Giving less and less…

I want to talk about something that's a little awkward to talk about. Something I've been feeling more and more. Something that affects EVERY healthcare professional. Something we need to talk about more. I want to talk about compassion fatigue, empathy exhaustion, professional burnout, or as I like to call it, giving less and less of a fuck!

All healthcare professionals whether working in the private or public sectors are challenged with providing patient-centered care in an efficient and effective manner, whilst trying to embrace and implement evidence-based practice, whilst trying to meet productivity goals and targets, whilst trying to maintain high professional and personal standards, usually with limited support or resources.

These daily challenges are a constant struggle for many clinicians that lead to increasing levels of stress and frustration, and can affect their physical and mental health, and impact on their quality of life.

stress

I know this first hand. I have been doing this job for nearly fifteen years, and for nearly every day in this fifteen years I have been listening to patients stories of distress, suffering, frustration, and confusion about pain, injury, or surgery. And for nearly every day for fifteen years I have been trying my best to help, support, encourage, and motivate these people find a way forwards, onwards, and upwards with what ever aliment or condition they have.

Its tough, really tough.

Year on year, month on month, day on day I can feel and sense a change in my approach in how I manage many of the patients I see. This is not only due to my knowledge and experience growing and evolving or the changes in evidence, but also due to my own compassion and empathy fatigue. To put it brutally honestly I can feel myself giving less and less of a fuck to more and more people I see.

In the beginning way way back in the beginning of my career I truly thought I could help everybody I saw, and I tried my damn hardest to do so. Nowadays I do not. Nowadays I find myself choosing less patients that I try that little bit harder to connect with, that little bit harder to motivate, to encourage, and toeducate.

You may think this is unprofessional, even lazy, and that as a healthcare professional I should give everything I can to everyone I see. And I agree, every patient deserves the best possible care they can get. But this is my compassion fatigue. This is my burnout. This is my giving less of a fuck.

Or is it?

I've learnt with time and experience that there are many patients who are not willing to be helped, and that some patients don't want to or will accept my advice or help? I have learnt from my countless past failures who I can, and who I can not help better. I have learnt over the years that there are many patients who despite saying contrary are unwilling to put in the effort or commitment to help themselves for many reasons, and that any attempts I make to assist them will have minimal to no effect on their problems or issues.

I also know that no matter how hard I try, I can not, and will not connect with, or encourage, or motivate everyone that I see. I also know that no matter what I say, or do, or try, I will make very little difference to some patients no matter how much I connect or how motivated they are. But I also now know this is NOT my fault.

Many patients think we need to fix them.

We don’t “fix” anything. We don't have magic hands that heal things, we don't have healing powers, or other supersitious clap trap. We physios simply offer advice and education to those willing to listen and learn. We simply try to facilitate a change in our patients lives and their problems. We simply try to encourage and motivate patients to move more, and we use physical activity in all its glorious ways and means to do this.

Magician wand

Many patients need to understand and recognize that having good physical and mental health, and being pain free is not an automatic right. Many need to understand that a shit load of hard work is required to maintain a healthy body and mind. Many need to realise that it takes effort to reduce the risk of disease, deterioration, and decline.

Human bodies are designed for physical activity on a regular, daily, hourly basis, and many simply don't do enough, nor want to. This is fundamental in everything we do as physios. If patients are not ready to accept this, if they are not interested and invested in their own health and outcomes, then we should not, and I will not waste my time.

Simply put, I will not waste my time and energy on any patient who thinks I should be more interested and invested in their progress and outcome than they are.

You may call this harsh, I call it realistic!

Don't get me wrong, I'm not saying we should all of a sudden become hard nosed bastards and throw everybody on the metaphorical scrap heap of 'life's no hopers' at the first barrier or hurdle we encounter with their motivation or effort. Rather that we should be more realistic in how much we can help some, and how much we can't help others.

