- Overwhelming stress can trigger a range of physical responses
- Recharge your body to cope with everyday pressures
Promoting doctors’ well-being
Ensuring quality patient care
Take actions ASAP to manage stress and to avoid burnout
Academy’s Commitment
Quality patient care and doctors’ well-being go hand in hand.1 As healthcare practitioners, our duty is to look after the health of patients and the community,2 and we can do this well only if we are willing and able to look after ourselves and each other.
Every one of our colleagues should also enjoy the opportunities for personal development and for meeting demands in other areas of life, and we can help each other to achieve that.
The Hong Kong Academy of Medicine (Academy), assuming a leading role in the medical and dental profession, has promulgated a Well-being Charter committed to cultivating and promoting well-being of Academy Fellows and specialist trainees of Academy Colleges. We pledge to acknowledge the importance of well-being, to take actions, and to advocate policy changes for the improvement of our Fellows’ and trainees’ wellness. Task Force on Well-being, chaired by the Academy’s Honorary Secretary, has been set up to devise plans and initiatives. Click here for the membership.
What's new
- Over 40 Peer Supporters available to offer support
- Self-assessment: Take CBI questionnaire to know more about levels of burnout
Our incremental approach
Manage stress, avoid burnout and stay well
Awareness
Helping you understand and recognise the causes, signs, and symptoms of burnout, stress, and other mental well-being issues
Self-assessment tools - Burnout, Anxiety and Depression
Take the following online tests for mental health self- assessment
Self-care
Providing practical advice for enhancing well-being and managing stress
- Physical15
- Intellectual16
- Financial17
- Occupational16
- Interpersonal/Social16
- Emotional16-17
- Environmental17
- Spiritual16
- Suggested readings
Social16
- Maintain curiosity, value lifelong learning and respond positively to intellectual challenges
- Expand knowledge and skills
- Be mindful of your financial decision making
- Participate in work that provides personal satisfaction and life enrichment that is consistent with your values, goals, and lifestyle
- Maintain healthy relationships, enjoy being with others, take care of others and let others take care of you
- Connect with Fellows through participation in activities organsied by the Academy’s Social Subcommittee. Click here for details.
- Identify, understand and respect your feelings, values and attitudes that may lead to negative emotions
- Lead a lifestyle that values the relationship between the individual, the community, and the environment
- Well-being is affected by the environments we live in and we as individuals also have a significant impact on these environments
- Connect with nature and plants by joining the Friends of Academy’s Gardening Corner Programme that promotes healthy lifestyle and connection with Fellows interested in organic gardening
- Find purpose, value, and meaning in your life, and participate in activities that are consistent with your beliefs and values
Audios for mindfulness practice
Promotion of well-being
Cultivating a culture of care and support, making recommendations for well-being improvement at the organisational level and organising well-being programmes
The Hong Kong Academy of Medicine (Academy), assuming a leading role in the medical and dental profession, has promulgated a Well-being Charter committed to cultivating and promoting well-being of Academy Fellows and specialist trainees of Academy Colleges. We pledge to acknowledge the importance of well-being, to take action, and to advocate policy changes for the improvement of our Fellows’ and trainees’ wellness.
A Task Force on Well-being has been set up to devise plans and effective promotion of our well-being initiatives. It is chaired by the Academy’s Honorary Secretary Dr. Wing-cheong Leung, and is composed of dedicated colleagues who share the same values in striving for a healthy workforce and a greater sense of fulfillment in every single individual.
We hope these diverse readings and videos offer something to remind us of the realities but also the joy of medicine. Many of these selections are grounded in how we find meaning in our lives and work, and bring meaning to what we do. Meaning may be found in those things that make us human – when we feel, make mistakes or need to connect with other human beings. To recognize this need for meaning, and then to seek to fulfill it, is a key aspect of doctor wellbeing.
Title: |
Better: A Surgeon’s Notes on Performance |
Author: |
Atul Gawande |
A series of real-life medical stories about little things that helped make medicine better. In particular, the afterword of this book entitled ‘Suggestions for Becoming a Positive Deviant’ offers ideas to make ourselves better and feel less like a ‘cog in the wheel’ in the daily grind of medicine.
Title: |
When Breath Becomes Air |
Author: |
Paul Kalanithi |
A beautiful and heart-wrenching memoir of a neurosurgeon who muses on what matters when unexpectedly diagnosed with metastatic lung cancer.
