Profile: Up close with Dr Lim Wen Phei

By Kimberley Wang, Manager, Media and Publications, Communications and Outreach

Burnout and fatigue among healthcare workers have come under the spotlight with the recent Omicron wave. Flu season, staffing shortage and insufficient rest have put them under further strain. What preventive measures or interventions could help in caring for their mental health? Dr Lim Wen Phei, Consultant Psychiatrist with Woodlands Health, who developed a psychological preparedness toolkit for COVID-19 frontliners believes taking care of oneself and a culture of openness about mental health are key.

With over a decade of healthcare experience, Dr Lim has served as Assistant Principal Lead (Psychiatry) at LKCMedicine since 2016. She won the Dean’s Awards for Education 2021 in recognition of her excellent education performance which has impacted the Years 4 and 5 LKCMedicine students that she teaches and mentors.

Q: Have you been interested in pursuing medicine since childhood?  

At the risk of sounding cliché, probably yes. But the childhood notion of medicine and the real-world notion of medicine has its differences. As a child, what really struck me about medicine was how attuned to people you have to be – those who are suffering, in pain and have unmet needs because of their health. Inherently, there is a need for one to have compassion and altruism, but once you enter medicine, you realise all those things are true at a fundamental level but there is so much more to medicine, such as understanding cultures, communities, and healthcare finance.

I entered healthcare with specific aspirations to help people – you get to work with people and for people. The idea of what drew me to medicine as a doctor compared to what I’m doing now is wildly out of my wildest expectations. Is it still worthwhile and purposeful? I would say yes.

Q: What motivated you to study medicine, and why did you choose to specialise in psychiatry?

I was one of the batches of medical students who were introduced to the residency programme, a specialist training programme based on the US-based ACGME model, quite early on in our career. Back in the day, the Director of Medical Services came to engage us to sign up for the residency. We were the first batch of students to experience residency which allowed us to apply for specialist training as undergraduates. Conventionally, we would have typically entered the workforce for a couple of years before we could apply. 

As fourth year medical students then, we had to make a decision about what specialty training or residency to apply for. I remember that there was a mad scramble to make such a momentous decision with rather limited experience. At that time, I felt what I related to most was psychiatry and family medicine. I liked family medicine because the breadth and scope were probably what drew me to medicine in the first place. The other was psychiatry because I thought it offered an understanding of humanity that I felt other specialties don’t quite explore. I also considered palliative medicine as the emphasis on patient-centric, sensible medical care really appealed to me.

To help with the decision to apply for residency training, I did a posting in psychiatry at NUH. I had discussions with the then-Head of Department, Professor CB Khare, on whether I should apply for psychiatry residency, which was a difficult decision considering the pressures of time and the novelty of the residency. There was something very definitive he said to me that helped me make the decision, “You have done this posting, you enjoy it, it sparks your interest, you’re good at it so why are you still considering? Does this not indicate to you that this is your calling? Just do it!”

Many years later, serendipitously, I found myself back in palliative medicine because I came across some clinicians who identify as end of life psychiatrists and thought, “Wow this is really the calling of all callings for me”. I joined Tan Tock Seng Hospital because I felt that the palliative medicine team was really strong and that laid the foundation of my training and specialty experience as a psychiatrist specialising in end of life care. For me, it was a marriage of the best of both worlds. 

Q: What advice would you give to your students on becoming a good doctor?

A piece of good advice that I have received and that I feel would be beneficial for learners from all contexts and generations is “To be a good doctor, one essentially has to understand life”. As doctors, you get a very intimate view of patients and their lives. Because of the nature of the work and the duty that has been entrusted to you by society, you are privy to people at their most vulnerable, when they are sick. Without the understanding of how people are and that our patients come from all walks of life, it would be rather difficult for us to be relatable and effective doctors. 

Understanding why patients come on a certain day for appointments, why they ask for their prescriptions to be front-loaded so that they can make use of the MediFund applications, why it is important that you treat parents because their illness and pathology affect the children, and in turn, how these factors inform health-seeking behaviours and illness behaviours. The understanding of life and people from all walks of life is really important for us to contextualise the care and not view care as a one size fits all, protocolised approach. No two patients are the same.

Q: What are some of the teaching experiences or interactions with students that have left an impression on you?

There is no one encounter but I can tell you what kind of encounters strike me. It is when the students submit their write-ups or drop us a text or thank you card at the end of their posting and mention things like “You know that patient I saw you with the other day and you did this, that struck me because it was through that interaction with the patient that I realised how important it is to explore the unspoken with the patient.” It is most rewarding when students appreciate that you are conveying the hidden or informal curriculum, it is even more rewarding that they actually pick up on it. 

As tutors, we teach these things unintentionally – what it means to be compassionate, what it means to do things like give space to a patient, and not progress the agenda because the patient is not ready, to “give face” to a fellow healthcare worker in a public space because that collegiality was necessary. Formal curriculum is easy to articulate – you can have learning objectives – but what’s fun to me is when they can catch higher order values that are not easy to explicitly teach and to appreciate. 

Q: Who are the teachers or mentors who have inspired you and what impact did they make in your life?

I wasn’t a crème de la crème medical student in my undergraduate years but I’ve been so blessed to come across people who gave me a lot of encouragement and saw me for what I could do. If I were to narrow down this sea of people that I feel rather indebted to, I would name three people.

