The term “compassion fatigue” was originally coined by Joinson,1 a nurse researching burnout in the emergency department. It is now understood to affect workers across the spectrum of helping professions, and to be extremely prevalent among physicians.
To shed light on this common and debilitating condition, MPR interviewed Dike Drummond, MD, Executive Coach and CEO of The Happy MD, an organization focused on physician burnout prevention and leadership.
How does compassion fatigue develop?
Many circumstances converge to create the phenomenon referred to as “compassion fatigue.” These include the actual demands of the job, the incessant exposure to pain and suffering, the sense of responsibility for the health and lives of others, and the high volume, high stress working environment in many healthcare organizations. However, I think it is important to note that “compassion fatigue” is part of a larger picture and cannot be looked at in isolation.
What is the larger context in which compassion fatigue develops and plays out?
Compassion fatigue cannot be taken out of the larger context of burnout. In fact, it is the second symptom of burnout. According to the Maslach Burnout Inventory,2,3 which is the gold standard for measuring burnout, there are three components of burnout. The first is physical exhaustion. The physician wonders, “How much longer can I keep going like this?” The second is depersonalization. Physicians find themselves becoming cynical and sarcastic toward patients. The third is a sense of lack of efficacy. “What’s the use? My work is no longer serving any purpose.”
Do you think that compassion fatigue is becoming more prevalent or getting worse?
Burnout and compassion fatigue are not new. Constant exposure to suffering and pain has always taken a toll upon people dedicated to relieving suffering and pain.
But certain aspects of burnout have worsened in recent decades.
The EMR is a major cause of stress that did not exist 20 or 30 years ago. EMRs were not designed by doctors and the user interface is brutal. One recent study showed that, on average, physicians spend two hours documenting for every hour spent in patient face-to-face contact.4 Back in the days of paper charts, no one ever spent that much time documenting. You either wrote notes by hand or you dictated them. And the advent of patient portals, e-mails, and texts means a large number of additional steps of dealing with patients during the course of the day. We returned patient calls back in the day, but didn’t have to deal with EMR, email, text and patient portals like today’s physicians do.