Compassion Fatigue: An Occupational Risk for Physicians

Home / Campus / Faculty and Staff Assistance Program ( Published on 2015-06-30 )

By Jamine Ergas, PsyD
Faculty and Staff Assistance Program

Residency and Fellowship is a very stressful time in a physician’s life. The long hours, multiple shifts, and difficult rotations can be a significant source of stress. In addition to the demanding aspects of the work itself, many residents and fellows have the added stress of a recent move, getting married, and/or starting a family. There are often not enough hours in the day to take care of personal or relationship needs. Many residents and fellows feel exhausted in the free hours they do have and need that time to recuperate before returning to work. All of these factors are major contributors to the stress level of residents and fellows, and to some extent, that stress is obvious and expected. However, there is another contributing factor that also impacts the wellbeing of resident physicians – the emotional stress of caring for sick, injured and/or dying patients.

Physicians, like many other helping professionals, come into regular contact with traumatized individuals. Studies conducted on the role of empathy in patient care have found that “…empathic doctors and nurses provide higher quality care and have patients who express higher satisfaction with service” (Regehr, Goldberg, and Hughes, 2002, p. 510). At the same time, the process of caring for and providing empathic treatment to traumatized patients puts physicians at risk for compassion fatigue, which Charles Figley (1995) defined as “the emotional residue or strain of exposure to working with those suffering from the consequences of traumatic events.”

The emotional impact of patient care may not always be obvious. In fact, individuals may unconsciously or consciously suppress difficult emotions until a shift or even an entire rotation is over. Sometimes, it is not until something in our personal life starts to suffer that we realize work-related interactions impact our psychological well-being. Although it makes sense to keep emotions as much “in check” as possible when caring for patients, it is also important to recognize that the work you do can be emotionally draining, and to find the space to acknowledge and process these emotions and establish the skills to cope.

Emotionally Difficult Aspects of Patient Care

  • Patients who die alone
  • Grief of family members
  • Very sick patients
  • Patients who have a condition similar to your own or someone close to you
  • Patients with whom you particularly connect
  • Suicidal patients
  • Sick and/or dying children
  • Neglected/abused children

The emotional impact of patient care can manifest in various ways. You may feel down, not quite yourself, anxious, hopeless, or unable to sleep or to concentrate. These feelings, along with those listed below, are all symptoms of what, in the research literature, has been interchangeably referred to as “burn-out”, secondary traumatic stress, and compassion fatigue.

Signs of Compassion Fatigue

  • Not wanting to go to work    
  • Changes in behavior – e.g.,  hypervigilance 
  • Recurring thoughts of the patient or situation
  • Withdrawing from loved ones
  • Apathy towards work and/or patients
  • Increased substance use

Prevention/Self-Care
Given the intensely stressful demands of your profession, coupled with consistent exposure to the suffering of patients, it is important to be on the lookout for the signs of compassion fatigue. Once identified, acknowledge and examine how your work impacts you emotionally. Seeking support from other residents, fellows, faculty mentors, friends, family, partners, spiritual counselors, and/or a therapist is an essential component to mitigating compassion fatigue. In addition to such social supports, your department’s Residency or Fellowship program can play a crucial role in preventing compassion fatigue, for example by offering trainings or group sessions for the purpose of processing feelings related to patient care. This not only normalizes the fact that residents, fellows, and attendings are emotionally impacted by their work, it also sends the message that addressing this impact is of vital importance to the well-being of physicians and patients alike. 

Tips for Preventing Compassion Fatigue

  • Make time to do things unrelated to your work. This may be challenging for busy residents and fellows, but it needs to be a priority!
  • Take time off
  • Regular exercise and a healthy diet
  • Talk to someone about the emotional aspects of your work
  • Get supervision
  • Identify what is meaningful to you in life and connect with it
  • Focus on the meaning and joy you find in caring for your patients

Assessing Compassion Satisfaction & Fatigue
If you are interested in assessing your risk of developing compassion fatigue, you can access the Professional Quality of Life: Compassion Satisfaction and Fatigue Scale (ProQOL) developed by Beth Hudnall Stamm.

Conclusion
Many of you are under an extraordinary amount of stress and may have more demands on you now than ever before. It may feel like you do not have enough hours in the day to stop and ask yourself, “How am I doing?”  Nevertheless, taking time for yourself to recoup from your busy shift or rotation will go a long way toward preventing compassion fatigue. Incorporating self-care into your routine will enable you to stay present and engaged with the important work you do. Not only will you benefit from taking care of yourself, your patients will too.

If life starts to feel like it’s too much, reach out to someone.  The Faculty and Staff Assistance Program (FSAP) can provide you with counseling services as well as referrals for therapists in the community. FSAP services are free and confidential and available for both personal and work-related issues. Please contact us at 415/476-8279 or visit our website for more information.

References

B. Hudnall Stamm, 2009. Professional Quality of Life: Compassion Satisfaction and Fatigue Version 5 (ProQOL). Retrieved from http://www.proqol.org

Figley, C. (1995). Compassion fatigue: Coping with secondary traumatic stress disorder. New York: Brunner/Mazel.

Regehr, C., Goldberg, G., & Hughes, J. (2002). Exposure to human tragedy, empathy, and trauma in ambulance paramedics. American Journal of Orthopsychiatry, 72(4), 505-513.

Huggard, P. (2003). Secondary traumatic stress: Doctor’s at risk. New Ethicals Journal. September 2003, pp 9-14.