Prof Nathan Consedine

The term ‘compassion fatigue’ is often applied as the personal cost of caring, but new research from the University of Auckland suggests the phenomenon could in fact be a self-fulfilling prophecy.

Professor Nathan Consedine, a health psychologist in the School of Medicine, said his group’s research raises questions about the idea that compassion is inherently exhausting; in fact, he argues that it can have a protective effect against burnout.

“Burnout in the health system is real, no doubt about it. But the experience of being too fried to care for other people is bundled up with the idea of compassion fatigue,” he said.

The notion of compassion fatigue has its basis in the work of author Carla Joinson in the early 1990s, which suggested emergency nurses experienced a particular type of burnout where they had exhausted their ability to nurture, said Prof Consedine. “The idea is that compassion is like a muscle or an energy reserve that gets depleted over time. However, if it were a reservoir, you would expect compassion fatigue to get worse over time, but it does not.”

More experienced practitioners, people who have been doing it 10, 15, 20 years, report lower levels of compassion fatigue, he said. “So, according to the theory, either they have found a way to give compassion without draining the reservoir, or they have found a way to fill up the reservoir. But my interpretation is there is no reservoir and it is not inherently fatiguing to care for other people.

Looking at fMRI data, it shows brain activation during compassionate states overlaps strongly with pleasure, he said. “It doesn’t look like effort – it looks like it feels good.”

Furthermore, the research suggests the very idea of compassion fatigue may be a self-perpetuating cycle, Prof Consedine added. “I think by constantly telling people that it is tiring to care, we are creating an expectation. And we know in health psychology research that expectations have a massive impact on the way people experience things.

“Making matters worse, describing the serious problems confronting healthcare in terms of compassion fatigue focuses research on the person providing care, distracting us from the health system and the preposterous workloads doctors and nurses are expected to carry,” he said.

Changing the narratives about compassion would be helpful for clinicians, patients and the health system, Prof Consedine said. “Providers often think ‘I haven't got enough time to be compassionate’, but it is more about the way in which things are done and what you see as the purpose of what you are doing.”

Concluding, he said the focus should not be on compassion fatigue but rather on increasing the net amount of compassion in the healthcare system, with the ultimate metric being the patient's experience of care.