The myth of compassion fatigue in veterinary medicine

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The myth of compassion fatigue in veterinary medicine

Knowing why you’re struggling is important, so it’s not helpful to label every negative experience in the veterinary profession as compassion fatigue. When I took an honest look at how I was feeling, I wasn’t running out of compassion. My fatigue stemmed from making ethical decisions within the boundaries of clients’ (often) illogical values or unreasonable budgets.
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Jan 17, 2017

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My friend and mentor Alice Villalobos, DVM, once asked me if I experienced compassion fatigue in my veterinary hospice work. “No,” I quickly responded. “I don’t believe I’ll ever run out of compassion.”

I went on to explain my thoughts on compassion fatigue and how I think it’s an overused term in the veterinary industry. I told her that I felt more drained in emergency work than in hospice care, and that’s when Dr. Villalobos said something that will stick with me forever: “I believe what we really struggle with in our profession is not so much compassion fatigue as ethical fatigue.”

Her assessment landed perfectly in my mind. In emergency medicine, I was rarely given full financial rein to do the very best for my patients. More often I was required to make decisions based on someone else’s monetary budget, decisions that could arguably border on ethical dilemmas:

Do I run blood work or spend this money on immediate treatment?

Do I use minimal sedation to suture up a pet so I have funds left over for pain medication and antibiotics?

Do I tell this family their pet has a 5 percent chance of living a few more months, knowing they will drain their savings account or go into debt just to get a little more time?

Do I euthanize this sick kitten that was just dropped off because we don’t have any foster homes?

These are ethically based decisions, not compassion-based. We all know that if we do not choose to negotiate this path with some clients, they will make a drastic decision (like euthanasia elsewhere or perhaps an unfair negative online review), which may lead to the pet not being helped at all. And to me, that is the ultimate failure.

In contrast, according to the Oxford English Dictionary, compassion fatigue is an “indifference to charitable appeals on behalf of those who are suffering, experienced as a result of the frequency or number of those appeals.” Basically, it means you stop caring because you’re required to care so often. Anyone in any kind of long-term caregiving capacity should be able to understand compassion fatigue, including parents.

“I believe we are more fatigued by the ethical decisions we have to make for a pet based on a client’s poor choices than we are by the perceived finite amount of compassion we believe exists within ourselves.”

While I understand compassion fatigue, I just don’t relate to it. I’ve cared for my infant child who didn’t sleep through the night for 11 months straight. I’ve attended to nine in-home euthanasias in one day. I’ve dealt with case after case in the ER, day after day. We all know the feeling of peeling off our socks and lying down in bed after more than 24 hours on the job, only to be awakened by a text or phone call from the clinic (or even a friend) with a question about another pet.

To me, this isn’t compassion fatigue. This is being overworked, underslept, burned out or simply really, really exhausted. In such moments, I’m not lacking compassion. I’m lacking rest (or a Snickers bar!).

The overuse of the term “compassion fatigue” can be a dangerous path for our profession, which is why the distinction between it and “ethical fatigue” has been so inspiring to me. Instead of using compassion fatigue to describe any negative emotion we experience on the job, diving deep and understanding our unique stressors offers a much more holistic approach to a healthy working environment. This was an important journey for me early on in my career and has made a huge difference in my emotional health.

Years ago, when a pet owner presented me with my fourth parvo puppy of the night and then proceeded to become angry because she believed I was “just in it for the money” and that I “must not care about animals,” I did feel like my compassion had been completely drained. I thought, “How can I possibly care when this person doesn’t realize the dedication and drive it takes to deal with people like her—especially when parvo is completely preventable with a $15 vaccine?

Interactions like these used to drain me. But as I watched this woman get angry with me, her 8-year-old daughter sitting in the exam room wearing clothes that clearly hadn’t been clean in some time, telling me she would beg on the side of the road to pay for her puppy’s treatment and that I was a terrible person for making her do that, I realized her anger had nothing to do with me. With all the struggles she must have had in her life, it took bravery to bring her pet into a clinic where she surely knew she couldn’t afford treatment.

