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OBJECTIVES

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  • Distinguish between engaged and dissociated health-care work.

  • Define burnout, compassion fatigue, and compassion satisfaction.

  • Recognize risk factors for burnout and compassion fatigue and protective factors for compassion satisfaction.

  • Identify strategies for preventing burnout and compassion fatigue and for promoting compassion satisfaction

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Andrew is a primary care clinician who has been working in a community health center for 9 years. This year, his ill parents have moved into the home he shares with his partner and children. At first, coming to work felt like a reprieve from the stress at home, but now he is finding himself resenting his patients, particularly those with intensive needs. He feels angry with patients who do not adhere to the recommended treatment plan, irritated by patients who present with undifferentiated and persistent complaints, and frustrated with the systemic barriers he faces to providing quality patient care. He sees little point in investing energy into helping people who do not seem to improve.

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INTRODUCTION

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Caring for underserved populations is an inevitably challenging endeavor. While health-care providers throughout medicine struggle with issues of burnout and compassion fatigue, providers of underserved populations are confronted with a greater burden than most. The difficulties unique to this work are numerous: the work environment is often unfavorable, institutional barriers to providing quality care seem insurmountable, financial limitations are frequent, and colleagues can appear “burned out” or unhelpful. Worse, providers regularly find themselves witnessing the injustices, traumas, and tragedies suffered by their patients. A provider who remains sensitive to the human struggles of his or her patients will experience a steady stream of complex emotions that require attention. Self-care becomes essential.

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A common misunderstanding of the notion of self-care is that self-care requires engaging less with work or distancing oneself from one’s patients. While adequate rest and time away from work are important, distancing, or “depersonalization,” is in fact one of the features of burnout and rarely leads to a happier, more satisfied health-care provider.1 In trying to protect themselves from the pain associated with their difficult work, many providers unintentionally depersonalize their work to the extent that they no longer take pleasure in it or engage wholly in it. Besides being miserable for the provider, this shift has been shown to lead to increased errors and worse patient outcomes.2 Particularly in a population that is already subject to marginalization, a provider who is disengaged and uninterested can be genuinely harmful.

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The task, then, is to find a way to engage deeply in one’s work, to confront the struggles associated with it, and to continue to feel empathy for patients, all while remaining healthy and satisfied as a provider. In this chapter, we explore the features of burnout and what is known about its causes and cures. We will also explore a newer concept, compassion satisfaction, and discuss its impact on the provider and patient experience.

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