Compassion fatigue is an early warning sign of physician burnout

For anyone in the helping professions, compassion fatigue is a common occurrence and a clear signal to take better care of your own needs.

Compassion fatigue is when you find yourself challenged to care about your patients in the way you know is proper and expected in your position. One of the key components of quality healthcare is the ability for you to connect with your patients and for them to sense that connection. Compassion fatigue cuts you off from the people who need you the most, and it extends well beyond just your patients.

Cynicism, sarcasm and feeling put upon are the first signs

If you find yourself being cynical or sarcastic about your patients you have compassion fatigue. It can come in the little voice in your head, or mumbling under your breath or “venting” to your colleagues or staff.

If you find yourself feeling like your patients / staff / institution are deliberately trying to wear you out or drive you crazy – you have compassion fatigue.

Your emotional bank account is empty

Being a doctor or other helping professional is the perfect compassion fatigue formula. Caring for others with difficult, often chronic illnesses is a draining emotional experience. Think of yourself as having an emotional bank account. You simply can’t get to the end of an office day with the same amount of emotional energy in your account as when you started. Your job is draining, even on a good day.

It is up to you to recharge your emotional bank account on your own time. That’s where the double whammy hits.

At the same time your job is draining, you have been conditioned throughout your medical training that  your needs come last.

For many of the doctors I work with, they find it very difficult to know how they might recharge themselves. Their needs have not been on their radar for years, even decades.

It’s like the oxygen masks on an airplane – you have to put your mask on first

The key to avoiding compassion fatigue is taking care of your own emotional needs first. You can’t give what you don’t have. You can’t get water from a stone. If your emotional needs are not being met, you can’t be there emotionally for your patients when they  need you the most. And no one teaches you how to get your own emotional needs met in medical school or residency. It’s every doctor for themselves.

Here’s the unspoken tragedy

If you can’t be emotionally present for your patients because of compassion fatigue … you can’t be there for your spouse, significant other, children or friends either. Everyone loses when you allow yourself to be tapped out at work. And this is just the start of a slippery slope.

Compassion fatigue is one of the three signs of physician burnout along with physical exhaustion and a sense that your work doesn’t make any real difference.

Compassion fatigue is a sign you are not getting your needs met. Your emotional bank account is tapped out. There’s nothing left. You are running on empty and cynicism and sarcasm are simply defense mechanisms when your back is against the wall.

Time for some exquisite self care

I imagine you have not taken enough time for yourself or the most important people in your life lately. Your emotional bank account may be even worse than empty … you may be overdrawn and in a major negative balance. Here’s are a few keys to address this urgently.

Do a great job with every patient you see and,

  • Cut your work hours back to minimum
  • Only chart what is necessary, stop worrying about complete sentences and punctuation
  • Strongly consider some time off
  • Take care of your needs first (remember the oxygen mask)
  • Get some rest
  • Get some exercise
  • Do something fun you have put off in a while
  • Spend some quality time with your significant other and children

Make recharging a part of your normal life

These non-work activities are key to keeping your emotional bank account full and to you being the best you can be. Be sure to schedule these recharging activities into your life every month from now on.

  • Choose your rechargers
  • Schedule them
  • Do them
  • Celebrate them

Begin to treat these recharging activities as equally important to your call schedule. Don’t skip or scrimp because these things don’t feel as important to you as taking care of other people’s needs. That’s just your training and conditioning talking.  It’s what got you to this point of compassion fatigue in the first place.

Remember the oxygen mask and get your needs taken care of first. Take exquisite care of yourself as the foundation for taking care of others. This is the only way you can be emotionally available for your patients and your family and avoid even deeper levels of burnout.

Dike Drummond is a family physician and provides burnout prevention and treatment services for healthcare professionals at his site, The Happy MD.

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  • Deep Ramachandran

    Thanks for bringing this issue to light, it’s an important issue. As you say, I too have observed that compassion is a tank that has to be replenished, or it goes empty. You make important points on a subject that we do not speak enough about, and offer some good pointers for reducing the problem.
    However I must also say that I would be surprised if most full time physicians, particularly those that work in the inpatient setting did not have these feelings on a weekly basis.
    As such, I would think of compassion fatigue in the same way I think of as actual fatigue due to sleep deprivation. That is, it’s part of the job, and it needs to be managed appropriately, as do many other aspects of physicians lives. While the presence of compassion fatigue should be acknowledged and dealth with, its mere presence is no more a sign of burn out as thirst is a sign of dehydration.  