I think we also need to recognise that as healthcare professionals we have just as many issues and factors as the patients we are supposed to be helping. Of course most healthcare professionals are empathetic in nature, but this is not limitless. We all have a finite amount of energy and enthusiasm, and we all need to use it wisely and appropriately. There is nothing worse than wasting your 'mojo' on someone you can't help, and then having none left for those you could.

Being aware of our own mental and physical health as a healthcare professional is paramount. If you are not looking after yourself, you wont be any good at helping others. If you want to be in this job for the long game you need to work out how to manage this in a way that is right for you.

single-malt

For me I find having a good social network is paramount. Having colleagues, friends, and family that I can talk too, moan too, bitch too, let of steam too is vital, and this blog. It is all cathartic for me. Physical activity and exercise is also vitally important. If you as a clinician are not letting off some steam and stress on a treadmill, a sports pitch, a road, or a weight room at least a few times a week, be prepared for some hard times ahead. Eat well and sleep well. Finally don't take life or physiotherapy too seriously, and enjoy those you love and who love you. I also find a good glass of single malt whiskey every now and then helps tremendously.

In summary I feel physios and other healthcare professionals don't talk about 'not giving a fuck' and most think it is a taboo subject. For me it is the 'elephant in the room' that is affecting us all in some small or large way. So let's talk about it more. I think there is very little recognition or support from our professional bodies or employers in regards to compassion and empathy fatigue. Instead the focus is always on the pressures and demands facing the patients, eg waiting times, budgets, costs etc. These factors tend to comes at the price of asking clinicians to see more patients with less time and resources without considering what effects this has on the clinician. This is a recipe for disaster, because if you don't look after those who look after others, things are never going to get any better.

As always thanks for reading

Adam

 

2 thoughts on “Giving less and less…

  1. Great post Adam, refreshingly honest as usual.
    There is no doubt, in my mind, that people are ‘choosing’ to be ill on some level albeit sub-consciously and out of their awareness. But this stance is a difficult one to take among other professionals although I find that it is most empowering towards the patients. (and also slightly different in Sport’s Physiotherapy although there is still ‘choice’ present)
    There is such a thing as ‘rescuing’ people which creates dependency and is expressed in co-dependency theory. This theory, that I have gained from my experience in Psychotherapy, suggests that most of us are caught up in the Drama Triangle which consists of ‘victim’/’rescuer’/’persecutor’. I think that as Therapists we should all be aware of this theory as our patients will all be suffering from the ‘victim’ state to some extent or another which encourages us into a ‘rescuer’ role. I have suggested previously that it could be argued that manual therapy comes from the ‘rescuer’ in us. We, as therapists are also in danger of entering ‘persecutor’ territory when our patients fail to get better. We can then ‘blame’ them for not completing their exercises by saying that they are not-compliant or poorly motivated. All of this is true of course, but it is how we view them that is significant.
    So if we see it as a choice that they are making on some unconscious level, that there is a ‘pay-off’ to be gained by them, that there is a deeper reason for this situation they are in then this is much more empowering isn’t it? I think so. But these ‘deeper reasons’ take us into the psycho-social factors and even politics if it is financially more stable for someone to remain diss-abled. These deeper reasons also take us into the territory of their relationships as has become more obvious to me lately.
    That’s why these conversations should be more prominent especially in the current political climate. It’s all a matter of responsibility, put simply. We are living in a society where the locus of evaluation is constantly placed out side of ‘the self’ and so people are unable to take responsibility for themselves anymore. What we see in our patients are often the extreme representations of that.
    I am interested in the new Wellness Centre being built in Llanelli, South Wales which is attempting to change the perception of the NHS as a place to go to get better rather than to be ill. But in my mind, we still have a long way to go.
    Thank you.

  2. A brave post and I couldn’t agree more. The empathy gland shrinks over time ! It is exhausting to have a patient sit in front of you who wants some clever analysis of why, after years of drinking, smoking and poor diet , their body is showing signs of strain. Important to say I don’t judge these patients either, people have every right to use their bodies in anyway they like..but let’s not skirt round the obvious and expect some quick turn around in 4-6 sessions of prodding and poking.

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