===
[00:00:00] This is the DriveTime Debrief, episode 153.
Hey guys, welcome back to the podcast. I'm Amanda. I'm Laura. And I'm Kendra. And today we're tackling a subject that deeply affects many in our field, including myself often. Compassion fatigue. Have you ever felt emotionally drained, detached, or even questioning your ability to care for others? [00:01:00] If so, this podcast is to normalize that and to let you know what you can do about it. You are so not alone. Compassion fatigue, sometimes called, quote, the cost of caring, is a silent struggle for many physicians. In this episode, we'll break down what compassion fatigue is, and its impact on our well-being, and share actionable strategies to overcome it. In the show notes, we'll have scientific references if you do want to pursue it and, learn more. So let's dive in. Okay, well, let's start with the basics.
Compassion fatigue is actually a real term. I introduced it to my husband this weekend. The term was first introduced by psychologist Charles Figley, who described it as a physical, emotional, and psychological toll that comes from helping others. Who are in distress over an extended period and the definition of the time really isn't there It's just an extended period of time.
It could be like five shifts out of the last seven days I'm feeling As healthcare professionals we encounter suffering daily. [00:02:00] It's an honor to care for others, but it's also demanding Over time this can lead to exhaustion reduced empathy, and evening questioning your career and I will say we meet with Clients a lot in the private coaching sessions and I hear this they often will book a coaching session after a long stretch or a particularly hard stretch of shifts and they come in.
The 1st thing they say is usually I don't think I can do this. I think I got into the wrong career. And we just kind of like, slow down here. Let's take a few best. Let's get some perspective. So here's an example. Dr Patel is a primary care physician who has been working long hours, managing both routine patient visits. And emotionally charged cases like delivering difficult diagnoses. After months of this, she finds herself snapping at colleagues struggling to sleep and feeling indifferent toward her patients. These are the classic signs of compassion fatigue. Studies show that up to 50% of healthcare workers experience symptoms of burnout and compassion fatigue at some point. But how can you tell? It's gotta be more than that. I know. It's gotta be more than that. Oh my gosh. I'm like, like, [00:03:00] there's no way. Maybe the dermatology office or something. I don't know, but we're going to err on the side of more than but anyways but how can you tell if you're affected? Here are some common signs, emotional exhaustion and irritability, check, detachment from patients or loved ones, check, difficulty finding joy in work or personal life, check again, physical symptoms like headaches or insomnia, and check.
I found myself like even working five of the last seven, okay. I'm so tired, but I'm waking up like, and like early and I'm like, Oh my God, I just want to sleep. Okay. One key takeaway here is that compassion fatigue is not a sign of weakness. It's a natural response to the challenges of our profession and by understanding it and talking about it and normalizing the conversation, we can actually start to address it. It's really hard. To verify this, despite multiple times of Googling it, so don't take this as the gospel. But, Mother Teresa's nuns would work, some way in the following. Basically, they would work six days on, and then the seventh day of the week had to be [00:04:00] fully off. And they did honor the Sabbath.
That's kind of what the whole situation was about they would work in that rhythm of six days on one day off for three weeks and then on the fourth, You are required to be away from the need helping the dying and giving comfort to the ill for an entire week So every third week After that, you were off for a week. Then you worked in that rhythm for about 11 months, and then you got an entire month off work in that rhythm for several years. And then you get to take an entire year off. Whoa. Wouldn't that be amazing? And the point was not just to take the time off. Obviously, it was to do something to nourish and refill, replenish, restore everything yourself, fill your cup.
We say this all the time we've posted about this. You cannot pour from an empty cup So if you yourself aren't getting filled up or taking the time to fill yourself up, you cannot continue to pour out So if this is true, and it's certain that many missionaries and [00:05:00] relief workers take sabbaticals It makes sense that when we've been working year after year without time away from the despair and sadness we would get affected by it No one offers for us to take a year off to feed our souls And sadly, even if we did have a year off, we might spend it scrolling social media or watching Netflix instead of truly replenishing ourselves.
Boom. Call it, calling it out, but I definitely think I could find a nice spa to retreat to. Yes, yes. For six months to a year. It doesn't mean that you have to abandon those things, but you could, you could mix in some of that and then also. Get your soul back online. Yeah. So let's look at some of the science of compassion, fatigue, and the impact that it has.
