News - Tackling Exhaustion and Abuse - Singapore Medical Association
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V O L . 5 0 N O . 5 | M AY 2 0 1 8 | M C I (P) 0 5 0/ 0 1 / 2 0 1 8
x h a u s t i o n
T a c k li n g E u s e
and Ab
news
CON T E N T S
Vol. 50 No. 5 2018
Editorial 16 Celebrating the Artistry behind
EDITORIAL 04 The Editor’s Musings Timepieces
BOARD Dr Tina Tan Mellissa Ang
Editor
Dr Tan Yia Swam 17 Scoring Against All Odds
Deputy Editors
Feature Mellissa Ang
Dr Tina Tan 05 Creating Value and Valuing
Dr Tan Tze Lee Creation: Caring for our Doctors
A/Prof Daniel Fung
Insight
Editorial Advisors
A/Prof Daniel Fung
18 Burnout in Young Doctors – Time to
A/Prof Cuthbert Teo Pause, Listen and Support
Dr Toh Han Chong Dr Faith Chia and Dr Sabrina Lau
Members
Dr Chie Zhi Ying 20 Overwork-Related Disorders:
Dr Jayant V Iyer
Dr Jipson Quah
Karoshi, Depression and Burnout
Dr Jonathan Tan
Dr Hiroto Ito
Dr Jimmy Teo
Dr Alex Wong 22 Mediation: the First Port of Call for
EX-OFFICIOS
Medical Disputes
Dr Lee Yik Voon
Khoo Yingxiang and Choo Jin Hua
Dr Lim Kheng Choon
EDITORIAL Opinion
OFFICE 24 Abuse of Healthcare Workers
Senior Manager Dr Habeebul Rahman
Sarah Lim
Assistant Manager
Exec Series
Sylvia Thay
President’s Forum 26 Independent Contractor vs Employee
Editorial Executive 08 A Quick Review of the
Jo-Ann Teo Relationship: Key Legal Points
Healthcare Landscape Jonathan Yuen and Francis Chan
ADVERTISING AND Dr Lee Yik Voon
PARTNERSHIP
Li Li Loy AIC Says
Tel: (65) 6223 1264 Calendar 29 MOH Healthcare Claims Portal
Email: adv@sma.org.sg
10 SMA Events Jun-Aug 2018 (MHCP) – Your One-Stop Claims
PUBLISHER Portal for All National Schemes!
Singapore Medical Association
2 College Road Level 2, Council News Agency for Integrated Care
Alumni Medical Centre 12 Highlights from the
Singapore 169850 Honorary Secretary
Tel: (65) 6223 1264 Indulge
Dr Lim Kheng Choon
Fax: (65) 6224 7827 30 Rare Family Getaway
Email: news@sma.org.sg Down Under
URL: https://www.sma.org.sg 13 2018 SMA Annual General Meeting Dr Chie Zhi Ying
UEN No.: S61SS0168E Lee Sze Yong
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editorial
No one would dispute that It could hinder interactions with
Singapore is a stressed-out nation our colleagues and our ability to
and that working here is stressful. function at work. It may also lead
Local work cultures often strive to burnout, with its accompanying Deputy Editor
for efficiency and productivity, psychological sequelae.
sometimes at the cost of the
This month, we feature a series Dr Tan is an associate consultant at the
people driving the organisations –
of articles focusing on healthcare Institute of Mental Health and has a
the workers.
worker abuse and burnout. Our special interest in geriatric psychiatry.
The healthcare profession is not Feature article is by A/Prof Daniel She is also an alumnus of Duke-NUS
exempt from this. Recent social Fung, who is Chairman Medical Board Medical School. Between work and
media discourse and erroneous of the Institute of Mental Health (yes, family life, she squeezes time out for
publications (#targetzeroabuse, he’s my big boss). In his article, he her favourite pastimes – reading a
#factcheck) have probably comments on burnout, the abuse good (fiction) book and writing.
touched a raw nerve with my of healthcare workers and possible
fellow colleagues, which, when solutions to this phenomenon. In
combined with the heavy duties addition, Dr Habeebul Rahman neither of these is something you
of clinical work, administrative shares his insights into healthcare would wish on your greatest enemy
responsibilities and other factors, worker abuse. (I hope). Nonetheless, these are
could lead to a lot of anger, hazards of our profession, and I
unhappiness and other negative I’m pleased to also introduce hope that this issue brings more
emotions. Worse still, when we Dr Hiroto Ito’s article, which shares clarity and understanding so that
ourselves experience abuse from about the Japanese phenomenon we may better help each other and
our patients and/or their family of karoshi (death by overwork), our patients.
members, what recourse do we especially among physicians in
have and where do we turn to for Japan. Locally, Drs Faith Chia and
help? While there may be resources Sabrina Lau write about burnout
and guidelines within our various among trainees in Singapore and
healthcare institutions, they may what our healthcare institutions can
be inadequate or there may be do to reduce burnout experienced
a lack of awareness about them. by our juniors (also applicable to
Not to mention, some of our GP seniors, of course).
colleagues may also not be able to Healthcare worker abuse and
tap on such institutional sources. burnout are real phenomena.
These can therefore cause feelings For those of us on the receiving
of helplessness and insecurity. end of abuse (hats off to my A&E
Unfortunately, such emotions are colleagues, especially) and/or
neither good for us nor our patients. who have experienced burnout,
04 MAy 2018 SMA News
FEATURE
Caring forour Doctors
Creating Value and Valuing Creation:
Text by A/Prof Daniel Fung, Editorial Advisor
A/Prof Fung is
a psychiatrist
who works with These days, it’s not uncommon to read about doctors who have
children and committed all manner of crimes, from indecent exposure to voyeuristic
adolescents.
He is also the
underskirt filming and molestation, to drug abuse and drink-driving. And
Chairman Medical tragically, even suicide. Just as having the risk of developing physical
Board of the Institute illnesses, doctors are equally likely to develop mental ones. There is no
of Mental Health and is
married to Joyce with five study of the prevalence of mental illnesses among medical practitioners
grown up children. He notices in Singapore. A recent paper in Taiwan showed that prevalence of mental
that there is an increasing issue
of burnout both in his patients illnesses was lower compared to the general population. However, a study
as well as among colleagues in Canada suggested that help-seeking behaviour among physicians was
and is focusing on helping
clinicians find joy in their work.
significantly lower. This may be related to stigma and fear of disclosure of
what the doctors suffer from until something bad happens.
