Physicians grief-struck by the prognosis of an terminally ill patient often endure feelings of frustration, failure, and even helplessness, which can lead to poor patient care, the New York Times reports.
For example, burned-out physicians may manifest defensive mechanisms, ranging from anger and curtness to even avoiding the patient's phone calls, creating additional stress for sick patients.
Other doctors may prescribe too many interventions for incurable patients, according to Diane Meier, a palliative care expert at Mount Sinai Medical Center. Meier notes that rather than turning to palliative care, many physicians who treat terminally ill patients "throw procedures at them… [t]o avoid feeling that they've abandoned their patients."
- Explore models for palliative care delivery and learn what distinguishes those cancer programs that have integrated palliative care services into oncology practice in this Oncology Roundtable study, Integrating Palliative Care into Oncology Practice.
Physicians can suffer compassion fatigue, burnout
Michael Kearney, a palliative care physician at Santa Barbara Cottage Hospital
, noted that physicians, especially those that care for terminally ill patients, are subject to two kinds of occupational stress: compassion fatigue and burnout.
Compassion fatigue occurs as a sort of "vicarious traumatization—trauma suffered when someone close to you is suffering," and can cause a physician to avoid thoughts of a patient's pain, become irritable, and endure physical and emotional distress.
Moreover, compassion fatigue can lead to burnout, which Kearney describes as "the end stage of stresses between the individual and the work environment." Burnout can result in emotional and physical exhaustion, detachment, and a feeling of never being able to fulfill one's professional ambitions.
'Mindfulness meditation' reduces stress, can promote patient-focused care
To help prevent compassion fatigue, Kearney recommends "mindfulness meditation," a mental exercise—as short as 8 minutes—aimed at reducing stress. Mindfulness meditation involves sitting quietly and focusing on one's breathing to calm and prepare the mind for a clearer perspective.
The exercise can help a physician become more self-aware, empathetic, and patient-focused, according to Kearney.
"It's like pressing an internal pause button," Kearney says. It helps the physician realize he is stressed, and "prevents him from in invoking the survival defense mechanisms of fight ('Let's do another course of chemotherapy), flight ('There's nothing more I Can do for you—I'll go get the chaplain'), and freeze (the doctor goes blank and does nothing)." Such reactions can severely distress a dying patient (Brody, "Well," New York Times, 11/26).
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