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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
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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. 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
practitioners found that approximately 15% of them had turned to alcohol, prescription drugs, or both to help them cope with work demands.6 Similarly, nurses have also demonstrated difficulty accessing positive coping patterns to combat clinical stress. One recent investigation highlighted the frequent use of cigarettes, sleeping pills, and power drinks among those nurses reporting significantly higher compassion fatigue scores than those who did not.7 In a culture comprised of healing warriors, how do we better address our wounded? Some organizations have adopted programs educating healthcare professionals on symptoms of compassion fatigue. Others have targeted coping strategies. One such program, lasting five weeks with five 90-minute sessions on resiliency, was found to ameliorate symptoms of distress in its healthcare staff.8 Mindful-Based Stress Reduction Training (MBSRT) and Compassion Cultivation Training (CCT) have also been popping up in healthcare organizations.9 With administrative support for clinical schedule allowance, such trainings may result in positive outcomes for physicians. These outcomes may include improved empathy, professional quality of life and self-compassion. I encourage healthcare providers to also monitor themselves for the symptoms mentioned earlier, establish go-to relaxation techniques, build a positive support system, make time to tend to physical wellness, and ask for help whenever needed. Individual therapists can help, and if substance use becomes a problematic coping mechanism, please know you are not alone and that places like the Hazelden Betty Ford Foundation can help. Self-compassion is a paradoxical concept and one that eludes most of us in the early stages of our doctoral development. What we understand is self-sacrifice. As someday-to-be psychiatrists, surgeons, pediatricians, and pathologists, we receive scrubs and a scalpel, place our sameness on a shelf, and begin to dissect what is human with our hands. It is the first in a series of us splitting from our mortal shapes in the hopes of becoming even better healers. In a context of formaldehyde and fortitude, it is our compassionate intentions that distinguish us from deviants. In time, our bladders learn to expand for the sake of the child’s surgery, our circadian rhythms tune to the beat of the trauma pager, and we always return to our scheduled rotation the morning after. To say that we are tired seems a sin and sine qua non. And still, we are human. We are human. As an addiction psychiatrist, and practicing human, allow me to simply suggest: accepting help from another healer may be your most heroic act yet.
Kristen A. Schmidt, MD, is board certified in addiction psychiatry and practices as Lead Psychiatrist at the Hazelden Betty Ford Foundation in Center City and St. Paul, Minnesota.
References: 1. Butler Center for Research. (2021). Research
Update. https://www.hazeldenbettyford.
org/education/bcr/addiction-research/healthcare-professionals-compassion-fatigue. 2. Sullivan, C. E., King, AR., Holdiness, J., Durrell,
J., Roberts, K. K., … Mandrell, B. N. (2019). Reducing compassion fatigue in inpatient pediatric oncology nurses. Oncology Nursing Forum, 46(3), 338–347. doi:10.1188/19.ONF.338-347. 3. Sontag S. (2003). Regarding the Pain of Others.
Picador Modern Classics: 129. 4. Vaillant G. (2008). Spiritual Evolution a Scientific Defense of Faith. Broadway Books, 198. 5. Selamu, M., Thornicroft, G., Fekadu, A., & Hanlon, C. (2017). Conceptualisation of job-related wellbeing, stress and burnout among healthcare workers in rural Ethiopia: A qualitative study. BMC Health Services Research, 17(1), 412. doi:10.1186/s12913-017-2370-5. 6. Kaffash, J. (2017). Revealed: One in seven
GPs turns to alcohol and drugs to cope.
Pulse. pulsetoday.co.uk/news/clinical-areas/ mental-health-andaddiction/revealed-one-inseven-gps-turns-to-alcohol-and-drugs-tocope/ 7. Jarrad, R., Hammad, S., Shawashi, T., &
Mahmoud, N. (2018). Compassion fatigue and substance use among nurses. Annals of
General Psychiatry, 17(1), 1–8. doi:10.1186/ s12991-018-0183-5. 8. Rajeswari, H., Sreelekha, B., Nappinai, S.,
Subrahmanyam, U., & Rajeswari, V. (2020).
Impact of accelerated recovery program on compassion fatigue among nurses in South
India. Iranian Journal of Nursing and Midwifery Research, 25(3), 249–253. doi:10.4103/ijnmr. ijnmr_218_19. 9. Sansó, N., Galiana, L., González, B., Sarmentero, J., Reynes, M., Oliver, A., & Garcia-Toro, M. (2019). Differential effects of two contemplative practicebased programs for health care professionals. Psychosocial Intervention, 28(3), 131–138. doi:10.5093/pi2019a12.