    • Dike Drummond MD

       Thank you for your comment Deep,

      And thirst IS a sign of dehydration. It is an early warning sign. If you ignore it and do not replenish yourself by drinking what happens? If you keep ignoring it, day after day?

      This is the challenge for physicians. We are conditioned to put everyone else’s needs first – pathologically so. We are also conditioned to be workaholic, even to the point of ignoring our own physical needs. This sets up the current statistics on burnout. Here they are. On average, 1/3 of doctors are suffering from burnout every single day worldwide, regardless of specialty. Some surveys show burnout rates above 70% !

      This is a consistent pattern over the last 20 years AND I suspect the numbers are getting slowly worse in the US with the chaos of the changing EMR and political environments.

      We each have three bank accounts to keep in a positive balance.
      Spiritual (your Purpose)

      “The system” and your organization are not going to help you recharge yourself between office days. You were never taught how to do so in your training. And – despite your conditioning – these activities are as important as anything else you do in your week.

      Keep breathing,

      Dike Drummond MD

  • Sue Wintz

    This is an excellent post, thank you.  It is something that I see every day in my work as a chaplain.  Professional
    chaplains provide expert care not only to patients, but are an essential source
    of support for compassion-fatigued physicians and staff.  Their expertise
    can assist in identifying immediate and longer-term resources to cope with the
    challenges faced by health care providers.  While I have always had strong relationships with physicians and have been able to provide support to their expressions of compassion fatigue, many physicians and health care organizations overlook the benefit that professional chaplains bring.  I would encourage physicians to learn more about what we as chaplains can provide and utlize us as resources not only personally but in providing rounds and education to address the issue.

    • Dike Drummond MD

       Thanks for your comment Sue,

      I agree 100 percent. I think of burnout as being an exhaustion of three separate “bank accounts”
      Physical, Emotional and Spiritual. I see your work as supporting the physicians and their patients in the emotional and spiritual realm. You can work as a team for the patients and you can minister to the emotional and spiritual needs of the physician too.

      Keep up the great work,

      Dike Drummond MD

  • Molly Ciliberti

    I wished that I had read this when I was burning out from 15 years working ICU/CCU. I quit before I couldn’t emphasize with my patients but the nightmares and the sense of failure was quite overwhelming. This post is equally valuable to critical care nurses, oncology nurses and other nurses who deal with dying patients especially.

    • Dike Drummond MD

       Thank you for your comment Molly,

      It is important to realize that ALL of the helping professions suffer from burnout that is heralded by compassion fatigue. Doctors, Nurses, Counselors, Social Workers, Law Enforcement, the Military, Teachers … and many, many more.

      When you find yourself being sarcastic, cynical, feeling put upon by the very people you are meant to serve … that is compassion fatigue.  It can be very uncomfortable when you catch yourself unable to empathize. You are OK. It is a defense mechanism because you emotional bank account is overdrawn. This is a sign that it is time for some exquisite self care.

      Dike Drummond MD

  • James

    I appreciate the compassion you are showing us, your colleagues. I believe what the Dalai Lama says, Compassion is the natural state of being and exists in unlimited quantity. I do believe that physicians have the potential to suffer from empathy fatigue. Perhaps this is only semantics but for me makes a difference as I am always comforted to know that compassion has no limit and I only need to connect with my unlimited well of compassion as I bear witness to suffering.

    • Dike Drummond MD

       Thanks for the comment James. Your statement that physicians have the “potential to suffer from empathy fatigue” is incorrect in my experience. ALL helping professionals – doctors, nurses, therapists, fire fighters, police and others – will suffer from empathy fatigue at some point in their career. For some it will become their normal way of being.

      AND at the same time … there is a place (out beyond right and wrong) where we each can find that bottomless well of compassion. We just never learn that in our training. It is every person for themselves when it comes to the self care that works for you to keep your channel to that source open. That is part of what I teach my clients.

      Dike Drummond MD

  • houriganterry


    I have forwarded your thoughts to people I
    Hope will absorb them and take some actions.

    Lucky for me, I have avoided this barrier in the past
    year because of a colon ca DX. Believe it or not,
    life is much better now: I can see around one blind
    corner (of hundreds we know about but never experience)
    and it has changed everything: relations with my pts and
    former enemies, estranged family members, name it.
    With the exception of stressful unnecessary old
    relationships I’ve dropped, every other new or old
    one is better than I knew I could have. I’m baffled
    by this but grateful for it.

    Could you send an email so I can send you some
    short pieces? You will find them of value if you haven’t
    read them.

    Thank you for putting it in writing,

    Terry Hourigan

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