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Stephen Padilla
14 Feb 2018
While there are no easy answers, the question of whether strikes by healthcare professionals are ethical is worth considering.

Empathy is lower and burnout higher among residents in Singapore compared to their counterparts in the US, a recent study suggests.

“Residents in Singapore had lower empathy and higher rates of burnout compared to US literature,” researchers said.

Mean empathy score in the Singapore cohort was 104.9±13.2, which was lower than 120±15.6 for physicians in the US. [Am J Psychiatry 2002;159:1563-1569]

Burnout prevalence was also significantly higher at 80.7 percent than that in the US (range, 47‒70 percent). Furthermore, mean burnout scores among residents in Singapore (emotional exhaustion [EE], 34.1±11.2; depersonalization [DP], 15.2±6.1; personal accomplishment [PA], 39.4±7.7) were significantly higher than the respective median US scores (EE, 21.0; DP, 5.0; PA, 42.0). [Arch Intern Med 2012;172:1377-1385; Acad Med 2010;85:1630-1634; Arch Surg 2004;139:933-940; Acad Med 2011;86:1304-1310]

An association existed between physician empathy and burnout. Residents with higher empathy scores were more likely to achieve higher PA (r, 0.477; r2, 0.200; p<0.001), and lower EE (r, 0.187; r2, 0.035; p<0.001) and depersonalization (r, 0.321; r2, 0.103; p<0.001) scores. [Singapore Med J 2018;59:50-54]

“Among the three subscales of the Maslach Burnout Inventory (MBI), empathy was positively correlated with PA but inversely associated with EE and DP, the other indicators of burnout,” researchers said. “Possible explanations for this include: (a) burnout reduces empathy, and (b) empathy prevents burnout (‘job satisfaction’).” [Br J Gen Pract 2012;62:346-347]

The findings showed that the relative influence of empathy and burnout to each other may not be very robust, according to researchers. Logistic regression analysis revealed small r2 values, suggesting that while an association exists between empathy and burnout, there is still a large undefined component in their combined construct that warrants better understanding.

“We opine that empathy and burnout may be manifestations of the same personal-emotional construct. Further studies would be useful to understand the intricacies of empathy and burnout in the development of a resident’s professionalism,” they added.

Interestingly, empathy and burnout scores remained stable during residency training, which contrasted those in studies on US residents, where a trend of declining empathy as well as increasing fatigue and anger was observed during the course of their training. [Acad Med 2005;80:164-167]

“The exact cause of this is unclear, and there may perhaps be certain cultural factors that are protective toward empathy decline and burnout,” researchers said. “Alternatively, empathy decline and burnout may happen earlier even before residency, during training in medical school, and levels may have ‘bottomed-out’ by the time students graduate.”

A total of 446 trainees at a residency-sponsoring institution in Singapore completed the Jefferson Scale of Physician Empathy (JSPE), MBI and a self-designed questionnaire in this study, which sought to assess the levels of empathy and burnout among residents in Singapore, and compare findings with the US literature.

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