Title: |
The Sound of a Wild Snail Eating |
Author: |
Elisabeth Tova Bailey |
“This isn’t a book about answering big questions, or solving hard problems. It’s a book about the healing powers of connection. It’s about a journey, a journey back from the brink… we are reminded that nothing, no matter how small, is without significance.” ~ Kathleen Yale, Onion Magazine
Title: |
The Road to Character |
Author: |
David Brooks |
At its core, ‘character’ is who we are and what we stand for. It’s what we have left when we are stripped of everything. Through the stories of historical and contemporary figures, we are led to consider the facets of a meaningful life.
Title: |
First Do No Harm: Being a Resilient Doctor in the 21st Century |
Author: |
Leanne Rowe and Michael Kidd |
Doctors take an oath to ‘first do no harm,’ referring to patients under our care, but physician self-care is equally important and all too often overlooked.
Title: |
Long Walk Out of the Woods: A Physician's Story of Addiction, Depression, Hope, and Recovery |
Author: |
Adam B. Hill |
A physician shares the darkest depths of his depression, suicidal ideation, addiction, and the important lessons he learned through years of personal recovery.
Title: |
Curiosity |
Author: |
Faith Fitzgerald |
Link: |
Ann Intern Med. 1999 Jan 5;130(1):70-2. |
DOI: 10.7326/0003-4819-130-1-199901050-00015 |
“It is curiosity that converts strangers … into people we can empathize with.” –FT Fitzgerald
Title: |
Facing our mistakes |
Author: |
David Hilfiker |
Link: |
N Engl J Med. 1984; 310:118-122 |
DOI: 10.1056/NEJM198401123100211 |
What is the impact of a devastating mistake on a doctor? How is the culture medicine culpable in perpetuating the mindset that harnesses doctors to the ‘yoke of perfection’?
Title: |
Mistakes |
Author: |
Michelle Kittleson |
Link: |
JAMA. 2019;322(10):984. |
DOI:10.1001/jama.2019.5696 |
“The stash of kind notes Never sees the light, but the Mental file stays fresh.” ~Michelle Kittleson
Title: |
A doctor’s touch |
Author: |
Abraham Verghese |
Link: |
https://www.ted.com/talks/abraham_verghese_a_doctor_s_touch?language=en |
How often do we go through the motions because we are distracted or rushed? This TED talk by an acclaimed Stanford doctor-author reminds us of the importance of the human touch in clinical consultation.
Title: |
Medical Humanities Repository |
Author: |
Medical Ethics and Humanities Unit, HKUMed |
Link: |
https://mehu.hku.hk/repository-and-resources/ |
Designed for anyone who is interested in the world of medical humanities to explore, converse and to co-curate content to cultivate reflective and compassionate healthcare professionals.
Title: |
Literature, Arts and Medicine Database |
Author: |
NYU School of Medicine |
Link: |
https://medhum.med.nyu.edu/ |
A comprehensive and continually updated database of medically-related literary works searchable by topic and keyword. Each entry is accompanied by an annotation written by a medical humanities scholar.
Title: |
Clinician Well-Being Knowledge Hub |
Author: |
US National Academy of Medicine’s |
Link: |
https://nam.edu/clinicianwellbeing/ |
This American-based resource has a good collection of articles, research studies, and other resources on doctor well-being.
Peer Support is a way of giving and receiving support.18 Peer support is not therapy but offers temporary social support as empathic and non judgemental listening from a colleague in a safe space. It is entirely confidential and voluntary.19
Both quantitative and qualitative evidence indicate that peer support improves quality of life, increases and improves engagement with services, and increases whole health and self management. 20
The Academy has launched the PSS, which is a voluntary programme for Academy Fellows and specialist trainees to offer or find support through informal communication that may be beneficial to mental well-being.
Any Academy Fellows are welcome to enroll as Peer Supporters (renewable annually on a voluntary basis).
