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A day in the life of a Dually-Trained Counsellor

At the National Cancer Centre Singapore, Ms Yanni Chen dons two counselling hats – she’s a medical social worker and a genetic counsellor. 

Q1: Tell us about what you do - how did you end up in such a unique job mix?

I started as a medical social worker, and over the years, as I speak with patients and family members, I noticed a stigma associated with hereditary cancers, such as an accompanying guilt of passing down a disease to a loved one. Cancer genetics is unfamiliar to many people. Who should go for a test? Are there risks involved? What does the result mean for them? I wanted to equip my patients with the relevant knowledge so they can make an informed decision. 

Q2: Was there a defining moment before you went on to pursue a Master’s degree in Genetic Counselling?

An encounter with a blind patient gave me the final push to train in Cancer Genetics.

She was diagnosed with late stage kidney cancer and the Von Hippel-Lindau (VHL) Syndrome, an inherited disorder characterized by the formation of tumors and cysts in many different parts of the body. Worried she might have passed on her condition to her son, she had to make decisions to balance between the need to know, and what to do when the results are out. I was intrigued by her condition and wanted to do more to help this group of people.

Q3: How are the two roles alike? And where do they differ?

As a medical social worker, I provide psychosocial support for both inpatient and outpatient cases, for patients, caregivers, as well as their family members. It can range from handling suicidal cases to sharing what financial assistance schemes are available for a treatment.

As a genetic counsellor, I manage individuals and families who are at risk for genetic conditions through professional assessments. It involves working through the family tree or medical history, discussions on benefits and limitations of a genetic test, helping with decision making.

Sometimes, patients are referred from the Cancer Genetics Service to medical social workers to address issues beyond a genetic condition, such as household disputes and requests to withhold information from a patient. Being dually trained, I am able to manage cases where patients require both psychosocial and genetic counselling.

Q4: What is one top concern amongst the patients you’ve seen?

At the Cancer Genetics Service, most patients are worried about breaking the news, if they are positive. 

During the counselling sessions, we provide space for patients and family members to explore their feelings and concerns, and address the accompanying feelings of doing or not doing a test.

The goal is to make a joint decision as a family. However, the ultimate decision lies with the patient (21 years old and above).

Q5: What is one thing you wish the public knew?

That they do not have to go through the cancer journey alone.  There are trained counsellors, psychotherapists and dually trained social workers to support patients and family members through diagnosis, treatment and survivorship.

Support groups are available too. For example, the At Risk of Cancers (ARC) Support Group is for patients who are diagnosed with hereditary cancer syndromes and their family members. Individuals who are considering genetic testing can speak to those who have had testing done, and how to live with this condition. 

Q6: How do you unwind after a day?

Sometimes patients remind us of our own family members, and it’s never easy to draw a line to shut off completely when we are off work. But I enjoy taking a warm shower to wash away the day’s burden and cares, or turn on Netflix, or go for a jog.