Tuesday, May 29, 2012

How to Treat Compassion Fatigue

Like the oxygen masks on an airplane,  you put your mask on first

 Bryan Mingle  /  Rise Health Contributing Blogger

One of my favorite modules in a year-long classroom certification program for Alcohol and Drug Counseling addressed "burnout." The instructor, who was at the top of her license in Orange County, Calif., treatment centers overseeing SAMHSA services, told the future counselors that it was the No. 1 enemy for the new and the experienced. 
 While many jobs and professions bring on burnout, health-care fields involving contact with patients carry the highest risks -- and the lowest tolerance. Can you imagine being a frightened patient in need of empathy and an even-keeled delivery and facing a doctor whose manner and energy said "shell-shot."
Luckily, burnout precautions and preventative plans often are provided for counselors, nurses, physicians and other providers in health-care settings. But not always.  
  I learned during  my first year as a chemical dependency counselor in a chaotic detox unit in Jacksonville, Fla.  that the greatest teacher is experience itself.  In other words, the old adage of no pain, no change, proved very true.
While self-care was reviewed during evaluations by my supervisors, practicing it when 12-hour days were piling up was a challenge and a reality that myself and  fellow social workers knew too well. I had one or two role models where I worked, but for the most part staffers around me were drowning in work and documentation of that work. At some point, the return on such workaholism showed up negatively. I'll never forget one evening, after several days in a row of  12-hour shifts, I was scouring the nurses station for a missing chart and one of my patients, watching and waiting in his nearby med line, shouted out: "Bryan, are you OK? You look like you really need a drink." Good insight.
Other therapists and I began to engage in "process sessions" on van rides to the parking lot before and after our shifts, or during gobble-down lunches on a picnic table roped off from the milieu. We vented about work. About patients. We basically had big complaint sessions, which, as it turns out, is one of the top tell-tale signs of  compassion fatigue and burnout.
Real patient-centered care mandates that the providers walk their talk and center some care around their own lives. I left the detox unit after a year and began working at Rise Health in a practice support center that was a virtual extension of primary care practices for a safety-net hospital in Boston.
Call volume was high from the start,  and many of the patients on the other end of the phone had a low tolerance for frustration and were demanding of their needs. What I learned as a counselor applied to all of our patients on the other end of the phone at Rise: Offer unconditional positive regard and genuine empathy; do no harm. Listen, reflect back and offer options/solutions.
To do that on a consistent basis requires the self-care that my instructor in California relentlessly taught about.
Today I came across a column and a web site that are echoes of my concerned teacher, who frequently told  us that she wanted each of us to be the counselor who would treat her daughter the same way we would our own family member. I am publishing it here to remind myself and others in the health-care field about a very basic component of any treatment plan: self-care. If you never leave the basics, you don't have to return to them.

Cynicism and sarcasm are among the first signs of burnout

Physician Burnout and Physician Stress – Find Solutions Now