The first would be my predecessor who was the Assistant Principal Lead (Psychiatry) before I was, Associate Professor Habeebul Rahman. He was instrumental in my formative years as a resident. He was one of the best educators one could ever have because of how good he was at getting students to think for themselves. His compassion for learners and faculty in difficulty is really respectable. Some of the projects I’m doing today is very much is based on what I learnt from him. 

The second person is Associate Professor Tham Kum Ying. Prof Tham was instrumental in what a good role model she was. Her ability to uphold the need for high clinical care standards and yet, ensure health professions education is not compromised is really quite remarkable. What I feel is most respectable about her is her ability to mentor those who come after her. She is so generous in terms of how much she’s willing to impart to people who are ready to learn. There are not many women in medicine in our region who display such remarkable vigour and knowledge and command such respect.

The last person is Associate Professor Nicholas Chew who is now the Chairman Medical Board for Woodlands Health. Before he was my big boss, he was the then-Designated Institutional Official for the National Healthcare Group Residency. I really respect him for his ability to think outside the box and about the possibilities, such as what the future of healthcare is going to be like. In public healthcare, we spend so much time fighting fire, but we don’t think enough about aspirational needs. He is a reminder to me that it is always important to have a dreamer, a creative, in my team so that we won’t be stuck in a certain way of thinking.

Q: Amid the COVID-19 outbreak in 2020, you put together a toolkit to psychologically prepare staff members who are newly deployed to the screening centre and outbreak wards. What feedback have you received and what are the next steps?

One thing I learnt after developing the psychological preparedness toolkit is that there is definitely a demand for the psychological care of healthcare workers. After we rolled it out and it went to the press, we had other hospitals, government agencies, and private healthcare vendors asking us for a copy so that they could develop their own. Up to today, I still get requests, even from overseas healthcare administrators, asking us for a copy. The lesson learnt is psychological care, either pre-emptive or responsive, is needed for healthcare systems.

We have updated the toolkit along the way and had many iterations. It includes pragmatic information like the latest updates on quarantine orders and helplines, so it had to be updated to reflect those changes. We updated not just the psychological care aspects but the operational parts to help people keep abreast of the protocols that they are supposed to adhere to because hygiene factors need to be addressed first before you can move people on to talk or think about personal and collective self-care.

The conversation on the well-being of healthcare workers has started and it is one that not only healthcare management is talking about but has also penetrated the collective consciousness of the public. We now see meaningful discussions about issues like burnout, attrition and assault towards healthcare workers and how this is detrimental to the healthcare workforce and threatens the continuity of healthcare talent if we do not do something to arrest it.

I would like to believe that the interest in healthcare in Singaporeans is definitely present. The idea is to keep people in a good state of mind so that they continue to pursue their interests and passion in healthcare without getting burnt out, or leaving the system jaded, angry, ill or injured. Perhaps several generations ago, psychological care of healthcare workers may be seen as something that is good to have, but today, it is increasingly viewed as an essential component of any healthcare system.

The trouble with a lot of staff support systems and employee assistance programmes in public hospitals is that it functions at a very perfunctory level. Most programmes will focus on a narrow set of strategies, such an outreach, education, triage or assessments. Very few healthcare employee assistance programmes have the capacity to run the full breadth of services.

Special care needs to be given to high-risk healthcare populations like nurses, medical social workers, departments where there is the risk of emotional fatigue or assault, and disciplines like emergency departments, ICU, critical care and mental health. Right now, as far as I’m aware, we do not have employee assistance programmes that have the maturity to deal with special populations within healthcare. I’m glad the conversation has started and the openness and interest in mature employee assistance programmes is there. We need to continue to ramp up and we have a long way to go.

Q: With the recent Omicron wave, there is increasing concern about the risk of burnout and fatigue among healthcare workers. What preventive measures or interventions could help in caring for their mental health?

Firstly, on an individual level, taking care of oneself is quite important. There are some people who have pathological habits of presenteeism. We observe individuals with a strong sense of personal responsibility, especially in resource-stretched situations during the initial phase of the COVID-19 pandemic. However, prolonged presenteeism can take a toll on one’s personal health – either physically or mentally – and that can cause aggravated health problems for these healthcare workers later on.

Secondly, awareness and mental health literacy. The best of hospital systems and the best of staff health benefits is moot if there isn’t a culture of openness about mental health at the workplace. If you have a colleague who’s not doing well, there is no loss in you reaching out to ask, “Are you ok?” and this is a question anybody can ask. What’s the worst that can come from asking this question? You are told, “I’m alright.” But that mentality of openness, it starts from us.

Thirdly, to continue in one’s vocation as a healthcare worker, one has to continue to find meaning and purpose so one can continue to find work interesting and insightful. The ability to grow and the autonomy to chart one’s lifelong learning are elements that allow us clinicians to practise at the top of our license.

Supervisors and reporting officers play really important roles in making sure that the teams stay afloat and thrive. Team culture and again, an openness to support people who are not doing well because they are burnt out, have compassion fatigue or mental health issues. Reporting officers need to equip themselves with the skills to manage those situations because it is not practical to exclude or take out everybody who has mental health issues in the workforce. The idea is to create a culture of inclusion so that everybody can cope and thrive.

Q: What are some of the things that you do to care for your mental health and wellbeing?

 I kickbox and do gardening, which is a hobby that my husband and I share. We have a rooftop where we grow chilli, laksa leaf, pandan, and ginger. The gardening bug rubbed off on my husband and now he enjoys it as much as I do. When I’m in the mood, I like to cook but I don’t quite like to eat as much as I like to cook. I would ask my friends to come over and we will have a massive eat out with crabs, lobsters and crayfish and themes like Western, Chinese or grill.