The dark side of being a Malaysian doctor

Recently, an open letter by a tired doctor from Sungai Buloh that went viral in social media drew our attention back to the long standing problem among doctors in Malaysia: burnout. Dr Vivian explores why burnout is rampant among Malaysian doctors, via the personal experiences of 3 Malaysian doctors who have gone through burnout themselves.

“I was extremely exhausted and felt very down most of the time. I felt numb, stagnant and mentally drained. At work, I became like a robot.” Dr A, a Malaysian medical officer, talked about her previous experience while working in a government hospital. These stories are now becoming increasingly common. Why are more and more Malaysians doctors experiencing burnout?

What is burnout?

Burnout is an occupational phenomenon which is a result of chronic workplace stress that has not been successfully managed. It is characterized by:

  1. feelings of energy depletion or exhaustion
  2. increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job
  3. reduced professional efficacy

Source: World Health Organization (WHO)

Physician burnout is a public health crisis that urgently demands action, according to a Harvard report. A study done on 250 medical officers working in a Malaysian tertiary hospital revealed that the prevalence of burnout was as high as 25.2%. That means 1 in 4 doctors are suffering from burnout! Surprisingly, this problem may even begin during the medical school years. One study showed a local medical school having almost 68% of their medical students reporting burnout. 

The struggle

Dr V, an ex-house officer talked about her burnout experience. ‘‘I realised I was burning out when I started feeling so terribly exhausted after work that I had no interest in doing anything else, including self care. Fortunately, my family and friends noticed my change and came to my aid’’. On the other hand, Dr. A was not as lucky. Putting her emotions and thoughts as self- blame all along, she did not realize the problem until she read an article about burnout. Before that, she was blaming herself continuously. “I kept thinking: ‘Why wasn’t I strong enough like everyone else, why couldn’t I just hold on for a couple more months, why am I built this way.’ I did survive my first posting as a house officer, why couldn’t I survive this one?”

But why?

Burnout is not a badge of honor. If taken lightly, burnout could eventually lead to mental illness. Hence there is an important question that we need to answer – what is contributing to burnout among Malaysian doctors? These doctors share their thoughts. 

Heavy Workload

“Not having enough rest is one of the reasons”, said Dr A. Undeniably, with long working hours, lack of staff and increasing number of patients especially during this COVID-19 pandemic, medics are starting to experience work overload. Not to mention the additional guilt and anxiety of whether they are putting their loved ones at risk for the virus. “There was a period during my housemanship when I had to work 70-80 hours per week with no off days. Annual leaves were frozen due to lack of house officers. I was extremely exhausted. That was when I started having burnout,” she added. 

High stakes

The great responsibilities that every doctor has to carry, cause burnout too.“The high stake nature of the job, and the little time I had to take care of myself to begin with, is the root cause. It snowballs and everything starts to seem to contribute to burnout after that,” shared Dr V. As doctors, besides providing the best medical care for their patients, they also have to communicate well with patients, colleagues and administrators. Failing any of these results in serious consequences. Having to be extra cautious and alert with everything they do, it is no wonder that some doctors suffer from stress and end up with burnout.

High standards

Burnout is a cumulative effect rather than because of a specific factor.

Dr N

For Dr N, various reasons have contributed to her burnout. The sudden change of workplace during her second year of Master’s program in anesthesiology and intensive care was one of them, as she was not prepared for how different the new hospital was. Besides workload and responsibilities, her personality trait led to burnout. ‘‘I felt frustrated because less competent peers would be rotated to less taxing areas, less difficult bosses and had more free weekends and off days. I unfortunately held myself and others to a high standard so when other people or myself don’t meet those standards, it caused a lot of frustration for me. I knew it was unfair to impose those standards on other people but I was a very typical Type A personality person at the time,’’ Dr N said.

The impact of burnout

Burnout could have a huge impact on one’s life in many aspects. With burnout, Dr V’s life is not the same anymore. “Burnout robbed a lot out of my life, personally and professionally. I tended to overwork myself, going on continuous stretches working just to get stuff done, with the aim to finish and be able to rest. However, no matter how much I rested, it was never enough. I even started withdrawing from family and friends, neglecting hobbies and interests as well.” Things were worse for Dr A. Her personal relationships were affected due to burnout. She even lost 5kg in 2 weeks.

Burnout affected me physically, mentally and emotionally. I did not feel healthy at all.

Dr A

Dr N recalled how burnout had changed her. “Initially I found myself being easily irritated. This was directed to friends and family at first but was then breeding to work. I felt very dissatisfied with work and I could not enjoy what I did. As a result, I considered quitting my Master’s program and even medicine. I tried looking for jobs online and even went as far as applying for some. For a while I felt lost since I felt like my entire life, my free time, my skills all revolved around the competence I had as a doctor. I did not know who I was outside of being a doctor.”

Aside from the clear risks to the doctors themselves, poor work performance caused by burnout and other mental health issues can also undermine patient care. They are at greater risk of making errors at work, have difficulties with other colleagues and staff due to increased frustration and hostility, which may lead to communication breakdown.

Put your oxygen mask on first before helping others

You have to take care of yourself before you can take care of others.

Dr Phil

Having a healthy mind is of vital importance as a doctor, especially in these troubling times with the global pandemic still in full force. By identifying the reasons behind the burnout among doctors in Malaysia, steps must then be taken to remedy these factors. Doctors should be encouraged to prioritise their own health so they can continue caring for others. Dr A put it beautifully when she said: “We have to move on from the thought that being a doctor means we have to go through extreme stress and burnout from working tirelessly to be a good one.”

We are talking about burnout in our weekly Instaseries on our IG page, head there to see more facts, stories and keep the conversation going so our voices will be heard!

If you are a healthcare worker looking for some emotional support, Medic Footprints Malaysia is here to help you. We are now offering psychological support services through Rapid Transformational therapy (RTT). Click here to know more about RTT.

Want to know more wellbeing tips especially during the COVID-19 pandemic? Check out this great article by Dr Laura Allison, a consultant medical psychotherapist. You can also sign up here for our mailing list, and follow us on our Instagram and Facebook page for more updates, events and career opportunities.

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Vivian Chuah

Vivian Chuah is a medical graduate from Malaysia. She enjoys writing, travelling and drawing. 'Keep trying' is her personal motto.

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