13 responses to “Compassion Fatigue What you don’t know will hurt you”

  1. I consider myself very fortunate that my family medicine residency in Santa Rosa, California incorporated both a psychologist-led peer support group for interns, and a mandatory Balint group for the R2 and R3 years.

  2. What is a Balint group? Is EMDR a useful alternative?

  3. I learned from this seminar to establish a support system and practice low impact debriefing

  4. I am also a senior FM resident in the US (it is three years here) and I find the timing of this quite interesting, as I recently wrote a small piece (which may appear in a local medical publication) reflecting on compassion fatigue and burnout.

    Working in a severely underserved area, we are often told by our program and staff that we should take care of ourselves, but there is no true support from them in this regard. Like the first commenter, we, too, have several behavioral staff on faculty. I have had multiple experiences with tearful peers coming to me, on the verge of breaking down. In hindsight, I have had increasing symptoms of burnout since late in my first year of residency. Nine months of Q3 call in intern year alone, while taking care of a medically and socially complex population and being thrown under the bus by staff can be draining.

    To the previous generation(s) that did Q2-3 36-48-hour calls, I have an enormous amount of respect for you and how you made it through those times. Having not had a 48-hour call since my days as a medical student, I don’t know how you did years of that. But, the daunting challenge of understaffing persists. One such challenge I can recall from earlier this year was (attempting to) managing four actively laboring women while also doing eight medicine admissions (each admitted for no fewer than five acute issues, aside from their page-long list of chronic comorbidities) with/for my intern (who knew little and actually shed tears several times throughout the call) and “supervising” the same intern while they managed an inpatient medicine census of 30 patients (4-8 of whom were critically ill).

  5. I believe I have suffered from compassion fatigue during my 42 years working in health care, first as an RN for 18 yrs, then as a family doctor.
    I wonder if women suffer more from compassion fatigue. I suspect women develop more empathy for patients, and therefore vicariously “take on” or experience the suffering.
    I was unable to locate any Balint groups in Vancouver, BC. I would definitely have joined one.
    I do feel “burned out”. I have no more energy or resiliency, to provide care. I retired one year ago, 5 years sooner than I intended to, because of this.
    Having a few people for support, is not very realistic. My spouse and my best friends did not want to hear about the reality of my work stressors. Peer colleagues also did not have time for this. The pace at which one must provide care is also stressful. Hospital crowding, wait times, these issues are so out of one’s control.

  6. @DavidB Balint groups originated in Europe in the 1950s and were originally aimed at general practitioners wishing go explore patient/doctor relationships. It is a grouping of physicians who meet regularly (e.g. monthly) to discuss and reflect on the impact of their work. Here is more info:

  7. EMDR has indeed been found to be effective in reducing intrusive traumatic thoughts and images (related to indirect and direct trauma exposure) as have some tapping techniques such as Thought Field Therapy (TFT) and Emotional Freedom Technique (EFT) though I am not sure that there are RCTs (randomized control trial) studies for the latter two techniques.

  8. As an instructor in a MN-NP program I will be working to find space in an already crowded curriculum to discuss this with students. It should be part of their preparation for practice. We already do some of this on an informal basis. This article has convinced me that we need to provide a more structured opportunity for discussion of this topic.

  9. This was the 1st article that I’ve read in the series “This Changed My Practice”. I have been aware of these issues for a long time–ever since med school (UC San Diego ’76). Throughout my career, I have had numerous opportunities to choose between time and money. I’ve almost always chosen the time, and been very well-served by that choice. This substantially boils down to a couple of questions:
    1. How much money do I need? For most people, the usual answer is, essentially, “A little (or a lot) more than I have now”. I learned very early in life that beyond a certain point, more money does not provide more happiness. More commonly, it provides less. I’ve felt vindicated in recent years by research indicating that, beyond an income of about $50K/yr. (stretch that out to $50K beyond med school debt servicing in the modern era of debt slavery), more money, indeed, does NOT produce more happiness. An illustrative question: “How much do you have to be paid to have a bad life?”
    2. To what extent am I personally responsible for solving all of my patients’/all of the health care system’s problems? This one is harder. There will always be sick people there at the end of the day. There will still be system dysfunctionality (short-staffing, for example), too. Striking a healthy balance between “doing the right thing” and defending one’s boundaries will vary a lot from one person to the next, but the issue will remain under all conditions. I also think that making huge amounts of money tends to make some of us feel guilty if we’re not chronically over-working ourselves.
    Well…that’s enough for now. I could go on about this for quite some time.

  10. Philipians 4:13 “I can do all things through Christ which strengtheneth me.”

    I used to get compassion fatigue and burnout.
    However, since I became a born-again Christian filled with the Holy Spirit, I have boundless support to give to these patients, even the really depressed, chronically suicidal types.
    At the end of the day, it really does boil down to “Love your neighbour as yourself.” All these people want is just to be heard, shown that you care for them, and if you can uplift them spiritually with some kind words, all the better. I try and spend less time addressing the psychosomatic symptoms which I think as physicians, we tend to overmedicate for anyway, rather than addressing the underlying problem (which ultimately is distance from God)
    Now here’s the kicker… if you can encourage them to pray, and feel the Holy Spirit for themselves, you will end up seeing them a whole lot less :) God is the ultimate counsellor :)
    What I speak of works, and God is very real.

  11. I recently came across this excellent article and find it very heartening. I don’t recall receiving any training of this sort during my residency in the 1980s. I spent the first part of my career working in a wonderful group practice in Southern Ontario, which was very nurturing. However, since moving to the Vancouver area and finding myself running a semi isolated solo practice, I am feeling the loss of support more and more. Truly, these daily stresses do accumulate silently, until an incident makes you aware of the burden you have been bearing. I would be very interested in finding a Balint group in the Vancouver area.

  12. Glad to see this issue getting the attention it needs.

    re: Meditation: I highly recommend checking out the Mindful Practice work of Ronald Epstein, Michael Krasner, and colleagues at University of Rochester. Ron’s book “Attending” is a masterpiece. At BC Children’s and Women’s Hospital we are doing a mindfulness course for MD’s, modified from the Rochester model. I wrote more about this for UBC Postgrad: https://postgrad.med.ubc.ca/2017/03/17/staying-present-mindfulness-in-health-care/

    One thought to consider: Is “compassion” and “empathy” the same thing? Is “compassion fatigue” actually something more like “empathic distress fatigue”? (Klimecki et al 2012)

    re: Balint Groups: There are a few people trained in this in BC. My division (Adolescent Medicine) is about to start this for our group. Hopefully there will be more opportunities for this.

    Dzung Vo, MD
    Division Head, UBC & BCCH Division of Adolescent Health and Medicine, Dept of Pediatrics

  13. Dear Dr. Vo, thank you for your comments and resources! I agree with you that “compassion fatigue” is not the accurate term for this phenomenon, and that it is best defined as empathic strain. The field still has a long way to go to improve clarity on nomenclature. Some of my colleagues and I who are specialists in the field have created a think tank to further explore best practices and improve research (www.stsconsortium.com) and will be producing some best practice consensus guideline recommendations in the year to come. Thank you for your insights and input! Warmly, Françoise Mathieu

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