For many physicians, the term “compassion fatigue” may imply, as the words describe, that fatigue leads to the loss of ability to feel compassion for others.
After all, what physician doesn’t have a day when s/he is too tired, running on too little reserve, and feeling some degree of emotional numbness?
Many physicians may not realize, however, that compassion fatigue can go much deeper. According to the Compassion Fatigue Awareness Project, physicians and other health caregivers suffering from compassion fatigue may actually develop a secondary traumatic stress disorder. According to their website:
When caregivers focus on others without practicing self-care, destructive behaviors can surface. Apathy, isolation, bottled up emotions and substance abuse head a long list of symptoms associated with the secondary traumatic stress disorder now labeled: compassion fatigue.
In this post, I have compiled 5 facts about compassion fatigue that physicians might not know, but should.
1. Compassion fatigue is different from burnout. In the article “Overcoming Compassion Fatigue,” the authors summarize:
Whereas physicians with burnout adapt to their exhaustion by becoming less empathetic and more withdrawn, compassion-fatigued physicians continue to give themselves fully to their patients, finding it difficult to maintain a healthy balance of empathy and objectivity.
In other words, physicians suffering from compassion fatigue may not only be suffering from burnout, but will continue to try to draw from an empty well, harming themselves in the process.
2. The symptoms of compassion fatigue may be physical. Chronic physical symptoms can include gastrointestinal symptoms and headaches. Just as we see in our patients, when chronic stress is suppressed internally, it finds its way out externally, often manifesting as a physical symptom.
3. Admitting you might be suffering from compassion fatigue does not mean you are no longer a caring doctor. In fact, it can mean the opposite, as summarized on the Compassion Fatigue Awareness website:
Accepting the presence of compassion fatigue in your life only serves to validate the fact that you are a deeply caring individual. Somewhere along your healing path, the truth will present itself: You don’t have to make a choice. It is possible to practice healthy, ongoing self-care while successfully continuing to care for others.
4. Inability to release the stress of work after hours is a sign of compassion fatigue. As the authors explain in the article “Caring is Hard Work” in ACP Hospitalist,
Separating life inside and outside of the hospital is an important component, and clinicians who engage in spiritual and mindfulness practices may be better able to avoid compassion fatigue … “Something simple is having a ritual when they walk into the hospital of finding a way to ground themselves, either saying some kind of mantra or some kind of prayer or setting the intention for the day, and the reverse when they leave work to release it.”
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A tool I try to use in my own life, is to visualize putting all my stresses and worries about patients into a drawer that I shut for the night, knowing in the morning I can open the drawer and face them again, hopefully after a good night’s rest.
5. The personality characteristics that drive many physicians to a career in medicine, are also risk factors for developing compassion fatigue. From the Compassion Fatigue Awareness website:
Leading traumatologist Eric Gentry suggests that people who are attracted to care giving often enter the field already compassion fatigued. A strong identification with helpless, suffering, or traumatized people or animals is possibly the motive. It is common for such people to hail from a tradition of what Gentry labels: other-directed care giving. Simply put, these are people who were taught at an early age to care for the needs of others before caring for their own needs. Authentic, ongoing self-care practices are absent from their lives.
Don’t wait. Awareness is the first step. Pick one small thing to start the first step to better self-care. Go to bed 30 minutes earlier. Leave the office 30 minutes earlier one day a week. Start with little steps and build from there. As a retiring physician said to me my first week in practice, “It’s a marathon, not a sprint.” It’s imperative to find ways to pace yourself; you cannot go at a full-on sprint day-in and day-out for your entire career. Not if you want to make it to the finish line intact.
It is possible to attain compassion satisfaction, according to the article “Caring is Hard Work” in ACP Hospitalist:
The flip side of compassion fatigue is compassion satisfaction. Whereas we may get drained helping people, we also get sustained in helping people, and we can derive a great deal of satisfaction.
After all, that’s why most of us became doctors to begin with.
Jennifer Lycette is a novelist, award-winning essayist, rural hematology-oncology physician, wife, and mom. Mid-career, Dr. Lycette discovered the power of narrative medicine on her path back from physician burnout and has been writing ever since. Her essays can be found in The Intima, NEJM, JAMA, and other journals. She can be reached on Instagram, LinkedIn, Facebook, and Mastodon.
Her books explore the overarching theme of humanism in medicine. Her first novel, The Algorithm Will See You Now (Black Rose Writing Press), a near-future medical thriller, is available now. Her second novel, The Committee Will Kill You Now, a prequel in the form of a near-historical medical suspense, is out 11/9/23 and available for preorder now in paperback and on Kindle.
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