Canadian Medical Association

 What is compassion fatigue?

Compassion fatigue is the cost of caring for others or for their emotional pain, resulting from the desire to help relieve the suffering of others. It is also known as vicarious or secondary trauma, referencing the way that other people’s trauma can become their own. The symptoms of compassion fatigue make it more difficult to provide patient care and to perform other duties.

Note that compassion fatigue is not the same as burnout. Burnout is a psychological syndrome of emotional exhaustion, depersonalization and reduced personal accomplishment. It typically emerges over time as a response to prolonged stress and can occur in any profession. In contrast, compassion fatigue mainly affects health care professionals who provide direct patient care. Compassion fatigue can also have a more rapid and acute onset.

Compassion fatigue and COVID-19

The COVID-19 pandemic has drastically changed workplace conditions, which may lead to an increased risk of physicians experiencing compassion fatigue. The pandemic has caused an influx of very ill and infectious patients who are experiencing potentially life-threatening symptoms into critical care units. In some cases, as outlined by an article in the Journal of Clinical Nursing, the stress and trauma of the situation have been compounded by bed shortages, staff shortages, lack of ventilators and lack of proper personal protective equipment.

Physicians must also deal with the added risk of potentially contracting COVID-19 and becoming infectious themselves. Many have taken steps to avoid exposing their loved ones, which has led to social isolation and a reluctance to seek help and support.

Warning signs of compassion fatigue

Compassion fatigue develops over time; you can spot the signs if you know what to look for. The Centre for Addiction and Mental Health explains that the main symptoms of compassion fatigue include the following:

  • feelings of helplessness and powerlessness in the face of patient suffering
  • reduced feelings of empathy and sensitivity
  • feeling overwhelmed and exhausted by work demands
  • feeling detached, numb and emotionally disconnected
  • loss of interest in activities you used to enjoy
  • increased anxiety, sadness, anger and irritability
  • difficulty concentrating and making decisions
  • difficulty sleeping and sleep disturbances like nightmares
  • physical symptoms like headaches, nausea, upset stomach and dizziness
  • increased conflict in personal relationships
  • neglect of your own self-care
  • withdrawal and self-isolation
  • an increase in substance use as a form of self-medication

Coping and management strategies

Identifying compassion fatigue can help you start taking steps to manage it. British Columbia’s Compass Mental Health Program has provided some tips for coping during these stressful times:

  • Practise mindfulness throughout the day by being aware of your thoughts, feelings and physical sensations.
  • When you start to feel anxious, help yourself calm down by focusing on your breath and slowing down your breathing rate.
  • If you feel overwhelmed and out of control, take a moment to think about what you do have control over and what you can change.
  • Establish a good self-care routine that includes eating healthy, getting more exercise and getting enough sleep.
  • Reach out to others for support, whether that’s friends, family or a peer support group.
  • Set aside time for meaningful activity and find ways to connect with loved ones.
  • Take a break from the news and limit the time you spend online every day.

Lessons from the 2003 SARS outbreak

The SARS outbreak of 2003 can offer important insights into mitigating compassion fatigue. According to an article in the Canadian Journal of Public Health, there are two evidence-based interventions for reducing pandemic-related stress by fostering individual resilience.

  1. Folkman and Greer’s framework: A sequential approach designed to recover positive emotions and encourage effective adaptation during serious illness. Physicians can also use this framework to develop effective coping strategies.
  2. Psychological first aid: An approach for facilitating resilience following a traumatic experience. Psychological first aid can help reduce stress, provide important information and facilitate social support.

Organizational support

Hospital leadership and management also play an important role in mitigating physician compassion fatigue. Dr. Sharron Spicer explains that when it comes to preventing compassion fatigue, good management and good leadership go hand in hand. Managers should take steps to ensure that physicians can provide safe and effective care to their patients. Improving the culture and efficacy of the work environment can also contribute to greater physician resilience. Leaders should advocate for necessary changes, address conflict when it arises and ensure mentorship and succession planning.

Effective organizational strategies can support a culture of wellness that leads to a decrease in compassion fatigue and an increase in compassion satisfaction. Compassion satisfaction refers to the pleasure derived from work, from helping others, and can be related to providing care, working with colleagues, intellectual challenge and altruism.

Physicians face unique stressors in the workplace, but there are ways to handle these challenges. Understand the signs of compassion fatigue and use the actionable items in this article to help prevent or manage it.

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