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.”
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