Physician Health & Wellbeing — COVID-19 and Beyond
The Cost of Compassion in Healthcare Professionals There is a cost to caring too much. Compassion — like a taken-for-granted, worn Achilles’ tendon pulled too taut — may rupture and wound. We physicians, within these bodies, also can fall to the ground; how long we stay there may depend on how stubbornly we resist admitting that we own an Achilles at all. “Compassion fatigue” is a very real problem for healthcare professionals. In a recent Healthcare Professionals and
Professionals who are repeatedly exposed to the traumatic experiences and narratives of their patients, and who have a desire to alleviate that suffering, are at especially high risk of compassion fatigue. This includes physicians but also psychologists, oncologists, pediatric clinicians, HIV/AIDs care workers, emergency medical responders and others, with nurses being the most notably affected due to the overtly
While burnout is an insidious process that is often the result of a challenging work environment, compassion fatigue results from doing the work itself. Compassion Fatigue Research Update, the Hazelden Betty Ford Foundation’s Butler Center for Research distinguishes the condition from burnout, describing it as an acute onset of the following symptoms: exhaustion, apathy, irritability, negative reactivity, diminished sense of purpose, hopelessness, and an inability to maintain objectivity.1 While burnout is an insidious process that is often the result of a challenging work environment, compassion fatigue results from doing the work itself.
By Kristen A. Schmidt, MD
24
Winter 2021
caring nature of their job.1 In 2019, one study demonstrated that 86% of nursing respondents reported high levels of compassion fatigue.2 In the age of COVID-19, compassion is a precious commodity. Since its existence is invariably linked with the material ability to extend help, the dearth of hospital and community resources available makes caring for patients in a pandemic landscape especially challenging. In her essay entitled, “Regarding the Pain of Others,” Susan Sontag suggests, “It is because a war, any war, doesn’t seem as if it can be stopped that people become less responsive to
the horrors. Compassion is an unstable emotion. It needs to be translated into action or it withers.”3 The pandemic’s uncertain terminus has the potential to anesthetize providers; callouses may form where compassion was born. Such a shift away from our ability to experience compassion would, according to positive-emotion proponents, be unnatural. Humans release dopamine, oxytocin, opioids, and other soothing biological chemicals when helping someone in need.4 Compassion has therefore been assumed to exist as an evolutionary advantage with recurrent reinforcement through neurohormonal feedback. With the advent of COVID-19, however, self-protection and care for others are placed in uncomfortably close proximity. Compassion fatigue has bloomed in the cracks of contradiction, since healthcare professionals are continually asked and encouraged to go to work, while others remain isolated at home to keep their own families safe. Symptoms of anxiety, fear, irritability, and distress have been the result.1 Because it implies a limit in our capacity to care for patients, talking about compassion fatigue feels taboo. Accepting or admitting vulnerability is seen as a sign of weakness for many healthcare providers. In one study, acknowledging compassion fatigue was synonymous with shame.5 In an effort to manage symptoms privately, physicians may resort to substance use and develop a co-occurring disorder. A study evaluating compassion fatigue in general
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The Journal of the Twin Cities Medical Society
