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. 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.

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Mindfulness: A Surprisingly Practical Tool for Time Management

As a doctor you’ve studied, trained, and practiced for years, probably decades, to provide the best care for your patients. But as our world has become increasingly tech-driven and connected, the pressures from both within and outside of the healthcare workspace for your time and attention have multiplied.

Whether it’s pings from the EHR, text messages from the hospital, urgent calls from colleagues or families, or the never-ending torrent of emails, your attention has become more fragmented than ever before.

When you’re busy and feeling time-pressured, mindfulness may seem to be an uneasy, even unwelcome, construct.  Who has time for it? Yet it turns out that simple mindfulness practices can help you to reframe and de-escalate the struggles of the day.

Mindfulness won’t cure the ills that physicians face in the current healthcare environment, but it can mitigate their impact. In this article I will show you how using mindfulness can create the mental space you need to confidently and calmly manage patient care while protecting your precious time.

Start with Mindful Mornings

Mornings can often feel a little frantic, but finding room for a simple 5-minute mindfulness practice can help to set the tone for your day. Here are some ideas to get you started:

• Sit quietly with your morning coffee, allowing time for it to cool while you check in with your breath. Take a slow deep breath in through the nose, pause for a moment, and then breathe out through the mouth. You can use the box breathing technique, or simply find a rhythm that feels comfortable.

• Use a mindfulness app like Insight Timer or Headspace. You can enter the time you have available and you’ll find a wide range of guided meditations.

• Set a 5-minute timer and journal about anything that comes to mind.

Practice Mindful Transitions

Mindful task transitions can help you maintain your focus and prevent mental fatigue. Before moving on to a new task, appointment, or procedure, take a moment to pause, breathe deeply, and clear your mind.

You’ll be more present for your patient, which can build trust and connection. And this mindful pause can enhance your efficiency by helping to prevent the accumulation of mental clutter, or what is known as attention residue.

Embrace Single-Tasking

Multitasking used to be considered a prerequisite superpower for productivity. Doing two or more things at once--what could possibly go wrong? A lot, it turns out.

Emergency Department physicians may be the most pressed to multitask, with a recent Scandinavian study finding that almost 20 percent of their time is engaged this way. Not surprisingly, this study found that the more a physician multitasked, the more stressed they became. And other studies have found that multitasking can increase the risk for errors.

While you may not always have control over who or what interrupts you, it can help to remain mindful of the things that are pulling on your attention. When you are able to tune out distractions and put non-pressing matters on hold, you’re likely to be more productive and efficient with your time.

To tune up your ability to focus, regular meditation can help. That’s because mindfulness meditation is, at its foundation, a practice of returning your attention to the present moment.

Cultivate Presence

What exactly is presence? Actress Anna Deavere Smith, in her book Letters to a Young Artist, counsels that “Presence means you hold your own space, control the space around you, and sometimes welcome others into it.” Here she is describing the persona of an artist, but as a physician, you too are tasked with holding space, while simultaneously creating a place of safety for your patients to enter.

In being present, you are listening mindfully, without jumping to conclusions or judgments. You’re paying attention not only to the words but to the body language and, sometimes, to the unspoken fears beneath the words.

This might sound like it could add time to the encounter, but the truth is that when you lead with mindfulness, your patient is more likely to feel heard and safe. You are more apt to integrate information that might otherwise slip beneath your radar, so your differential may be more accurate.

And as you build trust, your treatment plan may be more readily accepted, and you’re likely to get fewer in-box messages or worried phone calls after the encounter.

End with Mindful Reflection

As you close out the day, take five to ten minutes to reflect on your “wins”, your “dones”, and your “to-dos”. Acknowledge both your successes and areas for improvement, without falling into self-criticism.

By creating a to-do list for the next day, you can set aside your lingering worries and unchecked boxes, knowing that you’ve made a plan to tackle them tomorrow.  

Your closing-down practice could even include stopping at a coffee shop on your way home to enjoy a cup of decaf and take a few minutes to journal and debrief before entering into your home life.

This time between work and home can also give you a safe space to decompress from your work day so that you’re able to be present for your loved ones, making the most of the time remaining in the day.

Conclusion

Mindfulness is not going to solve all that is troubling healthcare. It doesn’t mean pretending that the troublesome systemic problems facing physicians don’t exist. But by cultivating a mindful approach to the day, it’s likely that your time will be spent more meaningfully. And as a result, your focus and productivity will improve, and you’ll have more bandwidth to be present for your patients and your loved ones.

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Dealing with Regret: Discovering Growth and Self Compassion

High-stakes decisions with no easy solution, challenging interactions with patients and family, and outcomes that don’t always go as planned: these are unavoidable facts of life for most physicians.  

The lost opportunities or unanticipated consequences may lead to feelings of regret that can haunt you when you least expect it. Although this is completely normal, coming to terms with regret can be difficult. This aspect of professional life is rarely discussed out in the open, making the journey forward all the more arduous.

In this article, we’ll talk about regret, what it can teach you, and how it might help you to become an even more effective physician.

Regret Is Normal, and It’s a Sign of Compassion

Although it can feel crushing in the moment, regret is not a weakness or a marker of failure. Instead, it can help to reframe regret as evidence that you are compassionate and invested in the outcome of your decisions. Whether that’s the well-being of your patients, the strength of your relationships, or the integrity of your work, you wouldn't feel regret if you didn’t care deeply.

Learning from Regret

When you recognize regret in this way, you can break the cycle of rumination and open yourself up to the multitude of lessons it holds, including opportunities for reflection and growth.

