Message from the PresidentDr Ludwig Chun-Hing TSOI
Burn-out as a health phenomenon
In May this year (2019), the World Health Organization (WHO) included “burn-out” in its 11th Revision of the International Classification of Diseases (ICD-11) with a detailed description. However, the condition was not classified as a disease, where some local newspapers misinterpreted; rather, it was labeled as a phenomenon. The concept of burn-out has
been around for years amongst the medical profession, and various tools have been devised to gauge it (e.g. Maslach Burnout Inventory and Copenhagen Burnout Inventory). Nonetheless, the nature of burn-out remains obscure and it is subject to interpretation by different individuals. For many, it is a subject under the discipline of psychology or sociology. And unfortunately, doctors are not immune to the condition. In fact, due to their job nature and long working hours, doctors are prone to the condition.
Health in burn-out
As health is not just a matter of disease-free state, it embraces the bio-psycho-socio-spiritual wellbeing of a person. We cannot say a doctor is healthy just because he is disease-free; his psychosocial status must also be well in order to qualify for the brand “healthy doctor”. That is to say, if a doctor is stressed out due to his work, although he is not “sick” literally, he is “not healthy” according to the definition. In fact many doctors, A&E doctors included, are not healthy in this context. And yet, there is no general solution to the situation and burn-out doctors are allowed to practice without support/restriction. However, this may put a health risk to the patients receiving treatment, and legal risk to the doctor practicing medicine.
WHO definition
Burn-out is defined in ICD-11 as follows:
“Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:
feelings of energy depletion or exhaustion;
increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job; and
reduced professional efficacy.
Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.”
Special emphasis must be put on the word “occupational” – that means, it is a condition related to the work, stress and productivity. And hence it has strong psychosocial roots and implications. In short, burn-out is an occupational phenomenon that stems from chronic work-related stress. As such, it can be postulated that once someone who is “burn-out” in one occupation, will find himself anew when he is removed from his work environment. However, life is complicated as there are confounding biological and social issues, e.g. the subject may have concomitant depression due to prolonged stress, or the subject may have already divorced due to his reaction to the adverse working environment.
What can we do?
Unlike a biological disease where the diagnosis is certain and the treatment is straightforward, e.g. an antibiotic is targeted towards a bacterial infection or Vitamin C is for scurvy. There is no cure for burn-out. Some doctors may simply drop out of the profession; others may indulge in alcoholism or drug abuse; some may even deteriorate to a formal psychological condition. And there are geographical and cultural differences in the way we as doctors tackle the challenge. In an academic debate held on 29th June in the Annual Scientific Conference 2019 of the Taiwan Society of Emergency Medicine, the Hong Kong and Taiwan teams had a wonderful exchange on this topic. It could be seen that the perspectives and solutions regarding the phenomenon will vary according to the locality (e.g. whether having a drink after work or monetary compensation for overtime will help). In general, regular exercise, good eating habits, leisure time, nurturing hobbies, having a mentor, getting together with family and friends are regarded as useful to stay away from burn-out. But as I said, there is no easy fix for the matter, and if the stress is so much that it is devastating to health, one should consider switching to another profession.
This is my last issue of “From the President” before my retirement from the presidency of the Society. I would like to thank the editorial team to upkeep the standard of our newsletter and to furnish all the tedious work of the publication in the past years. I am confident our newsletter will strive from strength to strength and to reach new height under the leadership of my successor.
From the EditorsDr Chor-man Lo & Dr Sam Siu-ming Yang
Welcome to the new issue of our newsletter.
Burnout has become an important issue in modern society. It affects every occupation and physicians are no exception. It is said that the burnout rate among emergency physicians is far
higher than that of the average doctors. To further elaborate on this, our President, Dr Ludwig Tsoi will have a discussion on the topic
Echoing the issue of burnout, exercise is a very fantastic and practical way to de-stress and re-energize us after our tedious work, provided that you do not fall into the group of workaholics. HKSEMS has collaborated with the Sports Team of HKCEM to organize the Training Program in Trail Running 2019. We hope that through participation in exercise, our members can benefit from a better work-life balance, so that they can impose a positive influence on the general public as well.
