"When Caregiving Takes a Toll: How to Recognize and Combat Compassion Fatigue"

A little over a year ago, a local TV station aired a story about a nurse who singly ran a primary healthcare clinic in a remote part of Kenya. So significant were the demands of her job that she had to use a cart as a makeshift ambulance for some of her patients. But perhaps what was most concerning was that the story highlighted her as a heroine to a helpless community more than a victim of a failed and unsupportive health system, especially in a country having increasingly many unemployed health workers. Not only was she required to take up clinical duties she was not adequately trained in, but she also stretched her physical, mental, and financial resources. Often, such working conditions reveal the thin line between compassion and apathy.

The art of clinical practice has the special ability to bring purpose joy and fulfillment through service to humanity. Yet a critical evaluation of the clinical landscape for most junior doctors reveals a progressive waning of empathy and compassion (Samuel, Sophia & Thompson, 2018). The demands imposed on doctors, nurses, and other critical hospital staff, exacerbated by the rising patient expectations, can potentially trigger dissatisfaction, depression, and even suicide. While these pressures are inevitable in many ways, we must be constantly aware of mental and emotional exhaustion to shield ourselves from the slippery path of compassion fatigue.  

First, our benevolence may turn into exhaustion when there is a loss of meaning behind our acts of service. As clinicians, it is important to appreciate that what we do is greater than what we potentially gain from it. Purpose may come in many forms, for instance, serving God, supporting family and friends, helping humanity, or reducing suffering. The meaning attached to work is affirmed when patients feel helped and satisfied.  I believe doctors who offer holistic care tailored to the patients' and community's needs are more likely to find gratification from clinical practice than those who focus on routine disease-focused care. Nonetheless, a potential setback of attaching meaning to our day-to-day duties is the possibility of moral injury when negative occurrences or adverse outcomes bring a sense of failure and self-betrayal. Unfortunately, with overstretched health systems, adverse outcomes are bound to increase (Neumann, 2011). It is therefore important for workers not to overestimate their ability to influence outcomes, as they are just a part of a complex system affected by many physical, economic, social, cultural, and spiritual factors.

Another way healthcare workers can promote satisfaction is by celebrating their achievements and accomplishments. Too often, we let the successes and accomplishments pass by without necessarily attaching due value to them. An organization that constantly acknowledges and rewards successes is likely to enhance its employees’ motivation (Slavin et al., 2011). Additionally, many doctors tend to reflect a lot more on adverse outcomes as opposed to successes. While negative outcomes offer invaluable lessons for healthcare providers, it is essential to be mindful of their tendency to skew our perception from the many positives we encounter. Celebrating achievements may even come in subtle forms such as ticking off a checklist or journaling a difficult case that was managed effectively.

Promoting a healthy work-life balance is essential for health workers to offset the exhaustion that sometimes results from clinical duties (Slavin et al., 2011). Few career pathways have a workload as heavy as that in the healthcare profession. As a family medicine resident, for instance, I sometimes work shifts as long as 60 hours straight with very little rest. When adequate recovery time is lacking, our clinical duties may easily end up more burdensome than motivating. The monotony associated with a rigid routine often results in increased work-related stress.  As a doctor, I am, therefore, mindful of balancing my clinical duties with other hobbies and interests by routinely setting time to travel, blog, and meet friends and family. I once read a reflection from a doctor who described his clinical responsibilities as just one of the planets revolving around his solar system in a purposefully regulated balance. The ability to seamlessly maneuver between different interests and responsibilities breaks the cycles of monotony and makes us more well-rounded and better at life.

Finally, strong interpersonal relationships, both on and off work, are greatly important to promote coping with work-related stressors. Workplaces that develop a strong sense of community are likely to have better employee satisfaction than those that do not. Additionally, teamwork is greatly enhanced when health workers complement each other thus promoting synergy. According to Samuel, Sophia & Thompson (2018), Balint groups which are composed of doctors who regularly meet to reflect on cases and other challenges offer a healthy way to rejuvenate and enhance identity, a sense of belonging, and motivation. Additionally, the role of mentors, role models, and counselors to offer professional and psychological support cannot be overemphasized. It is by acknowledging the limits of our humanity and the need for support that one can flourish not only as a professional but also as a human.  

References

Neumann, M. et al. (2011) Empathy decline and its reasons: a systematic review of studies with medical students and residents. Academic medicine. [Online] 86 (8), 996–1009.

Samuel, Sophia & Thompson, Heather, 2018. Critical reflection: a general practice support group experience. Australian journal of Primary Health, 24(3), pp.204–207.

Slavin, Stuart J et al., 2011. Helping medical students and residents flourish: a path to transform medical education. Academic medicine, 86(11), p.e15.