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 donโ€™t โ€œfixโ€ 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

 

75 thoughts on “Giving less and less…

  1. You’re def digging into the annals of most busy therapists minds with this one, but its a tough one to admit due to our reliance on empathy and compassion as an intervention and a business tool!
    I think we become very good at ‘turning it on’ even when our cups are severely depleted! I suppose that makes your post more reassuring because the more I practice the more I just want to tell patients to man the f–k up!
    I recall reading some research somewhere suggesting the more empathy shown to a person, the worse they percieve their symptoms to be!
    When it comes to the passive patient that expects to lay dormant on a plinth and be fixed, I blame the antiquated education of therapists such as osteo’s and chiro’s. As a practicing osteo (def not in the classical sense) I spend half my time convincing patients that their joints don’t just slip out of line and need putting back and that their own volitional movement is far more effective than my theatrical, pulling, prodding and pressing. However, this culture is perpetuated by the self proclaimed body mechanics who convince patients that they regularly need ‘re aligning’ or ‘fixing’ Somehow an audible crunch makes everything ok and at the same time deepens this viscous circle of patient reliance and lack of self autonomy. I don’t think there’s anything wrong with well directed and controlled shots of empathy and compassion for the active participant who endevours to take control of their health but finds it difficult. However, for the deluded passive recipients of musculoskeletal healthcare who outsource their bodies to the biggest blaggers, I think a stiff dose of candid education is the way forward and ironically as much as it may not be what the patient wants to here, it will keep our cups full and help to debunk the archaic crap still spouted by so many therapists out there. great stuff sir!

  2. Great post Adam and timely, having just ticked over 25 years in private practice. Increasingly I find it difficult to motivate myself to cajole non-compliant patients into doing anything outside their weekly appointment with me in terms of exercises, stress relief, lifestyle changes and have finally let go of the guilt I felt when they didn’t get better.

    A smart mentor told me 15 years ago that you can’t help everybody, wish I’d really understood that back then. I’m making sure my new grad team members are getting that message quickly. Invest your time and emotional energy on the right patients and less on the time-wasters.

    I can recommend Mark Manson’s “The Subtle Art of Not Giving a Fuck” as a useful read in this area as well.

  3. Hi Adam !

    Thank you so much for your post , I have been working in the physio field for few years though definitely not as long as you , however I can totally feel what you have written on this post. And that has totally described all my frustration in the recent period and that explains it !! I’m glad that from reading your post I have understand where’s and why’s and how’s my confusion of unhappiness with my job stemming from ! Thank you again !

  4. Hi Adam,

    I enjoyed your blog as it does certainly seem to resonate with current practice.
    My undergraduate project looked at burnout in physio students and physical activity and I found that even spending short periods of time in clinical practice can increase your risk of burning out.

    One of the main risk factors is (maybe obviously ) organisational stressors which I think are all too common in health care settings. Certainly I’ve found in my short time in the NHS that little is being done to protect staff.

    Work out at work is a great concept because as, you’ve described physical activity can be a great buffer for negative health states such as burn out, but is often a limp showing of physios making a token effort. Maybe more could be done to help staff be more physically active or maybe that issue is much bigger than just health care?

    I feel that another big factor in health care is that the culture is not condusive to health for the staff. How many wards are chocka with sweets and chocolate, how many of the staff are overweight and ‘on a diet’ and how many staff drive into work? I get looks of shock if I decline a slab of triple chocolate cake on cake day because this is the born. These are the same staff that are supposed to offer ‘healthy’ advice to their patients….

    I do fear that as services and staff feel the ever tightening squeeze in the health service, these negative health states will be more and more prominent. Blogs like this one are key to highlighting issues such as burnout, so keep up the good work mate!

    Thanks

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