L9 Prof Development Responding to suffering (changed 9_7)

Overview

This lecture introduces the personal health risks doctors face from repeated exposure to patients’ suffering, defines burnout, compassion fatigue and moral distress as distinct but related phenomena, and then moves into a panel discussion (with Dr Tania Moerenhout, Dr Jonathon Keast and Prof Chris Jackson) built around four open questions on identifying suffering, helping suffering patients, personal distress, and coping.

Why it matters

• 1-2% of doctors may be performing poorly due to ill-health.
• Around 15% of doctors will be impaired at some point in their careers.
• The four Ds of doctor impairment:
  • Depression (anxiety and depression are higher among doctors than in the general population)
  • Drugs (including alcohol)
  • Dimming (burnout and compassion fatigue)
  • Disruptive behaviour
• Doctors have a suicide rate roughly twice that of the general population.

Burnout

• A state of emotional, physical and mental exhaustion due to chronic stress, usually with a gradual onset.
• People experiencing burnout may be at the end of their tether, become cynical, and become inefficient at their work.
• Symptoms:
  • Lack of motivation and poor performance
  • Fatigue, poor sleep, difficulty focusing
  • Increased mental distance from work
  • Increased feelings of negativism or cynicism towards work
  • Decreased feelings of personal accomplishment
• Associated with a very high workload and/or a non-supportive work environment.

Compassion fatigue

• Results from continued exposure to patient trauma and suffering; a form of secondary traumatic stress.
• Caring, feeling and acts of compassion decline, replaced by outward impassive detachedness and emotional numbness.
• Can have a more acute onset than burnout, sometimes triggered or exacerbated by a particular event.
• Can give rise to negative emotions: anger, annoyance, intolerance, irritability, cynicism.
• These symptoms can lead to interpersonal problems, difficulty concentrating on tasks, and declining cognition and judgment.
• Disturbs the ability to think clearly, modulate emotions, feel effective, and maintain hope.

Moral distress

• Occurs when you know the ethically correct action to take but are prevented from doing so by internal or external constraints.
• Caused by the psychological unease, frustration or guilt that arises from being forced to compromise one’s professional values or ethical duties.

Panel discussion

A panel (Dr Tania Moerenhout, Dr Jonathon Keast, Prof Chris Jackson) discussed four questions; the slides record only the prompts, not the panellists’ answers:

1. How do you identify suffering in a patient?
2. How do you help a patient who is suffering?
3. Does human suffering cause you distress?
4. How do you cope?

The transcript preserves only the discussion prompts shown on the slides; the panellists' verbal answers were not captured in the source material.

Self-test

1. List the four Ds of doctor impairment.
2. What proportion of doctors may be impaired at some point in their careers, and what is their relative suicide risk compared to the general population?
3. Define burnout and describe its typical onset.
4. List the symptoms of burnout.
5. Define compassion fatigue and distinguish its onset from that of burnout.
6. What negative emotions and effects can compassion fatigue give rise to?
7. Define moral distress and explain what causes the associated psychological unease.
8. Distinguish compassion fatigue from moral distress in terms of their underlying cause.

Answers

Reveal answers

1. Depression, Drugs (including alcohol), Dimming (burnout and compassion fatigue), Disruptive behaviour.
2. Around 15% of doctors will be impaired at some point in their careers; doctors have a suicide rate roughly twice that of the general population.
3. Burnout is a state of emotional, physical and mental exhaustion due to chronic stress, typically with a gradual onset; sufferers may be at the end of their tether, become cynical, and become inefficient at work.
4. Lack of motivation and poor performance, fatigue, poor sleep, difficulty focusing, increased mental distance from work, increased negativism/cynicism towards work, decreased feelings of personal accomplishment.
5. Compassion fatigue results from continued exposure to patient trauma and suffering (a form of secondary traumatic stress), with caring and compassion replaced by impassive detachedness and emotional numbness; unlike burnout’s gradual onset, it can be more acute and triggered by a particular event.
6. Anger, annoyance, intolerance, irritability and cynicism, leading to interpersonal problems, difficulty concentrating, and declining cognition and judgment; it also disturbs the ability to think clearly, modulate emotions, feel effective, and maintain hope.
7. Moral distress occurs when you know the ethically correct action but are prevented from taking it by internal or external constraints; the unease/frustration/guilt arises from being forced to compromise your professional values or ethical duties.
8. Compassion fatigue arises from repeated exposure to others’ trauma and suffering, whereas moral distress arises from being blocked from acting on what you know to be ethically correct; the first is a response to witnessed suffering, the second to constrained ethical agency.