“A family history of neurologic disease was, in large part, what prompted me to enter the field of neurology. Having that personal experience empowered me to be an empathetic medical provider but also taught me the importance of resilience for patients and caregivers,” says Justin Jordan, MD, MPH Clinical Director for Neuro-Oncology at Massachusetts General Hospital.
“I’m holding hands with patients from the moment they’re diagnosed through their entire journey of whatever their healthcare problem may be. The good visits are good for me too, and the bad visits are bad for me too. When you’re so emotionally invested in the well-being of the people for whom you’re caring in clinic, resilience is incredibly important.”
At the 2018 annual meeting of the American Academy of Neurology, Jordan was invited to give a talk on physician resilience in the face of such high rates of burnout in the field. But burnout is not the only problem, he said, many physicians are also suffering from compassion fatigue.
Jordan agreed to answer some questions to help us understand this problem and what neurologists can do about it.
What is the difference between burnout and compassion fatigue?
“The truth is there’s really a dearth of literature about this,” says Jordan, and there can be a fine line between the two. However, “there are a handful of champions, and there’s a great paper from JAMA in 2009 by Michael Kearney, called Self-Care of Physicians Caring For Patients At the End of Life.
“What they say is burnout results from stressors that arise from the clinician’s interaction with the work environment, while compassion fatigue evolves specifically from the relationship between the clinician and the patient. I think for burnout there are some strategies that can be implemented in lifestyle or the workplace, whereas for compassion fatigue, there are some skills to learn.”
What skills can help mitigate compassion fatigue?
Among these skills, Jordan says, “achieving closure when necessary is an important one. Many people don’t take the time for closure. Just take five minutes to call the family and express your condolences or even attend the funeral.”
Look at the big picture
“Even if an outcome is adverse or not what you had hoped for, it helps to remember the amount of good you were able to bring to the patient, and also for a physician to have the opportunity to contribute to research.”
Don’t go it alone
“For some doctors that may mean seeing a therapist. It may be another doc in town who you meet up for coffee, and although he or she may not know about secondary multiple sclerosis, he or she still knows human disease.” Jordan also mentions groups that can help, like the Balint Society. “They run healthcare provider resiliency groups.”
Be mindful of boundaries
“Professional boundaries are incredibly important, and those boundaries are not hard and fast. Some physicians like to give their personal cell phone numbers to patients, and others have a boundary there.” Jordan says it is important to balance what is good for the patient with what is good for the doctor.
Balance hope with realism
In many ways the physician’s role, says Jordan, is “to be the bringer of hope and the champion of next-wave therapeutics, while at the same time bringing realism to the patient’s and family’s expectations. That grounding, no matter how much hope you want to interject, I think helps ground the physician as well.”
Come up for air
“Some of this is a little bit like snorkeling or scuba diving; you have to come up for air, whether that’s time with family, seeing a movie, or going on vacation, and really turning it off.”
Jordan says that there is no one skill that is a panacea, but each of these can add something that ultimately makes a big impact in preventing compassion fatigue. “I think that the skill set for this will never be perfected. This is an ongoing journey in a physician’s own career just as much as it is for the patients being treated.”