Coming to the end of October, it is time for a new council of HKSEMS to be formed. We hope that we can continue to enhance the cohesion of the community of Emergency Medicine (EM) as well as the development of EM so that a better service can be provided to our patients!
Council News
Dear Members of HKSEMS,
Welcome to the 3rd issue in 2019. Let’s review the activities organized the Council in these 3 months.
Induction Program on Emergency Medicine July 2019
The Induction Program on Emergency Medicine co-organized by HKSEMS and HAHO IEC (for new EM trainees and Doctors rotated to A&E) was held on 12th July in A&E Training Centre of TSKH, followed by a lunch session (co-organized with the Young Fellow Chapter of HKCEM). Representatives from the Trainee delivered a talk on practical trips on being an Emergency Medicine Trainee.
The 22nd Annual Congress of the Chinese Society of Emergency Medicine (CSEM 2019)
The Annual Congress is the official annual meeting of the Chinese Medical Association (EM Division) (中華醫學會急診醫學分會) which took place in Beijing International Conference Centre from 4 to 7 July 2019. Dr Clara Wu and Dr Chan Lap Wa were invited to speak in the Conference.
Training program in trail running (co-organized with the HKCEM sports team)
HKSEMS co-organized this course with the HKCEM sports team, comprising of 6 sessions, aims to gather a group of Trail runners to practice and run together!!
Expedition Medicine and Kitting up as an Expedition Medic
Professor Jimmy Goh will be invited to speak on Expedition Medicine and Kitting Up as an Expedition Medic, this seminar will be held on 27th September 2019 in TSKH AETC.
Medical Tips
Wide complex tachycardia
Main differential diagnoses:
Ventricular tachycardia (VT)
Supraventricular tachycardia (SVT) with aberrant conduction due to bundle branch block
SVT with aberrant conduction due to the Wolff-Parkinson-White syndrome
It is important to differentiate VT from SVT with aberrancy, as this will significantly influence the management of the patient. SVTs usually respond well to AV-nodal blocking drugs. On the other hand, patients with VT may suffer from hemodynamic deterioration if administered an AV-nodal blocking agent.
Electrocardiographic signs that are suggestive of VT:
Absence of typical RBBB or LBBB morphology
Extreme axis deviation (fourth quadrant, so called no man’s land) — QRS is positive in aVR and negative in I + aVF.
Very broad complexes (>160ms)
AV dissociation (P and QRS complexes at different rates)
Capture beats — occur when the ventricle is transiently captured by an impulse from sinoatrial node to produce a QRS complex of normal duration.
Capture beat
Fusion beats — occur when the simultaneous impulses originating from sinoatrial node and ventricle merge to produce a hybrid complex.
Two fusion beats following a capture beat
Positive or negative concordance throughout the precordial leads, i.e. leads V1-6 show entirely positive or entirely negative complexes.
Positive concordance
Brugada sign – The distance from the onset of the QRS complex to the nadir of the S-wave is > 100ms
Josephson sign – Notching near the nadir of the S-wave
RSR’ complexes with a taller left rabbit ear. This is in contrast to RBBB, where the right rabbit ear is taller.
Note that most of the published criteria have high specificities but very low sensitivities for diagnosing VT. In case of doubt, treat as VT.
Upcoming Events and Conferences
AGM 2019
The AGM 2019 of HKSEMS will be held on 26th October 2019 at 18:00 in James Kung Room, 2/F, in the Hong Kong Academy of Medicine Jockey Club Building. All are welcome.
ACEM 2019
The ACEM 2019 will be held from 7 November to 10 November, and all are welcome to join. During the Conference, we shall be promoting the ACEM 2021 to be co-organized by HKSEMS and HKCEM .
Asian Conference on Emergency Medicine (ACEM) 2021
The 11th ACEM organized by HKSEMS will be held on 17th to 19th December 2021. Please save the date, and see you on this big day!!
