The myth of compassion fatigue

Here is a challenge: Review the schedule of patients you have seen today. As you recall each patient, ask yourself this question: Did I genuinely feel compassion towards my patient in that encounter?

I will be brutally honest with you (and myself). For me, on many days, that figure is maybe, at best, about 5 percent.

It’s tough. We are running 30 minutes late. Three irritated waiting room patients yearn for our presence. Our inbox has 13 secure messages, 12 refills, seven staff messages, three handicapped parking requests, two jury excuse letters, and four demands for off-work slips. And, of course, we get monitored and graded on how efficiently we handle all this. The daily hustle can be overwhelming. And then we must leave the clinic in time to pick up our kids in daycare before the late fee kicks in. We worry about whether we’ll be home for dinner or whether the family will eat without us … again. So, do we feel genuine compassion when our patients come to us with run-of-the-mill, mundane complaints like low back pain, tension headaches, or nighttime coughs in those encounters? As for myself, most of the time, I confess I do not.

We often explain and excuse this by pleading compassion fatigue. I take this to mean that we give so much compassion daily that we are tapped out. We no longer have any more compassion to give. Our compassion tank is drained. I disagree. Compassion fatigue is a myth. We don’t give too much compassion. We are so overwhelmed with the daily doctor hustle that we don’t have the time or inclination to give much compassion in the first place. To anyone. It’s not compassion fatigue. It’s physician workload fatigue. It’s “Lucy in the Chocolate Factory” fatigue! Like Lucy in the Chocolate Factory, our minds are focused on not much else but the next batch of electronic medical data products rolling down the health care assembly line.

So, how do we bring genuine caring to our patients? How can we express compassion even on those “Lucy in the Chocolate Factory” days? How can we raise our compassion meter from 5 percent to 50 percent or even to 95 percent as we struggle with the “physician inbox fatigue” syndrome?

I know the answer. The answer is simple. Yet, it is not so simple. It takes one crucial flip of the mind switch. I bet most of you already know what I’m talking about. I bet most of you already know the answer. I knew it too. But recently, a young woman rekindled my appreciation of this profound truth. Christina works in our hospital member assistance program (read “complaint department”). I asked her how she dealt with all the angry patients who often lashed out at her personally, frustrated, for example, by their long waits in the physician exam room, the nightmare search for a clinic parking spot, and the endless delay of the doctor’s office return phone call.

Christina responded to my question with a simple but potentially life-changing answer. I don’t think there is any more important wisdom in the physician-patient communication realm than the words I heard her speak next.

“I put myself,” said Christina, “in their shoes.”

“I try to imagine myself,” continued Christina, “waiting an hour for the doctor in the waiting room, knowing I’m late to pick up my daughter in daycare.”

I think of myself spending 25 frazzled minutes finding parking.

I think of myself waiting anxiously at home for the doctor’s phone call, worried sick about my child’s health.

I put myself in their shoes.

Yes, sometimes our patients can be tough,” continued Christina, “but I love my job.”

So, if, like Christina, we can walk in our patient’s shoes, then perhaps, we too may feel more compassion for those folks with a cough that robs sleep or for those whose backache keeps them from playing catch with their son or for those who lie awake at night wondering if the tension headache will burst from an aneurysm.

If we try to walk in our patient’s shoes,
Perhaps then, we too will be able to feel more compassion,
Perhaps we too may have more love for our job.
And perhaps we too may find in our daily work lives more joy and meaning.

And while I will sing Amen to this choir,
I know I am a sinner.
I know I will struggle even today, trying to walk in the shoes of my afternoon’s fifth worried well, nonspecific, dizzy patient.

But if you, my physician brothers and sisters, looked back on your schedule today and found yourself regularly walking in your patient’s shoes, then God bless you.

I wish I could.
But I’ll still try.
Every day.
Every patient.

Scott Abramson practiced neurology with Kaiser Permanente Northern California for over 40 years, from 1979 to 2020. Throughout those years, Dr. Abramson was passionately involved in physician communication and physician wellness endeavors. Some of his insights and stories from his experiences in these endeavors can be found in video format on his YouTube website channel: Doctor Wisdom.

Others are available in his recently published book, titled Bedside Manners, for Physicians and Everybody Else. What they don’t teach in medical school or any other school.

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