Physician Burnout and the Four Phases of Compassion Fatigue

Posted by Dike Drummond MD

stop-physician-burnout-compassion-fatigueCompassion Fatigue is one of the psychological consequences of being a doctor

Losing the ability to feel empathy, sympathy and compassion for your patients is a constant risk for all of us.

This is a consequence of your choice to become a Lightworker years ago.

That choice guaranteed our exposure to the trauma, tragedy and agony of our patient's struggles. No one teaches you that compassion is a finite resource that must be regularly refilled or physician burnout is inevitable for all of us.

In this blog post, let me show you

  • why doctors are at unique risk for Compassion Fatigue and burnout ... it is the result of a decision you made long ago
  • how to recognize Compassion Fatigue
  • the four phases of Compassion Fatigue – where do you stand?
  • a specific method to restore your Emotional Energy Reserves and recover from your own Compassion Fatigue
  • and finish with a set of online Compassion Fatigue resources if you would like more tools or to study this important topic in more detail

This is Blog Post #297
Complete Blog Library  is Here

The Origin of this Lightworker’s Dilemma

Let’s start at the beginning
– the point in time where you chose to become a doctor in the first place

compassion fatigue resources physician burnoutYou remember that fork in the road? Back when you were making the decision about whether or not you would to apply to medical school. Remember? It was a true choice point, a bifurcation in the course of your life. You could choose:

(A) Go to Medical School   

You are smart, a super hard worker, you are a helper, driven to make a difference -- so naturally you chose to go to Medical School and become a doctor -- and probably made someone very proud in the process In that fleeting moment the die were cast and your professional life shifted.

From this point forward, you will be a Lightworker

You are a Healer -- allied with the Forces of Light in the Universe -- in our constant battle with the Forces of Darkness:

Illness ~ Suffering ~ Death ~ Dying ~ and family members’ crazed attempts to deal with these things

Your choice to become a physician will provide you with knowledge and skills to become a modern healer with great power. At the very same time, this choice exposes you to a discreet set of dangers. Healers are at constant risk of becoming exhausted and consumed by their work. This double edged sword is the nature of the Lightworker's Dilemma. 

No one told you about the risks you took on as a physician, did they? Here are a few. 

  • You doubled your risk of suicide
  • Increased your risk of burnout 1.7X
  • And will inevitably expose yourself to the pain and suffering of your patients and their family members in ways that are a daily risk to your mental health and family relationships.

Compassion Fatigue is a flashing red light signaling there is danger ahead -- if you don’t heed its warning and take better care of yourself.

Physician Burnout and the Four Phases of Compassion Fatigue

Compassion Fatigue is actually the 2nd of the 3 Symptoms of Burnout. The other two are relentless exhaustion and loss of a sense of purpose (“what’s the use”).

It signifies a negative balance in your Emotional Energy Account. You are tapped out and have no emotional energy to share with your patients and their families.

Compassion Fatigue = you notice you are cynical and sarcastic about your patients and find yourself alternating between complaining about them (venting) and feeling guilty about complaining.

It is caused by prolonged exposure to the Forces of Darkness and the suffering of your patients and their families

Here are the Four Phases of Compassion Fatigue:

(notice where you are positioned in these layers??)

Phase Zero:
Zealot Phase – You are enthusiastic, excited, committed to making a difference. You go the extra mile and volunteer to pitch in without being asked or ordered.

Phase One:
Irritability Phase – You notice you will sometimes avoid contact with patients and their families. You may notice you make small mistakes, cut corners and occasionally lose concentration and focus. You start to become crabby.

Phase Two:
Withdrawal Phase – Your enthusiasm for your work falls, exhaustion is more frequent and severe and you are irritated by your patients. Your team and family notice your enthusiasm is gone and you are much more withdrawn

Phase Three:
Zombie Phase –Your irritability slides into disdain, hostility, suspicion and blaming your patients. You notice hopelessness and even outright anger.

What can you do to reverse Compassion Fatigue?

NOTICE where you are in the four phases above.

All change begins with awareness. Remember you were taught to ignore exhaustion and compassion fatigue in your training. No one cared how YOU were doing. The only assignment was to survive the training experience. Mission Accomplished.

Now it is up to you to notice the ebb and flow of your energy, empathy and compassion over the course of your career. If you are not pleased with your level of Compassion right now, Einstein’s Insanity Trap says you will need to take new actions to get a new result … right.

Do something to recharge your Physical and Emotional Energy Accounts
Step out of Einstein's Insanity Trap by taking a couple new actions here.

a) Physical Energy Recharge:

Rest, nap, circle the wagons and take good care of yourself, go to bed early, eat right, cut back on alcohol, yoga, massage, mani/pedi, take a mini or a major vacation.

b) Emotional Energy Recharge:

compassion fatigue and physician burnout The People I Love Reconnection

Grab a piece of paper or  your journal and follow these steps:

a) Think of all the people you love – friends, family, colleagues
- make a “people I love” list … a written list on a piece of paper

b) Look at your list and ask:
“For which one(s) of these people has it been “way too long” since I said hello and told them that I love them??”

c) Circle those people and write/call/visit them.
Make a plan.
Act on your plan.

Notice how your energy feels after one of these acts of reconnection. Take a big breath and soak up the love, like a big sponge – in all the right places and just the right amounts.

d) Make this “keeping in touch” a habit going forward.

Save your list of loved ones. Put connection calls and letters in your calendar. Stay in touch, spread the love and feel it in return. Keep your Emotional Energy Account more full going forward.a

This will provide you with more energy to share with your patients, their family members and your staff. It will have a positive impact on your personal quality of life as well.

Isolation and loneliness are big issues for physicians, especially when we are under stress. You will find when you reach out, your loved ones will reach back. Try it for yourself.



How do you notice your compassion fatigue?
What actions do you take to refill your Emotional Energy Account?


Compassion Fatigue Resource Library:

  1. The Figley Institute One Day Compassion Fatigue Course Curriculum - LINK
  2. The American Institute of Stress - Compassion Fatigue page - LINK
  3. Physician Burnout and Self-Care: Why Self-Care is Not Selfish. Docwire Article by Robert Dillard - April 24, 2019 - LINK
  4. Compassion Fatigue Fact Sheet, ALS Society of Alberta (Canada) - LINK


Tags: Physician Burnout, compassion fatigue