Giving Less and Less

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 f**k!

All healthcare professionals whether working in the private or public sectors are challenged daily to provided patient-centred care in an efficient and effective manner. They have to do this whilst trying to implement the best available evidence-based treatments, meeting productivity goals and targets, maintaining high professional and personal standards, all usually in a high-pressure environment, with limited support or resources.

These daily challenges are a constant struggle for many clinicians that can soon lead to increasing levels of stress and frustration, that can affect their physical and mental health, impacting on their quality of life and careers. I, unfortunately, know this only too well due to first-hand experience!

I have been a physio for over 15 years now, and for nearly every day of those 15 years, I have been listening to patients stories of distress, suffering, frustration, and confusion about their 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 to find a way forwards, onwards, and upwards with whatever ailment or condition they have.

It's tough, really tough.

Year on year, month on month, day on day I can feel and sense a change in how I approach my job and 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 to more and more people I see.

In the beginning way back at the start of my career I honestly thought I would be able to help everybody I saw, and I tried my damn hardest to do so. However, I soon began to realise that my training and education hadn't prepared me for the brutal realities, hardships, and disappointments that this job brings.

I found myself unprepared for the feelings of frustration and failure I was getting with many of my patients when they didn't do what I asked, or show any signs of improvement when they were supposed to. I did everything I was taught and yet still felt like I was doing something wrong.

Can't help everyone

However, I don't feel like this as often anymore. Don't get me wrong I am still disappointed when patients don't get better, but I find myself now better at accepting, tolerating and recognising that I can not help everyone despite my best efforts.

I now know there are many patients who I just won't or can't connect with, who I just can't or won't motivate, encourage, educate, or help! This is often due to many complex and confusing physical, psychological, emotional and personal issues.

You may think this is an excuse for me to be lazy, accept failure, or pass the blame onto others. You may think that as a healthcare professional I have a moral duty not to accept failure and should try everything I possibly can, with everyone I see.

And I do agree that all patients deserve the best possible care attention and treatment from all healthcare professionals. But I have 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 or need my advice or help?

I have learnt from many failures over the years that there are many patients who are reluctant to improve, put in the required effort or commitment to help themselves for many reasons, and that my attempts to assist them will have minimal to no effect on their problems or issues.

I also know that no matter how hard I try with some, I can not, and will not be able to connect, encourage, motivate, guide or change everyone that I see. I also know that sometimes I will also make very little difference to some patients even when I do connect and motivate them.

We don't fix anything.

Physios are not magicians. We don't heal, correct, fix, or mend anything. The main role of a physio is to offer advice and education, encourage and motivate patients to move more, and occasionally make some lifestyle and behavioural changes.

As tough as this is to hear being healthy and pain-free is not an automatic entitlement given to everyone equally. Unfortunately for many of us, there is a lot of regular hard work and occasional sacrifice required to maintain a healthy body and mind and reduce the risk of disease, deterioration, and decline.

Humans are designed to move a lot, regularly, and many simply don't do enough. This is fundamental in everything we see and do in healthcare and if we are not interested and invested in our own health and longevity, then there is little we can do to prevent decline.

These days I will rarely waste any time and energy on anyone who is not interested or invested in their own health. Don't get me wrong, I'm not saying we should suddenly become hard-nosed bastards and throw everybody on the metaphorical scrap heap at the first barrier or hurdle in motivation or effort. Rather that we should be more realistic in how much we can help some people sometimes.

Clinicians are humans too

I also think we need to recognise that healthcare professionals are humans too and have just as many issues as those we are supposed to be helping. Of course, most healthcare professionals are healthier and motivated to help others, 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 energy, effort and skills on someone who doesn't want your help and then realising you having little or nothing left for someone who does want it.

As healthcare professionals being aware of your own mental and physical health is essential. If you are not looking after yourself well you won't be any good at looking after others.

Playing the long game

If you want to be in this job for the long game you need to work out how to manage these stressors in a way that is right for you. For me I find having a good network is paramount. Having colleagues, friends, and family that you can talk, moan, laugh and cry too is vital.

Physical activity and exercise is also important. If you as a clinician are not letting off some steam on a treadmill, sports pitch, or squat rack at least a couple of times a week, be prepared for some rocky times ahead.

Next, make sure you eat well and sleep well and try not to drink too much. Although I do find a good glass of single malt whisky every now and then can help lifes issues tremendously.

Also, don't take physio too seriously. I do understand that physio is a vocation not just a job for many of us, but don't get wrapped up in all the confusing and conflicting research, opinions, and treatments out there. And definitely avoid as many of the petty pathetic squabbles, ego bashing, and willy waggling as you can.

And finally, never ever neglect or ignore those you love and who love you the most. Again I understand that some peoples jobs are very important for many, but this should never come at the expenses of your family and loved ones.

Summary

Not many physios or other clinicians talk about compassion or empathy fatigue much, and I think many think it is a taboo subject. For me, it is the 'elephant in the room' that will affect us all in the future in some smaller or larger way. 

I think there needs to be more recognition and support from both professional bodies and employers in regards to compassion and empathy fatigue. Because with the growing pressures and demands on all clinicians to see more and more patients with less and less support, it will create more and more clinicians giving less and less support to their patients.

This is a nasty vicious self-destructive circle if there ever was one.

As always thanks for reading

Adam