- Nature of peer support
- Enroll now
- List of Peer Supporters (48 Peer Supporters as of June 2023)
- Poster
For enquiries, please email the Academy Secretariat at [email protected]
- List of Clinical Psychologists working in Non Government Organisations and Private Practicing (published by the Hong Kong Psychological Society)
- List of Private Psychiatrists practicing in Hong Kong (published by the Hong Kong College of Psychiatrists)
- Oasis Centre for Personal Growth and Crisis Intervention
- Caritas Family Crisis Support Centre:18288
- Hospital Authority Psychiatric Hotline:24667350
- Social Welfare Department︰23432255
- Suicide Prevention Services︰23820000
- The Samaritan Befrienders︰23892222
- Tung Wah Groups of Hospitals - CEASE Crisis Centre︰18281
Be a mental health first-aid kit - Start a conversation with someone you care about or know when they are not behaving as usual21
- Steps to initiate a conversation21
- Ask “Are you okay?”
- Listen with an open mind – empathetic and non-judgemental
- Encourage action – what could be done to fix the problem?
- Check in – keep track of the improving progress
- Try an interactive conversation roleplay video here
"Mental Health Tips for Doctors", a pamphlet that offers advice and useful tips to doctors who are feeling mentally and emotionally exhausted (published by the Hong Kong College of Psychiatrists).
The Academy, assuming a leading role in the medical and dental profession, is committed to cultivating and promoting well-being of Academy Fellows and specialist trainees.
In October 2021, a Well-being Charter has been promulgated. Some of the purposes are to foster a caring and supportive culture within the healthcare professions, to advocate policy changes and propose initiatives to the Government on professional well-being issues, to organise mental health training, and to embed awareness of well-being in training and continuous professional development.
Employers are encouraged to promulgate good practices to build supportive systems at the organisational level through the establishment of effective communication channels, deployment of appropriate resources, and quality improvement strategies.
Better equipped, better mental health care: Getting started with mindfulness
What is mindfulness?
Mindfulness is defined as intentional present-moment awareness without judgment. It can be cultivated through a variety of meditation practices. Training in mindfulness has been proposed as a means of alleviating burnout of the healthcare providers, increasing satisfaction, and improving patient care.21
The Academy has been conducting a free mental health training programme, titled “Mindfulness Induction Group”, to equip Fellows and specialist trainees with techniques of applying mindfulness in daily lives and workplace to reduce stress and improve well-being. Five sessions were successfully held. Stayed tune for the announcement of the upcoming sessions on the Academy website and this webpage, or through e-blasts.
Testimonials
- A practical and concise introduction to the concepts and practice of mindfulness.
- Good introductory course for beginners & those not knowing the gist of meditation.
- Difficult topic made easy to understand and friendly encouraging guidance by instructor.
- Instructor is inclusive and non-judgmental. Audio clips received after the course is useful.
- It introduces the concept and practical application of mindfulness in daily life.
Audios for mindfulness practice
Engaging in activities to de-stress
The Social Subcommittee formed under the Academy’s House Committee has been organising a wide range of activities, aiming for enhancement of Fellows’ mental, physical and social well-being. Click here for details.
Name arrow_downward_alt | Specialty arrow_downward_alt | Academy College arrow_downward_alt | Year of admission | Type of practice |
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- attend and complete relevant training provided by the Hong Kong College of Psychiatrists beforehand
- give consent to publish general personal information on the Academy’s webpage, and provide contact means (e.g., email address / phone number) which may be made available to Support Seekers under special circumstances
- be a motivator to bring in positive energy and aspirations to Support Seekers
- ready to share your experiences and offer your support to those seeking your help
- connect and follow up with the Support Seekers as needed
- decline any request for assistance if you are unable / not available to offer help
- make referrals to other Peer Supporters or propose alternatives to those whom you are not able to help
- keep the conversations with the Support Seekers confidential
- provide feedback and alert the Academy if you encounter any situations that are considered vulnerable to undesired circumstances or further support is required.
- let emails or messages sent to you unanswered; an interim reply during busy times will suffice, or a proper referral to other if needed
- be involved in any financial relationship with the Support Seekers
- help your Support Seekers in a way other than providing support or guidance (e.g., to help secure a job)
- be involved in verbal, written or physical conducts that are sensitive or may be unwelcome by the Support Seekers, with considerations of issues concerning Equal Opportunities, Sexual Discrimination or Harassment, and Disability Discrimination etc.