So when you're constantly exposed to suffering, your brain's stress response kicks in. Understandably, our brains have a hard time distinguishing between bad things happening to people in front of us and it happening to us. The amygdala, Our sweet little amygdalas, they're just [00:06:00] trying to keep us alive, but they torture us so much. That amygdala processes our emotions and it can become hyperactive. Anybody who is a neuroscience student out there, I really would love for someone to do a functional MRI study on physicians, especially either like physicians in training or. ER physicians and look at the size of our amygdalas because I imagine they're probably double or triple width. What a typical one would be because we see so much that is so stressful, and our brains feel under threat and over time, that chronic stress leads to changes in our brain's neuroplasticity. So it can affect our emotional regulation. It can affect our decision-making. It's interesting, we've seen this. I've certainly seen this on some of my clients, is that emotional regulation can become more difficult the longer you're [00:07:00] in a field that's high stress.
Like emergency medicine surgeons have seen it and to an extent as well, where when you are stressed so much and you're not getting your physical needs met, like sleep and adequate Nutrition and exercise and even water. Our brains figure that it's not so important to show up as a kind, patient person. Like, we become easily triggered and it's just part of what happens to us, over a long period of time being exposed to these high-stress environments. So here's a sample scenario. Dr. Lopez. ER doctor has witnessed a series of traumatic cases in a single week, fatal car accident, young patient's overdose, and the grieving family, and he begins to feel emotionally numb.
The numbness is his brain's way of trying to protect him. Understandably. Right. Thank you, brain, for keeping us alive. But it [00:08:00] also impacts his ability to connect with patients and colleagues, and I'll also say with families like this over and over again. We see this where doctors have this emotional numbness set in, and then when they go home, like if they have young children, they are unable to connect with them in the way that they want or with their spouse, they're unable to connect in the way that they want.
That state of heightened stress impacts the body as well. Elevated cortisol levels, disrupted sleep, and even weakened immunity are common. Have not seen the research on this, but I've heard a couple of people make reference to ER doctors' cortisol levels that at some point we actually don't generate as much cortisol as we did initially.
Have you guys heard that? I haven't seen research on that, but like that we burn out on it. I'm gonna have to go. Certainly plausible. I mean, it seems possible. Yeah. I mean, it seems like it would be not too far fetched anyway, I'm gonna go do a literature deep dive on it and see [00:09:00] if anybody, if that came out of actual research. But it makes sense. And weaned immunity definitely makes sense.
And when our bodies and minds are exhausted, it just becomes harder to connect with anyone. And then if we're not connecting well. In particular, with our patients who we're supposed to be, you know, compassionate towards, it can lead to feelings of guilt or even inadequacy, like, I'm exhausted.
I'm not doing my job efficiently and I'm not even caring about people anymore. So why am I even here? If you feel this way, you are not alone. It's very, very, very common. Research shows that compassion fatigue is linked to higher rates of medical errors. Lower patient satisfaction and even increased physician turnover. That's not surprising at all. a 2016 meta analysis by Calker and Joss found that healthcare workers with compassion fatigue are more likely to experience depression and anxiety. Again, not surprising at all. And just as [00:10:00] a reminder, if you are experiencing this, It is not something that's broken in you.
It's a product of the environment that you're working in and your brain's natural responses to try to try to keep you alive. Remember our brains are interested in keeping us alive, not so interested in us thriving and feeling great. Our brains don't care so much about that. They just want us to do what, what keeps us alive.
And so This is what happens when we're in these environments for long periods of time. Yeah, This is just something all three of us were at a conference one time and they talked about their own experience as a patient And gave the example of what the doctor said to them, which was very callous was not In his best self, and the entire room was like, Oh my god, I can't believe what a horrible doctor, and like, What a jerk, must be a narcissist, you know, what a, What an a hole, why is he even in medicine in the first place? However, having done this work, I'm more like, I wonder what has happened [00:11:00] to that doctor. Yeah. Because most of us don't go into medicine like that. Yeah. But a lot of It's a neonatologist. And neonatologists are not known for being horrible people. Right. I'm just saying like, so I wonder if we could like Because we're so quick to judge and then we feel that we're also judged when we do something wrong.
