Why should we care?
As in other professions that involve caregiving, veterinarians require high levels of compassion, empathy, and a willingness/desire to care for others. This often puts us in situations where we are exposed to traumatic events that, over time, will take a toll on our mental and physical health. These include animal abuse, dealing with both animal and human suffering, the loss of long term patients, and, of course, humane euthanasia. Experiencing these situations on a day-to-day basis can lead to compassion fatigue.
Disclaimer: We have no formal training in psychology, social work, or any other similar profession. The information in this post is purely intended to raise awareness regarding a very important issue facing the veterinary profession. It is not intended to be the only source of information you turn to on this subject. We hope this post serves to start an important dialogue between you and your colleagues, as well as with your family and friends.
It is important to mention the ethical dilemmas we’re faced on a daily basis and the term ethical fatigue/exhaustion should be considered. As opposed to human medicine, for example, we do not have the financial freedom to simply do what is best for our patients in every situation.
Other times veterinarians feel their hands are tied when a pet owner cannot or will not do what is medically necessary for a pet. Finally, we have all heard of a vet who has been faced with a “convenience” euthanasia; that is, being asked to humanely euthanize an animal at the request of its legal owner, even if the pet is not ill.
Even though the healthcare costs in human medicine are much higher than in the veterinary field, our clients don’t necessarily recognize it. If they go to the doctor, their insurance will usually pay for most of the bill. On the other hand, if they bring their uninsured pet to see us, they have to cover the whole bill out-of-pocket, which gives them the false idea that veterinary care is more expensive than human medicine. There is also the large misconception that veterinarians are pocketing all of this money, and that we are truly out to swindle our clients.
These issues can be bigger problem in general practice and emergency medicine. In these cases, families don’t necessarily have the time to mentally and financially prepare for the stress that is involved with a sick pet that needs care. However, even at specialty practices, it is not uncommon to have to decide which tests to submit in order to stay within a certain budget, or deciding if the remaining finances will be used for another day of hospitalization versus a needed diagnostic test. All of us have been in situations where an animal could have been saved if finances were not part of the equation.
Ultimately, the goal is to do the best we can for our patients, despite having to face these issues day-in and day-out. In an ideal world, every practice would have a social worker or other trained professional to effectively manage these situations while allowing veterinarians to focus on their work. It wouldn’t be a perfect solution, but it would truly benefit all players in the relationship – the veterinarian, the client, and the pet.
For now, these burdens fall on the veterinary team. This has led to the high rates of mental illness, anxiety disorders, substance abuse and suicide in the veterinary profession. It is crucial that current veterinarians and students are aware of these problems, not only for themselves, but for their colleagues! The stigma surrounding mental illness must end. These diseases are too prevalent to be ignored, and when they are, the consequences are terrible.
It is imperative to recognize that burnout and compassion fatigue are not the same!
To distinguish them, read the following definitions from various sources and follow the links for more information. We’ve also added other definitions that you might encounter in your reading:
– Also called “vicarious traumatization” or secondary traumatization (Figley, 1995). The emotional residue or strain of exposure to working with those suffering from the consequences of traumatic events. It differs from burn-out, but can co-exist. Compassion Fatigue can occur due to exposure on one case or can be due to a “cumulative” level of trauma.
– The physical and mental exhaustion and emotional withdrawal experienced by those that care for sick or traumatized people over an extended period of time.
- Some researchers consider compassion fatigue to be similar to posttraumatic stress disorder (PTSD), except that it applies to those emotionally affected by the trauma of another (eg, client or family member) rather than by one’s own trauma.—Michael K. Kearney et al., The Journal of the American Medical Association, 18 Mar. 2009
- Clinicians should be aware of how their emotional withdrawal or lability and “compassion fatigue” can jeopardize the care of dying patients and their families.—Deborah Cook and Graeme Rocker, The New England Journal of Medicine, 26 June 2014
– A state of exhaustion and biologic, physiologic and emotional dysfunction resulting from prolonged exposure to compassion stress. Individuals that experience compassion fatigue feel overwhelmed from bearing the suffering of others, but typically continue to engage in self-sacrifice in the interest of their patients and clients. Factors that place individuals more at risk for experiencing compassion fatigue are high empathy, a history of traumatic experiences, and the existence of unresolved trauma. Factors that affect the severity of compassion fatigue are the duration of the experience, the potential for recurrence, exposure to death and dying, and the presence of a moral conflict.