Perhaps the lesson is learning to slow down, to listen more closely to your patient, to take an extra breath before responding to a difficult conversation. Maybe it’s committing to take a more active role, advocating more effectively when faced with challenging situations. Or it could be a recommitment to ongoing learning and professional growth.

It’s important to acknowledge that although the past cannot be changed, it can inform the future.

Here are some questions to ask yourself that might help to create mental space for new ideas:

• Are there ways that you can mitigate the consequences, even now?

• What would have needed to happen for things to have turned out differently?

• What actions are within your control?

• What resources might you need that were not available to you then?

• How might you respond next time you’re faced with this situation?

The Importance of Self-Compassion

As a physician, perfectionism is probably one of your driving forces. But at the same time, you may hold yourself to impossibly high standards.  

Although you may never have been taught this in training, at some point in your career, you will very likely make a decision that, in hindsight, turns out to be wrong. Other times, some outcomes will simply be beyond your control.

Self-compassion means treating yourself with the same kindness and understanding that you would offer a colleague or friend. And at the same time, caring for yourself helps you to stay present and capable of providing the best care for your patients.

Sometimes regret can feel overwhelming, despite your best efforts to overcome it. When needed, professional help in the form of a counselor or a coach can be sustaining.

Turning Regret into Action

It’s important to not only acknowledge regret, but to turn your reflections into action. Use this hard-earned awareness to make adjustments, both big and small, that will help you navigate future challenges with more confidence and clarity. Depending on the source of your regret, it might mean

• Taking a course

• Learning or perfecting a skill

• Seeking feedback or support from a trusted colleague, coach, or mentor

• Implementing measurable changes in a process or procedure

• Practicing mindful communication

• Setting clearer boundaries

• Reaching out to a mental health professional

Moving forward from regret is about progress, not perfection. It's about using each experience to inform your next steps without getting stuck in the past.

Discovering Resilience and Growth

Learning from regret will strengthen your resilience and shape your compassion for others who may find themselves mired in similar situations. Through this process, you will build a toolbox of strategies that will support you through the inevitable challenges in the future.

Regret may never completely disappear, but with time and practice, it can become a guide, pointing you towards opportunities for personal growth and a deeper connection with the values that first led you to find your place in the medical profession.

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Coaching for Healthcare Leaders

As a member of the American College of Cardiology’s Physician Well-Being Working Group, I am fortunate to be part of the change that’s happening within cardiology and healthcare in general.

Coaching is increasingly recognized as a way to support and retain physicians, an aid for reducing burnout, and a tool that can improve the healthcare environment for physicians, staff, and the patients that we serve.

The first in a series of webinars put on through the ACC was presented in early 2024. You can watch it here, or maybe take it along with you and listen during your commute to work.

How Do You Know if You’re Burned Out?

Burnout is not going away.

It’s no surprise that nationwide, levels of burnout reached record highs during the pandemic, impacting over 60 percent of physicians. But now that we are back to a semblance of normal, the percentage of physicians experiencing burnout symptoms hovers a little under 50 percent. That’s still far above the “baseline” of 38 percent in 2020.

Topping the list of burnout-inducing specialties are

💉Emergency Medicine,

💉Internal Medicine,

💉OB-GYN

💉Family Medicine

Although burnout has decreased in all of these groups, more than 50 percent of doctors surveyed in these specialties described classic symptoms of burnout.

While any improvement is good news, the fact that nearly one in two physicians across the board are suffering from burnout is nothing to celebrate.

Not only is burnout demoralizing, but it also contributes to job turnover and increased healthcare costs. Not surprisingly, a Mayo Clinic study found that burnout can raise the likelihood of medical errors. And a 2019 study reported a conservative yearly cost to the US healthcare system of $4.6 billion dollars.

So how do you know if you're burned out?

❓ A. Is it just a feeling?
❓ B. Is it something we can measure?

If you answered B, you're right. Burnout isn’t just a trending term. There are standardized tools to measure burnout. The Maslach Burnout Inventory is the granddaddy of burnout tools, and has been in use since 1981.

Burnout affects doctors of all ages and across all spectrums. It is not a personal failing, and it’s not a mental illness.

If you’re experiencing burnout, it’s important to understand that burnout is not your fault, and you’re not alone. Here’s what you need to know:

✴ According to the World Health Organization and the ICD-11, burnout results "from chronic workplace stress that has not been successfully managed."

✴ Symptoms of burnout include:

🚫 feelings of low energy or exhaustion
🚫 negative feelings or cynicism about your job
🚫 loss of motivation and a sense of detachment from work

✴ Burnout is not a mental health condition.

So how do you know if you’re burned out? If you're wondering if you've just hit a rough spot or if you're truly burned out, you could invest in the Maslach Inventory. Or you could save yourself a little time and money and take a simple Two-Minute Burnout Inventory created by Chris Bailey for Harvard Business Review.

If you're a physician living with burnout, you don't need to suffer in silence. There are ways to get through it, but you can't always get there on your own.

Systemic changes to our profession are critical, and there are signs that change is coming. But while we wait for the slow gears of progress, it's important that you take care of yourself now.

Your health, your loved ones, and your patients are counting on you. If you’re feeling burned out, consider coaching, either through your institution, or through a certified Physician Coach. Studies, including a randomized controlled trial published in 2024, have found coaching to be an effective strategy for reducing physician burnout.

There are no easy answers to the complex issues facing healthcare today, but getting clarity on your own needs and values will empower you to chart your own course.

An earlier version of this article was published in April 2023.

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.

If you’d like to learn more about my coaching practice, you can schedule a complimentary introductory meeting by clicking the link below.