The price of care

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Working in the healthcare sector can be draining, particularly when it feels like you’re getting nowhere fast with patients looking for an instant fix. But the natural consequence, compassion fatigue, can lead to burnout if it’s not properly managed. By Amanda Lohan

fatigue_webDoctor Jillian Benson is a medical GP working in some pretty challenging environments. Among other roles, she currently works with newly arrived refugees at the Migrant Health Service, and with remote Aboriginal communities through the Kakarrara Wilurrara Health Alliance. Benson has been part of the team organising a World Health Organization-sponsored mental health program for nurses working in Vanuatu, and is active in Doctors’ Health South Australia.

It’s a tough job, but somebody has to do it, and Dr Benson has learned that self-care is a vital piece of the puzzle. “I work in some difficult areas so I obviously need to make sure I look after myself,” she says. “I also work in doctors’ health so I’m interested in helping other people look after themselves.” Consequently,
Dr Benson has undertaken considerable academic work in the areas of vicarious trauma, burnout and compassion fatigue, and has some useful tips for overcoming these hurdles.

“To me, compassion fatigue is just a fancy definition for a really bad day,” says Dr Benson. While there is no universally agreed definition for compassion fatigue, Dr Benson says that you can recognise it as that feeling where you’ve simply “run out of being nice for the day”. The edge of anger that can be interpreted as a lack of respect for the patients can have a harmful impact on your therapeutic relationship.

While anyone can experience compassion fatigue, it is more commonly found in people who lack support, who are isolated, or who have their own personal experience with neglect or trauma. It is also more common among those who work with a difficult clientele. For dentists, the challenge might arise from being frequently faced with chronic disease, patients looking for a quick fix where none exists, or working with people who have suffered trauma or neglect.

In this environment, it can be difficult to identify signs of progress towards wellness. Benson calls this “therapeutic impotence”. “You’re not seeing changes so you don’t feel like a good therapist. You take what’s happening with the patient and internalise it and make it your fault, which often turns into anger.” As a result, you may become irritable, drink too much, isolate yourself socially, retreat into computer games, or just generally stop looking after yourself. “Everybody will have unhealthy ways of coping,” says Dr Benson, “and we all secretly know what they are.”

“The difficulty with compassion fatigue is that we might come home and be a bit grumpy and have a beer or scotch and watch some crap on TV and the next day we’re fine,” says Dr Benson, “but if we do that day after day it starts to become a habit.” At this point, Dr Benson says you begin to move into burnout territory, which is far more difficult to treat.

Regular reflective practice will help you to identify when you start exhibiting the signs of compassion fatigue, but the next step is to act. Fortunately, there are many things that can be done to directly combat compassion fatigue. A healthy diet, regular exercise and adequate sleep will always be up there on the list of self-care recommendations, but Dr Benson says that the idea of what is “healthy” should extend to everything you do.

There is considerable anecdotal evidence to support the pursuit of at least half an hour of endorphin-producing activity a day. It begins with spending more time doing the things you enjoy so that work stresses have a smaller role to play in your daily life. While the idea of pursuing hobbies may sound like a simplistic solution, Dr Benson says there is much to be gained from these “success experiences”. “If you have a difficult clientele, genuine success at work may be a rare thing. Hobbies allow us to fill that void,” she says. Talking to other people about your concerns may also help to lessen the burden. Peer support can be obtained through a structured arrangement such as ongoing clinical supervision, or it can be found in less formal settings such as debriefing with family and friends or “talking shop” with colleagues at a CPD event.

For those people without an adequate support network, or for whom the peer support mechanisms aren’t working, she advises seeking formal psychological help, “As health professionals it’s something we’re not good at, but it can be good for us, our friends and family, and particularly our patients.”

For many, a sense of spirituality can also help to restore the balance. “It’s not necessarily religious,” she explains, “It’s just something that takes you to a deeper part of you. It’s about why we help people, our purpose in the world and our relationships with other people.” It may involve referring to a piece of literature that informs a way of behaving, such as a religious text or a poem, or it might be as simple and accessible as an inspirational fridge magnet that reminds you of why you wanted to become a health professional in the first place. Dr Benson says that addressing your own needs will have a direct positive impact on your patients as well, because it will help you provide better care. “We need to give out of our fullness, not our emptiness.”

Further reading

Read about the role of peer support in combating compassion fatigue in ‘Compassion Fatigue and Burnout – The Role of Balint Groups’ by Jillian Benson and Karen Magraith (Australian Family Physician, Royal Australian College of General Practitioners, 2005).

You can also check out the chapter on self-care for health professionals in the book Mental Health across Cultures: A Practical Guide for Health Professionals by Jillian Benson and Jill Thistlethwaite (Radcliffe Publishing, Oxon, 2009).

In addition, the NSW Health Education & Training Institute has produced the comprehensive ‘Oral Health Superguide’ covering best practices for supervisory relationships. It is a great, practical resource for supplementing organised peer support activities. Download a copy at www.heti.nsw.gov.au/programs/cssp/oral-health-superguide.

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