MAy 2018 SMA News 05
Burnout: a state of mental scrutiny. A doctor’s ethical dilemmas healthcare workers, suggesting that
exhaustion are publicly debated in courtroom this is not uncommon.
settings which focus on transparency. These external pressures work on
Beyond the problem of identifiable
illness is the problem of well-being. Fearful of the consequences of not the internal ones a doctor faces. Apart
Well-being is defined as a continuous following standardised practice, from completing medical school, every
process of growing and thriving and physicians become increasingly new doctor, through our development
in layman parlance, happiness. There defensive in the way they practise. of the American-style residency
have been many stories of unhappy In fact, it is now no longer sufficient training programme, is expected to sit
doctors who are struggling with their to practise what everyone else does for a series of formative and summative
lives and work. Dr Elisabeth Poorman, (Bolam-Bolitho test); the doctor must examinations to be fully trained and
a resident working in Massachusetts, now provide the appropriate treatment qualified. This includes the GP. A paper
US, describes this in an interview. advice and information to patients and on residency burnout in 2018 suggests
“By the end of my first year of their family (modified Montgomery that our residents have higher levels of
residency, I knew I was in trouble. I was test). The recent emphasis by our burnout and lower levels of empathy
overwhelmed by the 15-hour days, the Court of Appeal, for the modified compared to their counterparts
unbearable sadness of the tragedies I Montgomery test to be considered in the US. A quick review of a few
witnessed, my feelings of impotence alongside the Bolam principle, ensures studies across disciplines (eg, internal
and my fears of making a mistake. that doctors must work with patients. medicine, palliative care and mental
My life was my work and everything The expectation is for the doctor to health) and across professions (eg,
else seemed to be falling apart: my empower patients to make meaningful nursing) suggests that this is a system-
physical health, my relationships, my decisions in their own care. This wide problem in healthcare.
ability to sleep after months of night requires clinicians to spend more time
shifts.” This unhappiness can gnaw at explaining to and educating patients, Tackling burnout
the doctors and make them think of which adds to the increasing amount
death even in the absence of clinical What are the possible solutions to
of work that must be done.
depression. Hebert Freudenberger, this? The obvious external factors can
a German psychologist, coined the be ameliorated. Academics suggest
Increasing incidences of reducing workload such as night calls,
term burnout in 1974 to describe physician abuse
this state of mental exhaustion that improving physical resilience through
emanates from professional work. Another issue that doctors and other exercise, and even team building.
Burnout can be described in three healthcare professionals face is the One group suggested the importance
inter-related symptoms: emotional increasing incidences of abuse. Several of mindfulness and relaxation. Skills
exhaustion, depersonalisation (a articles, including a World Health training to manage stress can certainly
detached feeling of self which can be Organization report and a 2016 New be taught and included within the
deeply disturbing) and a reduced sense England Journal of Medicine review, general competencies that doctors
of accomplishment leading to loss suggest that physician abuse is an learn alongside clinical techniques. But
of purpose and meaning. Studies of increasing hazard in healthcare. In there is little emphasis on the internal
burnout across the world suggest that 2015, a physician in Boston was shot factors that make a doctor.
many doctors (between 30% and 70%), dead by the son of a deceased patient, The doctors today have been
especially junior ones, have at least sparking widespread discussion on the selected based largely on academic
one symptom and the range varies issue. In certain settings, it is a given abilities. Today, all three medical
between specialties. that doctors and nurses are regularly schools in Singapore have an
Practising physicians today battered physically and emotionally academic criterion as a first cut for
face a myriad of challenges. From by irate patients and their family entry. But is the ability to do well in
the outside, they must deal with and friends. A local editorial in 2015 examinations a sufficient criteria for
increasingly demanding patients who estimated that seven in ten healthcare the identification of the physician
are educated, have high expectations workers have faced physical abuse of tomorrow? A study of medical
and yet are cost-conscious. The system and that there is generally "significant students in Australia showed that
continues to look at human fallibility under-reporting" in this area. Across students have different personality
as a way to blame the individual, industries, the healthcare industry is traits that make them vulnerable to
often ignoring the system-level far more prone to workplace violence different situations. Personality traits
problems that lead to error. In general, than others. If you walk into hospital reflect their characteristic patterns of
healthcare professionals and doctors clinics and emergency departments thoughts, feelings and behaviours.
have self-regulatory frameworks that today, you will be greeted by signs This suggests that besides the ability
are increasingly coming under public that urge you to not abuse our to process information, make accurate
06 MAy 2018 SMA News
diagnoses and other cognitive skills, systemic change using improvement Further readings
there is also a need for an evaluation science. Improving care also comprises
1. Eley DS, Leung J, Hong BA, Cloninger KM, Cloninger
of the student’s ability to handle caring about improvement. Only CR. Identifying the Dominant Personality Profiles in
problems, withstand stress and be with a renewed sense of purpose Medical Students: Implications for Their Well-Being
resilient in the face of changing needs will the doctor be able to function and Resilience. PLoS One 2016; 11(8):e0160028.
and demands. Some of this can be as an effective member of the 2. Gagné P1, Moamai J, Bourget D. Psychopathology
trained but other aspects may be healthcare team focused on building and Suicide among Quebec Physicians: A Nested Case
deeply ingrained personality traits relationships – not just externally Control Study. Depress Res Treat 2011; 2011:936327.
that should form part of the criteria with patients but just as importantly, 3. Perlo J, Balik B, Swensen S, et al. IHI Framework
for identifying suitable candidates to internally with one another. for Improving Joy in Work. IHI White Paper.
be doctors in the first place. Cambridge, Massachusetts: Institute for Healthcare
As I pondered these issues of Improvement, 2017.
The three medical schools use burnout among physicians, I wanted to 4. Kao LT, Chiu YL, Lin HC, Lee HC, Chung SD.
a variety of screening measures understand this at my own workplace, Prevalence of chronic diseases among physicians in
developed across the world. There the Institute of Mental Health. Over Taiwan: a population-based cross-sectional study.
is of course no perfect system, but a the last few years, several studies are BMJ Open 2016; 6(3):e009954.
system in which personality profiles suggesting that our healthcare staff face 5. Koh MY, Chong PH, Neo P.S, et al. Burnout,
are identified, and strengths and significant stress. This is not surprising psychological morbidity and use of coping
weaknesses are recognised from as across the world, mental health mechanisms among palliative care practitioners: A
multi-centre cross-sectional study. Palliat Med 2015
the outset, has a better chance of professionals face intense pressures Jul; 29(7):633-42.
improving long-term outcomes and of external stress and internal turmoil.
