"There's no such thing as compassion fatigue"
“I hear prominent people talking about ‘compassion fatigue.’ It’s a misnomer,” says Barry Kerzin, MD adjunct professor of psychiatry who is a Buddhist monk.
“There’s no such thing as compassion fatigue, just empathy fatigue,” he says.
“If we are healing professionals,” Kerzin posted in a Human Values Institute blog, “and we are around people who are sick, and often, angry and depressed, we’re going to take that on. And then it’s much easier to burn out.”
The key is to make a shift, to cultivate compassion rather than empathy, he explained during a visit to Pitt in the spring. He defines empathy as “standing in the other person’s shoes. We are so close emotionally that, inadvertently, we take on the others’ suffering. And if we do that many times in a day—day in, day out—that’s an avenue, I sometimes call it a boulevard, to burnout.
“A way to protect ourselves, to have less burnout, is to move beyond empathy to compassion.”
Compassion is the wish to relieve suffering—rather than the adoption of another’s suffering, he explains.
“When you’re empathetic, you’re enmeshed. So we train people to take a half-step back emotionally. If you’re not so quite on top of the other person, so close, the heart is still open, but you have other cognitive faculties that are available . . . to more clearly see how to reduce the suffering of the other person.”
“But how?” a third-year student asked Kerzin after a recent talk.
“There are no tricks here,” Kerzin said. “There’s no magic, just knowing that you want to be a little less close, to create a little bit of distance emotionally. Just knowing that will help you get there when you find yourself being empathetic.”
The student shook his head and said, “I will try.”
“It’s not as hard as you think,” said Kerzin. “Knowing that is at least half the battle.”
Learn more about cultivating compassion and healthy self-confidence with Kerzin’s AIMIcare app, free from Apple and Google Play stores.
“Doctors should think of their work as something almost sacred”
Even before medical students spend much time in the clinic, they can be maxed out, says Juliet Jarrell. She’s a SHARP (Student Health Advocacy Resource Program) representative—a mental health advocate for her second-year classmates. In that role, she meets with many of her peers who are looking for support or referrals for professional resources. Jarrell often hears them say that with the pressure of their studies, they find themselves becoming increasingly impatient, so much so that they have trouble paying attention to the concerns of friends and family.
And that sets the stage for trouble during their future practice, Jarrell says.
Health care trainees cannot afford to abandon compassion, says Kerzin. One of his priorities as a teacher is to help them cultivate it.
“There is a common perception that compassion is, if not actually an impediment, at least irrelevant to professional life,” he says. “But not only is it relevant, when compassion is lacking, our activities are in danger of becoming destructive. This is because when we ignore the question of the impact our actions have on the well-being of others, inevitably we end up hurting them.”
He shares this message from his patient the 14th Dalai Lama:
“Even under pressure of time, doctors should think of their work as something almost sacred, as akin to spiritual service. In my own experience, a smiling doctor puts us at ease, whereas a stern-faced physician is a source of anxiety. Even when doctors and nurses know the patient in their care is unlikely to survive, it’s important to be kind and compassionate toward them. At the time of death, it’s crucial to be at peace, not angry or fearful. At the start of our lives, we encounter compassion in our mother’s affection, and as our lives come to an end, we need compassion again.”
Read more about Pitt Med's efforts to help med students attend to their minds so they can better attend to patients in our cover story.
