Genetic Counselling: Job, Passion, and Calling

Yasmin Bylstra, Senior Principal Genetic Counsellor, SingHealth Duke-NUS Institute of Precision Medicine (PRISM), appreciates the opportunity to journey alongside patients through different stages of life. “As genetic counsellors, we take the time to understand our patients and their circumstances during appointments. We sit down with them to go through their genetic information and address their concerns which may change over time.”

Balancing clinical and research work

But is a genetic counselling session always bad news? “I guess it depends on the area of practice,” says Yasmin. “In ophthalmology where patients are losing their vision, genetic testing could open up avenues for clinical trials and therapeutics. It could also give them answers—would their children be affected by the same genetic condition? How should they make adjustments for their lifestyle and career choices? In these cases, genetic counselling can bring tremendous benefits.”

On the other hand, there’s the relatively recent practice of preventative genetic counselling. “It’s only in the last couple of years that we started informing healthy individuals of their genetic risks,” she explains. “But is this beneficial, or is it causing harm? Are people using this newfound information for their healthcare or are they putting it aside? That’s what I’m trying to find out in my current PhD research.”

 Yasmin says, “That’s the beauty of my role. In addition to clinical work, I get to do research that has direct clinical impact. It works the other way too—I encounter clinical findings that I don’t quite know what to make of yet, and I bring it back to see if we can find more answers in the lab. I feel really privileged to be able to do both clinical work and research—that I enjoy—as a genetic counsellor.”

Being part of a growing profession

“Compared to when I started over 15 years ago, the field of genomics has changed enormously. Back then, we could only test one gene at a time. It was extremely expensive and could take two years to receive the results,” Yasmin shares. “Now with reduced genetic testing costs and the ability to screen for multiple genes which can generate a large amount of genomic information, it feels like everyone’s just trying to catch up with the latest developments and technologies.”

That also has implications on the role of genetic counsellors. Yasmin says, “It used to be that genetics was mainly focused on specific areas such as cancer and cardiology. But now that it’s pretty much embedded everywhere, we are beginning to see a wider range of people drawn to the genetic counselling practice. It’s great how some of us work in education, others in management or laboratory services…and everybody brings their strengths and domain expertise to the community.

“But that said, we are still a small profession in Singapore. In SingHealth, there are about 12 of us. So I would love to see genetic counsellors as a key part of hospitals and research institutes. This could then open up opportunities for us to be embedded in the primary care setting—and in doing so, open up access to genomics for everybody,” Yasmin says with a smile.