If we can start getting to like, more understanding man, then we can also forgive our own flaws. Yes. You know, there's probably a good reason why he was. Seemingly callous that day. Maybe he hadn’t slept in 48 hours. Maybe he saw a bunch of babies die. Absolutely. Like, that's the thing. Like, if we can just withhold judgment for a little bit, and that's what we're trying to explain with this podcast, is it might make sense why some of us have disconnected. And if we want to reconnect, Then here actually are some strategies for overcoming compassion fatigue. So now we understand what it is and why it happens. Let's shift our focus to solutions., I hate it when there's articles and [00:12:00] podcasts, like there's this huge problem.
The end.
Yep. Well, I don't feel better about it. Sometimes awareness is key, but then we need a part two. We need a part two. It doesn't help me, like, I need to fix it sort of mindset. But, okay. So here's five evidence-based strategies that you can consider using. The first is self-care practices. Taking care of your physical health is foundational. And this would be an interesting thing too, like what sleep deprivation does to your amygdala, because I am so much more reactive when I haven't slept well. And I cannot help it. I'm more like a, I'm a wreck right now, and I need a nap, and I'll get with you tomorrow, because I can't, I, there, there is no talking myself out of it right now.
My amygdala is on fire. Yes. So. Make time for adequate sleep, regular exercise, or balanced nutrition. Same thing, like you were talking about, Kay, like, if I know that I am gonna work several days in a row, I'm likely gonna be shot that last day. Let's not schedule a bunch of emotional things for me.
Heh heh heh heh heh. Maybe we need [00:13:00] a day or two off before we like do something just happy hour. That's it. Just make sure that happy hour is at the end. Exactly. Yeah. So it sounds simple to do to practice self care, but these habits are also the first to go away when we're really busy, right? It's not a checkbox for most of us. So maybe put a checkbox on your to-do list. So here's your example scenario. Dr. Nguyen, a pediatrician noticed her energy levels plummeting after skipping meals and working late into the night for weeks. Well, shocking, isn't it? By setting a boundary to take lunch breaks and exercising three times a week, even just a brief walk, she felt more energized and patient-focused.
Okay, so number one, self-care practices. Number two, mindfulness and meditation. Practicing mindfulness helps you regulate your emotions and stay present. That's literally the purpose of mindfulness. A bunch of ER docs I know are like, I can't sit there. My mind wanders. Perfect, you're doing it right. That's the whole purpose of it, is to get awareness of your monkey mind and practice re centering. The wilder your [00:14:00] brain is, the even more useful mindfulness will be for you. You are doing it right to be a wreck when you sit there with yourself in silence. That's the whole purpose, so if you wanted to do something like that, apps like Headspace or Calm can guide you through short exercises. I like the little eight-minute ones that they have or like mm hmm.
They tend to be under 10 minutes. I'm willing to sit with myself for 10 minutes. I'm not going to be doing these four hour meditations that a lot of the gurus do that doesn't work for me. So maybe another thing. Yeah, another thing too is like, if you really are wiggly, you can do a walking meditation.
It's not one size fits all. You can do different things. Yoga for a lot of people is a meditation just to get in your body since a lot of us are up in our heads. Fishing is a great one. I mean, honestly, my husband and kids, they are hunters. They often are not successful, but they still love the experience of sitting at the break of dawn. in nature. I've tried it once and it really is incredible, [00:15:00] but otherwise I don't like to get up like that. So that's where early in the morning, I will say my generous partners allowed us to start our sesh a little later this morning. Cause I just needed a little more time in the word this morning and to get my 15 minute, yoga and meditation.
