Last week, the World Health Organization (WHO) put the spotlight on this syndrome when it recognised “burnout” in its International Classification of Diseases as an “occupational phenomenon”, though not a medical condition.
WTF Is Burnout?
Burnout, according to the WHO, is characterised by feelings of energy depletion or exhaustion, increased mental distance from one’s job, feelings of negativism or cynicism related to one’s job and reduced professional efficacy.
It described the syndrome as one that results from chronic workplace stress that has not been successfully managed.
There is no major study on burnout in Singapore, but that does not mean the syndrome is not common here.
Burnout Is A Big Problem In Singapore
Dr Lim Boon Leng, a psychiatrist at Gleneagles Medical Centre, said the lack of definitive diagnostic criteria would mean that it is difficult to conduct studies on burnout to begin with.
“Personally, I do believe that burnout is a big problem in Singapore as we hold ourselves to high standards and are very mindful of productivity,” he said.
“Also, Singapore is an extremely competitive and materialistic society. As such we hold our jobs and job titles in high esteem and are afraid of losing our jobs.”
A survey released by health service company Cigna in March this year showed that Singaporeans are among the most stressed at work globally, with almost one in eight considering their stress unmanageable.
On top of a busy work schedule, they find it hard to cope with the “always on” corporate culture.
Surveys on workplace stress done by human resource firms have also shown that many workers here are highly stressed or expect their stress levels to rise. The results indicate burnout might be common.
Among doctors specifically, a study published in late 2017 in the Singapore Medical Journal, showed that the burnout rate amongst junior doctors in Singapore was higher than that in the United States (US). They also had lower levels of empathy. Furthermore, physician burnout has been found to be an economic burden, said Assistant Professor Joel Goh from the Department of Analytics and Operations at NUS Business School.
His study on the cost of physician burnout in the US, published in the Annals of Internal Medicine journal last week, showed that in the US, physician burnout will likely cost their health care system approximately US$4.6 billion (S$6.3 billion) a year.
“In physicians’ quest to care for patients, they often forget to care for themselves,” said Prof Goh. Investing in burnout prevention and remediation is not only good and ethical managerial practice, but can also make good business sense, he said.
“Do you really want a burnt out guy taking care of you? It ultimately trickles down to the care that patients receive,” said Prof Goh. “But, even if there was zero impact on patient outcome, there’s something to be said about ensuring that the people who work for you are cared for. It’s what good management is.”
Caregiving is another area where stress is known to run high. “The demands of caregiving can be overwhelming, especially when you feel you have little control over the situation,” said Dr Kinjal Doshi, the principal clinical psychologist at the Singapore General Hospital.
“Prolonged exposure to such stress will eventually lead to burnout and it takes a toll on your physical health, relationships with others and psychological well-being.” If nothing is done, caregivers may start to report feelings of helplessness and have difficulty managing emotions such as sadness and anger, he said.
How To Manage Burnout
“For burnout per se, without other consequential psychiatric disorder, some adjustment in workload or respite from work may be all that is needed,” said Dr Lim. Patients with burnout get medical leave, he said. “Ironically, many individuals would refuse to consume the medical certificates as they are either too committed to their work or are afraid of being judged negatively by superiors and peers.”
To prevent a burnout, it’s important to find someone with whom you can talk about your feelings and frustrations, prioritising activities that bring you joy and meaning, and to get plenty of sleep. The fear is of the burnout becoming worse. It can manifest as physical, affective, cognitive, behavioural and motivational symptoms. It can overlap with psychiatric diagnoses like adjustment disorder, depression and anxiety disorders, said Dr Lim.
“In seeing these cases, I will consider job burnout as the triggering factor of these psychiatric conditions,” he said.
Should burnout develop into depression or anxiety disorder, medication treatment or psychotherapy may be needed. “Allowing the diagnosis of burn-out helps to fill the gap between work stress and overt psychiatric illnesses,” said Dr Lim. “This allows burnout to be recognized and for working adults to seek help earlier without having to be diagnosed with a traditional psychiatric condition like depression, which may carry more stigma.”
Nevertheless, if workplace stressors remain unchanged, burnout can recur.
According to The Great-West Life Centre for Mental Health in the Workplace in Canada, burnout is more likely when employees expect too much of themselves or feel unappreciated for their work efforts.
Prevention strategies for employers include setting reasonable and realistic expectations, making sure employees have the necessary skills to meet them, helping employees understand their value to the organisation, and assessing the workload for those who feel pressured to remain working beyond normal business hours.
To help support burnt out employees, employers can develop a plan that includes asking the employee how best to recognise their successes and victories. This could include immediate and personal praise, opportunities for growth and development, public recognition, or incentives, the centre said.
How To Tell If You’re Burnout
Burnout is characterised by physical, mental and emotional exhaustion, which is associated with daily excessive and prolonged stress.
It may not be a medical condition, but it is a work-related mental-health issue. And it can creep up on you.
You will know it when the symptoms appear. Burnout can manifest in physical, affective, cognitive, behavioural and motivational symptoms, said Dr Kinjal Doshi, principal clinical psychologist at the Singapore General Hospital.
People who are burnt out may experience nausea, light-headedness, restlessness, nervous tics, increased heart rate, high blood pressure and sleep difficulties, he said.
As the burnout worsens, they may have depression-like symptoms such as chronic fatigue, physical exhaustion, weight loss or weight gain.
Individuals may also complain of headaches as well as muscle aches and pains, he said.
One key identifying symptom of burnout is emotional exhaustion.
“Symptoms associated with depression and anxiety as well as poor ability to regulate emotions and increased irritability are often experienced in individuals with burnout,” he said.
“Cognitively, individuals who are burnt out become cynical and have reduced empathy towards others.”
Those who are burnt out may also report subjective cognitive difficulties such as difficulty paying attention and recollecting information, said Dr Doshi.
They may take more sick days and have reduced work productivity, given the reduced life and job satisfaction, he said.
“Burnt-out individuals therefore will withdraw from their responsibilities and isolate themselves from others.”
They may procrastinate at work and engage in unhealthy coping activities such as drinking alcohol and smoking excessively.
Text: Joyce Teo / The Straits Times / June 2019