am.

causes of my burnout

Here’s a sad laundry list of the various factors that caused my burnout, and I’m sure that most of y’all would be able to relate to some of them in your own working lives:

Massive disclaimer in a tiny font: I’m not pointing fingers at any hospital, department or individuals; I’m just sharing my personal experience with burnout with anecdotes from my very first Housemanship posting, because it happened to be precipitated by various occurrences in that time period.

  1. Not being able to disconnect from work – I was expected to remain contactable on demand even after leaving work, because my bosses would occasionally text to ask about our patients. I chose doctoring because I wanted a job where I didn’t need to take work home, and having to think about work after hours was unpalatable. It made me sympathise with my friends in the corporate world who are constantly replying emails even at 10pm on a Saturday night.
  2. Feeling unfulfilled and unstimulated at work – Mindless admin work, endless copy-pasting, printing & signing stacks of documents day in and day out. Quoting this article, the fundamental experience of boreout is meaninglessness – “the experience that the work doesn’t really have any purpose, that there’s no point”. I honestly tried so hard to be optimistic and find joy or meaning in my work, but even the smallest spark of motivation was snuffed out by the tidal wave of paperwork we had to do.
  3. Unsustainable workload/high patient turnover – All of us (the House Officers in this posting) were extremely efficient, as we had become so well-trained at churning out paperwork over the months. But the worst part was that no amount of efficiency was ever rewarded. Even when we discharged 10-15 patients every day, the same number came flooding right back in, and we felt like exhausted workers in a production line.
  4. Cognitive overload/mental fatigue – This was closely related to the high patient turnover. It was mentally tiring to have to familiarise ourselves with 10+ new patients every morning despite knowing that they would only stay 1-2 days (something unique to the specialty I was posted to).
  5. Low workplace morale – In my very first week of Housemanship, one of the more senior HOs told me that she was counting down the days till she could leave that posting. For the record, it was 58 days, but my countdown was standing somewhere closer to 120 days. My fellow HOs and a fair number of the residents/trainees were burnt out (and some even quit), constantly complaining – their grievances were very much justified and valid – but it rubbed off on the newer HOs as well, and we ironically bonded over complaining.
  6. Lack of support – In surgical postings, Medical Officers (our immediate seniors, the first-line that HOs run to when we need help/advice) were often in the Operating Theatre or running clinics. As a complete newbie and the only House Officer in my team (due to manpower constraints), I felt lost, swamped and confused, but felt like I couldn’t approach my bosses for assistance as they were constantly busy and I feared being bothersome.
  7. Workplace politics – I cannot overstate the importance of a healthy, supportive and genuinely kind working culture. My past month in a new department has been nothing short of amazing, and it feels good to be able to speak casually and banter with my bosses without fear of offending anyone. :’)
  8. Unfair wages – I know that from an outsider’s POV, it seems unreasonable to complain about a starting pay of $4k before CPF ($3.2k is our actual take-home pay, or around $3.8k once we add our call pay). But I tabulated my working hours in a spreadsheet, and turns out I worked around 330-350 hours in a month, including calls (30-hour shifts), for an hourly rate of around $10-11/h. And the posting I was in was already known to have comparatively excellent working hours (my friends in surgical postings worked around 400-420h per month). As one my close friends/a fellow House Officer said, it would only be fair if we were paid more so we can pay off our $125k in student loans and still have leftover money to save for our own future (housing, marriage, kids, etc) or enjoy our lives/adequately de-stress outside work.
  9. Poor work-life balance – When you’re pulling 80-100 hours at work every week, and working overnight at least 1-2 times a week, it’s hard to juggle having a social life, getting adequate rest and having time to yourself. When you’re already so close to burning out, every little bit of joy is essential to your sanity (hence my monthly beach outings). But when you can’t even wrangle enough time for a life outside work, you start to question why you’re putting your own health and mental wellness on the line for a job in which you’re clearly replaceable.
  10. Inadequate sleep – Singapore is the most fatigued country in the world, and I’m not even surprised. My friends in tech are working “996” (9am to 9pm, six days a week), my finance friends are pulling 14-hour work days 6 days a week, doctors are working 80-100 hours a week, and none of it is healthy. or sustainable in the long run. Getting the healthy/recommended 7-8h of sleep was impossible for some of my friends in Surgery who were working around 15 hours a day, and I watched their physical and mental health deteriorate over the months, but we were powerless to make any change, because manpower is just stretched too thinly (especially with COVID).
  11. Not having control – Our lives as junior doctors (the first ~5-6 years of our working lives) revolve around work and the call roster, and even simple things like making dinner plans with friends and family became a luxury (which I will never take for granted again). I had to reschedule or show up late to so many dinners, skip visiting my grandparents because I was on call over the weekend, the list could go on.

