Articles Published in The Canadian Veterinary Journal

Moving from Compassion Fatigue to Compassion Resilience Part 1: Compassion - A Health Care Priority, Core Value, and Ethical Imperative

Introduction

The practice of clinical veterinary medicine is a highly specialized field of care, unique in the caring professions. Working in this profession offers immense joys and rewards, from improving the health of animals to supporting the well-being of clients, and together, preserving the human-animal bond. Caring for patients and clients can be thoroughly satisfying, yet it can also incur a cost, “the cost of caring,” commonly known as compassion fatigue.

Compassion fatigue is an occupational hazard within the high care professions in which empathy, compassion, and caring for others are at the core of practice. Compassion is central to the delivery of medical services, and the cornerstone of the helping relationship, yet the ability to work in a compassionate manner can wane. Almost everyone who cares for others in the practice of medicine will eventually experience some degree of compas- sion fatigue, and the consequences cannot be underestimated.

This multi-part series takes a comprehensive look at the concept of compassion fatigue in veterinary medicine.

Part 1 will focus on the rudiments of compassion, to appreciate its significance in practice and to the profession. Part 2 will focus on exploring our understanding of compassion fatigue from its origins to what we are learning about it today from research in the social neurosciences. Part 3 will focus on the causes of compassion fatigue, the many realities of life in practice that make us so susceptible. Part 4 will look at the symptoms and consequences, as, quite simply, you can’t contend with compassion fatigue if you can’t see it. And lastly, Parts 5 and 6 will focus on resilience, specifically on the wide-ranging ways in which we can be sustained and continue to thrive in practice. Compassion fatigue can affect anyone in the role of healer, helper, or rescuer. In veterinary medicine, we are often all three. To practice in medicine is an honor, a privilege, and a gift.

So is your life. You owe it to yourself to learn about compassion fatigue and how you can move to compassion resilience.

Compassion - A Health Care Priority, Core Value, and Ethical Imperative

Compassion, a complex term derived from the Latin roots com-, which means “together with;” and pati, “to bear or suffer,” (1,2) has been contemplated in philosophy and religion for several thousand years (3). According to The Centre for Compassion and Altruism Research and Education (4), compassion is understood as “a process that unfolds in response to suffering. It begins with the recognition of suffering, which gives rise to thoughts and feelings of empathy and concern. This, in turn, motivates action to relieve that suffering.” Compassion thus consists of 3 facets: noticing, feeling, and responding (5). As “the sympathetic consciousness of others’ distress, together with a desire to alleviate it,” (6) compassion is based on a passionate connection with others as fellow beings.

Compassion is associated with the virtues of kindness, selfless- ness, and altruism, and likewise, pity, sympathy, and empathy (7). What differentiates compassion from the latter virtues is the motivation to act (8–10). Compassion entails pity, sympathy, and empathy, but goes beyond these, to some act of caring or comforting. As the Dalai Lama (11) says, it is “an openness to the suffering of others with a commitment to relieve it.”

As a precious aspect of our human nature, compassion is the essential quality required in caring for others (12). It is considered a core value and ethical imperative within any help- ing profession (13). In medicine, compassion is endorsed as a health care priority and a hallmark of quality care (14). It also offers several practical benefits (15). According to the literature, compassion enhances the quality of information gathered from patients (16), and as the majority of diagnoses are made from case history (a critical part of diagnostic reasoning) (17–19), by extension, it enhances the diagnostic process. Compassion also increases patient satisfaction with health care services and improves clinical outcomes (20,21), key overarching goals in the provision of health care services. The same benefits — enhancing the quality of information gathered (and resultant diagnostic acumen), increasing satisfaction with health care services, and improving clinical outcomes — can be envisioned in the delivery of veterinary medicine.