So being honest, with yourself, like knowing that just because it's there. It's worth pushing back something 30 minutes to an hour, whatever you need, because I recognized I am spent. I need some me time. Like I was yearning for it. It was calling out to me. So it was worth it to just say, Hey, I need a little more time this morning. And That in itself can be a replenishment of the soul, like not just doing these things by getting comfortable recognizing and then giving yourself the permission or asking, you know, the permission of whatever, pushing something back an hour or whatever it is. I mean, that in [00:16:00] itself is a real breath of fresh air when you can get real comfortable at doing that. And how much would you appreciate it if your spouse is activated? If they were like, Hey, I can't show up in a good way right now, if I could have 30 minutes to not play PlayStation because that's not necessarily helping the activation, do you see what I'm saying? Like, but to choose something that really is sitting in the quiet, to go from level 12 back down to like a level 4 of something, to really do something useful to deactivate yourself or whatever like that would, that would make sense to me. As opposed to, I've been away all day, and I also don't want to engage for the next four hours. An explanation and doing something that actually was helpful I wonder if our relationships would be better if we could just be honest about that. Okay. So here's an example scenario. Dr. Ahmed, who's a surgeon. Started using a five minute breathing exercise before surgeries to center himself. He found it improved his focus and reduced his overall stress levels. There really are five minute things, even one [00:17:00] minute things, that you can find on YouTube or any of these apps. Or even just listening to something relaxing can help you. There's a list of grounding exercises that you could try, but maybe we do that on a different one. Okay, number three, peer support and debriefing. So create or join a peer support group where you can safely share experiences. My client yesterday was just like, it is so useful to talk to somebody who gets it. Because we just don't, sometimes even our loved ones can't possibly imagine what we've just gone through. But also having a place, and sometimes that's not always available where we work, to safely share experiences. So debriefing after difficult cases can help you process emotions, can help you see where you're personalizing things that have nothing to do with you, it's not a statement on you or anything else. That, where you can safely process your emotions, can help you build resilience. Normalizing what you're going through is medicine to me, so here's an example scenario. After a particularly challenging shift in the ICU, Dr. Smith and her [00:18:00] colleagues held a brief team meeting to share their feelings about the day's events. This helped them process the emotional toll. Strengthen their team bond. Some places are great about this and like tell us about it If you guys are doing something that's working for you You can email us at podcast at the whole physician comm I would love to know because we always can improve What we're doing if somebody's doing something that's works I think this is so important and it helps like, you know, after a code or something really awful happening, just acknowledging, you know, as physicians were generally the team leaders, just taking a moment to acknowledge the humanity of the patient, the humanity of everyone involved and recognizing the impact it has on our psyches. There's nothing that will help your team feel more seen and heard. It is just so important it's part of why we named the podcast, the debrief, the DRIVETIME debrief, because debriefing just [00:19:00] helps put everything in perspective. And so if it's something that you're not doing.
Just know it's there for you. It's an opportunity to really support yourself and your team. and this can be done in clinic too. Like, I've got a client who deals with lots of child abuse in her clinic. And just being able to debrief with colleagues about that can really help mitigate the negative effects that it can have on us if we just shove that stuff down. Mm hmm. Okay, next one is gonna feel like shots fired. Prepare yourself. Number four, boundary setting. Learn to say no when your plate is full. Setting boundaries with work and patients is essential to maintaining your well being. So, here's our example scenario. Dr. Kim, a family physician, started limiting her work hours and saying no to non urgent patient requests after hours. This gave her more time to recharge and improved her overall happiness. So many of us have the hardest time. We're so programmed with it, but what about patient care? But what [00:20:00] about, who's going to do it if I don't do it? That is a great way to just burn yourself out to a crispy, crispy burnt chip. Also, you're not allowing your patients the opportunity to figure stuff out for themselves sometimes.
Like if you're responding to a bunch of stuff that is not helpful, or your staff. It's actually not helpful to anyone. Yeah. Yeah. Sometimes letting the process flounder a little bit so that solutions can be found, might be useful in some scenarios. Okay. And the number five of this section is organizational interventions.
This is what we all hope for. This would be great. It's not available all the time, but. If you can advocate for changes in your workplace, such as reduced workloads, wellness programs, or access to mental health resources, anything you can do to advocate for useful changes, that's going to benefit everyone. So here's an example scenario. There's a hospital where Dr. Garcia works. That he was able to implement a rotating on-call schedule to [00:21:00] reduce physician burnout. And this change significantly improved staff morale and patient care. We have some partners married to certain surgeons who've been on call almost every day of their lives. Only if they take a vacation out of the country do they turn their phones off and I can't even imagine. 'cause, it turns out, in residency I found out if I even took home call, I would eat my own. So that would never work for me, but like, it's okay to work out schedules like this where you share the load if that's what you need.
