Valerie Brooke, MD
When I realized last year I was feeling burned out in my job as a physician, I dove into learning as much as I could about the symptoms of burnout including a particular sub-type of burnout that occurs in response to repeated exposure to patient suffering: compassion fatigue. Something that has increased exponentially as the COVID-19 virus and its variants have done the same.
I started my studies by reading a book entitled, Compassionomics - The Revolutionary Scientific Evidence that Caring Makes a Difference. In retrospect, I don’t think it’s all that revolutionary or novel. It makes total sense that caring matters: why else did we become physicians or nurses or therapists? We entered the medical field with an expectation of making a positive impact on the lives of our patients.
The book summarized over four hundred scientific studies proving what I intuitively already knew. Compassionate care has tremendous benefits for patients’ physical and mental health, promotes care providers’ sense of well-being, and even improves entire healthcare systems. Furthermore, compassion is not something a person is either born with or without; it can be effectively taught to care providers with measurable differences in the care they provide to patients as well as their own individual health after compassion training. If compassion is such a powerful influencer on health, why is it not discussed and taught in medical education?
Compassion fatigue includes symptoms of lack of energy, apathy, and dissatisfaction in one’s work. This term was initially conceived in the 1990s in the context of nurses in Emergency Departments who experienced continued traumatic patient experiences. Over time, the concept of compassion fatigue spread to include other healthcare workers including physicians and therapists.
So, what exactly is compassion fatigue? It’s not necessarily a lack of empathy or awareness of another’s suffering, but rather a lack of desire to take action to relieve this suffering. Many do not even agree with the term compassion fatigue as it implies there is a finite amount that will invariably dissipate over time. Regardless of the definition, compassion fatigue is what I experienced last year. I felt like I was working with a dead internal battery. No amount of sleep or rest could fill up my cup.
The most surprising thing I learned about compassion and physician burnout is the inverse relationship between the two. That is, physicians with the most compassion have the least amount of burnout and emotional exhaustion. And there is evidence that mindful based practices like meditation can actually increase compassion.
So, it seems the key is not to fixate on compassion fatigue, but rather focus on compassion itself. As the authors of the article Beyond Compassion Fatigue assert: “An exclusive focus on compassion fatigue is similar to providing an “ambulance at the bottom of the cliff.” How about we instead begin at the top of the cliff and do what we can to keep healthcare workers from falling over the edge in the first place.