Who’s Caring for our Caregivers? Burnout and Compassion Fatigue in the Medical Field

This past weekend, I completed the Medical College Admissions Test (MCAT). To prepare for this eight hour monster of an exam, I devoted several hours each day for several months to put myself in a position to be successful. Throughout my college career, I have been warned frequently by many people about burning out. While burnout is observed in college students, the term was coined originally to refer to emotional exhaustion experienced by workers in the public services (reviewed in Kumar, 2016). As a pre-med student who aspires to one day become a physician, it is easy to focus on all of the positive aspects of a career in medicine. However, this blog post intends to take a deep dive into the life of a physician to study the not so glamorous aspects of being a doctor.


Image from Health eCareers

Physicians are exposed to extremely high levels of stress each and every day. Doctors work with patients each day and must cope with the grief of losing a patient, the frustration in caring for people who are beyond saving, and a sense of failure when a patient has a bad outcome. This chronic stress leaves doctors at an increased risk of mental health disorders like depression and anxiety, substance abuse, suicidal thoughts, and general impairments in work performance (reviewed in Kumar, 2016).  Additionally, doctors are at a heightened risk of burnout. A recent study conducted in the United States found that nearly 50% of doctors report at least one symptom of burnout. The symptoms of burnout include emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment (Kumar, 2016). Experiencing burnout not only impairs a doctor’s ability to help their patients, it has a direct negative impact on the emotional and physical well-being of doctors everywhere.

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Figure 1. A model for Compassion Fatigue (Cocker & Joss, 2016).

In addition to burnout, many physicians and health care providers struggle with compassion fatigue. Compassion fatigue is not as clearly defined as burnout (Najjar et al., 2009), but is a term that describes a type of stress that results from exposure to an individual who has experienced serious trauma (Cocker & Joss, 2016).  Compassion fatigue is marked by anger and irritability, exhaustion, and the reduced ability to feel sympathy and empathy. There is overlap with burnout, as many health care providers also employ negative coping behaviors such as alcohol or drug use, have a difficult time making decisions and caring for patients and clients (Cocker & Joss, 2016). Some of the individuals who are at a greater risk for compassion fatigue include physicians, nurses, social workers, and disability sector workers. There have been few studies exploring compassion fatigue in emergency and community service workers, though it is likely that these individuals also experience this type of fatigue (Cocker & Joss, 2016).

Image taken from The Suburban Times

Despite the similarities between these two phenomena, there is a discrete difference between the two. Burnout results more from the stresses a doctor experiences due to interactions with his or her environment, while compassion fatigue stems from the actual relationship between the clinician and physician (Gallagher, 2013).

Burnout and compassion fatigue can significantly impact the mental and physical health of physicians and other health care providers. Physicians might be able to protect against burnout by participating in a variety of intervention programs. Interventions like mindfulness-based programs, group, and individual therapy sessions including cognitive behavioral training, relaxation, and other multi-component programs have been studied, but the number of studies is small and the effects are not robust (Kumar, 2016).

Similarly, yoga, mindfulness, structured meditation, and music therapy have been explored as options for helping healthcare providers cope with compassion fatigue. However, much like the research concerning physician burnout, studies are limited in sample size, generalizability, and show small, mixed effects (Cocker & Joss, 2016).  It seems ironic that the people that take care of us and protect our health are hurting their own health in the process of doing their jobs. Going forward, future research is needed to develop concrete treatment plans to prevent, and treat, burnout and compassion fatigue in populations of caregivers in the United States and globally.

References

Cocker F, Joss N. Compassion Fatigue among Healthcare, Emergency and Community Service Workers: A Systematic Review. Int J Environ Res Public Health. 2016;13(6):618. Published 2016 Jun 22. doi:10.3390/ijerph13060618

Gallagher R. Compassion fatigue. Can Fam Physician. 2013;59(3):265–268.

Kumar S. Burnout and Doctors: Prevalence, Prevention and Intervention. Healthcare (Basel). 2016;4(3):37. Published 2016 Jun 30. doi:10.3390/healthcare4030037

Najjar N, Davis LW, Beck-Coon K, Carney Doebbeling. (2009). Compassion fatigue: a review of the research to date and relevance to cancer-care providers. J Health Psychol. 2009 Mar;14(2):267-77. doi: 10.1177/1359105308100211.


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