Yeah, which I would argue if you're human, you do need. Yes. I mean, come on. Okay, so there's a website, Mission Resource Network for Missionaries, that suggests how our attempts to soothe our compassion fatigue get it wrong sometimes, and what to do instead. And so here are, some of the thoughts from that. Here's a common strategy. Just keep going. Our happy little moniker suck it up buttercup. Just keep going. Just keep swimming. Better strategy. Use your [00:22:00] feelings. So this is something that we definitely learned in our training to just keep going, keep our heads down, nose to the grindstone. And The current thinking is that by acknowledging and addressing, especially our uncomfortable feelings, we actually will experience less burnout. So, just know that while doctors are really intellectually intelligent, our emotional intelligence tends to drop during our training. And a lot of that is because we forget feelings. We don't even acknowledge that we have them. And It's just feelings are just information that our brains are trying to offer us.
And when we allow ourselves to experience them without judgment, it's just so much more helpful. It helps us in our lives and our work helps us know what needs to be released, what needs to be adjusted. What needs to be prayed or meditated through their feelings are a way to listen to our spirit and Sort [00:23:00] out how we relate to the universe It's really really important to pay attention to our feelings Even though we've been taught feeling schmeling's and just shut them down. That's a recipe for emotional and physical Disease truly. All right, number two common strategy. Take a break. Taking a break's great. A better strategy is when you're taking a break, do something that fills you. So burnout is less a result of being too busy and more centered around doing things that constantly drain you or being around people that drain you to just, just saying it's important when you take pauses, when you're taking pauses from work, do something that fills and restores you. If you take notice after two hours of scrolling Instagram or TikTok, do you feel filled? If you learned something awesome, like I know Amanda learns stuff on TikTok all the time, great. If you are not feeling filled because you've just been [00:24:00] catching up on celebrity gossip and still don't feel great, just notice, notice.
And is that The activity you want to use when you're taking your break and trying to fill yourself up. So good things to fill and restore. You could possibly spend time with family. Might not be done with family, but it could be time with family. Might be avoiding family time. Spiritual practices, time in nature, exercise, creativity, like a hobby, or maybe you want to write a book, or whatever it is that actually recharges your batteries before you return to your regular practice. Okay, number three. Common strategy. Organize. Prioritize. Yes, okay, that's great. All very left brain, which we love as doctors. Better strategy. Work in your values. So it's common to think when you're overwhelmed, I could just get a little more organized or have more help, things would get better. And that can be true, but it usually doesn't solve the burnout issue. What's more useful is to start to notice what tasks you're doing that [00:25:00] don't support your specific personal values. Okay. So if cleaning your baseboards gives you fulfillment, fantastic. If not, like for me, it does not find a way to not do that. Either just don't do it or hire somebody else to do it.
Choose the things that don't fill you up to offload onto someone else. And keep the things that align with your calling. Like, for me, spending as much time as possible with my kids does fill me up. So you know, if that's not the case for you, get a really great babysitter or nanny. If, you know, doing your laundry fills you up or helps you, I find it a little bit meditative to fold clothes sometimes, not as much as I do.
So it's still my goal to find someone to do that for me. Successfully offloaded that yet. Yeah, this is really good for all of us recovering people pleasers out there for some reason. It was like this unwritten. I have [00:26:00] to be all things to all people, right? Because that's what. Fulfills the fruits of people pleasing. I will tell you the most liberating thing was really getting clear on my values. And one of the things that really, for me, flipped the switch on not only becoming a recovering people pleaser, but really beating back burnout was really good, like starting to hack those things. Like just because I can. Having the skills does not mean it aligns with my values and I started hacking away and I'll tell you the people that are closest to you will notice first.
I.E. my husband and he was like, wait, you know, right? Because I was doing all of the things and then I, you know, started hacking away. That doesn't align with my values. I'm not taking that on or you can choose. I have this much time. 30 minutes. Do you want me to do this or this, which is more important to you?
I'll do one, you know, like even just setting boundaries within that. But I'll tell you, the biggest thing was just the freedom that it felt. It was almost insidious because you get clear on your values. You only do those things [00:27:00] that align with it and then you take a step back and you're like, Oh, like, what, what was I doing all along?
Like what, what, where did that land before? Like totally wringing myself out. And now it's like, I will never go back. No. No. Yeah. And it turns out once you have liberation. Yeah. And it turns out that things that don't align with your values do align with someone else's values. That's exactly right.