6. Lee PT, Loh J, Sng G, Tung J, Yeo KK. Empathy and
predicting the likelihood of burnout. It Working together with our human burnout: a study on residents from a Singapore
is also timely that in the last five years, resource and research departments, I institution. Singapore Med J 2018 Jan; 59(1):50-4.
the Institute of Healthcare Improvement have noticed a worrying trend of medical 7 Philips JP. Workplace Violence against Health
has been increasingly arguing for the leave and attrition by some groups of Care Workers in the United States. N Engl J Med
need to have its triple aim of population staff. It would be easy to give simple 2016; 374(17):1661-9.
health, cost-effective care and patient reasons such as attractive job prospects 8. See KC, Lim TK, Kua EH, et al. Stress and Burnout
satisfaction supplemented by a fourth in other areas of healthcare or the lure of among Physicians: Prevalence and Risk Factors in
aim (thereby calling it a quadruple private practice. Along with a group of a Singaporean Internal Medicine Programme. Ann
Acad Med Singapore 2016; 45(10):471-4.
aim): provider satisfaction. The joy like-minded colleagues, we are starting
in work initiative and white paper out on a journey to combat burnout 9. Sikka R, Morath JM, Leape L. The Quadruple Aim:
has received widespread recognition by trying to understand the meaning care, health, cost and meaning in work. BMJ Qual Saf
2015; 24(10):608-10.
and is not just a touchy-feely appeal and purpose of a public mental health
to improving our job satisfaction. service that practises what it preaches. 10. Tan AL, Chia GS, Ng BY, Fong YT. Violence Against
Healthcare Staff - A Multidimensional Problem. Ann
Instead, it is a clarion call for us to work It is important that in our value-driven Acad Med Singapore 2015; 44(11):511-3.
together, ask the question of what gives healthcare system focused on outcomes,
11. Yang S, Meredith P, Khan A. Stress and burnout
meaning and purpose, overcome the we create value not only for our patients among healthcare professionals working in
impediments and share this across the and population, but one that our a mental health setting in Singapore. Asian J
healthcare organisation to develop healthcare providers will also value. Psychiatr 2015; 15:15-20.
"Academics suggest reducing
workload such as night calls,
improving physical resilience through
exercise, and even team building."
MAy 2018 SMA News 07
PRESIDENT'S FORUM
Text by Dr Lee Yik Voon
The evolving healthcare Clinic licensees had to register
landscape for CorpPass, a digital identity akin
to the SingPass but for corporate
Long before I was elected as the
transactions. Many applicants faced
59th SMA President, doctors
multiple rejections and it was only
have been facing mounting
later that we realise that there were
Dr Lee is a GP pressures from all sides. The policy some missing data that hindered
practising in changes and various healthcare the registration of clinics.
Macpherson. He is developments discussed below are
also a member of just a few examples of what has The Enhanced Screen
the current National transpired in the recent years. for Life (SFL) is a subsidised
General Practitioner health screening programme
Advisory Panel. He is a implemented in Community
Regulatory issues
pet lover at heart who
Health Assist Scheme (CHAS) GP
is the proud owner of The proposed Healthcare Services
a dog, and regularly clinics. However, the massive
Act (HCSA) going online by the end
feeds neighbourhood response overwhelmed the
of 2020 will be replacing our age-old
community cats. He existing CHAS submission portal
also enjoys playing Private Hospitals and Medical
on day one and IT support was not
online war games and Clinics Act. With it in place, we will
responsive after implementation
thinks that playing be moving from premise-based for months; all while clinic
Pokemon Go is a good licensing to service-based licensing.
form of exercise. licensees were still learning the
Being one of the few countries workflow of the scheme and
in the world to have the National claims submission procedure.
Electronic Health Record (NEHR),
the HCSA aims to make it a Medical practice
requirement for all doctors to In 2016, the Health Insurance
contribute patients’ data to it, with Task Force studied the rising
a hefty penalty to be imposed on costs in healthcare over the years
those who refuse to comply. and released their report and
08 MAy 2018 SMA News
recommendations. One of the causes from the comfort of their homes that we can treat our patients and
was attributed to the increase in or offices, and have electronic make the right judgements to the
doctors’ fees. When SMA was forced medical certificates and medication best of our ability.
to withdraw our Guideline on Fees in couriered to them. However,
Secondly, we need to have a
2007, we warned that doctors’ fees are doctors who signed up for
telemedicine services aware of training curriculum with a heavier
will rise as there is no longer a guide
on what constitutes overcharging. the perils of prescribing medicine emphasis on ethics instead of “just
Nevertheless, we welcome the without physically examining getting the job done”. It is sad
upcoming implementation of the a patient? The SMC ECEG and that the art of medicine may no
new fee benchmarks to guide our National Telemedicine Guidelines longer be relevant if science-based
charging of medical fees. both strongly emphasise that medicine takes over. However, it
the standards in telemedicine may not surprise us that the art of
Third-party administrators
consultations should be similar to medicine would be able to hold its
(TPAs) have limited the way we
those of face-to-face consultations. own against the head-on charge of
practise medicine by controlling
costs and restricting who we can Another concern is with how AI in medicine.
refer our patients to under their artificial intelligence (AI) could Thirdly, we need to constantly
schemes. With the revised version potentially replace doctors. It upgrade ourselves both formally
of the Singapore Medical Council is said that AIs are now capable and informally. As medicine
(SMC) Ethical Code and Ethical of collating and analysing data progresses with time, we as
Guidelines (ECEG), TPAs no longer from medical libraries worldwide, practitioners of medicine should
calculate administrative fees simulating human emotions and be cognisant of the changes
based on a percentage of the bill performing deep learning.
that medicine is undergoing and
but must use a fixed quantum, upgrade our knowledge in parallel.
and this has worked well so far. Effecting change Never give up on yourself and
It was a harrowing experience Hence, it is definitely not surprising never think that you are too old to
for doctors: some resigned from why some of my contemporaries learn new tricks. Don’t be afraid to
various TPAs at short notice while have given up their medical practice ask “stupid” questions, for we would
some re-joined after TPAs changed to work as locums, go into early
the way they justify and calculate be fools to ignore our ignorance
retirement or move out of the medical when holding critical responsibility
administrative charges. field entirely. How can we make as practising doctors. Be aware
With regard to medical the practice of medicine viable and of the changes around us and be
negligence cases, the modified satisfying so that we can continue to active in trying to contribute to the
Montgomery test was introduced. practise evidence-based medicine,
improvements in our society.
