Conversations on Compassion Fatigue with a Family Physician

compassion-fatigue-family-physician-conversations

Conversations on Compassion Fatigue is a series where we interview professionals from high-stress and trauma-exposed environments to discuss issues around compassion fatigue, organizational health, vicarious trauma, moral distress and self-care. 

This time, we sit down with a Family Physician to discuss her thoughts on compassion fatigue and burnout and how it shaped her practice.


 

Can you tell us a bit about your work as a Family Physician?

 

“I have been working for 24 years now as a family physician. I have a varied practice, including working in a cancer clinic and attending labour and childbirth. I’ve been at my current job for about 9 years working in a higher needs area of the city.

Many of my patients have complex mental health issues, struggle with addictions and/or living below the poverty line.

When I took over this practice from the previous doctor, many of my patients were on high doses of opioid prescriptions. I recognized that there was a need for tapering of their prescriptions – and there was a lot of resistance to this idea. This was before opioid tapering was a typical or well-known practice.” 

 

What has been your experience with compassion fatigue?

 

“In order to get buy-in from my patients to reduce their medication, I had to learn about them and understand their histories. As I was doing this and talking to patients more and more, I uncovered stories of abuse, trauma, and violence. 

I heard from many who were presently suffering from chronic pain that they had endured childhoods with a lot of adversity. Listening to story after story of child neglect, abuse and household dysfunction was intense and upsetting.

This process resulted in me experiencing a significant burn out.

I was the classic story of someone experiencing vicarious trauma and compassion fatigue. I started to break down in tears or lose my calm. When someone would ask a simple “How are you?”, I would respond by getting teary. I am usually quite a positive person who is not prone to depression, so this was a new and distressing experience. 

In order to overcome this, I looked for people who could understand what I was going through. It helped to have someone who could understand why hearing all of these stories had negatively impacted me. Speaking to those who knew about compassion fatigue was really helpful as I was able to put a name to what was going on.

I did stay at my current job and ended up going full circle with this group of patients, even though they were being tapered and initially resistant. Now these patients are a place of strength for me. Many of them coped very well with the tapering and ended up feeling better.” 

 

What did you learn from your experience with compassion fatigue?

 

“I have discovered that you can learn to care – and your patients do need to feel like you care for them in an unconditional way – but its important to have your personal limits and boundaries. There is a cost in overly empathizing with your patients and feeling as though you have to “rescue” them from their issue.

I have a term for this – compassionate disinterest. This is when a caregiver should have unconditional positive regard and acceptance of a patient in order to establish a deep empathy. However, one must also develop a level of disinterest so that there is a clear avoidance of “rescuing” the patient.

One can have deep wishes and hopes for a patient – but there has to be a confidence that the best approach for self efficacy and improved health comes when a person motivates themselves.

Over time, people will respond to your confidence in them. There is a subtle way to navigate this, and it is hard to learn – but it is very important for both the patient and the health care provider. 

In the end, getting overly invested in your patients or clients is not helpful to them or to you.”

 

What does your self-care practice look like?

 

“For my own self-care, I try to exercise regularly, eat well, get good sleep and have a sense of when I’m taking on too much stuff.

I am more aware now of when there is a”tug-of-war” that starts to happen between what I need and what my patients’ need. I try to prioritize my needs as much as theirs – believing firmly that people need to help themselves. My role is not to take over care. It should be more like a coach – supporting people to make personal improvements and then helping them take responsibility for their health and well being. 

It is a constant battle to achieve a balance – but things have been a lot easier now since I’ve fine-tuned how I connect with my patients and my family practice is a source of strength.”

 

Has your work encouraged you to do self-care?

 

“My workplace has tried to be supportive. We do have an allowance of personal days and paid vacation time.

It is a good place to work – but like many health care settings, we are doing a lot of work with limited resources which makes it often feel like an overwhelmed work setting.There is a lot to do with very little money and resources and often front line providers are feeling that stress the most.”

 

In your field, what do you think could be done to help mitigate the effects of compassion fatigue?

