Radiology practice leaders must take “urgent action” to address the growing problem of moral distress in the specialty, experts contended in a new analysis published Wednesday.

This concern occurs when a provider knows the right thing to do for a patient, but institutional constraints might prevent him or her from doing it. Moral distress is often a major cause of burnout, researchers wrote in the American Journal of Roentgenology [1].

Wanting to better understand its prevalence, corresponding author Bettina Siewert, MD, and colleagues conducted a national survey. They found that 98% of respondents had experienced at least some moral distress in at least one scenario, with 48% saying the pandemic had influenced their feelings of grief.

“Moral distress is prevalent in radiology, typically relates to systemic causes, and is a reported contributor to radiologists changing jobs,” Siewert, with the Department of Radiology at Beth Israel Deaconess Medical Center in Boston, and co-authors concluded. “Urgent action is required by radiology practice leadership to address moral distress, as radiologists commonly practice in environments contradictory to their core values as physicians,” they added.

To measure this issue in imaging, researchers used the Validated Moral Distress Scale for Health Care Professionals, adapting it for radiology and adding some additional questions. They asked respondents to weigh 16 separate clinical scenarios, gauging how frequently they face them and the level of distress that might arise. A total of 425 RSNA members were targeted, across 228 unique radiology practices.

The final sample included 93 individuals for a response rate of 22%. About 18% said they had left a clinical position because of moral distress, and 28% said they had considered doing so but never acted on it. And the three scenarios that caused the highest levels of moral distress included higher case volume than can be read safely, workload preventing resident teaching, and lack of administrative action or support.

Respondents pinpointed “educating moral distress sources” as the most common counter measure to address moral distress, at 71%, the study found. Another 44% said conferring with other specialties might help, and 22% suggested utilizing more ethics consultations.  

“Radiologists could apply their professional expertise to such dialogue,” the authors advised. “Arranging these interactions requires support by leaders, at the level of both institutions as well as national professional societies, which could engage the societies of other medical specialties in impactful discussions. Radiologists must be valued as consultants and be empowered as the gatekeepers of imaging appropriateness to be able to provide the best care for patients.”