Burnout and compassion fatigue – growing risk in veterinary profession

Burnout and compassion fatigue – growing risk in veterinary profession

Professional burnout is a progressive process in which a veterinary surgeon subjected to prolonged stress and physical, emotional and psychological tension separates from work and other relationships in his or her life. As the newest text says, in recent years, an increasing number of professionals burned out have been observed. It has a negative impact on well-being, personal and professional life.

Compassion fatigue syndrome
Engaging and responding to the needs of clients is often associated with strong emotions, as well as the use of verbal and non-verbal communication techniques. Social skills that are necessary to deal with the emotions of animal owners (e.g. at the time of euthanasia or emotionally unstable customers) require extraordinary patience, long practice and adequate time for practising. This very special and deep form of care, not even for the animal itself, but for its owner, a stranger to us, is a very big risk for the so-called compassion fatigue syndrome. It appears if the spiritual, emotional and psychological balance of the veterinarian is not preserved. Strong psychological and emotional fatigue associated with the constant feeling of compassion is a burden arising as a result of constant and excessive exposure to traumatic events experienced by animal owners and their family members.

Stages of professional burnout
Compassion fatigue is not the same as burnout but is one of the important risk factors for professional burnout of veterinary surgeons, which has been divided into 12 stages, of which individual one fluently passes into subsequent ones.

1. Coercion to check yourself, an obsessive demonstration.
2. Even harder work and inability to stop.
3. Neglect of own needs, overeating/eating inadequate food, sleeplessness, no social interaction.
4. Displacement of conflicts, rejection of problems, sense of threat, panic and emotional shakiness.
5. Revision of own values – distortion, rejection of friends and family, hobby. Focus only on work.
6. Denial of problems, lack of tolerance, impediment of social contacts, perception of employees as stupid and lazy. Cynicism, aggression. Perceiving the problem as a result of lack of time and work pressure, not because of changes in life.
7. Withdrawal from social life. Reaching for alcohol or drugs to feel relief from stress.
8. Unusual changes in behaviour. Obvious changes noticed by friends and family.
9. Depersonalization. Not seeing your own and other values, rejecting your own needs.
10. Inner emptiness. Eating void, sex, alcohol, drug addictions.
11. Depression. Uncertainty, a sense of being lost, exhaustion, seeing the future in dark colours.
12. Burnout syndrome. It may include mental and physical breakdown, suicide attempt. Time for treatment.

(source: Veterinary Burnout – Cheryl Bellamy)

Symptoms and behaviours indicating burnout
With time, the veterinary doctor begins to isolate more and more, avoids contacts, stops talking about himself. He is exhausted, his efficiency drops, he conflicts with colleagues and clients. He can not give as much as before. More and more often, he complains about animal owners and treats them even hostile. He approaches others with reluctance, similar to himself. Often he does not control his emotions, he is cynical, embittered. He ceases to have a desire to go to work, blames himself and others, he is constantly tired and resentful. There are also problems with concentration, mainly in the listening to others and clients, stereotypical treatment of others and sometimes even hostile attitude. Then there are frequent colds and headaches, digestive disorders, problems with sleeping, being cut off from friends, overuse of sleeping pills and sedatives, prescribing psychotropic drugs on his own (veterinarians can prescribe human drugs in Poland). Finally, cynicism, unwillingness to change and lack of trust in others, even those closest to him, especially partner, which often results in the breakdown of the relationship and family.

Stress applies to all of us
Although every veterinary surgeon operates in a stressful environment, not everyone experiences burnout. Its potential increases depending on individual and personality characteristics. Perfectionists, who are quite numerous in our industry, are more exposed due to their unrealistic standards and abstract expectations of themselves, their work and others. Also, those doctors who have a problem with maintaining a balance between work and personal life. In fact, very few of us can afford to completely break away from work after work, especially if you run a one-person practice or you are on call after work. An important factor increasing the risk of burnout is overloading with duties, low earnings, lack of incentive system, tight schedule, lack of evaluation of work and feedback on our hard efforts, conflicts with colleagues, clients or the boss.

Owner’s finances and professional burnout
One of the important stressors of veterinary surgeons is the financial constraints of the owner of the animal. Many veterinarians in a US study confessed that the owners’ low financial ability negatively affected their ability to provide adequate care to the animal and was one of many factors contributing to dissatisfaction with work and the sense of burnout. The feeling that we can effectively cure the animal and we have the right knowledge, technique and the necessary equipment, and the owner can not afford treatment is in fact very frustrating. No wonder that conversations with owners about the cost of treatment are very stressful.

