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Hospitalists Beware Detrimental Effects of Compassion Fatigue


Sometimes those in helping roles could use some help, too. Caring for people who are suffering can cause a form of burnout known as “compassion fatigue.” After a while, it’s quite possible to become disillusioned and numb.

“Hospitalists can be affected as easily as any other physician in the hospital setting,” says Patricia Smith, founder of the Compassion Fatigue Awareness Project, the educational arm of Healthy Caregiving LLC in Mountain View, Calif. “This can be due to long hours, overload of patients, new procedures, and processes that are mandatory in healthcare reform, issues among hospital colleagues, poor leadership, and the types of violence and trauma they are experiencing, especially if a hospitalist is in the ED as a first responder.”

Compassion fatigue is a traumatic stress disorder marked by such symptoms as isolation, emotional outbursts, exaggerated sense of responsibility, chronic overeating, alcohol or drug abuse, recurring nightmares or flashbacks, sadness or apathy, and persistent physical ailments.

When signs of compassion fatigue appear to overwhelm a colleague, offer a shoulder to lean on and accept the legitimacy of the individual’s feelings. Health professionals often are “not valued for the caregiving work we do, and we are not validated for who we are,” Smith says. “To provide this level of support to each other is the best thing we can do.”

Healthcare workers who succumb to compassion fatigue often experience too much empathy and perform their jobs with unwavering devotion.

Self-neglect is common and makes them more susceptible to compassion fatigue, says Dennis Portnoy, a licensed psychotherapist in San Francisco and author of “Overextended and Undernourished: A Self-Care Guide for People in Helping Roles.”

Hospital-based educational sessions on compassion fatigue can be beneficial. “Helpers are often predisposed to being more attentive to the needs of others than they are at caring for their own needs,” he says. “Many helpers understand the importance of self-care intellectually, but this knowledge doesn’t lead to taking better care of themselves.”

Hospitalists might be reluctant to seek emotional support from colleagues, family, and friends. Support is essential in the prevention of and recovery from compassion fatigue. It’s also important to establish firm boundaries, Portnoy says. He suggests providers cultivate a healthy detachment from traumatic events while being empathetically engaged with people in distress.

To allow for detachment, job duties ideally should consist of more than direct patient care, says Katherine C. Chretien, MD, FACP, chief of the hospitalist section and clerkship director at Washington, D.C.’s Veterans Affairs Medical Center. As one of seven hospitalists in the group, she avoids scheduling anyone for longer than two consecutive weeks of attending on wards.

“At the end of one of those blocks, I am emotionally exhausted and need a break from that,” Dr. Chretien says. That’s when physicians should spend time on administrative and research tasks or quality improvement (QI) projects before resuming patient care.

Striking a balance between work and leisure also promotes resilience. “We have to care for ourselves first in order to care for others,” says Dr. Chretien, 38, founder and editor of the Mothers in Medicine blog, launched in 2008. She’s married to a physician, and they have three children, ages, 7, 5, and 2.

Listen to Dr. Chretien discuss the importance of fair schedules, work-life balance, and support systems

Dr. Chretien, who is an associate professor of medicine at George Washington University, recommends that hospitalists open up about their experiences—both good and bad—with peers. “We have regular meetings where we have an agenda to talk about our division issues,” she says. “But also, it’s an open forum to share whatever is on your mind.”

Despite the difficult challenges that arise, “there are moments when you’re so glad you’re a physician,” Dr. Chretien says. “You see the humanity in what we do.” TH

Susan Kreimer is a freelance writer in New York.

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