Letter to the Editor
Thanks to Drs. Alberto Hazan and Jordana Haber for their excellent article on compassion fatigue. (“Compassion Fatigue: PTSD's Wicked Sibling,” EMN 2016;38:19; http://emn.online/May16MindfulEM.) Of course, this is one of the key features of burnout, and it is novel to think of it as a form of PTSD because it occurs in the midst of ongoing moderate stress, rather than after overwhelming or major stress. Unaddressed burnout can presage depression in those predisposed (it does not cause it), so following their advice about developing other outlets for negative emotions is wise.
Nearly 23 years ago I wrote an editorial in EMN entitled “A Russian Solution for Burnout” following my first trip to that country where we were witness to some amazingly dedicated doctors providing very good care with the most minimal of support. Those trips led to the founding of the Society for International Advancement of Emergency Medical Care, which became the International Section of ACEP, which now has members who have adopted at least 50 countries and helped to establish emergency medicine as a specialty in quite a few.
In recent years, my EP spouse and I have participated in medical missions to Honduras and Mexico, and will soon travel to Peru. Just witnessing the hardships of medical providers in underserved countries and experiencing the gratitude of patients and providers who have nothing is enough to keep feelings of compassion fatigue at bay even upon return to our fraught system. If you are seriously considering the Drs. H's suggestion of taking time off, think about doing it in a service mode. Not only will your appreciation and empathy be replenished, but you will not have to face questions about gaps in your employment when it is time for licensure renewal and recredentialling.
It goes without saying that if you are really ill or bordering on impairment, you should instead be seeking medical care.
Louise B. Andrew, MD, JD
Sidney, British Columbia, Canada