I looked at her and said, “I want to thank you for bringing Piper here, and I’m so sorry if you feel judged by me or my team. Let’s figure something out together.”

Her anger subsided and she calmed down. I realized there was something worse in this world than being berated by a client’s misdirected anger. It was that puppy dumped and left to die on the side of the road with no person. It was letting that little girl feel that a veterinarian didn’t want to help. Seeing this woman as a human being instead of someone who was “out to get me” changed my perception and changed what was possible.

“I am the source of my own compassion. Therefore, it will never run out.”

Immediately, the compassion I had for the puppy drove my decisions because my self-defensive guard was down. Instead of being overwhelmed by a lack of desire to help the woman, I was able to concentrate on the need to help the patient. And most importantly, I began to realize something about myself—you can’t give what you don’t have, and as long as I was my own source of compassion, I would never run out.  

I realize this may not apply to everyone, but as a woman and a mother, I believe I have an endless supply of compassion. In hospice practice I work with people every day who need empathy and support, and I never feel drained by them. Do I feel tired, stressed, overworked, underslept and perhaps a little burned out at times? Of course, but that’s not compassion fatigue. It’s having an empty tank, and it can be refilled by engaging in things that bring us joy.

Simply put, it was not an overdraft on my compassion supply that led me to feel fatigued. It was the immense responsibility to make the right decision within the boundaries of someone else’s (often) illogical values or unreasonable budget. That is not compassion fatigue; it’s ethical fatigue.

 

Dr. Dani McVety is owner of Lap of Love Veterinary Hospice and In-Home Euthanasia in Lutz, Florida.

Recognizing compassion fatigue

First of all, I would like to thank Dr. McVety for writing about this topic. Whatever we prefer to call it, the stressors of life in veterinary medicine are obviously a big problem. We need to be having these discussions often, and acknowledge the negative sides of the work we do. However, I disagree with some of the points made. I believe that the article shows a fundamental lack of understanding about what compassion fatigue is.
Frankly, there is no set definition or term for the phenomenon commonly referred to as compassion fatigue. That being said, “running out of compassion” is not the result of compassion fatigue. That would be more a side effect of burnout, which can happen in any job, not just helping professions. Burnout often leads to apathy and depersonalization. Unfortunately, definitions in the dictionary are too simplistic to encompass the meaning of this syndrome.
Compassion fatigue refers to the negative effects from working a job which requires compassion. In fact, people who have the most compassion often suffer the most, unless they know or learn how to care for themselves properly while sharing the suffering and pain of others. These negative effects are well documented in other helping professions, and I do believe they are shared by the veterinary community.
That being said, what Dr. McVety refers to as “ethical fatigue” is valid. Moral, or ethical, stress has been shown to be the number one contributor to high levels of compassion fatigue in veterinary medicine. This is not surprising, as veterinarians and their staff members have to cope with ethical issues not shared by their human medicine counterparts.
I do a lot of work on compassion fatigue throughout Chicagoland, and I would be reluctant to completely shelve the concept from veterinary medicine. Not everyone struggles with every contributing factor, but that does not mean this syndrome is not real. More important than terminology, though, is identifying our own personal triggers, as Dr. McVety has, and work on them so that we can continue happily in our work. I found the comment, “I realized her anger had nothing to do with me…it took bravery to bring her pet into a clinic where she surely knew she couldn’t afford treatment” truly inspiring.

Rebecca Murray, CVT, MA, LCPC
Veterinary Specialty Center
Buffalo Grove, IL

Thank you

This landed perfectly in MY mind.

I am a trainer, not a vet. But as a trainer specializing in behavior change and aggression cases through force-free, science-based methods, I constantly deal with burnout. I needed this.

Thanks so much.

I think you just changed my life

Dr. McVety,

I want to say thank you for this article. Your words have struck a chord in me and I cannot express how perfectly this article applies to me in practice. I would like to quote it far and wide. I would like other vets to read it and I would like clients to see it. I, too, do emergency and have felt this way but your description is remarkable. Thank you. I don't want to hear about veterinary suicides anymore without the term ethical fatigue tied to it. Please know that your article has made an immediate and positive difference in my life.