The Cost of Caring: At What Point Do Doctors Face Compassion Fatigue?
I would often feel that I was living in an altered state where I was mentally and physically tired. Sometimes I felt as if I had nothing to give. It got to the point where I would feel physically sick before the appointment and actual get nauseous. It almost felt as if I were the one that was sick – as if I felt the tightness or throbbing in the exact same spot. 
There is a cost to caring – as psychologist and therapist Charles Figley points out – commonly called compassion fatigue.
1. What is Compassion Fatigue?
The term compassion means “to suffer with” and those who find themselves as caregivers – professionally and/or personally often absorb the pain and trauma of others until they are exhausted spiritually, mentally, and physically. Clinically, compassion fatigue is referred to as the symptoms of secondary post-traumatic stress caused by caregiving. Colleen Breen, the author of Making Changes: A Guidebook for Managing Life’s Challenges, describes compassion fatigue as “soul sadness.” Patricia Smith, founder of the Compassion Fatigue Awareness Project warns that caring for others too much can hurt not matter your age or in what capacity you are providing care.
A story in March 2012 on Good Morning America highlighted a staggering number of Americans who were suffering from compassion fatigue. According to the National Alliance for Caregiving and the AARP, more than 65 million Americans, ~30 percent of the population, is currently providing care for someone who is chronically ill or disabled. These caregivers spend an average of 20 hours a week caring for the loved one.
2. Do I Have It?
The rule of thumb, according to the Compassion Fatigue Awareness Project, is that if you believe you are suffering from feelings of compassion fatigue – you have a high chance of having it. However, awareness is the key in combating the feelings of chronic stress, negative feelings, and sadness that arise both in your personal and professional life.
Recognizing the symptoms of compassion fatigue is twofold: the individual level and the workplace. Generally speaking, the highest rates of compassion fatigue arise in places of care including hospitals, clinics, hospices, and nursing homes. For the allied medical health professionals, it is important to recognize both workplace systems and those that permeate into personal life.
3. Common symptoms of Compassion Fatigue: Individual
Normal symptoms include but are not limited to (adapted from the Compassion Fatigue Awareness Project and Caregiver Action Network):
- Bottled up emotions
- Feelings of isolation
- Turning to substance abuse to alleviate feelings
- Compulsive behaviors (overeating, overspending, gambling, sexual addictions)
- Poor self-care (hygiene, appearance)
- Recurrence of flashbacks or thoughts to traumatic event
- Chronic physical manifestations such as gastrointestinal problems and commonly recurring colds
- Apathy towards activities once found pleasurable.
- Mentally and physically taxed
- In denial about problems.
- Excessive blaming (yourself, family members, friends, co-workers, or medical professionals)
- Difficulty concentrating on tasks
4. Common Symptoms of Compassion Fatigue: Workplace
In care-giving organizations recognizing and effectively managing compassion fatigue can lead to a reduction in chronic absenteeism, worker’s comp costs, and high turnover rates. An awareness that compassion fatigue can affect workers at all levels of the organization from volunteers to management can help curtail the friction that can often result among staff.
Organization symptoms include but are not limited to:
- Constantly changing coworker relationships
- High turnover rates
- High absenteeism
- Aggressive behaviors observed among staff
- Diminished productivity in meeting deadlines, completing assignments or tasks
- Lack of visions for the future
- Inability of staff to believe improvement is possible.
- Negativity towards management or administration
5. How Are Care-Providers Affected?
A 2011 study in the Online Journal of Issues in Nursing depicted two case studies regarding strategies employed to combat compassion fatigue. One of the nurses left her job due to issues with compassion fatigue, while the other sought proactive interventions to deal with her stress.
Effective strategies often include tapping into the resources provided by the healthcare organization.
- Seeking a mentor or supervisor who can help identify strategies to cope with the current workload or cases. Some examples include changing a shift assignment, encouraging attendance at professional conferences, or reducing overtime hours.
- Asking the Pastoral Care Department for spiritual guidance via memorial surfaces for patients, offering comfort to families and hospital staff, and/or providing counseling and group programs.
6. Coping Mechanisms and Self-Care Strategies
Be kind to yourself.
Care-givers often try to juggle and ultimately suppress overwhelming emotion as a coping mechanism. Often these emotions cannot be ignored and surface at the grocery store, the office, a doctor’s visit, or permeate dreams. One day you find yourself in crisis mode, where the physical, emotional, and mental are all tied up.
By educating yourself and practicing self-care strategies you can ward of crisis and effectively deal with compassion fatigue:
- Recognize symptoms of compassion fatigue with education
- Accept that other days will be better/worse than others
- Understand that those close to you may not be there when you feel you need them the most
- Surround yourself with family, friends, co-workers who can validate you
- Clarify your boundaries – professionally and personally
- Express your need verbally
- Keep a journal of strategies that work for you (meditation, joining a work-related group or activity, allotting a certain amount of time for yourself).
The importance of coping mechanisms and self-care strategies is paramount in staying on a path of mental, physical, and spiritual wellness. Reducing compassion fatigue means not fighting the symptoms but working with feelings which occur during and after the interactions with a sick patient, family member, or client. Self-care is often the most important care and something we readily forget.
 Figley, C. R. (Ed.) (1995). Compassion fatigue: Coping with secondary traumatic stress disorder in those who treat the traumatized. NY: Brunner/Mazel.
 Lombardo, B., Eyre, C., (Jan 31, 2011) “Compassion Fatigue: A Nurse’s Primer” OJIN: The Online Journal of Issues in Nursing Vol. 16, No. 1, Manuscript 3.