This test considers whether the provide integrated and team-based
patient has received useful medical care, and make it an attractive career Fourthly, we need to open
information that was material to option to our juniors? our eyes and not just stay within
him/her especially with regard Some things will have to give the confines of our silos and our
to consent. This is as opposed to as we are not perfect. Is doing our comfort zones. The fresh air, warm
the commonly accepted Bolam- best and in good faith no longer smiles and bright sunshine will help
Bolitho test that is still applicable to acceptable? I think the key is that to invigorate us, the changes will
treatment and diagnosis. we need to know what is the best intrigue us, and hopefully, we will
Additionally, patients want to be that we can do for our patients in turn be able to give our patients
empowered in the decision-making and refer the rest to those who are the best advice we can.
process in the treatment and better at it. By doing some of the items listed
management of their conditions. Firstly, we need all stakeholders above, we as medical doctors can
They access the internet for related to be realistic and pragmatic in renew our efforts to remain relevant
medical information and challenge their expectations of medical in our society. We should engage
their doctors with the information doctors. Doctors are human too; actively with various stakeholders
gathered. However, are they able we have our basic needs, as well as and prevent problems by identifying
to determine the reliability of the our moments of weakness. We will and solving them “upstream”.
information or news? do our utmost for our patients but
we also have to satisfy our basic Lastly, do share warmth,
Technological advances knowledge and collegiality with
needs and protect ourselves from
Advancements in technology have burnout. We need to take care of your friends and colleagues because
given us telemedicine, with the ourselves well before we can take our fraternity can only be strong if
expectations of convenience to care of others well. If we are in a we help one another to get out of
patients as they consult doctors compromised state, I do not think the rut and move forward.
MAy 2018 SMA News 09
CALENDAR
SMA EVENTS
Jun–Aug 2018
CME
DATE EVENT VENUE WHO SHOULD ATTEND? CONTACT
POINTS
CME Activities
24 Jun Family Medicine and All Shirong/Margaret 6223 1264
BCLS and CPR+AED SMA Conference Room 2
Sun Specialities cpr@sma.org.sg
30 Jun Medical Expert Witness Training Mr Roland Lim 6593 7884
State Courts 2 Doctors
Sat (Day 2) mewt@ams.edu.sg
7 Jul Medical Expert Witness Training Mr Roland Lim 6593 7884
State Courts 2 Doctors
Sat (Day 3) mewt@ams.edu.sg
Novotel Singapore Aspiring and Current
14 Jul Taking the Plunge – Jasmine 6223 1264
Clarke Quay, Level 5, 2 Practice Owners, Clinic
Sat Going into Private Practice jasminesoo@sma.org.sg
Cinnamon Room Managers and Staff
15 Jul Family Medicine and All Shirong/Margaret 6223 1264
BCLS and CPR+AED SMA Conference Room 2
Sun Specialities cpr@sma.org.sg
Clinical Directors, Heads of
18 Aug Departments, Programme Jasmine 6223 1264
Medical Professionalism (Basic) TBC 2
Sat Directors and Core Faculty jasminesoo@sma.org.sg
of Residency Programmes
19 Aug Family Medicine and All Shirong/Margaret 6223 1264
BCLS and CPR+AED SMA Conference Room 2
Sun Specialities cpr@sma.org.sg
Decipher the Clinic
Aspiring and Current
25 Aug Management System and Jasmine 6223 1264
TBC 2 Practice Owners, Clinic
Sat Be Ready for the National jasminesoo@sma.org.sg
Managers and Staff
Electronic Health Record
Non-CME Activities
27 Jun SMA Annual Golf Tournament Azliena 6223 1264
Raffles Country Club NA SMA Members and Guests
Wed 2018 liena@sma.org.sg
10 MAy 2018 SMA NewsSMA ANNUAL GOLF TOURNAMENT 2018 Date: Wednesday, 27 June 2018 Time: R egistration starts from 12 pm (Shotgun will start at 1.30 pm) Venue: Raffles Country Club Dear c ollea g u es a n d f r ien ds, This year, th e SMA Annu al Gol f To urn ament w ill be h el d a t Ra ff les Co u ntry Cl ub's c h allen gin g 18-h ole Lake Co urse. With the generous support o f sponsors, you can look forward to: • The GP versus Specialist Competition (top 5 + 1 [lady] scores from each group) • The “Friends o f SMA trophy" (for non-doctors) • T he ch ance o f winning the hole-in-one prize, a Mercedes-Benz E 200 AVANTGARDE sponsored by Daimler South East Asia Pte Ltd • Exciting gol f ing and lucky draw prizes • A sumptuous dinner • Goodie bags with attractive door gi fts • Last but not least, an enjoyable day o f gol f ing with friends Don’t miss your last ch ance to play at Ra ff les Country Club as they will be closing to make way for new developments. Wait no l o n g er! Sign up now and encourage your friends to join us at the SMA Annu al Gol f Tournament 2018. Register now at https://www.sma.org.sg/gol f . Registration closes on 15 J u ne 2018. See you there! Yours sincerely, Dr Chan Kwai Onn Convenor, SMA Annual Golf Tournament 2018 Main Sponsor: Hole-in-One Sponsor:
council news
Report by Dr Lim Kheng Choon
Dr Lim is the
Inaccurate article on ongoing efforts and initiatives in primary
Honorary MOH’s conclusion on higher care transformation.
Secretary of insurance claims SMA’s 1st Vice President, Dr Wong Tien
the 59th SMA Hua, is currently SMA’s representative on
Council. He
On 25 March 2018, a newspaper article
is currently by Ms Salma Khalik alleged that “the this panel.
an associate [Ministry of Health] MOH concluded that
consultant much of the higher claims was the result Singapore Resuscitation and
at Singapore of overcharging and overtreatment by First Aid Council
General Hospital.
doctors in the private sector.” The National Resuscitation Council and
SMA immediately wrote to MOH to National First Aid Council have merged
seek confirmation and clarification on to form the new Singapore Resuscitation
the allegations relating to higher claims and First Aid Council (SRFAC), with effect
from policyholders with Integrated from 1 April 2018.
Shield Plans and full riders. MOH A/Prof Lim Swee Han, SMA’s
subsequently clarified in an official current representative to the National
reply that “MOH has never drawn such a Resuscitation Council, is now the chairman
conclusion or made statements alluding of the SRFAC. We would like to congratulate
to this view.” A/Prof Lim on his new appointment.
During this period, several SMA
Council Members also met with a group SMA seminar on useful tax
of concerned SMA Members regarding pointers for doctors
the allegations. The false statement was The “Tax Obligations on Medical
subsequently clarified as incorrect by Practice” seminar was held on 31
The Straits Times on 30 March 2018 in the March 2018 and was attended by 86
“What It Should Have Been” section. participants.
