too tired to care thursday

Originally created by Katie Rebillot, D.O. as part of the 2016 Emergency Medicine Wellness Week


“This drunk is here EVERY SINGLE DAY.”

“This patient with sickle-cell disease is obviously drug-seeking.”

‘These old and demented nursing home patients are so annoying. I have to call everyone now and it’s going to take up my entire shift.”

If this sounds like you, you might be experiencing … COMPASSION FATIGUE



Compassion fatigue is a phenomenon known as vicarious or secondary traumatization — that is, a specific type of burnout defined as a state of physical, emotional and mental exhaustion that comes from exposure to or caring for those suffering from traumatic events or chronic illnesses (such as alcoholism, sickle cell disease, or dementia).

As emergency physicians, we are particularly at risk for compassion fatigue because we see the same patients come in for their chronic illnesses over and over with fluid frequency…hence the term “frequent fliers.” And what’s more, we have seen our previous treatment efforts thwarted by patient non-compliance, systems failure, lack of family support, etc, so it’s easy for us to justify not treating them with the same care, respect and empathy as before because it didn’t seem to work last time, right? Why should I waste my time and effort, my EMPATHY AND COMPASSION, on a patient when it’s not going to matter in the end because they are going to be right back here tomorrow, drunk as a skunk…This is a slippery slope, my friends.



Related post: Fatigue, Not Just for the Weary


This is the easy part, because all you have to do is take care of YOURSELF FIRST! It’s the same thing I’ve been preaching all week…every solution starts with you and it’s a choice you make everyday. Create personal and professional goals to improve your emotional and mental state to overcome compassion fatigue.

Personal goals: Finding time to take care of yourself leads to you becoming a happier person in general. Happiness -> better sleep -> more patience -> more understanding ->  seeing patients as people (not the stereotype they may or may not represent) -> increased empathy -> better overall care of the patient.

Professional goals: Talk about it. Our mentors and peers are the most valuable resource when it comes to stress at work because they are experiencing it too! Discussing stressors helps relieve initial stress, however to prevent burnout and compassion fatigue, it needs to be an ongoing discussion about our special patient populations, limiting system factors that increase frustration, lack of positive feedback from patient experiences, etc. Talking about it helps you gain insight from your peers’ experiences, as well as the opportunity to adopt their different coping mechanisms and strategies to decrease stress.

In the end, all of our patients are treasures and we are blessed to be given the opportunity to care for them. Remember that time earlier in your life when you had lofty aspirations of walking around in a white coat and would have done anything to be accepted into medical school? And then, in medical school, if you had the opportunity to change a patient’s bandage or put in a foley, you jumped at the chance to do something PATIENT-ORIENTED, right? Somewhere along the way, most of us lost that zest for patient care and started focusing solely on labs, imaging and disposition of our sick patients, because that’s how we learn medicine and become the best doctors we can be. However, the most valuable lesson our patients can teach us is not what a AAA looks like on bedside sono or what anaphylaxis looks likes, they teach us compassion, empathy and humility. These things are taught in the hospital setting, not in our textbooks.

Once upon a time in a galaxy not so far away, you had the best day of your life when you were accepted into medical school. Becoming a doctor means different things to everyone and we all do it for different reasons, nonetheless we should all cherish the opportunity and take the responsibility with great care and humility. We were given the gift of being physicians for a reason and we must remember that our patients, regardless of their current age, socioeconomic status, living situation, chronic illnesses, etc, are PEOPLE too. They are mothers and fathers and daughters and sons and had jobs and hobbies and things they lived for at some point in their life. To care for these special populations is a sacred job we’ve been given and we should really approach every patient with an open mind and heart. At the end of the day, that could be your mother lying in that stretcher not remembering who she is and being combative with staff because she has a UTI. Wouldn’t you want her doctors to treat her like she was their mother?

More resources on compassion fatigue

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