You’re seeing a health professional, but as a patient, you can sense something’s off in the clinical encounter. It’s clear that your doctor, nurse or therapist is eager to cut the visit short. He or she fails to make eye contact and seems impatient or on edge. When you try to describe your pain or trauma, instead of leaning in to listen more deeply, the provider keeps the conversation breezy. If anything, you find yourself hearing about his or her professional woes or even personal problems at home.
Behavior like that could be a sign of compassion fatigue, says Jeff Harris, program manager for the employee assistance program at the University of Southern California. It’s more than professional burnout. Compassion fatigue leads to fear or panic at the prospect of dealing with a patient’s or client’s trauma, Harris says, and dread of what the next patient encounter will bring.
Vicarious trauma – a health provider experiencing patients’ suffering as their own – is a risk factor, Harris says. Certain cases, like losing a pediatric patient who is the same age as their own child, hit too close to home. Or providers may work in specialties, like oncology, where patient loss is all too common.
“People form a bond with their physician or nurse,” he says. “And part of the healing process [for the patient] is the hope I’m being cared for a compassionate, nurturing person.” But when a patient dies, the doctor or nurse takes on the family members’ grief and raw pain as they try to help them cope. “And that suffering splashes up on you,” he says. “You’re exposed.”
Insidious Onset
“You don’t know you have compassion fatigue until you look at in retrospect,” says Dr. Joe Imperato, aradiation oncologist who specializes in breast cancer, with a career spanning 32 years.
“Initially, you find you have less patience with your difficult patients,” says Imperato, an associate professor of radiology at the Rosalind Franklin University Medical School. “Then it progresses. You find that even the fact that you have to see another patient – you’re just tired. Even if it’s a routine patient, even if it’s a standard case, even if it’s an easy case.”
A few years ago, scheduling shifts to accommodate a technology software upgrade led Imperato into a dispute with a patient’s wife. While the dispute was minor, Imperato says, that interaction was a crisis point. “After that incident, I realized I had changed,” he says. “And it was really born out of just frustration that had been building up from multiple other causes.”
Patient care or sadness over loss was not at the core of his compassion fatigue, he insists. “As oncologists, we go into this field knowing there are patients we cannot possibly cure,” says Imperato, a past president of the Illinois division of the American Cancer Society. In those cases, he says, he does his best to give patients the best quality of life for the remaining time they have.
For him and others, Imperato says, the root of compassion fatigue and burnout is frustration with a shifting health care system and the increasing loss of autonomy and control physicians have over their practices.
Keeping Compassion Alive
When you’re constantly focused on stabilizing critically ill patients, dealing with their injuries, multitasking and coordinating their care, it’s possible to lose sight of the actual person in the hospital bed, says Elizabeth Mills, a critical care nurse in Wilmington, North Carolina.
In the adult trauma unit where Mills works, many patients have been in car accidents or are victims of violence. Drugs or alcohol are often factors. Incidents involving a crime, in which the patient may have hurt somebody else, can strain your compassion, Mills says. “You’re human also,” she says. “But I just try to focus on what I’m doing at the moment. I’m someone who cares about people, and I’ve got to manage their pain and what they’re doing or going through at that moment.”
Supportive work environments help “tremendously,” Mills says, such as facilities that offer freecounseling to clinical staff. Having team members who support one another is key, she says.
She finds ways to shore up her empathy. “When I’m having trouble feeling sorry for a patient, I really try to learn something about them,” she says. “A story about them. Where did they grow up? What did they do? Are they retired? Their family situation. I really try to find something like that to get myself back to the fact that this is a person with a life.”
Mills takes care of herself when she leaves work. “I have learned to go off the grid at moments on my days off, where I don’t have a phone or computer or anything nearby,” she says. “And I try to pay attention to the simple things in life. Like right now it’s springtime, and the flowers around this area are really beautiful. Or I’ll go down to the beach and sit and watch the ocean and just focus.”
Ebb and Flow
John Kleber, a mental health professional in Charlotte, North Carolina, works with kids with severe mental and behavioral health diagnoses. He’s spent time in locked psychiatric units in his career, and it can be challenging. “You often do have situations where everything around you is kind of out of control,” Kleber says. “That, in and of itself, is extremely overwhelming.”
Some kids Kleber works with are involved in legal issues. Many are hostile. “It absolutely drains on you when you feel like you’re repeatedly dealing with all their anger,” he says. “Kids who are especially angry will lash out and be very disrespectful. It’s hard not to take it personally sometimes. And it’s hard not to get fed up with it.”
With some jobs, Kleber says, he couldn’t stop thinking about work no matter where he was. “I was having physical reactions,” he says. “I was having knots in my stomach. Those kinds of issues were definitely a cue that, OK, I really need to learn how to manage this better or decide if this is something I can do long term.”
His wife understood some of what he was going through. “When you’re entrenched in other people’s trauma, it’s vital to remind yourself that you’re outside the situation,” says Kati Kleber, a critical care nurse and author-blogger. “You want to be present and provide empathy, but know your boundaries emotionally.”
On a deep level, Kleber says, prayer and Bible study replenishes his stores of empathy. And so does maximizing time off and just having fun with family and friends.
Now in his sixth year in the field, Kleber is learning to notice small victories, like when parents follow staff recommendations and see improvement. “Or maybe a kid has gone a full two weeks without having an outburst,” he says. “We try to find whatever positives we can and stay strength-based.”
Time for a Change
Imperato opted to leave his hospital position. “The minute I made that decision and announced it, I literally felt like a weight had been lifted off my chest. And it was amazing – the transition of actually sleeping through the night. And suddenly being interested in doing something. You were no longer perseverating over these issues, most of which you had no control over,” he says.
Imperato never sought out counseling. “In retrospect, I should have,” he says. “But as a rule, physicians are really poor at doing that. We are terrible at seeking help because we feel it brings a stigma on you if you seek out professional help.” The newer generation of physicians may be approaching things differently, he says.
Today, Imperato, in addition to branching out into part-time teaching, is doing what’s known as “locums work.” He fills in temporarily for physicians when they go on vacation, for instance, or while they’re on maternity leave. He gets to choose when, where and how much he wants to work.
Compassion Satisfaction
Health professionals can take steps to inoculate themselves from compassion fatigue, Harris says. Strategies include practicing mindfulness, learning to be present in the moment and stating affirmations like: “My work matters, and while I can’t make someone happy right at that moment, I know I can bring good things into their life.”
There’s a strong spiritual component to healing, Harris adds. “What drives mental health professionals, and generally medical professionals, is a reverence for life,” he says. “We believe that life is important. It matters; it’s worth fighting for tooth and nail. And sometimes to lose that battle – we can’t let it discourage us.”