SMA will continue to be vigilant
The participants were informed
for fake news and advocate for both
about tax obligations; possible business
patients and members.
arrangements for clinics and their related
To view both SMA’s letter and MOH’s tax implications; the latest Budget
reply on this matter, please visit https://bit. 2018 highlights; implementation of
ly/2r2PQCn. information technology systems; and
services offered by the Employment and
Participation in the Employability Institute. Also covered
National General Practitioner were tips on how to better manage a
Advisory Panel medical practice, obligations for self-
SMA was invited by MOH to participate in employed doctors and the importance of
the National General Practitioner Advisory keeping proper records.
Panel. The panel comprises private and To find out more about courses
public primary care providers, and is set organised by SMA, please visit https://bit.
up to develop strategies and support ly/2Fc8wED
12 MAy 2018 SMA News2018 SMA Annual General Meeting
COUNCIL NEWS
Text by Lee Sze Yong, Manager, Council Support
Dr Lee Yik Voon was elected as SMA to meet the proposed target of $450,000. Elections for the 59th SMA Council
President during the SMA Annual These donations are mainly used to were then conducted. Dr Ng Chew Lip,
General Meeting (AGM), held at the provide support for the living expenses a new member to the SMA Council,
Alumni Medical Centre on 15 April 2018. of needy medical students across all also made a short introduction. Dr Ng is
Outgoing President Dr Wong Tien three local medical schools. currently an ENT associate consultant in
Hua began the proceedings by thanking Members present affirmed the SMA the public sector. The SMA Council looks
SMA Members for attending the AGM. Council’s proposal to elect Minister forward to serving members and the
He highlighted several important for Health Mr Gan Kim Yong as an medical community, for the betterment
developments in 2017, including the SMA Honorary Member. The Honorary of healthcare for all Singaporeans.
inception of the Ministry of Health’s Fee Membership was conferred during the
Benchmarks Advisory Committee (of SMA Annual Dinner held on 12 May 2018.
which SMA is a member of), successful Members present also affirmed the Legend
advocacy efforts by the three professional re-appointment of the following members
bodies (Academy of Medicine Singapore, Standing (from left): Dr Woon Yng Yng Bertha,
as trustees for the SMA Trust Fund for a Dr Lee Hsien Chieh Daniel, Dr Chan Teng Mui
College of Family Physicians Singapore three-year term from 2018 to 2021: A/Prof Tammy, Dr Tan Tze Lee, Dr Chong Yeh Woei,
and SMA) on managed care issues, Cheong Pak Yean, Dr Lee Pheng Soon, Prof Dr Wong Chiang Yin, Dr Ng Chew Lip, Dr Noorul
and the organisation of the inaugural Low Cheng Hock, Dr Tan Kok Soo and Dr Fatha As’art
Singapore Medical Week by SMA. Tan Yew Ghee. Sitting (from left): Dr Anantham Devanand,
Dr Wong also thanked the various Also brought up during the AGM was
Dr Lim Kheng Choon, Dr Wong Tien Hua,
SMA representatives for volunteering Dr Lee Yik Voon, Dr Toh Choon Lai, Dr Loo Kai
the impending expiry of SMA’s lease Guo Benny, Dr Ng Chee Kwan
their services and the secretariat staff for with the Alumni Association (AA) at 2
ensuring the smooth operations of SMA. Not in picture: A/Prof Chin Jing Jih, Dr Lee
College Road, including the chronology Pheng Soon, A/Prof Tan Choon Kiat Nigel,
He highlighted that it was a pleasure and of communication with AA. Adj Prof Tan Sze Wee, Dr Tan Yia Swam
honour to serve as SMA President for the
past three years.
Honorary Secretary Dr Lim Kheng 59th SMA Council • 2018-2019
Choon referred members to the SMA
Annual Report 2017/2018, which is themed President Honorary Secretary Council Members
Dr Lee Yik Voon Dr Lim Kheng Choon Dr Chan Teng Mui Tammy
“Stronger Together”. Next, Honorary A/Prof Chin Jing Jih
Treasurer Dr Loo Kai Guo Benny presented 1st Vice President Honorary Assistant Secretary
Dr Chong Yeh Woei
Dr Wong Tien Hua Dr Anantham Devanand
the accounts for SMA, highlighting a Dr Noorul Fatha As’art
surplus of $315,000 for 2017. 2nd Vice President Honorary Treasurer Dr Lee Hsien Chieh Daniel
Dr Toh Choon Lai Dr Loo Kai Guo Benny Dr Lee Pheng Soon
Adj Prof Tan Sze Wee, Chairperson of Dr Ng Chew Lip
Honorary Assistant Treasurer
SMA Pte Ltd (SMAPL), highlighted SMAPL’s A/Prof Tan Choon Kiat Nigel
Dr Ng Chee Kwan
main role of investing returns from SMA’s Adj Prof Tan Sze Wee
surplus. SMAPL recently invested another Dr Tan Tze Lee
$1 million into the investment portfolio. A Dr Tan Yia Swam
Dr Wong Chiang Yin
donation of $78,000 was also made to the
Dr Woon Yng Yng Bertha
SMA Charity Fund (SMACF).
Dr Wong Chiang Yin, one of the SMA Members can access the full AGM minutes by logging into their membership portal at:
SMACF board members, highlighted the https://bit.ly/2ra0xTz.
need for SMACF to raise more donations
MAy 2018 SMA News 13CPR COURSES
for Medical
Professionals
Venue:
Course fee Member NON-MEMBER
Singapore Medical Association
2 College Road, Level 2, Alumni Medical Centre AED $80.25 $128.40
Singapore 169850
Basic Cardiac Life Support
(BCLS) (re-certification) + $149.80 $256.80
Course ContentS: AED
• The Chain of Survival
BCLS (re-certification) $80.25 $128.40
• Adult One-Rescuer Cardiopulmonary Resuscitation
(CPR) / Adult Two-Rescuer CPR BCLS (full course) $128.40 $214.00
• Adult Foreign Body Airway Obstruction
• Guidelines for Proper Chest Compression Course Time DATE
• Adult Recovery Position
BCLS (full course) 9 am to 4 pm
• Child One-Rescuer CPR
BCLS (re-certification) 9 am to 1 pm 24 June, 15 July
• Child Foreign Body Airway Obstruction
and 19 August
• Infant One-Rescuer CPR BCLS (re-certification) + AED 9 am to 6 pm
2018
• Infant Foreign Body Airway Obstruction
AED 2 pm to 6 pm
• Application of Automated External Defibrillator (AED)
CME Points: 2 to 4 The Certification Card is valid for two years.