 

“In healthcare, we need to start thinking and talking more about the root causes of health issues. We need to work on improving housing, food security, early childhood supports etc.

I know that those are bigger issues, but we need to stop this “putting out fires” style of healthcare and instead focus on prevention of diseases and ill-health.

Another important issue that I try to teach my patients about is ACEs or Adverse Childhood Experiences. I talk to them about the effects that their early childhood experiences can have on their health and how these negative experiences can have even changed the development of one’s brain.

We know that exposure to early childhood toxic stress can affect things like your impulse control and decision making skills which will impact one’s ability to adapt to certain situations. These early childhood negative experiences predispose may you to making decisions later in life that may not be in your best interest.

This education is so important for two reasons. First of all, it helps to remove the sense of self-blame. Behaviour change can’t happen if your patient is struggling with feelings of intense self-loathing and guilt. The second reason is it allows forgiveness. Understanding the past can help patients make a plan for the future and move on.

Guilt, shame and other negative emotions lose their power when you understand where they come from.”

We need to stop this 'putting out fires' style of healthcare and instead focus on prevention. Click To Tweet

 

What do you find challenging about your work? Most rewarding?

 

“The systemic issues in the healthcare system are on-going and challenging. Managing that can be very frustrating and difficult. However, when you can find a way to gain strength from your patients and build a healthy relationship, this can fuel your energy for this work.

I am inspired daily by my patients who persist in overcoming multiple barriers to improve their health and well being. When my single mom comes to my clinic with her two children after taking two buses to get there AND she arrives on time, I’m amazed and inspired.

People have a lot of resilience if we look for it and support it. 

 

Are there any resources you would recommend?

 

Trauma and Recovery by Judith Herman

The Body keeps the Score by Bessel van der Kolk

Trauma Stewardship by Laura van Dernoot Lipsky

The Deepest Well by Nadine Burke Harris


 

 

Q&A Interview: Dr. Patricia Fisher & Meaghan Welfare

On November 9-10th, Dr. Patricia Fisher & Meaghan Welfare, BA, will be offering Manager’s Guide to Stress, Burnout & Trauma in the Workplace at the Lamplighter Inn in London, ON. Last week, I sat down with Dr. Fisher & Meaghan Welfare to ask them a few questions about this unique training opportunity for managers in trauma-exposed workplaces.

Q) Why did you decide to offer this course together?

Dr. Fisher: I am excited to offer this program with Meaghan both because of her extensive professional background in mediation and compassion fatigue and expertise in working with highly stressful, complex workplaces such as the Canadian Armed Forces, and also because of her enthusiasm, commitment and passion for the work.

Meaghan: Dr. Fisher is a trailblazer in the field of high stress and trauma exposed work places. I am thrilled to be working alongside her to offer this amazing course.

Q) What are typical issues you see manager’s encountering in trauma-exposed workplaces?

A: Many work setting with a high level of trauma exposure such as corrections, child protection services, law enforcement and health care, to name a few, are dealing with significant external pressures such as inadequate funding, escalated staffing challenges with higher staff turnover and recruitment and retention, insufficient resources, interagency complexity, difficulties maintaining a positive and collaborative work culture, generational issues and succession planning, etc. This environment of heightened stress leads to higher levels of negative effects on staff and that in turn impacts the capacity, culture and productivity of the organization at all levels. Given all this, managers typically face multiple competing demands for their time and attention, and are often highly stressed, isolated and pressured themselves. Often managers are forced to be in a reactive, crisis-driven mode where they have to attend to the fire burning highest and closest. The challenges they address are often complex, layered and their immediate crisis-responses can sometimes lead to unintended consequence – these in turn generate more challenges that they need to deal with later.

Q) What kind of management strategies will participants learn about in this course?

A) Participants will learn how to understand the complex stress environment that they work within and to assess for the specific areas of resilience and the focal areas of risk. We will help each participant learn how to increase staff resiliency and reduce stress consequences. We use a risk needs assessment tool to define the participants’ priority action areas and help them develop practical plans and strategies to preserve and amplify their strengths, and address their challenges.