According to Lazarus and Folkman, stress is “resulted from an imbalance between demands and resources or occurred when pressure exceeds one’s perceived ability to cope.”4
Stress can be a positive experience in that it keeps one alert, motivated and ready to face challenges or changes (stressors); but stress can become a problem when stressors persist without relief or periods of relaxation which can eventually lead to burnout.3,5,6
- Sources of stress
- Symptoms of stress
- Coping with stress
- Heavy workload
- Time pressure
- Sleep deprivation
- Irregular meals
- Threat of malpractice suits
- Poor career structure and uncertainties
- Inadequacy of resources and staff
- Lack of senior support
- Poor organisation’s culture and climate
- Personality
- High demands on self and colleagues
- Confrontation with emotional and physical suffering
- Staff conflicts
- Professional isolation
- Low-level support from friends and family
- High patients’ expectations and demands
- Stress over-spill from work to home and vice versa
- Lack of leisure activities
- Lack of free time
- Home demands
- Disruptions to social life
The UK National Health Service (NHS) identifies the following symptoms of stress:
- Headache or dizziness
- Muscle tension or pain
- Stomach problems
- Chest pain or a faster heartbeat
- Sexual problems
- Difficulty in concentrating and making decisions
- Feeling overwhelmed
- Constantly worrying
- Being forgetful
- Being irritable and snappy
- Sleeping too much or too little
- Eating too much or too little
- Avoiding certain places or people
- Drinking or smoking more
To prevent the persistency of stress from turning into burnout, the NHS suggests “10 stress busters” to help relieve stress:8
Burnout is a psychological syndrome conceptualised as resulting from chronic workplace stress that has not been successfully managed. It is characterised by three dimensions:3,4
- Overwhelming exhaustion
- Feelings of cynicism and detachment from the job; and
- Sense of ineffectiveness and lack of accomplishment.
Burnout “refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.”3
- Prevalence of burnout
- Symptoms of burnout
- Factors of burnout
- Impacts of burnout
As is the case in many other countries, burnout is highly prevalent among health care practitioners in Hong Kong. According to a recent survey, the prevalences of burnout (measured by the Copenhagen Burnout Inventory) among local residents in-training or doctors within 10 years of their specialist registration (n=514) were:
- Personal burnout: 72.6%
- Work-related burnout: 70.6%
- Client-related burnout: 55.4%
A considerable level of depression and dissatisfaction was found to be associated with burnout among young doctors.
Learn more about the study conducted by the Academy- Reduced effectiveness and productivity
- Cynicism
- Absenteeism, presenteeism, workaholism
- Lacking motivation
- Heightened levels of frustration, negativity
- Unable to see anything positive or be creative
- Lack of emotion / becoming dispassionate
- Disengaged
- Feelings of hopelessness and helplessness
- Possible dual diagnosis of depression
- Life may not seem worth living
- Reduced effectiveness and productivity
- Cynicism
- Absenteeism, presenteeism, workaholism
- Lacking motivation
- Heightened levels of frustration, negativity
- Unable to see anything positive or be creative
- Lack of emotion / becoming dispassionate
- Disengaged
- Feelings of hopelessness and helplessness
- Possible dual diagnosis of depression
- Life may not seem worth living
If you notice yourself experiencing these descriptions, please seek help as soon as possible as recovery from burnout would benefit greatly from early intervention. Learn more about self-care tips and support that you may seek in the later chapters.
If you notice yourself experiencing these descriptions, please seek help as soon as possible as recovery from burnout would benefit greatly from early intervention. Learn more about self-care tips and support that you may seek in the later chapters.
Main factors causing burnout11
- Practising clinical medicine involves a combination of great responsibility and little control
- A degree of stress is inevitable especially when you are seeing patients who are hurt, sick, scared, and dying on a day-to-day basis
- Job demands, professional liabilities and policy issues
- Interpersonal clashes and leadership issues
- Lacking life balancing as you are expected to ignore personal, emotional, and spiritual needs to unhealthy levels
- Conflicts with your family members and financial pressures
- Being a workaholic, superhero, perfectionist, and “lone ranger”
- Believing “patients come first” even when you are not with patients
- Never showing weakness
Neurobiological impacts12
- The prefrontal cortex (PFC) has extensive connections with cortical and subcortical brain areas that provide top-down control over thought, attention, action, and emotion when we feel rested, interested, and in control
- The higher cognitive functions of the PFC (highlighted in green) are impaired by fatigue or uncontrollable stress (grey), posing potential ramifications to clinical practice
- Impaired PFC self-regulation may explain a number of challenges associated with occupational burnout, such as reduced motivation, unprofessional behaviour, decreased compassion, and suboptimal communication with patients
Take the following online tests for mental health self- assessment