Please return this slip for CPR Courses for Medical Professionals to Shirong, Singapore Medical Association, 2 College Road, Level
2, Alumni Medical Centre, Singapore 169850. Tel: 6223 1264, fax: 6224 7827 or email: cpr@sma.org.sg. A confirmation
email will be issued to all applicants.
Please let us know if you have a medical condition or old injury.
Date (please select your preferred slot)
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Please register me for (please tick whichever is applicable)
BCLS (full course) BCLS (re-certification) BCLS (re-certification) + AED AEDThe Medico-Legal Seminar on Mental Capacity Assessment
Caring for Pers ns
EVENT
Lacking Mental Capacity Text by Jasmine Soo, Executive, Event and Committee Support
The Medico-Legal Seminar on Mental also advised that if the patient is unable
Topics Covered Capacity Assessment, a collaboration to Understand, Retain, Weigh and
between the SMA Centre for Medical Communicate the information (URWC),
Persons with Ethics and Professionalism (SMA CMEP) he/she is deemed unable to make a
Intellectual Disabilities and the Ministry of Social and Family decision for himself/herself.
• Introduction to Persons with Development (MSF), held two runs on The session also included a checklist
Intellectual Disabilities 30 September 2017 and 14 April 2018 for assessing mental capacity, the Mental
– Dr T Thriumoorthy at the Health Promotion Board with Capacity Assessment Framework and
• Background of Persons with 47 and 83 participants, respectively. a role play session. During the role
Intellectual Disabilities Participants hailed from varying play session led by Ms Lim Hui Min,
– Dr Bhavani Sriram specialties including general practice, participants learnt how to assess patients
psychiatry, paediatrics and neurology. lacking capacity and what should be
• Assessing Mental Capacity with
the Assessment Tool Both runs covered topics relevant included in a medical report.
– Dr Giles Tan Ming Yee to Persons with Intellectual Disabilities The seminars ended on a great
(PWIDs), while the latter had an additional note after a fruitful panel discussion,
• Overview of Mental Capacity afternoon session covering topics relevant
Assessment for Doctors as participants leave with improved
to both PWIDs and dementia patients. knowledge on the topic.
– Dr Wei Ker-Chiah
During the morning sessions, a video We would like to thank the
Caring for Persons with Diminished clip of a mental capacity assessment organising committee for their
Capacity (Temporary/Fluctuating) consultation between a patient and Dr tremendous effort and all our speakers
• Introduction and Overview Bhavani Sriram was shown. Referencing for taking time to share their expertise.
on Caring for Persons with it, Dr Giles Tan provided participants with Last but not least, we would also
Diminished Capacity a step-by-step guide on how to utilise the like to thank the following Voluntary
– Dr T Thriumoorthy Mental Capacity Assessment Tool – a tool Welfare Organisations (VWOs) for
developed in 2017 by the SMA and MSF supporting the event: Cerebral Palsy
• Overview of Dementia and to assist doctors in filling up the Medical Alliance Singapore, Down Syndrome
Clinical Aspects of Temporary Report (Form 224). Association and Association for Persons
Fluctuating and Permanent Loss
This session helped participants to with Specials Needs. The booths they
of Capacity
better understand the Mental Capacity set up helped to raise awareness of
– Dr Bharathi Balasundaram
Act and the assessing of mental capacity, what these organisations do for PWIDs
• LPA Certification and Mental and guided them on making good among the doctors.
Capacity Assessment clinical judgements in the area of
– A/Prof Goh Lee Gan mental capacity.
Legend
• Mental Capacity Assessment The afternoon session emphasised
Reports for the Courts 1. Speakers and panellists. L to R: Dr Giles Tan
the five statutory principles in protecting Ming Yee, Dr T Thirumoorthy, Dr Bhavani
– Ms Lim Hui Min
persons who appear to lack capacity and Sriram, A/Prof Ruby Lee and Dr Wei Ker-Chiah
1Celebrating
EVENT
the Artistry
behind Timepieces
Text by Mellissa Ang, Assistant Manager, Membership Services
On 7 March 2018, SMA, in great length about his personal
partnership with TAG Heuer, relationship with watches over
“This year’s SMA Watch
organised an exclusive SMA the ages, from his first TAG Heuer Appreciation Night made a
Watch Appreciation Night for SMA quartz watch that was gifted to him welcome return for watch
Members. Organised for the second by his father, to the luxury brand’s enthusiasts. Following last
year running, the event allowed Tiger Woods golf watches that he
SMA Members the opportunity to purchased for his wife and mother.
year’s discussion with
immerse themselves in the intricate The managing editor of watch Dr Bernard Cheong, Mr Timmy
details of valued timepieces and magazine Timewerke emphasised Tan gave us a light-hearted
appreciate their history and value. that beyond the price tag attached look at his horological journey
During the first edition of this to luxury watches, it is important to
appreciate the story behind each
from childhood through his
event held in 2017, watch collector
and horologist Dr Bernard Cheong timepiece and ensure that one’s teens and subsequently into
shared with his medical colleagues watches are properly maintained. his adult years collecting
about his love for the artistry and SMA hopes that such networking some memorable timepieces.
workmanship behind TAG Heuer’s sessions, organised in collaboration Let’s hope this will be a yearly
classic timepieces and its then newly with external partners such as TAG
launched Connected smartwatch. affair that all SMA watch
Heuer, will be able to provide reprise
Dr Cheong, who is an SMA Member, from the daily grind of clinical geeks can look forward to.”
even distributed signed posters work and increase opportunities to – Dr See Hock Chuan
that featured close-up shots of the catch up with colleagues in a more
mechanics and gears behind casual setting. Look out for other
a watch. networking sessions organised Legend
This year, veteran watch specially for you in the second half 1. SMA Members and guests listening
journalist Mr Timmy Tan spoke at of 2018! intently to Mr Timmy Tan at TAG Heuer’s
Wisma Atria boutique
1EVENT
ervices
er, Mem bership S
nt M a n a g
g, Assista
ellissa An
Text by M
Dark clouds, thunder and lightning the championship title from the Dr Poh for his saves and deflections
dominated the skies overlooking The get-go, with the former surprisingly that were out of this world, and which
Cage Sports Park on 1 April 2018, just achieving consecutive wins even placed SingHealth 1 team at its 2nd
as the 44th SMA-Goldplus Universal after the weather took a turn for the runner-up position. The top scorer
Inter-Hospital Soccer Tournament kicked worse. After enduring six gruelling of the 44th SMA-Goldplus Universal
off its first two matches of the day. Heavy matches over a three-hour time frame, Inter-Hospital Soccer Tournament was
rain soon pelted down onto the pitches, the TTSH team eventually claimed awarded to Dr Kenneth Leong from
halting the games just as they started. the championship title, proving that TTSH, for his stunning scoresheet of
What an April Fool’s prank! their poor performance at the 2017 four goals in this competition.