Each participant will be able to re-evaluate the efficacy of their strategies and make necessary adjustments over time.

When we consider the Organizational Health Model – the 12 vital factors are all causally linked and this approach supports them to effectively address the areas of:

·        Leadership

·        Staff wellness

·        Succession planning

·        Trust and respect

·        Communication

·        Work-home balance

·        Training effectiveness

·        Vision

·        Rewards and recognition

·        Ability to adapt

·        Employee commitment and teamwork

 

All of these are central to the capacity of a group to function effectively in a healthy and productive way. With this training, participants will develop skills to help them achieve resiliency and promote these vital factors.

 

Thank you Dr. Fisher & Meaghan!

 

 

 

 

Reflections from our team members

As you may know, TEND Academy is composed of a team of highly skilled, extremely dedicated professional individuals, all of whom work full time in the helping field in addition to providing training and education sessions for our little company.

At the start of this new year, I asked the TEND Academy associates to share their reflections on the work. Here are some of their words:

From Diana Tikasz, MSW, RSW: “I love a good snowstorm.  It invites us to slow down.  If we accept the invitation, we are rewarded with inherent stillness, beauty and wonder.  It creates an opportunity to pause, reflect, and reconnect.  It can be an occasion to reset ourselves and gain perspective as we gaze at each delicate snowflake falling.  As we take a second to pause,  we create awareness, and with awareness comes choice; the choice of how we wish to experience this moment and how we will step forward through the “storm”.  I wish you all the best the season has to offer and the possibility to explore the power of a pause.”

From Rebecca Brown, MSW, RSW: “As I reflect back over this past year, I am once again humbled and in awe of the amazing people I have had the privilege to meet through our connection with Vicarious Trauma and Compassion Fatigue.  I have been honoured to be in the presence of helpers and healers from such fields as Victims’ Services, Alzheimer’s Society, Special Education Teachers, Medical Staff, Educational Assistants, Probation Officers, and Camp Counsellors for Children with Cancer.  I am left with such a feeling of hope and a better appreciation for the capacity for resilience in people.  I am inspired to continue to make our workshops relevant and impactful, and it is with a renewed focus on resilience that I am looking forward to the New Year.”

and from Lori Tomalty-Nusca, RECE, RT.

“I love to do CF training sessions. I always walk away feeling that I have learned something from the audience, as I hear about different workplaces, different ideas and different aspirations to change a small part of life to make balance and self care important (as I feel it should always be). Everyone works so hard to make the lives of our clients/families better, and often we forget to celebrate the small successes that our clients have already made, because we, the helpers helped them along their journey. I especially love it when complete strangers come up to me at the end of a presentation, often with tears in their eyes, saying that they are inspired and are committed to change aspects their lives to make work/life balance better…it really is the best gift!

Happy New Year, and to all a good balance!!!”

For more information about TEND Associates, please click here.

Making Workplace Conflict Work for You: Three Key Strategies

By Meaghan Welfare, Conflict Management Practitioner

In today’s workplace we can be certain of only three things: there will be change, there will be stress and there will be conflict. It’s inevitable. As we navigate through our work days, we are confronted with conflict on different scales: perhaps someone drank the last cup of coffee and didn’t make more, maybe someone jammed the photocopier and walked away, or maybe you are experiencing bullying and harassment. The fact of the matter is that conflict has an ubiquitous influence on our working relationships. A recent survey conducted by CPP Global found that employees spend an average of 2.8 to 3.3 hours a week dealing with conflict, (low level and un-escalated conflict) and human resource workers spend upwards of 51% of their week addressing conflicts. A 1996 study demonstrated that 42% of a manager’s time is spent on conflict-related negotiations.

So, the million dollar question…What can we do about this?  While conflict is never truly preventable, we can learn effective approaches for maximizing positive outcomes and harnessing conflict to make it work for us.

Read More

How will you navigate the changing landscape of your work?

Has your work changed?