Someone does love to clean my house actually. Yes. And she's way better. A lot more focused way it, yes. So much better at it. And yeah, so just know it doesn't make you a hero to try to do everything, especially if you hate it, don't do it. All right. So number four, common strategy, try to control everything. Okay. More shots fired. Recognize your role. All right. So healthcare workers are left brain people a lot of the time. We become more [00:28:00] left brained. Through our training just because we have checklists, we have to check off and we have to make sure things are done just so. And when we stay in that left brain, we actually are going to increase our risk for burnout. So when we feel a burden, and I say that about the left brain is that the left brain is the part that wants control. It wants to make sure that everything is fixed. Everything's just so everything's running perfectly and orderly. And the more we focus there, the more burned out we're going to become. Guess what? We can't fix everything. And we are going to come up against difficult situations for our patients, for people we care about. We feel a lot of empathy for them and our brains are going to react like these are our own problems and they're going to try to fix them. So, this for me personally surfaces a lot with my kids when they have a [00:29:00] problem immediately, or if they have a feeling that's not positive or heaven forbid, they think something less than positive about themselves. My brain immediately goes into fix it mode. Like, no, no, no, no, this, what? You're amazing. Why would you, why would you ever feel like you're anything less than amazing? And actually this is going to negatively affect them and us because It doesn't validate their feelings, it doesn't make them feel any better, and we can't fix it. We just can't. So over time, day after day, trying to fix things that are not in our lane, that are not our job to fix, is going to just burn us out. We're going to become more and more exhausted. So this missionary website that we mentioned earlier. Encourages us to act from compassion, but not need to be responsible for every solution or attached too deeply to every single problem so we can have compassion and I actually think about this [00:30:00] one guy who, it was so heartbreaking. He was mid thirties and had literally blown every vein on his entire body from IV drug use. And My brain was just trying to think of how to help, and he had horrible staph infections. How to fix this guy? Oh, if he just like, you know, if we could just do this, this, maybe get him this resource, it could fix him.
And, you know, it's great to think about these things and offer resources where they're wanted, but we cannot fix other people's lives unless they want them to be fixed. So if you're spiritual, you can give situations like this to God, give it to the universe. If not the universe, just recognize that you're responsible for you.
And showing up in a compassionate way is a great Way to show up well being compassionate doesn't mean that you're correcting people's problems [00:31:00] for them and realize that Autonomy, we're all here on our own little learning adventure We are in charge of ourselves and other people want to be in charge of themselves, too So, again, it's tough, especially with your kids.
I don't know, for me personally, especially with my kids, especially like truly with anyone where you know a simple solution, like you can think of something easy that would help them feel so much better if they were open to it.
Most of the time, it's just not our place to force that on people. And there's nothing more exhausting than to try to fix something and somebody else doesn't want it fixed, doesn't want your help. It's just going to burn you out. So save your resources for yourself and for the people who actually want your advice and ask for it.
Good. Yeah. Thank you guys today for joining us on this journey to better understand and combat compassion fatigue. Remember taking care of yourself is not selfish. It's essential, right? If you're having a [00:32:00] hard time, like collecting all of this that we put out there, how about we start with our basic physiological needs, right?
Those are essential for survival. And if you want to stay neutral, just start there. Like sleep, hygiene. Nourishment and like start there and, you know, just remember that we are in this to help people, but we can only give out so much. There is a time when you can no longer pour from an empty cup. And so when you're recognizing that when you're addressing these feelings, when you are noticing feelings are just signals.
So when you're, astute to a signal. What is it telling you? Right? Just take some time to figure that out. And as we wrap, think about one small action you can take today. Like I said, what can you do to prioritize your wellbeing? You know, buzzword for the last year or two since COVID really, self care, right?
But what even, what even could you do to honor your basic physiological needs? Maybe it's scheduling a walk, journaling for five minutes, doing a five minute, you know, [00:33:00] calmer headspace app, meditation, spending time in the ward, praying, reaching out to a colleague. What about a cup of coffee?
What could you do? If you. Think of something or if something occurs this week, after you listened to this, send it over to us, email us at podcast@the whole physician.com. We'd love always, always love for you to leave us a review, but tell us more about what you are doing to help fill your cup.
We'd love to share it on air and we'd love to hear what other people are doing. You can also connect with us on the socials. Join us next time as we explore resilience building strategies for healthcare professionals. Until then you are whole, you are a gift to medicine and the work you do matters. [00:34:00]