inter-hospital soccer tournament was We would like to thank Goldplus
The soccer players, representing a thing of the past. Earning the most
seven hospitals and private practices, Universal Pte Ltd for their generous
match points, they emerged victorious sponsorship of the players’ jerseys and
sought refuge under the shelters set up over the defending champions – KTPH, tournament balls, as well as Red Bull
beside the pitches and hoped for the who ended up in the 1st runner-up Singapore for their much appreciated
lightning alert to be lifted and rain to position instead. The SingHealth 1 supply of drinks.
subside. Thankfully, the rain eased into team gave TTSH and KTPH teams a run
a drizzle in under half an hour and the for their money with their goalkeeper,
players eagerly returned to the pitches Dr Poh Kai Chin, saving countless goal Legend
to pit their skills against their colleagues’ attempts by their opponents. By the 1. The TTSH champion team after fighting hard
and vie for the championship title. end of the tournament, even players to clinch the title
from other teams were applauding 2. The KTPH team all ready for the tournament
This year’s inter-hospital soccer
tournament adopted a different game
format, away from the round-robin No. of
Team Results No. of goals
system that was previously used to game points
determine the winning team. All seven Tan Tock Seng Hospital Champion 11 8
teams had the privilege to play against
every other institution as a result, Khoo Teck Puat Hospital 1st Runner-up 11 4
which translated to consecutive back-
breaking matches amid the already SingHealth 1 2nd Runner-up 10 4
uncooperative rainy weather.
Private Practice 4th Placing 9 2
Poor weather conditions and
slippery pitches resulted in multiple SingHealth 2 5th Placing 6 0
tied games and neck-to-neck match
points. Tan Tock Seng Hospital (TTSH) Singapore Armed Forces 6th Placing 4 2
and Khoo Teck Puat Hospital (KTPH)
National University Health System 7th Placing 3 0
teams were strong contenders for
1
2
MAy 2018 SMA News 17INSIGHT
When the first residents started asking for
time off from training because they felt
burnt out, we secretly thought that they
were, you know, weak. It must be the new
generation; they didn’t make them like
they used to in the days when housemen
could do every other night call with no
post-calls and still come back asking for
more. However, it didn’t stop at those first
few. There were those who were just “sian”
(Hokkien for weariness) with life, but there
were also those who broke down at a “how
are things going?”, those who could not
find anything left in themselves to give to
those they were caring for and those who
had gone beyond burnout into depression.
It was then that we comprehended that
burnout is a very real thing and wondered
what the system was doing to our young,
bright trainees.
Burnout in In Prof Christina Maslach’s words,
burnout is “an erosion of the soul caused
Young Doctors – by the deterioration of one’s values,
dignity, spirit and will”. The Maslach
Burnout Inventory (MBI) measures three
dimensions of burnout: emotional
exhaustion, depersonalisation and personal
accomplishment.1 Symptoms range from
fatigue, lack of motivation and disinterest
in patients, to physical symptoms and
absenteeism. Clearly this does not bode
well for both the patient and the physician.
A distracted physician who is not paying
attention to details is likely to make
mistakes; there may be the lack of ability to
engage and develop personal connections
with patients, and absenteeism and
Text by Dr Faith Chia and Dr Sabrina Lau attrition will adversely affect trained
manpower. The physician may seek
unhealthy coping mechanisms that lead
to health problems and their relationships
Dr Chia is a senior Dr Lau is a geriatric
consultant in the medicine senior
with family and friends may suffer.
Department of resident and a
Rheumatology, Allergy chief resident in A cause for concern
and Immunology of the NHG Internal
Tan Tock Seng Hospital. Medicine Residency Worryingly, burnout appears to be on
She is actively involved Programme. As head the rise. The 2017 Medscape Lifestyle
in undergraduate and of Resident Affairs, she Report showed that the percentage
postgraduate education leads cohesion and of burnout had increased from 2013,
and has been the education events, and
programme director serves as the bridge with emergency medicine, obstetrics
of the NHG Internal between residents and gynaecology, family medicine and
Medicine Residency and faculty. When internal medicine being the top four
Programme since 2014. not at work, she can specialties affected.2 Burnout rates in
She keeps sane by reading be found soaking up
US physicians are up to 54.4% with
voraciously and trying to vitamin D playing
reach her toes at yoga. beach volleyball. higher rates in residents, fellows and
early career physicians.3,4 The situation is
18 MAy 2018 SMA Newssimilar in Singapore; both the SingHealth imperative. Recent systematic reviews Healthcare Improvement’s white paper
residency and the National University have shown that tackling burnout described, it is time to go back to the
Health System have published studies does not rest solely on the individual’s anchor of “what matters to you?”11 It
citing ranges between 71.8% to 80.7% shoulders and a shared responsibility may be difficult to remember this in
in at least one MBI burnout domain.5,6 with both individual and organisational the middle of fighting with computer
In the National Healthcare Group (NHG) interventions works best.9 systems that hang, demanding patients
residency, the preliminary results of an It is also essential to create meaningful and endless tedious administrative tasks.
ongoing study presented at the Asia social connections and group However, we are confident that each
Pacific Medical Education Conference identification. One of the struggles we of us had a good reason that led us to
2018 found that 64.3% of internal face as the number of trainees increase our pursuit of medicine, and if we keep
medicine residents are at risk of clinically significantly is that people become lost holding on to this conviction, while
significant burnout, with ranges of 46.7% in a system where they rotate through practising self-care and self-compassion,
to 61.8% in other specialties.7 Numbers many departments and hospitals at we will not only help ourselves but also
like these tell us that burnout is not a short intervals. Our programme seeks become role models to our juniors,
problem of a few individuals with acopia; to address this by creating smallness demonstrating that the career we have
it is a systemic issue. in bigness – creating “houses” for chosen is truly worthwhile.