Is there more stress and uncertainty in your job than there used to be?

 

57% of Canadians report high levels of stress

 1/3 Canadians put work first and let it interfere with family

(Duxbury & Higgins, 2012)

 

In 1991, according to the Duxbury study on work-life balance, 46% of Canadians reported being satisfied with life. In 2012, it has plummeted to 23%. As many of you know first-hand, the recent economic downturn has led to significant budgetary compressions in the public purse. As a result, many of us working in the helping fields and in the civil service have experienced massive changes: layoffs, reorganizations, job abolitions, changes in mandate, elevated conflict and a lot of uncertainty and fear of what is yet to come. Over the past ten years, I have crisscrossed the country many times to offer compassion fatigue training in nearly every province and territory. During my workshops, I get to meet with public sector employees, health care workers and other helping professionals as well as with management and human resources. Lately, I have been hearing the same words from nearly everyone I meet:  “change”,  “stress”, “conflict”, “uncertainty” and “overload”.

Is this true for you as well?

Read More

Who guards your time?

A friend of mine who works in a very busy children’s mental health centre came to work one day to find this life sized Power Ranger guarding her office. If I got the story straight, some of her staff thought she could put him in front of her door to let people know to leave her alone when she needs time to work on stuff. He is her guard. Isn’t that fantastic? Now, of course, only in Los Angeles would you be able to find a full sized action hero mannequin, right? (that’s me on the right, giving him a little squeeze, for those who have never met me).

So here is my question for you, dear reader, on this beautiful Sunday morning, before I dash off to yoga: Who guards your time? Who protects you from unwanted incursions? Do you have a clear sign (or a big red guy) that lets the world that you need to be left alone? How would I know, if I was your friend or your work colleague, that you do not want to be disturbed? Do you answer your phone at all hours of the night and day, or are you comfortable setting limits on calls, texts and emails? Can people drop in on you unannounced any time or are you clear on what works and what does not work for you?

There are ways to set boundaries where you can still be kind and warm to others. Then there are days where I just feel like wearing a t-shirt that says **** off! What are your best strategies?

A new resource: Cognitive Training Workshops for everyone

 


I wanted to share with you a wonderful new resource – a series of cognitive training workshops offered by my friend Nancy Salay. Nancy is a lecturer at Queen’s University where she teaches and does research in the Philosophy department and the School of Computing. Her area of specialization is cognitive science.

Nancy has 15+ years of experience teaching cognitive skills, both at universities and in the private sector.  She has long struggled with the problem of how to bridge the gap between theory and practice; Her new initiative, Do It Better is the result. Nancy is now offering hands-on workshops for teachers, health care workers and professionals in the corporate world.

Check our her three one day workshops:

Teachers: The Focused Classroom

Health Care: The Age-Defying Brain

Corporate: The Working Brain

Tools for private practice

Ah! I am back, after a rather unpleasant five days of fever/coughing and feeling generally really crummy. I am still sounding like a one-man band but feeling back to myself. It’s not easy for a normally high energy person like me to be sidelined for this long, but I was a good girl and got lots of rest and drank more lemon tea than you can shake a stick at. I have a bit of a backlog of resources I would like to share with you, so I’ll post them in the coming days. One of them is from Lynn Grodzki and is intended for anyone out there wanting to launch a private practice or needing more help with the marketing/financial aspects of their existing practice. Lynn is a highly accomplished therapist who has written several excellent books on the business aspects of running and maintaining a successful private practice. I recently read “Building your Ideal Private Practice: A Guide for Therapists and Other Healing Professionals” and found it was filled with invaluable information on identifying your niche clientele, establishing realistic goals and making sure you take smart, calculated risks with integrity. Lynn also writes a regular newsletter which you can subscribe to and she very generously shared all her books with me when I sent her a quick email.

The topic of launching and marketing a private practice or consulting business is a topic that my friend Robin Cameron and I enjoy tremendously. In fact, when she returns from her world travels (Robin is on a sabbatical with her family), we plan on offering more resources on this topic, likely in the Fall.