Working with sufferers

An overstrained support system and a lack of government directives mean hard work for those trying to alleviate chronic pain

Wolfberries float in homely grey soup, alongside strands of wheat noodles, a drumstick and baby bok choy. The aroma of lunch for Sherlyn, a medical social worker in a restructured hospital, overpowers the smell of fried chicken from the Jollibee outlet downstairs.

But Sherlyn wasn’t paying attention to her lunch. In the five minutes since the noodles arrived, she had received two calls from her office.

It’s her second year as a medical social worker, and she already feels that the job isn’t really for her.

“At times (you) help too much, and you don’t even care about yourself; (you) end up having issues of your own,” she says.

She gets another call, this time pertaining to a patient request to move to a nursing home. “Sometimes you can work until 10pm just for case management,” she says.

Sherlyn is one of an estimated 285 medical social workers in the public healthcare sector who have become increasingly strained by the demands of an ageing population.

Shifting priorities and high bed occupancy rates at hospitals mean that healthcare professionals rarely have time to listen to the people that they need to help the most.

And as more patients suffer from chronic pain, these healthcare professionals have found that they don’t have time for the psychological needs of patients, even though they influence how chronic pain sufferers experience treatment and support.

“I feel, for myself, that it’s my job to listen to my patients,” says Sherlyn, who asked to remain anonymous for this article.

“But there were times when I failed to listen… usually I’ll try as much as possible to listen to them, but there are times when I’m really overwhelmed with my work and that blocks my patients’ words out.”

“Sometimes it’s difficult for people to understand how it feels living with chronic pain,” says Catherine, who has worked as at a medical social worker for nearly nine years. Like Sherlyn, she asked to be anonymous for this article.

“When these people try to (talk) about their pain — to maybe, the Social Service Office — people may not understand why is it you cannot work,” she adds. That some patients remain functional despite their chronic pain, while others do not, complicates how social aid is given, Catherine adds.

A management issue

Yet, changing how patients are treated is a challenge — given a top-down approach to healthcare in Singapore.

A study of 15 local pain doctors, pain nurses and physiotherapists investigating treatment delivery and potential treatment barriers, found that pain management services were given a low priority by higher management, and that there were major barriers to effective pain management.

Often, patients were not aware of the treatments available, and there was a lack of understanding of multidisciplinary treatment approaches, which deal with the psychological, on top of the biological aspects of pain.

A lack of funding has also hiked up costs for psychological treatment, said participants in the study, published in Disability and Rehabilitation.

Supplemental treatment methods are not subsidised by the government.

“Imagine people walking around with pain, feeling misunderstood, frustrated, not having a cure, but no one is doing anything about it,” says Dr Yang Su-yin, clinical lead for pain psychology at TTSH and the lead author of the study.

Any change, however, has to come from the top, she adds. “To have an overhaul of our system and to have a bit more buy-in from the top, that will open the floodgates for more people, more patients to come forward to see through treatment and actually see a better outcome.”

But major barriers — combined with mistaken perceptions, both in sufferers and health professionals, have cost sufferers more.

Ivy Li, who suffers from a slipped disc in her lower spine, says that at times doctors thought that her pain was all in her mind.

Li, who also suffers from chronic depression and borderline personality disorder, says that her psychiatric condition made doctors wary of giving her pain relief.

At one point, an emergency ward doctor “rolled his eyes” at her when she told him that the painkillers she had been given weren’t helping.

“They said, ‘Actually maybe you don’t need any medicine, but you think that you need medicine’ — and it was very hurtful,” she says. “It was just very insulting — like you go to a medical facility, and you’re stripped of your dignity.”

Andy Ho Hau Yan, an assistant professor at the School of Social Sciences in Nanyang Technological University, says that the more sufferers feel misunderstood, the less they want to share.

“It could be a vicious cycle,” Asst Prof Ho, who studies community health psychology, adds.

“That further points towards the fact that professional caregivers need an understanding of what chronic pain is.”

After large awareness campaigns, the public has become more aware of ailments like dementia and diabetes.

“These are the two major focuses now because the government said something,” Asst Prof Ho says.

“When there is a government-led initiative, then people follow, people will recognise that this is important.”

“If you really want to make some changes within the hospital, it’s something very big, that is something you can’t really do yourself,” Sherlyn sighs.

She adds that suggestions to the system will need to go through a proper research process to ensure that it will help patients — but Sherlyn is already overwhelmed. While she does have research ongoing, she finds it difficult to cope.

“That’s why I have this sense of helplessness.”

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