Nada Khan is an Exeter-based GP and an NIHR Academic Clinical Lecturer in General Practice at the University of Exeter. She is also an Associate Editor at the BJGP.
What is the cost of caring? It seems pretty high when seven in 10 GPs reportedly experience a sense of compassion fatigue and feel they can’t empathise with their patients. These results from a recent Medical and Dental Defence Union of Scotland (MDDUS) survey of just under 2000 GPs across the UK highlight the ongoing stressors impacting GPs and their patient interactions.1
The term compassion fatigue was initially used in the nursing literature to describe a loss of being able to nurture, resulting in nurses feeling depressed, detached, and experiencing physical symptoms like headaches and insomnia.2 To understand compassion fatigue it’s useful to unpick firstly what caring with compassion means. A few years ago, Antonio Fernando and colleagues wrote an editorial here in the BJGP about compassionate care in general practice, describing it as building on the capacity to empathise and share perspectives.3 When clinicians care with compassion, they not only recognise and understand a patient, but actively support and help them.2 So when a doctor experiences compassion fatigue does that mean that there is a limit to how much compassion a doctor can provide?
The term compassion fatigue was initially used in the nursing literature to describe a loss of being able to nurture, resulting in nurses feeling depressed, detached, and experiencing physical symptoms like headaches and insomnia.
Compassion fatigue is not just about not having ‘enough left in the tank’ to act when we think we should. The increasingly pervasive sense of compassion fatigue is linked with moral distress, which has been described as knowing what the right thing to do is, but constraints within the environment make it impossible to pursue that right course of action. It’s a feeling that ‘there’s nothing I can offer’ a patient.4 This emotional response can degrade a doctor’s ethical integrity and can lead to poorer quality of care and feelings of anger and burnout. Moral distress flies in the face of compassionate care – we can’t practice compassionately when external barriers prevent us from doing so.
Why compassionate care matters
Providing patients with compassionate care provides us with a sense of personal fulfilment and satisfaction in our work. When doctors experience compassion fatigue, it can lead to emotional distress, pain, suffering, and contributes towards doctors leaving their patient-facing clinical work.2 Aside from the personal impact on individuals, it matters because those experiencing compassion fatigue will struggle to deliver good quality patient care. Doctors experiencing lower compassion, satisfaction and higher stress at work tend to be more irritable with patients and colleagues, and feel that they aren’t working to their best standard of care.5 In the recent MDDUS survey, almost half of the doctors surveyed felt that compassion fatigue meant that they worried they wouldn’t be able to provide safe care to their patients.1
How to build back compassionate care
Being a doctor is a ‘complex biopsychosocial activity’, and the root causes of compassion fatigue include organisational factors, individual and doctor-specific factors, patient factors, and the inherent nature of the job.3,5
Self-care interventions and education programmes are the main strategy promoted to try to prevent compassion fatigue, putting the onus on the individual to build skills in coping and emotional self-care. Other interventions, like the Schwartz round, which involves a structured and reflective group discussion around a case or personal experience, are often offered by big employers or NHS hospital trusts. While these programs can reduce feelings of stress, they don’t stop the underlying external reasons including a lack of time, resources and finances. These can fuel feelings of compassion fatigue amongst clinicians.2 And while individual wellness and clinician resilience programmes are often promoted in the NHS to combat stress and prevent burnout, such measures also do not fix the structural and systemic roots of our moral distress. Just like moral distress, compassion fatigue is shaped by the cultural, political and financial environment in which we practice that challenge our professional integrity and our ethical principles of practice.6 When I spoke to Monica Molinaro about her work around moral distress amongst Canadian family physicians for the BJGP podcast, we talked about how GPs can’t individually be held responsible for fixing the root causes of insufficient resourcing or social inequities that often cause an inability to meet increased health care needs especially amongst marginalised patients.
What to do when the system isn’t working
Practices can work at better organising their local procedures in terms of allocation of work to allow clinicians sufficient time to complete patient-facing and non-patient facing administrative tasks.
If the system isn’t working, is it our responsibility to find ways to care for ourselves to help us to provide compassionate care? Given that the factors impacting on compassionate care are multifactorial, there may be some things that we can do to help. Individual doctors may wish to try mindfulness training or compassion meditation (if you’re so inclined) as these can help us develop wellbeing and a mindset focussed on wanting to act to relieve suffering.3 But doctors need to be supported to take time out to undertake these activities, which need to be available locally. And mirroring the burnout discourse, we need to tread carefully when putting the onus on individuals to address compassion fatigue – this needs doing alongside a parallel wider approach looking at organisational failures.7
While some of the larger organisational issues within the wider NHS might seem insurmountable, there may be things that we can do at a local, practice level to foster compassionate care. Operational burdens like constant interruptions and missing or poorly functioning equipment contribute to job dissatisfaction and stress. Practices can work at better organising their local procedures in terms of allocation of work to allow clinicians sufficient time to complete patient-facing and non-patient facing administrative tasks.8 Practice teams can work together to change their culture around minimising interruptions and ensuring better communication and coordination of staff
Compassionate care helps us stay connected through our feelings and actions to the human aspect of medicine. And when that feeling is lost, it degrades our sense of who we are as clinicians. The cost of caring is high, but when we acknowledge it, and its causes, we can work to address it.
References
- Campbell D. Seven in 10 GPs in UK suffer from compassion fatigue, survey finds: The Guardian; 2025 [Available from: https://www.theguardian.com/society/2025/jan/02/seven-in-10-gps-in-uk-suffer-from-compassion-fatigue-survey-finds?CMP=Share_iOSApp_Other.
- Sinclair S, Raffin-Bouchal S, Venturato L, Mijovic-Kondejewski J, Smith-MacDonald L. Compassion fatigue: A meta-narrative review of the healthcare literature. Int J Nurs Stud. 2017;69:9-24.
- Fernando AT, 3rd, Arroll B, Consedine NS. Enhancing compassion in general practice: it’s not all about the doctor. Br J Gen Pract. 2016;66(648):340-1.
- Molinaro ML, Shen K, Agarwal G, Inglis G, Vanstone M. Family physicians’ moral distress when caring for patients experiencing social inequities: a critical narrative inquiry in primary care. Br J Gen Pract. 2024;74(738):e41-e8.
- Dasan S, Gohil P, Cornelius V, Taylor C. Prevalence, causes and consequences of compassion satisfaction and compassion fatigue in emergency care: a mixed-methods study of UK NHS Consultants. Emerg Med J. 2015;32(8):588-94.
- Kherbache A, Mertens E, Denier Y. Moral distress in medicine: An ethical analysis. J Health Psychol. 2022;27(8):1971-90.
- Khan N. Burnout, patient and physician safety BJGP Life 2022 [Available from: https://bjgplife.com/burnout-patient-and-physician-safety/.
- Sinnott C, Moxey JM, Marjanovic S, Leach B, Hocking L, Ball S, et al. Identifying how GPs spend their time and the obstacles they face: a mixed-methods study. Br J Gen Pract. 2022;72(715):e148-e60.
Featured image by Peter Chiykowski on Unsplash
