GOT COMPASSION FATIGUE? DOC, YOU’RE HEADING FOR BURNOUT

I’ve noticed a concerning trend amongst my hospital registrar colleagues lately. Put them together after-hours, and there’ll be callous, cynical sniping at anyone within their firing range – patients, nurses, and other colleagues.  I know for a fact they are caring, compassionate people. I also know they’re under-supported, over-worked and emotionally exhausted. And I worry they’re burning out.

A little black humour never fails to blow off steam, and it can be a healthy way to acknowledge and relieve some of the emotional burden carried by the caring professions. But at what point does it become unhealthy, and would you recognise it?

Empathy Fail (unable to credit this gem - found it on a twitter feed with no artist reference)

(unable to credit this gem – shared on Twitter with no artist reference)

 Try my BURNOUT QUIZ

  • Are you often negative, cynical or sarcastic about your patients and colleagues?
  • Do you feel like your patients or colleagues are deliberately trying to drive you crazy these days?
  • Do you expend all your energy just surviving the work day, and crash when you get home?
  • Do you dread going to work, or seeing certain patients?
  • Do you feel like you’re not in control, and you’re at the mercy of everyone else’s needs and urgency?
  • Do you suppress your emotions because you don’t have any energy left to deal with your own problems?
  • Are you racing through slap-dash consults with poor notes, OR constantly running late as the day unravels on you?
  • Are you shirking responsibility and leaving your work for others, OR micro-managing and having difficulty handing over the reins?

 If you’re ticking the boxes, you might be burning out.

Interestingly, a Danish study found gender differences in burn-out behaviours for male and female doctors. Men could be completely burnt-out, with serious detachment and cynicism, but still work like an automaton while their personal lives hit rock-bottom. Women on the other hand, would hit emotional exhaustion first, begin to doubt their abilities, feel they weren’t making a difference and lose professional self-esteem.

I’m in General Practice, I left the hospital system because I wasn’t built for that environment and I would most certainly burn out. Plus, I love General Practice – a happy solution for all! But in GP-Land, I deal in people’s daily lives – in the disillusioned, the miserable, and the lonely.  I see the unable-to-copes, the end-of-tethers, and the straw-broken-camels. And when I start to see this in my colleagues, I’m reminded that medicine can be a very, very unhealthy profession, for a combination of factors:

1.    Personality traits: Type-A, Perfectionists and Over-Achievers

You’d probably like your doctor to be all of the above, if you were a patient. But it means they’re a workaholic, who strives to compete and achieve, and is always convinced they’re not quite good enough. Medical schools and specialist training colleges breed competition, one-upmanship and professional insecurity – and bad habits can last a lifetime. Plus, it means they have a REALLY hard time admitting they’re having a really hard time.

2.    Higher Risk and Responsibilities

If the average person makes a mistake at work, the repercussions might be financial – you might lose a sale. If a doctor makes a simple mistake, they might kill someone. Or wreck a life. A contentious doctor has this constantly at back of their mind, every working day. It’s a sobering thought.

3.    Bureaucracy and Limited Resources 

In the public system, there are never enough staff, hours, appointments, beds or programs to provide ‘optimum care’. So there’s a constant pressure on doctors to make judgement calls about how to best utilise limited resources – and arguments from every player involved that their request or demand is the most important. In private practice, this includes the financial and logistic issues involved in running a medical business.

4.    Shift Work and Long Hours

Shift work has been proven to kill you (1,2) and that’s no surprise. But in no other professions are 16-24hr shifts by sleep-deprived workers considered a safe or viable option! They’re inflicted on doctors, because ‘that’s the way things have always been done’, and doctors are considered conscientious and clever enough to ‘withstand’ such unsafe practice. It will probably take many fatal errors with Coroner’s recommendations before the public forces the government to employ more doctors and outlaw unsafe hours.

5.    The Emotional Burden

Doctors and nurses are exposed to trauma, heart-ache, pain, anguish and confronting stories on a daily basis.  We don’t just read about these things – we talk to, counsel and comfort these people.  We have to tell someone they’ve miscarried, or they have cancer. We have to treat angry, grumpy  and manipulative patients to the best of our abilities, despite their behaviour towards us. The emotional toll can be crippling, so you learn to detach.

6.    Learnt Ability to Detach

It’s a survival skill in the caring professions to detach from other people’s suffering, lest you suffer with them. But you can become too good at it – especially if it you start detaching from your own emotions to simply get through the day. Or if you depersonalize patients – allowing cynicism or callousness in your work. Your emotionless detachment can become a habit outside work –  as many a burnt-out doctor’s divorced partner would attest.

So what’s the solution?

  • Demand a culture change in medicine – Gen Y and the growing proportion of female medical graduate (54% at last count), are going to push for a paradigm shift in medicine over the next 10-20 years, one that values a work-life-balance and is kinder to families.
  • Don’t obstruct them, to appease hospital management and budgets, or because you think ‘they should slog it out like I had to.’ Work with them, and advocate for a better, healthier profession for everyone involved. Patients don’t win with burnt-out doctors either.
  • Don’t lose touch with reality – constantly evaluate your work experience against what a ‘normal’ work experience should be, and make changes where you can – would working 4 days a week mean you’re not going to burn out in the long run?
  • Learn your limits – and know when to take time off. There’s no need to race to the finish line in training, and if it takes an extra year but you’re sane, that’s a damn good trade.
  • Don’t heal thyself – seek help if you need it. Have your own good GP, and check in with them if you’re not coping – sometimes just admitting you’re struggling to someone can lift a weight from your shoulders and help you find practical solutions.
  • Watch out for your colleagues, and check-in with them if they’re exhibiting the burnout list symptoms above.

For more excellent advice, see www.thehappyMD.com. And look out for yourselves!

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