Recovery from Burnout or Compassion Fatigue

Physician burnout and compassion fatigue are a very real part of being an oncology clinician.

Burnout is not just from being out of control of how many patients are scheduled, illogical requests for prior authorizations, insurance denials, or hours spent with the EHR.

It’s from situations like these:

Your patient Simon has testicular cancer that could be cured with chemotherapy, but instead, he insists on only natural therapies as he awaits the miracle he knows will cure him. Susan has platinum-resistant ovarian cancer, and has developed ascites, edema, and a central line infection on the TPN you no longer think is helping her—but she and her family won’t hear of stopping it.

Either of these situations can cause you severe moral distress: not being able to do something that you know will help your patient or being forced to continue to do something you know is harming your patient. And then there is the helplnessness that comes when there really are no more viable options. And the grief from losing so many patients every year to cancer.

Unaddressed and unrecognized moral distress and unprocessed grief are key contributors to the compassion fatigue and burnout that affects between 35 and 45% of oncologists (Shanafelt T, Dyrbye L. J Clin Oncol. 2012;30:1235-1241).

Could you be one of them?

Do you find yourself: 

• replaying tough conversations and situations over and over in your thoughts?
• having a “hyperarousal” response when you are scheduled to see a patient for whom you have no other therapies? 
• avoiding rounding on your inpatients when their families are present?

Do you:

• Feel ineffective at work or find reasons to miss work?
• Find yourself increasingly angry at coworkers or family?
• Realize you’re emotionally exhausted: detached, numb, not really caring what is happening to your patients?
• Avoid having yet another tough “goals of care” conversation?

If you answered “Yes” to many of these questions, you are probably suffering from compassion fatigue or burnout. 

Thankfully, there are many solutions to this soul-draining condition.

First: recognize that these feelings are normal in any oncology clinician, especially those of us who haven’t been taught during our training that grieving is part of the job. Our nursing and social work colleagues know this so much better than we do; they comfort each other and would offer comfort to us, if we were open to it.

Sharing the care of patients like Simon and Susan with palliative care clinicians can also ease your burden, and help you find the words to help them and their families share what you see as optimal care for them.

Lots of other things also help:

1. It helps to name the feeling: grief, sadness, helplessness, anger, whatever you’re feeling. 
2. Consider sharing those feelings and the events that precipitated them with a colleague or family member or counselor or spiritual advisor—whoever you normally turn to in times of stress.  Grief is the most common problem—unacknowledged grief over the many patients we care for, and who, despite our best efforts, suffer and die.  
3. Make talking about the loss of a patient part of your routine: It can help for you and your practice to have a forum during which you talk about the patients who have died, and their loved ones, maybe once a month. Take turns offering something that is healing to the group—music, a poem or story and recite the names of those who died since the last meeting, allowing time for people to say what they remember about them. Debrief the tough decisions and tragic events.   
4. Be proactive about your day. Look at the day ahead: As little as 5 minutes before the workday starts—that’s usually enough to help strengthen yourself for what the day might bring.  And when something sad happens, share your feelings as soon as you can, and accept the support that your colleagues and staff are happy to give.

For other helpful advice, consider referring to Comprehensive Guide to Supportive and Palliative Care for Patients with Cancer (Chapter 13, pages 578-586) or its bibliography. 

To gain insight into patients like Simon, and others who are waiting for a miracle, view the video interview with the Reverend Doctor Gloria White-Hammond. Look for Videos under Recognizing and Addressing Spiritual Concerns.

To help you help Susan, or others for whom TPN is no longer effective, we have several videos showing you how best to discuss next steps. Look for Videos under Communication Pearls. These include

• Part 1: sharing your concern that there are no further cancer directed treatments to pursue. 
• Part 2: Eliciting goals of care when there are no further cancer directed treatments to pursue.
• Goals of Care: The Power of Purpose

And for when hospice is a next best next option, look for Videos under Hospice.

If you have any other scenarios you would like to discuss, please reach out. I welcome your thoughts and input. You can reach me here.

Remember, this is not your fault, it’s medicine’s fault. Medicine may have failed the patient, but you never will.

And please, take the time to take care of yourself. You’re worth it!