Focus on Physicians:
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Compassion Without Burnout: How Physicians Can Balance Empathy and Sustainable Practice
Balancing deep compassion with professional distance in the face of suffering and death can be challenging for newer physicians. Learning to care deeply while maintaining emotional boundaries is a skill that takes time to develop. Intense suffering, tragedy, and death are circumstances that most people only experience a handful of times in their lives. When your job is to make strategic decisions and take decisive action, the ability to harden yourself against another’s anguish is not a flaw; it is a necessary adaptation.
Balancing deep compassion with professional distance in the face of suffering and death can be challenging for newer physicians. Learning to care deeply while maintaining emotional boundaries is a skill that takes time to develop. This is the practice of equanimity. For many seasoned physicians, sustaining this balance is a lifelong point of tension.
Whether you work in a high-intensity surgical or critical care specialty or an outpatient practice in which you nurture long-term relationships with your patients, you are likely to face this challenge many times through your professional life.
Detachment as a Survival Mechanism
Intense suffering, tragedy, and death are circumstances that most people only experience a handful of times in their lives. For many physicians, this is the reality of a normal day at work.
When your job is to make strategic decisions and take decisive action, creating separation from another’s anguish is not a flaw; it is a necessary adaptation. It allows you to effectively care for your patients, alleviating the source of their distress without taking on the burden of every painful story. And it protects your patients, because it means that your decisions come from a place of wisdom and expertise.
At the same time, maintaining an emotional distance can often come across as distant and unfeeling. When it becomes habitual, you may even begin to believe that you’ve lost your ability to experience compassion. It’s a fine line to walk, and it’s something that is rarely taught.
If taken too far, suppressing your inherent pull of empathy can erode patient trust and increase your risk of professional burnout. It may also spill over into your personal life, impacting your ability to connect with those you love and risking your present and future well-being.
One Doctor’s Struggle: When Emotional Armor Becomes a Burden
A highly skilled interventional cardiologist I know recently reflected on the ways that his years of exposure to suffering created a powerful emotional detachment that threatened his health and his marriage.
Early in his career, the heavy weight of each patient’s experience felt overwhelming, as if every tragedy could pull him underwater. He often cared for people who sought him out knowing that their advanced heart disease left them with few remaining options. Many times, the procedures he could offer carried great risk. And while most patients benefited, some did not. There was a high risk of complications, and he knew that a few would die despite his best efforts.
Attempting to protect himself, he grew a thick, protective, rational shell which numbed him emotionally and created an aura of impassiveness that was often perceived as indifference and even coldness. Over time, this self-protection extended into his personal life, putting his marriage and family at risk.
His case-hardened persona was at odds with his personal values and created a feeling of disunity and distress. He was often tempted to numb himself to exhaustion with extreme exercise before going home, even when it was very late in the evening. He eventually realized that change was necessary—not only to sustain his career in interventional cardiology but also to repair and preserve his relationships with his wife and family.
When it became clear that he was about to lose the people who mattered most to him, he reached out for help. Over time, through a practice of mindfulness and self-care, he became able to extend compassion to his patients without becoming emotionally engulfed in each case. As a result, he could nurture his personal relationships without fear that this vulnerability would bleed into his professional role.
Finding a Sustainable Path Forward
How can you begin to find the balance between maintaining compassion and protecting yourself? It can be helpful to remember that detachment doesn’t mean not caring—it means setting boundaries to ensure longevity in a profession that demands so much of you.
Your emotional capacity is rarely infinite. It may help to think of it as an energy bank account that requires careful management. When you worry endlessly about outcomes beyond your control, you’re spending your energy recklessly, draining your account without benefiting yourself or your patients.
Just like a bank account, emotional capacity is not only about withdrawals, but also about strategic savings and interest. This comes through self-care. This might mean practicing mindfulness, connecting with colleagues who understand the emotional toll and have found healthy ways to manage the distress, or engaging in fulfilling activities outside of medicine.
Studies of surgeons engaging in a surgeon-focused mindfulness-based stress reduction program known as Enhanced Resilience Stress Training have shown important benefits. Similar programs are likely to help others who deal with high-stakes situations on a daily basis.
Coaching can also be a meaningful tool, providing a supportive space to reflect, gain clarity, and develop your own path forward. If the weight of it all feels too heavy, working with a therapist who understands the unique challenges physicians face can provide valuable support.