Compassion is recognized as a necessary quality of ethical practice and professionalism. The CVMA’s Principles of Veterinary Medical Ethics states that veterinarians should provide “competent veterinary medical care, with compassion” (22). It further states that we have a responsibility to be compassionate with clients and with each other, specifically that we should be “honest, fair, courteous, considerate, and compassionate.” Compassion is a health care priority, a core value and ethical imperative across all aspects of practice and in relation to each fellow being, human and animal. And of all the helping professions, the veterinary profession is the profession that cares for the most diverse range of species — or scope of “otherness.” As the quality that is able to cross the chasm of “otherness” to induce an “other-oriented” attitude is compassion (7), compassion seems of singular significance in veterinary medicine.

References

  1. Singer T, Klimecki OM. Empathy and compassion. Curr Biol 2014; 24:R875–R878.
  2. Fernando AT, Arroll B, Consedine NS. Enhancing compassion in general practice: It’s not all about the doctor. Br J Gen Pract 2016;66:340–341.
  3. Davidson RJ, Harrington A. Visions of Compassion: Western Scientists and Tibetan Buddhists Examine Human Nature. Oxford, UK: Oxford University Press, 2002.
  4. The Centre for Compassion and Altruism Research and Education. Available from: http://ccare.stanford.edu/ Last accessed April 8, 2019.
  5. Kanov JM, Maitlis S, Worline MC, Dutton JE, Frost PF, Lilius JM. Compassion in Organizational Life. Am Behav Scientist 2004;47: 808–827.
  6. Merriam-Webster dictionary. Available from: https://www.merriam- webster.com/dictionary/compassion Last accessed April 8, 2019.
  7. Gilbert P. Compassion: Conceptualisations, Research and Use in Psychotherapy. London, UK: Routledge, 2005.
  8. Armstrong K. Twelve Steps to a Compassionate Life. Toronto, Ontario: Alfred A. Knopf, 2010.
  9. Goetz JL, Keltner D, Simon-Thomas E. Compassion: An evolutionary analysis and empirical review. Psychological Bulletin 2010;136:351–374.
  10. Hiçdurmaz D, Ari Inci F. Compassion fatigue: Description, causes and prevention. Curr Approaches Psychiatry 2015;7:295–303.
  11. Dalai Lama. The power of compassion. New Delhi, India: HarperCollins, 1995.
  12. Geppert CMA, Pies RW. Compassion in clinical care. OBM Integr Compl Med 2019;4(1): doi:10.21926/obm.icm.1901016.
  13. Monk L. 5 Pathways for Healing Compassion Fatigue. CTRI Crisis & Trauma Resource Institute. Available from: https://ca.ctrinstitute.com/ blog/compassion-fatigue/ Last accessed April 8, 2019.
  14. Sinclair S, McClement S, Raffin-Bouchal S, et al. Compassion in health care: An empirical model. J Pain Symptom Manage 2016;51:193–203.
  15. Strauss C, Taylor BL, Gu J, et al. What is compassion and how can we measure it? A review of definitions and measures. Clin Psychol Rev 2016;47:15–27.
  16. Epstein RM, Franks P, Shields CG, et al. Patient-centered communication and diagnostic testing. Ann Fam Med 2005;3:415–421.
  17. Gruppen LD, Woolliscroft JO, Wolf FM. The contribution of different components of the clinical encounter in generating and eliminating diagnostic hypotheses. Res Med Educ 1988;27:242–247.
  18. Peterson MC, Holbrook JH, Von Hales D, Smith NL, Staker LV. Contributions of the history, physical examination, and laboratory investigation in making medical diagnoses. West J Med 1992;156:163–165.
  19. Gruppen LD, Palchik NS, Wolf FM, Laing TJ, Oh MS, Davis WK. Medical student use of history and physical information in diagnostic reasoning. Arthritis Care Res 1993;6:64–70.
  20. Redelmeier DA, Molin JP, Tibshirani RJ. A randomised trial of compassionate care for the homeless in an emergency department. The Lancet 1995;345:1131–1134.
  21. Sanghavi DM. What makes for a compassionate patient-caregiver relationship? Jt Comm J Qual Patient Saf 2006;32:283–292.
  22. Principles of Veterinary Medical Ethics of the CVMA, Revision: July 2016. Available from: https://www.canadianveterinarians.net/documents/principles-of-veterinary-medical-ethics-of-the-cvma Last accessed April 9, 2019.