Compassion fatigue in physicians and religious coping for patients nearing end of life

Lots of good stuff in last week's JAMA:

An article by Kearney et al, entitled "Self-Care of Physicians Caring for Patients at the End of Life." This article used a phrase I had never heard before, but it is really true and valuable: compassion fatigue. The authors explain that this is different than burnout which "results from stresses that arise from the ... interaction with the work environment." Compassion fatigue "evolves ... from the relationship between the clinician and the patient." What are our specific work environment stressors? Feeling like the grim reaper most of the time, endless Family and Medical Leave Act and insurance paperwork, the constant amount of work that is being shifted to physicians via electronic order entry and not enough time with patients or your family all come to mind. When I read this article, I found that compassion fatigue is harder to define, but may include a loss of self-awareness and a loss of engagement with your patients.
In any case, this is a great article to help you identify burnout and compassion fatigue in yourself or your colleagues, and gives you some ways to mitigate both situations with self-awareness (my personal favorite: stop at your window in your workplace and notice something in nature; consciously give it your full attention for a few moments. I did it today. I looked out my window and saw one of the first robins of the year. Ah, spring. It was lovely.). For me, yoga has also been a big help — after my class, we do five to 10 minutes of relaxation and meditation in the unfortunately named Corpse pose. The practice of meditation after a yoga practice forces me to slow down my mind, to let go of some stress and realize my internal joy (am I getting too spacey here for you? Yeah, me too. All I know is it helps me feel better when I am done).
Also check out "Religious Coping and Use of Intensive Life-Prolonging Care Near Death in Patients with Advanced Cancer" by Phelps et al from Dana-Farber. Somewhat unexpectedly to me (not knowing this area of literature very well), they found that patients with strong religious convictions were more likely to receive intensive life-prolonging therapy. The authors point out that this finding has been seen in other patients with cancer (those with lung cancer) as well as other diseases, so their finding was not unexpected to them. I guess I was hypothesizing that if you had a strong religious faith and (presumably) felt comfortable with the afterlife, then you might not shy away from your death, and the transition to hospice might be less challenging. However, these authors found the opposite. In discussing this with my colleague Toby Campbell (Hi Toby!), we discussed that there may be difficulty in transitioning to palliative care if one is strongly hoping for a miracle. One weakness of this study is that it includes mostly people of Christian faith — I don't know if we can apply these conclusions to "religious" people of other faith traditions.