Fierce competition, a multitude of veterinary clinics on our domestic market, and also often used by newly opened competition, price dumping contribute very negatively to the development of the veterinary industry and the well-being of veterinary surgeons. More and more hospital owners have financial problems due to unfair competition. Unfortunately, price dumping is the result of the lack of economic education of the majority of veterinarians who think that lowering prices will attract the client to the clinic. Unfortunately, some of the animal health facilities cannot withstand this type of price competition and must close. In combination with the fact that as many as 5 voivodships out of 16 in Poland are on the list of the poorest regions of the European Union (lubelskie, podlaskie, podkarpackie, świętokrzyskie, warmińsko-mazurskie) this confirms the poor financial condition of potential clients of veterinary clinics in selected regions. Another mystery is the fact that some municipalities have been looking for a veterinary surgeon for a long time without success wishing that he would have opened his practice in place of an earlier closed one.

Counteracting burnout
Fortunately, there are adaptation strategies that help veterinarians prevent burnout or internal rebuild once they have experienced it. Unfortunately, many doctors completely neglect their health as a result of long-term overwork, so step #1 will be looking after their health and listen to the signals coming from the body. The issue as trivial as balanced and regular meals and the right dose of sleep in comfortable conditions (not on duty, or after three working three nights in a row) are still a dream for many colleagues. Replacing meals with chocolates from the owners does not help, but promotes being overweight, diabetes and other diseases. You do not have time to cook? Prepare a pot of vegetables, groats, pasta and divide the portions into plastic packages for 3-4 consecutive days. Do not leave the house without breakfast. Take three meals to work – a box with lunch, a sandwich/snack, a portion of vegetables/fruit.

The essence of listening to your needs is also to find time for yourself. Only for myself. Not for time spent with the child but only for yourself. It is very difficult to break away from professional and parental responsibilities. However, without this, it is impossible to completely listen to your own needs. So think about it – do you have a hobby, passion, any interest? What can you do only for pure pleasure, internal development, entertainment? Sport is definitely helpful, but it should be a complementary part of your life and health. Do you have any other hobby outside of it that develops you internally? Something that makes you feel good and makes you happy?

The clinic will not burn down as you will not be in it, provided that you do not leave a metal cup in the microwave. Do not take work home, delegate duties to co-workers. We know well that no one will do this job better than you;) But you do not even know how much relief it is not to be able to worry about small details and not to answer phone calls for small matters. If you educate your colleagues and train them, they will take over some of your responsibilities over time and you will not have to decide on everything. It has been proven that we have limited energy to make decisions during the day. For those important and those less important. From the decision to operate the patient for whether we drink green or black tea. There is even a term of decision fatigue, for which we veterinarians, with all the complexity of our work and hundreds of decisions a day, are particularly vulnerable.

Do you take small breaks during the day? Are you getting up, walking in the practice? Do you go to the toilet regularly when you need to? Look out the window, talk to a member of the team, watch a short video for pleasure, look away.

Prevention

If you feel that you are getting close to the point where you have enough – find a professional psychotherapist’s help. Veterinary associations around the world pay more and more attention to the topic of stress and burnout. Check out our Wellness Seminar on this subject and see what you can do for yourself. You are not alone – we are for you.

Our job is very stressful and requires a number of preventive measures to not be burned down in a short time. Burnout also increasingly meets younger veterinarians. It is crucial to work out individual strategies to combat stress, because its long-term experiencing disturbs the functioning of the prefrontal cortex and, consequently, aggravates memory, focus, understanding of the situation and clinical judgment. It can be fraught with consequences for our patients and contribute to the loss of their health or life as a result of misdiagnosis caused by chronic stress and fatigue. As you can imagine, it will be even more stressful for the veterinarian. Let’s take care of ourselves – for ourselves and for our patients.

Author:  Natalia Strokowska DVM MRCVS

References:

1. Veterinary Burnout – Cheryl Bellamy

2. Brenda L. Lovell, Raymond T. Lee – Veterinary Wellness – Burnout and health promotion in veterinary medicine.

3. Herbert Freudenberger, Gail North The 12 Stages of Burnout – Scientific American Mind article.

4. Lee RT, Lovell BL, Brotheridge CM. Tenderness and steadiness: Relating job and interpersonal demands and resources with burnout and physical symptoms of stress among Canadian physicians. J Appl Soc Psychol. 2010;40:2319–2342.4.

5. Williams S, Davis H. Stressors in the veterinary profession. 12. Board Talk; 2002.

6. Cohen SP. Compassion fatigue and the veterinary health team. Vet Clin North Am Small Anim Pract. 2007;37:123–134. 

7. Gregg K. Takashima DVM, Client Economic Limitations & Veterinary Burnout, DVM Animal Care Group of Lake Oswego Lake Oswego, Oregon 54 cliniciansbrief.com August 2017

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