Being compassionate without burning out

True Christian healthcare is compassionate and comprehensive.  It is centred on Jesus and his heart to heal the whole person – body, mind and spirit.  As Christian doctors we try to keep this at the centre of our medical practice.  But often we do not know how to take care of ourselves with the result that many of us suffer burnout. 

For centuries, compassion has been the motive and the practice of caring for the sick, not least in Christian monasteries where ‘infirmaries’ were established as long ago as 680 AD.  Today, although healthcare facilities are widespread and diverse, compassion provides a strong motivation for those who work within them.  And, in these days of COVID–19, such compassion has been poured out dramatically even in the face of high personal risk.

A formal research interest in compassion has a much shorter history.  Since the 1960s, it has grown substantially with a sharp increase in publications over the past ten years.  PubMed In August 2020 listed 12,915 scholarly references to this topic.

In 2016, a formal definition of compassion in healthcare was derived from a systematic literature review by Perez-Bret, Altisent and Rocafort.  They proposed compassion to mean ‘the sensitivity shown in order to understand another person’s suffering, combined with a willingness to help and to promote the wellbeing of that person, in order to find a solution to their situation.’  Thus, compassion’s two defining components are of an empathic understanding of suffering coupled with targeted, practical response to bring relief.

Not surprisingly, many scientific references endorse the benefits to patients of being treated compassionately.  A systematic review in 2013 highlighted the improvement of patient satisfaction and adherence, a reduction in their anxiety and distress, better diagnostic and clinical outcomes, and an increase in the ability of patients to improve their own health.  Less well known is that acting with compassion also brings benefits to healthcare professionals: better immune functioning; increased satisfaction with their relationships; protection against professional stress, abuse, and suicide attempts; and the least risk of burnout.

However, offering compassionate care can come at a cost.  Nearly 19,500 learned papers show overwhelming evidence that healthcare professionals are at greater risk than the general population of suffering significant mental health issues, including burnout.  

A useful tool to consider in this context is the ‘Stress Curve’ based on the research of two psychologists Yerks and Dodson in 1908.  Plotting ‘Performance’ against ‘Pressure’ shows that as pressure increases, performance improves to an optimum point, beyond which increasing pressure causes performance to deteriorate, and if unchecked, leads to ‘Burnout’.

Burnout is a word used loosely in common parlance, but we must be precise in our use of terminology.  In 2019, the WHO officially recognised burnout, defining it as ‘A syndrome resulting from chronic workplace stress that has not been successfully managed’.

Being aware of the causes and symptoms of burnout is important.  The former is to enable doctors to avoid precipitating behaviours, and the latter, to enable early recognition of the possible onset of burnout – not just in ourselves but in colleagues.

Doctors then need to consider what internal coping strategies they may have developed.  Peer support or ‘looking out for each other’ is frequently identified as of particular significance.  Identifying external sources of support is another vital part of our assessment, especially sign-posting people to individuals in their local work setting who have been given specific pastoral responsibility for staff and trainees.

The underlying principle is summed up in St Paul’s words of exhortation to the Galatians: ‘Carry one another’s burdens and so fulfil the law of Christ.’ (Galatians 6:2)

---

Dr Andy Mott is a retired UK GP with thirty years’ clinical experience, and former GP Sub Dean of the Brighton and Sussex Medical School.

Dr Richard Vincent is Emeritus Professor of Cardiology at the Brighton and Sussex Medical School, of which he was co-founder and Associate Dean.

PRIME

To explore burnout and compassion as experienced in the healthcare workplace, the UK Christian charity PRIME – Partnerships in International Medical Education – has been presenting a series of seminars called Compassion without Burnout on which this blog post is based.

Noting the pressurised work of medical staff as they deliver care with both scientific rigour and personal compassion, we designed the seminar programme for their encouragement and support based on small-group discussions.  In these, we review the benefits and challenges of providing compassionate healthcare, the causes and signs of burnout, and the ways in which burnout in the workplace can be minimised. 

We use a PowerPoint presentation to give information but emphasise sharing and listening as we explore the work-related challenges of the group.  To this end we provide a safe space for reflection and grounded discussions that allow the sharing of honest comments about participants’ experiences.  So far, the reception of our seminars has been strongly positive, and, not uncommonly, participants wish to pursue these themes further.

If the subject of Compassion without Burnout is of continuing interest, please see our webinar recorded with the ICMDA on 26 July 2020.  For more information about this programme, or more generally about the work of PRIME,  please click here or email us.