A compassionate approach in medicine has a positive impact on patients and healthcare providers. Compassion helps buffer the impact of stress on the well-being of providers, improves patient outcomes (Seppala et al., 2014), and improves your ability to support your peers. Expressing empathy is part of communicating compassion. For example, knowing how to communicate bad news with compassion a skill that will help many patients. However, continually being faced with circumstances that call on you to offer compassion can lead to fatigue.
Compassion Fatigue vs. Satisfaction
Compassion Fatigue (CF) is the symptom that comes from being exposed, usually multiple times, to the trauma and suffering of others beyond one’s ability to cope (Cocker & Joss, 2016). Healthcare providers are susceptible, especially in a long-term crisis. Health effects of CF can include posttraumatic stress disorder (PTSD), anxiety, or depression. CF often manifests as exhaustion, anger, irritability, less enjoyment or satisfaction with work, and increased absenteeism. CF may result in harmful coping behaviors, such as alcohol and drug abuse or overeating. Programs to combat CF that help develop self-efficacy and resilience have shown some effectiveness.
Compassion Satisfaction, on the other hand, is the pleasure and satisfying feeling you get from helping others. It may come from providing physical healing, but also emotional support and encouragement. Compassion satisfaction is often a key component of job satisfaction in medicine.
Skills that help promote more Compassion Satisfaction and less Compassion Fatigue include:
- Become skilled at switching between work-mode and off-work mod
- Leave your feelings about what happens at work behind when you leave.
- When entering work mode, call to mind images and thoughts that help you feel safe and protected while working.
- Before entering a situation at work that is difficult to handle emotionally, take a few deep breaths to calm yourself.
- When facing difficult work, intentionally do things to care for yourself, including getting enough sleep, food, rest, and exercise. Pray, meditate, use deep breathing, or do yoga. Do something you enjoy.
- Learn from your mistakes.
- Notice what went well.
Professional Quality of Life Scale – This website presents a measure that assesses compassion satisfaction vs. compassion fatigue.
Video: Compassion Resilience and Setting Boundaries for Healthcare Workers by Sara Reed. 2020. Mental Health America. This hour-long video is rich with insights on setting boundaries to improve compassion resilience.
Cocker, F., & Joss, N. (2016). Compassion Fatigue among Healthcare, Emergency and Community Service Workers: A Systematic Review. International Journal of Environmental Research and Public Health, 13(6). https://doi.org/10.3390/ijerph13060618
Conveying Difficult Information
An article (Murphy, 2019) in the AMA’s news for medical students recommends the following steps:
- Understand the gravity of the news
- Prepare the patient for what you are about to say
- Have a plan
- Be honest
A list of skills needed to deliver bad news has been used successfully to train medical students (Vermylen et al., 2019). These include:
- Create initial rapport.
- Assess the patient’s (and family’s) perception and understanding of their medical situation.
- Ask permission to give the news, give the news in the first few minutes of the conversation.
- Give a clear and concise warning.
- Use the word “cancer” or other serious diagnoses rather than euphemisms.
- Wait some time after delivering bad news to let them process it, but not too long, judging as best you can by their reaction. Around 3 seconds is often a good pause.
- Express empathy as your next statement and as your response to their reaction, rather than hurrying to provide reassurance.
- Discuss the plan, but only after the patient asks or gives permission and not while they are feeling very emotional
Use general, good patient-centered communication skills, including the use of summary statements, avoiding jargon, and chunking information.
Resources on Delivering Bad News:
4 things medical students should know about delivering bad news – by Brendan Murphy, Patient Support and Advocacy, January 7, 2019, AMA
Read about a medical student’s practice session in breaking bad news to a standardized patient at the University of Michigan.
Vermylen JH, Wood GJ, Cohen ER, Barsuk JH, McGaghie WC, Wayne DB. Development of a Simulation-Based Mastery Learning Curriculum for Breaking Bad News. J Pain Symptom Manage. March 2019;57(3):682-687. doi:10.1016/j.jpainsymman.2018.11.012. PMID: 30472316.