12/07/2012 04:41 pm ET | Updated Feb 06, 2013

Rx for Compassion Fatigue

Doctors can feel helpless and patients become hopeless when there are no more treatments to offer terminally ill patients. When people think there is nothing left to do, everyone suffers. But there is still living to be done even in the process of dying, and there are meaningful ways in which mindful physicians can care for patients without developing compassion fatigue.

To a doctor, the death (and even impending death) of a patient represents the ultimate professional failure. The problem is that by trying so hard to extend life, doctors can miss the opportunity to be present, compassionately, as their patients make the last, final transition.

Maybe a reluctance to admit that medicine has nothing more to offer explains doctors' urge to engage in last-ditch efforts to sustain life. When there's nothing more to do, sympathy and/or empathy are often all that's left; and neither emotion is typically welcome. Sympathy, or the recognition of someone else's suffering, is the first step towards empathy, which involves "feeling" another's pain. Both hurt.

Most doctors chose their profession because of their capacity for empathy. This is a good thing, because the absence of empathy would seriously compromise the practice of medicine. But getting stuck in the experience of sympathy, or even empathy, simply extends the circle of suffering without offering the opportunity to do anything helpful. And doctors, perhaps more than almost any other professional, want to be helpful. That's why developing compassion, which enhances empathy with the desire to relieve suffering, is critical in end-of-life care.

But here's the problem: Experiencing empathy and even compassion becomes exhausting if you don't have the skills to maintain healthy mental boundaries and take care of your own stress. Those who work with the terminally ill often become numb when their grief, loss and helplessness feel overwhelming and become unproductive.

Compassion fatigue occurs when we try to care for everyone else and neglect our own needs. It happens when we get stuck in "feeling the patient's pain" and can't transform that emotional resonance into true compassion. Fortunately, the practice of mindfulness offers an antidote to this particular type of fatigue because it creates the mental conditions for the most powerful remedy available: compassion.

Practicing mindfulness is protective for caregivers (as well as patients... but that's another blog post) because it facilitates the experience of staying present during a patient's process of dying. Mindfulness refers to staying present with current-moment experience and staying aware of the quality of your attention so you can notice, and refocus, if you become distracted or dull.

Mindfulness is the process and outcome of training attention and awareness; and the practice can involve simple, secular exercises to train the mind. Mindfulness techniques strengthen desirable neural pathways in the brain that grow stronger and become more automatic with practice.

Although basic mindfulness techniques often involve paying attention to your breath, movement or other physical sensations, the point is to use simple strategies to isolate and develop mental skills that are ultimately generalizable to working with thoughts, emotions and behavior. The outcomes are multifold, encompassing physiological, emotional and cognitive benefits. They promote emotional balance and resilience, and they are protective against stress.

Jane Brody's recent article in the New York Times on mental training and compassion fatigue helped draw attention to the contribution of mindfulness to end-of-life care. She referenced research data supporting mindfulness practice among physicians. She also alluded to the need for physicians to care for themselves in order to provide better care for patients.

But, let's go one step further here and consider that mindfulness is the essence of healing because having the skill to be present with a patient is the most powerful expression of caring a doctor can offer. Treatments succeed or fail, and patients live or die, but genuinely acknowledging the experience and value of another human being is the ultimate and timeless expression of humanity.

For more by Deborah Schoeberlein, click here.

For more on caregiving, click here.

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