By Lauren S. Grider, DVM, CCFP
It is common for veterinarians to view their career as a calling. For many of us, this work helps form the core of our personal identity. However, caregivers experience emotional consequences when they provide aid to others, and many of the risk factors for compassion fatigue are frequently encountered in the veterinary field.
The traditional culture of the veterinary industry tells us that we should always be working harder and never be phased by professional challenges. We feel that we should remain positive, or at least stoic and unyielding, in the face of negative case outcomes and heightened client emotions. However, these beliefs can be harmful. Having idealistic expectations regarding the emotional toll of healthcare work is a risk factor for compassion fatigue.4,5 Sometimes we place others’ needs first, to the point that it creates physical or psychological harm to ourselves. When this happens, we are engaging in pathological altruism, and it is a challenge to veterinary wellbeing.1,2,3
Veterinary training focuses almost exclusively on patient care and does not prepare us to cope with the emotional stress inherent to our field. We aren’t taught the skills we need to manage the emotional reactions we feel when confronted with others’ suffering, and this compounds the issue with compassion fatigue in our profession.4,5 Secondary or vicarious trauma occurs when caregivers are exposed to others’ pain and suffering.1,2 Veterinary professionals who deal with cases involving injury, acts of purposeful cruelty, abuse, and graphic details are at greater risk for developing compassion fatigue.4,5 These types of challenging cases are frequently encountered in our field.
Empathetic distress is another risk factor for compassion fatigue. It occurs due to a caretaker’s unregulated empathy.1,2 Veterinarians who are experiencing empathetic distress take on the emotional pain of the client. Feeling concern regarding a client’s ability to cope with negative patient outcomes, including cases in which there is a high degree of attachment between a client and their companion animal, also contributes to compassion fatigue.4,5
Issues which we encounter in practice every day – requests for euthanasia to be performed for client convenience, financial barriers to providing care, inappropriately large workloads, and frustrating administrative rules – all create feelings of moral distress and increase the risk of compassion fatigue.1,2 Moral distress occurs when there is a real or perceived violation of a caregiver’s moral or ethical beliefs.1,2 This type of distress is often encountered when the needs of the patient are overshadowed by the demands of the client or the policies of the business. Compassion fatigue is more common in caregivers who manage large caseloads with many challenging clients and patients.4,5 Compassion fatigue is also associated with working in autocratic environments.4,5 In autocratic management structures, doctors and staff have minimal power or autonomy, and the administration places little emphasis on the satisfaction and fulfillment of its workers.
Additional risk factors for compassion fatigue include a history of personal trauma and/or anxiety and a lack of social support.4,5 Any concurrent life stressors – divorces, breakups, deaths, births, financial issues, and all of the difficulties of everyday life – increase the risk of developing compassion fatigue.4,5
After learning about these risk factors, I believe that the development of compassion fatigue in members of our field might be more safely viewed as a “when,” rather than an “if,” situation. The good news is that those of us who are at risk can learn which symptoms to watch out for, and we can intervene right away if they are noted. Several early warning signs of compassion fatigue have been identified:4,5
- Frequent tiredness
- Irritability / arguing about minor issues
- Inability to relax
- Constant feeling of being under pressure or in demand
- Lack of patience or tolerance
- Feeling that there is no time for family, friends, or self
- Memory and concentration issues
- Lack of interest or time for socialization and recreational activities
- Irritability and exhaustion
- Feeling unfulfilled at the end of the work day
Another helpful tool to use in screening for compassion fatigue is the Professional Quality of Life (ProQOL) Assessment. The ProQOL is the most widely used evidence-based assessment of compassion fatigue, compassion satisfaction, and burnout.5 It’s important to remember when taking this assessment that it represents a snapshot in time, so your scores will vary depending on how you are feeling and what is going on in your life when you complete the assessment. However, you can use this tool as often as you like. And here’s some more good news: The AVMA offers this assessment for free! (https://www.avma.org/resources-tools/wellbeing/assess-your-wellbeing)
Understanding these risk factors and early warning signs allows veterinary professionals to intervene quickly when symptoms are noted in themselves and others. The next part in this series on compassion fatigue will focus on intervention and management strategies.
This is part two of a multi-part series on compassion fatigue in veterinary medicine. The next part will focus on interventions for compassion fatigue.
1. Fonken, L. (2019). Living between the lines: Life, work and wellbeing. 2019 Pacific Veterinary Conference Proceeding. http://www.vin.com
2. Halifax, J. (2018). Standing at the edge: Finding freedom where fear and courage meet. Flatiron Books.
3. Klimecki, O. & Singer, T. (2011). Empathic distress fatigue rather than compassion fatigue? Integrating findings from empathy research in psychology and social neuroscience. In: Oakley, B., Knafo, A. & Madhavan, G., et al., editors. Pathological Altruism. New York, New York: Oxford University Press; 2011. pp. 1–23. DOI:10.1093/acprof:oso/9780199738571.003.0253
4. Teater, M. & Ludgate, J. (2014). Overcoming compassion fatigue: A practical resilience workbook. PESI Publishing & Media.
5. Alvis, D. (2020). Compassion fatigue: Certification training for healthcare, mental health and caring professionals. PESI, Inc.