I want to talk about something that’s a little awkward to talk about. It’s something that affects EVERY healthcare professional, and it’s something we need to talk more about. 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. They have to do this whilst trying to embrace and implement evidence-based practice, meeting productivity goals and targets, maintaining high professional and personal standards, and usually with limited support or resources.
These daily challenges are a constant struggle for many clinicians that can and do lead to increasing levels of stress and frustration, that can and do affect their physical and mental health and impact on their quality of life.
I know this first hand. I have been doing this job for over 15 years, and for nearly every day of those 15 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 15 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.
But it’s 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 back at the start of my career I was lead to believe and truly thought I could help everybody I saw, and I tried my damn hardest to do so. However, I soon realised that my education hadn’t prepared me for the many brutal realities, hardships, and disappointments that this job brings. I was unprepared for the feelings of frustration and failure I was getting with many of my patients, and I felt like it was my fault.
However, I don’t feel like this anymore. I still try my damn hardest to help all those I see, but I find myself better at accepting and recognising that I can not help everyone. I now know there are many patients who I won’t or can’t connect with, who I won’t motivate, encourage, educate, or help!
You may think this is unprofessional to talk about, and that as a healthcare professional I should try everything I can, with everyone I see. And I agree, every patient deserves the best possible care they can get. But this is my pragmatic realisation over the years, this is my compassion fatigue, 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 ready or willing to be helped, that some patients don’t want my advice or help? I have learnt from countless past failures who I can, and who I can not help. I have learnt over the years that there are many patients who despite saying contrary are reluctant 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 bond, connect, 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 do 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. 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 try to encourage and motivate patients to move more, and we use physical activity in all its glorious ways and means to do this.
Many patients need to understand that having good physical and mental health, and being pain free is not an automatic entitlement. 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 a lot of effort to reduce the risk of disease, deterioration, and decline.
Human bodies are designed for activity on a regular, daily, hourly basis, and many simply don’t do enough, nor do they want to. This is fundamental in everything we see and 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 I will not waste my time and energy on any patient who thinks I should be more interested and invested in their health and outcomes 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.
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