Studies have suggested that multiple the residents with peer leaders and
factors contribute to physician burnout, housemasters to increase social References
including excessive workload with support and a sense of identity. In true
1. Maslach C, Jackson SE, Leiter MP. Maslach
increasing patient demands, struggles to Singaporean fashion, most events centre Burnout Inventory. 2nd ed. Palo Alto, CA:
achieve work-life balance, inefficiencies in on food, but we also use the “houses” to Consulting Psychologists Press, 1986.
poorly designed systems, lack of autonomy compete in (mostly intellectual) games. 2. Peckham C, Grisham S. Medscape lifestyle
over schedules and clinical decisions with We focus on interactions outside of the report 2017: Race and ethnicity, bias and burnout.
increasing automated guidelines, the use work environment, for example in art, January 11, 2017. Available at: http:// www.
of electronic health records resulting in sports and community service. We feel medscape.com/sites/public/lifestyle/2017.
less time interacting with patients, and an that a formal structure of support is 3. Shanafelt TD, Hasan O, Dyrbye LN, et al.
overall erosion of the meaning of work.8 integral to identifying and helping those Changes in Burnout and Satisfaction With Work-
in need. We have built in buddy systems, Life Balance in Physicians and the General US
Locally, many specialties require residents
Working Population Between 2011 and 2014. Mayo
to complete both US and UK examinations, longitudinal mentorships by faculty, and
Clin Proc 2015; 90(12):1600-13.
resulting in higher examination burdens. have also engaged a psychiatrist to whom
4. Dyrbye LN, West CP, Satele D, et al. Burnout
In internal medicine, that comes up to residents can either approach informally
among U.S. medical students, residents, and
seven major examinations within a three- for aunt agony chats or be referred to for early career physicians relative to the general U.S.
year residency. NHG’s Resident Wellness triage for psychological support, with full population. Acad Med. 2014; 89(3):443-51.
Workgroup also identified factors confidentiality promised. 5. See KC, Lim TK, Kua EH, et al. Stress and Burnout
such as the burden of administrative among Physicians: Prevalence and Risk Factors in
tasks, fear of making mistakes, anxiety How can each of us help? a Singaporean Internal Medicine Programme. Ann
Acad Med Singapore 2016; 45(10):471-4.
over future career progression and Many of us are probably guilty of not
concerns over physical safety in certain 6. Lee PT, Loh J, Sng G, Tung J, Yeo KK. Empathy
taking as good care of ourselves as we and burnout: a study on residents from a
work environments (eg, emergency should. Learning how to incorporate Singapore institution. Singapore Med J 2018;
department) where cases of assault self-care skills into our practice can 59(1):50-4.
may occur. improve our well-being. Individual 7. Lau S, Kosim S, Hsu J, Lim WP, Chia FL. Burnout
physicians may benefit from planning in Residents and Program Directors: A Study on
How can institutions help? opportunities to exercise, learning and Prevalence, Factors and Interventions in a Tertiary
practising mindfulness and emotional Hospital in Singapore. Oral Presentation at the
So what can be done about this looming 15th Asia Pacific Medical Education Conference;
epidemic? We think that the first thing awareness, and having a reflective 10-14 Jan 2018, Singapore.
we need to do is talk about it. Talk about practice. Mindfulness is one of the
8. Shanafelt TD, Dyrbye LN, West CP. Addressing
it so that physicians who are burnt out interventions that have been shown
Physician Burnout: The Way Forward. JAMA 2017;
will know that they are not alone, that to improve cases of burnout.10 Many 317(9):901-2.
it is not a shameful secret and soldier institutions offer group practice sessions
9. West CP, Dyrbye LN, Erwin PJ, Shanafelt TD.
on until they run out of reserves, and so and our programme is embarking on a Interventions to prevent and reduce physician
that those at risk will be able to reverse study to look at whether a mindfulness- burnout: a systematic review and meta-analysis.
it. Talk about it to the faculty and equip based stress reduction course can reduce Lancet 2016; 388(10057):2272-81.
them so that they can identify the burnout in residents. 10. Goodman MJ, Schorling JB. A mindfulness
symptoms of burnout and be able to course decreases burnout and improves well-
Finally, and possibly most importantly
being among healthcare providers. Int J Psychiatry
give good advice. Talk about it to senior (although we have spent the whole Med 2012; 43(2):119-28.
management because an engaged article speaking about burnout), we
11. Perlo J, Balik B, Swensen S, et al. IHI Framework
leadership and institutional commitment should shift towards talking about joy in for Improving Joy in Work. IHI White Paper.
to building supportive systems through work. Medicine has always been thought Cambridge, Massachusetts: Institute for
quality improvement strategies is of as a calling, and as the Institute of Healthcare Improvement, 2017.
MAy 2018 SMA News 19INSIGHT
Overwork-Related Disorders:
Karoshi,
Depression
& Burnout
Text by Dr Hiroto Ito
Karoshi of cerebrovascular/cardiovascular Mental health in overwork-
Karoshi (過労死) – death (死: shi) due
diseases (Figure 1). A recent meta- related disorders
analysis confirmed that long working
to overwork (過労: karo) – has been In 2014, the Research Center for
hours are associated with a high risk
recognised in Japan for five decades. Overwork-Related Disorders was
of cerebrovascular/cardiovascular
This phenomenon has since spread to established following the enactment
diseases, especially stroke.1 The
South Korea and other Asian countries, of the Act on Promotion of Preventive
Japanese government has proposed
and recently to Western countries such Measures against Karoshi and Other
capping overtime at 80 hours per
as France. Karoshi is the fatal outcome Overwork-Related (Health) Disorders.
month and this new limit could prevent
of overwork-related disorders, which are Based on a summary of diagnoses
overwork-related cerebrovascular/
typically categorised into two groups: among compensated cases of
cardiovascular diseases in most workers.
vascular (cerebrovascular/cardiovascular) occupational mental disorders by gender
However, this might not address some
diseases and mental disorders. over a five-year period, rates of mood
overwork-related mental disorders
Work-related suicide or suicide because 39% of workers with mental disorders, post-traumatic stress disorder
attempts, known as karo-jisatsu disorders overworked less than 80 hours (PTSD) and adjustment disorders in male
(suicide from overworking), is a serious per month. (female) workers with mental disorders
issue for families and the society.
Karo-jisatsu is defined as the fatal
Figure 1 Workers' compensation certifications by overtime hours (2016)
outcome of workers who suffer from
overwork-related mental disorders
in Japan. If a worker could receive Cerebrovascular/
appropriate support and return to cardiovascular
work after treatment, it would be diseases
beneficial not only for the worker (n = 260) Overtime of 80 hours and
and family members, but also for the longer per month
employer and society. The indirect
costs of suicide are much higher than Mental disorders
(n = 498)
the direct costs of supporting workers
with suicidal ideations.
0% 20% 40% 60% 80% 100%
How do long working hours affect
people’s health and mental health? Data http://www.mhlw.go.jp/stf/houdou/0000168672.html
collected from workers’ compensation
certifications in 2016 showed that 80 Mean hours of overtime per month
hours or more of overtime per monthYou can also read
