Is it compassion fatigue or burnout?

Physician burnout has become a top concern, with roughly 42% of doctors across 29 specialties reporting they are burned out, according to a Medscape survey from early 2021. But you may be unaware that burnout has an equally dangerous cousin: compassion fatigue.

As explained by UCF Healthcare, compassion fatigue is commonly referred to as “the cost of caring.” Its symptoms are a result of the mental and emotional distress experienced by clinicians when they connect and empathize with patients.^[]

And it's a condition that can cause just as much damage to provider and patient.

Fortunately, there are several ways to mitigate and manage compassion fatigue. Here’s a rundown of everything you need to know about the symptoms and causes of compassion fatigue, as well as how to protect yourself from it. Plus, we’ll delve into the impact of the COVID-19 pandemic on compassion fatigue rates.

Causes and symptoms

When describing compassion fatigue, researchers often use burnout as a reference point. The authors of a review published in the Current Treatment Options in Pediatrics even define compassion fatigue as a “unique form of burnout.”^[]

Also known as secondary traumatic stress syndrome, it is the state that results from “prolonged, continuous, and intense” contact with patients. In short, when physicians are exposed to and empathize with large numbers of suffering patients, the work can drain doctors emotionally and even cause depersonalization.

Afflicted physicians have reported symptoms that range from sleeplessness to anxiety. Many report feelings of being a failure, a lack of confidence, and increased rates of substance abuse.

According to an article published by Duke Health, other symptoms include recurring thoughts about a patient, emotional withdrawal from loved ones, general apathy toward work, and negative changes in behavior, such as hypervigilance.^[]

Symptoms can also be physical, manifesting through chronic headaches and gastrointestinal problems.

If burnout is characterized by acute physical exhaustion, then compassion fatigue is defined by emotional exhaustion. And it can result in harm to the very people doctors strive to help.

Impacts on providers and patients

As noted in an article published by the American Psychological Association, compassion fatigue not only makes it tricky to empathize with patients, it can also make clinicians feel like they have nothing left to give.^[]

And according to the Current Treatment Options review, this helplessness can lead to decreased productivity and a drop in the quality of patient care due to increased attrition and medical errors. Evidence suggests that patients are less likely to adhere to their care recommendations when physicians are less invested in their work.

The findings of a study published in Occupational Medicine corroborate this insight.^[] The study looked at the direct and indirect effects of compassion satisfaction, compassion fatigue, and self-compassion in a cohort of 306 social workers. Researchers found that “compassion fatigue was a significant risk factor for well-being” and called for evidence-based interventions to reduce the phenomenon.

Compassion fatigue is associated with high rates of absenteeism, staff turnover, and impaired professional judgment. Furthermore, compassion fatigue can result in indifference to the suffering of others, which has clear negative implications for patients.

Has COVID-19 impacted compassion fatigue?

Early in the pandemic, concerns over a possible spike in burnout and compassion fatigue came from far and wide. In an article published in the Journal of Clinical Nursing, the authors posited that the risk of compassion fatigue would likely be heightened for clinicians in critical care units treating patients who have the life-threatening virus.^[]

Understaffed hospitals and clinics with inadequate personal protective equipment and shortages of beds and mechanical ventilators compounded the threat.

Clinicians, the authors hypothesized, would experience the added stress of possibly contracting the virus and passing it along to colleagues and loved ones.

Fast forward to over a year later and the data hasn’t entirely borne out this concern, at least according to some research. For example, a study published in Nature sought to explore how the pandemic had impacted rates of compassion fatigue, burnout, and compassion satisfaction, among a cohort of pediatric subspecialists.^[]

That said, anecdotal evidence indicates that, for some care providers, the pandemic has exacerbated compassion fatigue. One article published in The Guardian described a doctor retreating to a bathroom to cry in between patient visits. Scores of others appeared “drained from the relentless grief and trauma of the pandemic.”^[]

In an op-ed published by the Los Angeles Times in August, Anita Sircar, MD, wrote: “Compassion fatigue was setting in. For those of us who hadn’t left after the hardest year of our professional lives, even hope was now in short supply.”

But the good news is that doctors can avoid compassion fatigue with preventive strategies.

Treatment options and preventive strategies

According to the Occupational Medicine study, the fundamental tool for preventing compassion fatigue is self-compassion. Researchers recommend that physicians try to be warm and understanding toward themselves.

At the same time, it’s key to avoid being self-critical and hostile. Personal and organizational initiatives are necessary to help prepare clinicians to treat themselves with care and compassion, according to the study findings.

Optimal staffing levels, responsive supervision, and mental health monitoring are important components in fostering self-compassion.

The aforementioned Current Treatment Options in Pediatrics review notes that organizations can also help by providing staff with more autonomy and control over their workloads.

But what can doctors do? The authors of the review describe a series of techniques. The list includes things like mindfulness-based stress reduction, which involves meditation focused on the “non-judgmental attention to experiences of the present moment, including emotions, cognitions, and bodily sensations, as well as external stimuli.”

Another option is cognitive-behavioral therapy, which has been proven to help decrease the symptoms of burnout and emotional exhaustion. Improving communication skills may also help clinicians feel more connected with patients and colleagues, without draining those precious empathy reserves.

The path forward entails making self-care a part of your regular routine. As described by the American Psychological Association, this can mean blocking off as few as 5 minutes a day for a self-check-in to assess physical and psychological well-being. Adequate sleep, a healthy diet (some swear by stress-relieving vitamins and minerals), regular exercise, and time for relaxation and socialization all contribute to a vibrant self-care regimen.

It can be hard to find the balance, but you don’t have to choose between compassion fatigue and emotional withdrawal, nor do you have to take a break from your career.