Imagine feeling weighed down by all of that, all at once, and you have the perfect storm for burnout.

the road to recovery from burnout (in my new hospital) + starting therapy

In this past month, I’ve been going into work feeling excited about the day, something I never thought I’d say. I’m so much happier now in this new hospital and department, for a multitude of reasons. The working culture is healthy, chill and relatively low-pressure. We have fairly regular working hours (of course we still have to do calls) and there is a strong emphasis on work-life balance & wellness, which is perfectly aligned with my life priorities.

If you had told me exactly a month ago that I would be enjoying my work this much after just 1 month of being in a new environment, I wouldn’t have believed it. But it turns out that all I really needed was a change in work culture, and I’ve come such a long way in just this past month.

About 100 days into my first posting, I was feeling so mentally & physically drained that I decided to start looking for a therapist. To be honest, I had been so very tempted to quit at least 3 times before that, but I kept telling myself that things would get better once I rotated to my next posting (and thank God for my new posting/hospital, the people here are actual angels).

This pic is a pretty accurate representation of how my mental state deteriorated throughout my first Housemanship posting, and I’m sure it was apparent to those of you who’d been following this series from the very first month.

Back then, I was constantly feeling anxious and paranoidly checking my work phone because of the unspoken expectation to be contactable until the late evening; I was so scared of missing calls or messages from my bosses. It sucked to live life that way.

In stark contrast, my past month in this posting has filled me with a sense of calm, because our work Whatsapp group is completely silent after we knock off and walk out of the wards; the line between ‘work’ and ‘after work’ is clearly demarcated and respected.

I’m sure that you’ll be seeing a much happier side of me over the subsequent months, because I can already feel myself healing from the circumstances I had been put through for the first 4 months of my working life.

Closing that previous chapter and starting my second posting in a new place and specialty has had a profound impact on my psyche. I’m a lot more interested in this specialty and feel much more connected & committed to my patients. It sounds so cheesy but I enjoy managing my patients’ health and social issues holistically, and having time to think through their various conditions. I also feel like my work here is way more impactful and meaningful, and all this is helping me slowly but surely heal from the burn out.

Although I’m already in a much better place mentally, I’m still going to commit to seeing my therapist once a month (hmu if you want her contact!). As a fierce and very vocal advocate of mental wellness, I would like to put out the PSA that it is a huge misconception that you only need a therapist if you have psychiatric problems. Therapists/psychologists are professionally-trained, and serve as an external & objective voice to help anyone work through various life problems, provide concrete advice on how to improve your mental wellness, and aid you on the journey to self-improvement.

work-life integration vs work-life balance

During our first-ever consultation earlier this month, after hearing about my colleagues’ and my ridiculous working hours as House Officers, my therapist jokingly asked if I had ‘work-life balance’ or ‘work-life integration’, and it was tragically clear that I will only ever be able to enjoy the latter, because being an overworked junior doctor in Singapore is obviously the antithesis of work-life balance.

Quoting UC Berkeley’s Haas School of Business, “Work/Life Integration is an approach that creates more synergies between all areas that define “life”: work, home/family, community, personal well-being, and health.”

The main difference between work-life balance vs integration is that the latter accepts a certain degree of infiltration of work into one’s personal life, while work-life balance relies on more clear-cut boundaries. It takes more effort to set up and stick to those boundaries, but the pay-off is worthwhile to me.

I’m in the pro-work/life balance camp, because it’s futile and unnecessary to stress about my patients when I’m out of hospital; I trust that my team has done enough to stabilise our patients during the daytime/before leaving work, and if any issues arise overnight, I trust the on-call doctors to adequately handle them. TBH, that’s literally the whole point of being on-call, to give your colleagues a chance to go home and rest/enjoy life, while you hold up the fort for one night.

Another reason why I’m into work-life balance and not integration is that I enjoy having stability and a semblance of a routine. Being able to knock off at a relatively fixed time on most days (except when I’m on call) allows me to maintain a fulfilling life outside of work. In this past month, I’ve been able to achieve that: spending time with my family, having a social life, exercising, resuming some hobbies, and getting adequate physical & mental respite.

Anyway, this month’s post is getting a bit long, but I can’t and won’t shut up about how grateful I am to my current department for having such a wholesome culture and providing a welcome change in environment, and I’m excited to watch myself thrive at both work and outside work for the remaining 3 months here. 🙂

Here’s my song rec for the month – this time, it’s a cute and uplifting bop about an LDR:

I think that I would rather be distant with you
Than feel distant with someone who
Is standing in front of me
But I can’t even feel a thing
I would rather be distant with you
Than feel distant with someone who
Is living right down the street
But don’t feel close to me

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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If you’re interested in exploring my blog, click here for an index of all the posts I’ve ever written (travel, musings, doctoring), or check out my most read series below:

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