Is their anything physicians can do on a day-to-day basis to combat burnout?

I recommend some type of “boundary ritual” at the end of the workday. This is akin to pushing the “off” switch on the always-running “doctor programming.” Your boundary ritual is anything you do at the boundary between work and home while telling yourself, “With this action, I am coming all the way home.” For some people, it might be walking the dog, taking a shower, having a cup of tea, or simply taking a deep breath when you turn the doorknob of your home. This makes a clear internal state shift that you are no longer at work and in doctor mode.

Incorporating other types of self-care, such as yoga, running, or meditating, is very important to lower stress and facilitate recharge.


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Spending time with loved ones is an essential way of replenishing your emotional energy account. Imagine that all the people you love are standing in front of you. How many have you been in touch with lately? Your job is to connect in the next week with one of them—through email, calling to say hello, or having a cup of coffee. Make this a regular practice. When you feel you are spending an adequate amount of time with those you love, you will have more emotional energy for your patients. And make sure you focus on the loved ones you live with, like your wife and children. If you’re distracted by work, you don’t have the bandwidth to spend quality time with them, and you will more easily feel compassion fatigue.

Do you recommend specific techniques or exercises to address compassion fatigue?

In my experience, empathy exercises are counterproductive. Doctors who are burned out and trying to take on additional activities to bolster compassion and empathy find that these exercises add to their stress and burnout and quickly make everything worse. This is why you cannot consider compassion fatigue in isolation. The key is to realize that it is just one symptom of the underlying burnout.  When we focus on preventing burnout to maintain adequate levels of physical, emotional, and spiritual energy, the doctor will naturally and automatically have plenty of empathy and compassion available.

References

1.    Joinson C. Coping with compassion fatigue. Nursing.1992 Apr;22(4):116,118-9,120.

2.    Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol. 2001;52:397-422.

3.    Maslach C, Jackson SE. MBI: Human Services Survey for Medical Personnel. Available at: http://www.mindgarden.com/315-mbi-human-services-survey-medical-personnel. Accessed: January 1, 2018.

4.    Sinsky C, Colligan L, Li L, et al. Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties. Ann Intern Med. 2016 Dec 6;165(11):753-760.