Compassionate Boundaries
If you’ve ever felt guilty for not feeling deeply every time you witness a patient suffering, you are not alone. This is not a failure of empathy; it is a recalibration that allows you to keep showing up, day after day, for the people who need you. Compassion and detachment are not mutually exclusive, and compassion is not measured by how much suffering you absorb,
By setting boundaries, recognizing your own limits of emotional energy, and applying mindful detachment with care, you will find your way to practice compassionately while protecting your own well-being. You’ll create a meaningful separation between work and home. And you’ll be present and effective for your patients in their time of need.
If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.
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Burnout is an Expression of Grief, Not a Lack of Compassion
“The wound is the place where the light enters you.”- Rumi
With over 60% of physicians surveyed reporting burnout in 2021, it’s an epidemic in our profession.
Burnout is not a personal failing or a psychological illness. Rather, burnout is a response to chronic workplace-related stress.
But burnout is not a failure of compassion. In fact, burnout may be a natural reaction to the recognition that you are unable to provide the compassionate care that your patients need.
An earlier version of this article appeared on the KevinMD website in June, 2023
Over the last 5 years, the word “burnout” has become nearly synonymous with the state of healthcare. With nearly 50 percent of physicians surveyed reporting burnout in 2023, it’s an epidemic in our profession.
Physicians are often made to feel responsible for their symptoms of burnout, but by definition, burnout is not a personal failing or a psychological illness. Rather, burnout is defined as an occupational phenomenon that happens in response to chronic workplace-related stress.
Burnout is not a failure of compassion.
If you’re feeling burned out, it doesn’t mean that you don’t care. In fact, burnout may be a natural reaction to the recognition that you are unable to provide the compassionate care that your patients need.
The experience of burnout may mirror in some ways the experience of grief. Both are a response to loss. And like burnout, grief is often experienced as exhaustion and difficulty thinking clearly.
Compassion fatigue on the other hand is defined as a sense of indifference to the suffering of others. It’s an emotional withdrawal often caused by exposure to traumatic events. For physicians, it may be a response to relentless illness and death. The COVID-19 pandemic is a classic example of a driver of compassion fatigue, especially for those who worked in the ER and ICU in the early days of this disaster.
It’s not uncommon for physicians to experience compassion fatigue from time to time. It doesn’t mean that they are not compassionate people, but rather that they are suffering and in need of relief.
We might consider burnout as a type of disenfranchised grief. But it is not compassion fatigue. In fact, equating burnout with a lack of compassion may be a heavy-handed way of placing the blame on physicians while deflecting it from the systems that created the problem.
As a coach, I have found that many physicians with burnout are in fact grieving the lack of connection to their patients. Often this is due to system-wide emphasis on RVUs combined with excessive clerical work that undermines their ability to spend meaningful time with patients.
National organizations and many health care systems are beginning to take note, and as supportive processes are put in place, rates of burnout do seem to be slowly improving. But there is much work to be done.
If you’re experiencing burnout, it’s important to recognize it for the wound that it is, have compassion for yourself, and create a plan to move forward.
In the words of the poet Rumi, “the wound is the place where the light enters you.” What does this light illuminate for you?
If you’ve enjoyed this article and would like to stay in the loop for more insights on creating a sustainable, fulfilling, and happy life as a physician, sign up for my newsletter or reach out on my website. I’d love to hear from you.
As a physician coach, I will work with you to explore what’s possible and create a plan that aligns with your personal values and aspirations. Schedule your exploratory conversation with me by clicking the button below.
Navigating Burnout: My Podcast Appearance on KevinMD
Burnout is a symptom of a system that is not working for you. In many ways it’s a form of grief. It’s not your fault. But that doesn’t mean there’s no way out. In my interview with Kevin MD, I discussed the factors that contribute to burnout as well as some actionable steps you can take to improve your life as a physician and to combat the effects of today’s stressful environment.
If you’re a physician, or anyone active in healthcare today, you have probably heard of Dr. Kevin Pho and his KevinMD podcast and website.
Kevin posts interviews and articles daily, and I was thrilled to be a recent guest. In the episode, we discussed the burnout epidemic, and why it’s not the same as compassion fatigue.
Burnout is a symptom of a system that is not working for you. In many ways, it’s a form of grief. It’s not your fault. But that doesn’t mean there’s no way out. In the interview, I went over actionable steps you can take to improve your life as a physician and to combat the effects of today’s stressful environment.