By the AVMA
The unavoidable stress experienced when helping others in distress or harm’s way. This stress is expected, natural and unavoidable in the healthcare field and is derived from a sense of responsibility and desire to alleviate suffering. Unless addressed, compassion stress can escalate to compassion fatigue.
By the AVMA
– Cumulative process marked by emotional exhaustion and withdrawal associated with increased workload and institutional stress, NOT trauma-related
– A psychological syndrome that involves prolonged response to chronic interpersonal stressors on the job. Burnout is typified by emotional exhaustion, cynicism, personal inefficiency and ineffectiveness in the work environment.
By the AVMA
– A degree of fulfillment, sense of purpose and satisfaction derived from working as a care provider. This can involve positive feelings toward colleagues, contributions to the work environment and/or gratification from caregiving.
By the AVMA
– The action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another of either the past or present without having the feelings, thoughts, and experience fully communicated in an objectively explicit manner.
– Sympathetic consciousness of others’ distress together with a desire to alleviate it.
What does Compassion Fatigue look like? (Adapted from Mathieu):
- Reduced ability to feel sympathy and empathy
- Anger and irritability
- Increased use of alcohol and drugs
- Dread of working with certain clients/patients
- Diminished sense of enjoyment of career
- Disruption to world view, heightened anxiety or irrational fears
- Intrusive imagery or dissociation
- Hypersensitivity or Insensitivity to emotional material
- Difficulty separating work life from personal life
- Absenteeism – missing work, taking many sick days
- Impaired ability to make decisions and care for clients/patients
- Problems with intimacy and in personal relationships
- Isolation and loss of morale
- Cognitive ability decreases
- Potentiate Depression and PTSD
- Nervous system arousal (Sleep disturbance)
- Loss of self-worth, hope and meaning = existential despair
Do I have compassion fatigue, burnout or something else?
Taking the Professional Quality of Life Elements Theory and Measurement test (ProQuoL) can help determine the answer to this question.
The Compassion Fatigue Awareness Project website has two other tests that you should also take: Stress and Empathy.
Check out this great picture from a post on DVM360 (Illustration by Sarah Dowdy):
And look at this one on burnout from MindTools:
Why is essential to know what you’re dealing with?
Because the strategies to address them are different!!
Among other things, self-care, building resilience, and working on stress management are vital to address compassion fatigue.
It is also very important to know that Depression and Compassion Fatigue or Burnout are not the same entity. Depression can be present in addition to these and can make them worse/more severe. Evaluation by a health care professional is recommended and necessary in order for you to get the help you need.
Bottom line – if you feel that you’re struggling, please turn to your family, friends, and health care professionals. They can help you. On the same note, if you have a colleague that appears to be struggling, reach out to them and/or direct them to where they can get assistance. Feel free to share this post and any of the resources listed below!
- National Suicide Prevention Lifeline
- Compassion Fatigue Awareness Project
- AVMA Wellness and Peer Assistance
- The ABCs of avoiding Compassion Fatigue
- Burnout, Compassion Fatigue, Depression – what’s the difference?
- A world of compassion: Veterinarians unready for compassion fatigue
- Chipping away of the soul: New data on compassion fatigue and compassion satisfaction in veterinary medicine
- Depression – Mayo Clinic
- MA Veterinary Medical Association – Mental Health Resources
- Mindtools – Stress Management
- Compassion Fatigue in the Animal-Care Community
- When helping hurts: Compassion Fatigue in the Veterinary Profession
Note that the AVMA link above has even more resources on this subject that are worth your time!