Dr John Holden, chief medical officer at MDDUS and former GP partner, explains why compassion fatigue is rife in general practice and what can be done to tackle it
Exhausted. Rushing. Running late. The rinse and repeat daily routine for many GPs is not only a draining working environment – it can be a dangerous one, too.
Research conducted by the Medical and Dental Defence Union of Scotland (MDDUS) found that seven in 10 GPs suffer from compassion fatigue and struggle to empathise with patients because they are worn out from caring for them.
They are so physically and emotionally exhausted from dealing with patients’ concerns and demands they’re worried it will undermine the quality of care they provide.
In my view, it is worth pausing for a moment of reflection if this resonates with you, because caring for ourselves is the key to helping others and the first step is awareness.
What is compassion fatigue?
It has probably been around for a lot longer than we think but finally, we have a name for it.
In general terms, compassion fatigue is a term that describes the personal cost to an individual when they provide care.
Frequent requests and demands for help that sometimes go unmet, either due to unrealistic expectations or inadequate resource allocation, cause untold stress and can lead to a situation where the care giver’s ability to care diminishes.
Our membership research found that compassion fatigue is most prevalent amongst younger doctors aged 25 to 34.
It’s a worrying finding and a key driver for us in speaking out about the issue.
Why do GPs suffer more?
In general practice we work with limited resources, often in isolation and receiving minimal gratitude.
In fact, if you look at the matter deeper, general practice provides more than 300 million patient consultations each year, compared to 23 million Accident and Emergency visits.
Despite this, the drumbeat of reminders from politicians, patients and the press about how ‘poor’ the NHS primary care service continues unabated.
I know from colleagues on the front lines, the reality is that the more you do, the less you get back. There are always more patients to see, more documents to check, more students to mentor and more services to provide.
You work through lunch, you start early, you leave late all to stay on top of things. But you never do.
All this takes a personal toll on many GPs, who frankly are too exhausted to care. Whilst this goes against the grain of what we are all trained to do, it happens.
The impact on patients
Compassion fatigue creeps up with stealth and that makes it hard to recognise when you’ve stopped caring.
When you’ve lost the ability to care, it’s not easy to switch it on again at work – for example with a patient who is in vital need of care – not one who simply believes they’re entitled to it.
Almost half (44%) of our members we surveyed were concerned that compassion fatigue could leave them more likely to provide unsafe care and face complaints. Nearly two-thirds (64%) of all medics and 77% of GPs said it affected their ability to communicate with patients.
What can be done?
Funding for staff wellbeing services in the NHS has taken a hit since 2023. The mental health and wellbeing hubs established during the pandemic saw their funding stopped in 2023. Meanwhile, the lifeline services delivered by NHS Practitioner Health are on a temporary reprieve after a national outcry over plans to defund it last year.
This is an issue that Wes Streeting, the Health and Social Care Secretary, ought to move to the top of his inbox, if it’s not there already.
There are many services doctors can contact for help, and these include a free and confidential service offered by MDDUS to its members that’s available 24/7.
There are three steps to reduce compassion fatigue:
- Recognise it in yourself
- Find an outlet to talk about it at work. This could mean dedicated time out with colleagues who are dealing with the same stresses. It is important not to lock yourself away in self-protective mode
- Find time for yourself to do a de-stressing activity e.g. exercise, mindfulness, meditation
Some may say the NHS is crumbling, but it is vital that you do all you can to remain strong.
Dr John Holden is the chief medical officer at MDDUS and a former senior partner in a GP practice
interesting that mindfulness is a solution for compassion fatigue
ironically, when I run out of ideas, and compassion, for a patient, I tell them to do mindfulness
actually John I enjoyed your very good article – I was just being flippant yesterday – and I do strongly believe in (and practice) mindfulness! But my serious point would be that we should not beat ourselves up over experiencing compassion fatigue once in a while – it is very normal – and it is very difficult to survive the job consumed by self-critical earnest piety !
When you have been showing compassion to 30 patients all day, it is also very difficult to return home and continue to show more compassion, when you have fatigue and wish to switch off.
The young should look moving abroad. Gps are loosing hope as well.
John, can we add MDDUS’ shambolic advice to practices around handling complaints.
Always apologise to the patient and never stand up to them no matter how unrealistic their expectation/complaint is.
Perhaps your medicolegal advisers might like to reflect on their role in compassion fatigue and burnout in GPs.
This is a confused article. It conflates cognitive fatigue with compassion fatigue. Compassion fatigue is when you start hating every additional patient inflicted on you. Cognitive fatigue is when you start making harmful mistakes. The two are not the same.
1. Overworked
2. Financial Pressures
3. Negative right wing press
4. NHSE
5. Medicalisation of variances of normality.
6. Social media
7. Unsupportive secondary care
8. Mental health services non existent
9. Bored now