Radiologist says moral distress has made her contemplate suicide
A radiologist is sharing the story of one colleague who has experienced moral distress in the hope it will inspire others grappling with this problem.
Previous studies have explored this phenomenon in medical imaging, with one recent JACR analysis claiming such distress is “pervasive” in the specialty. Common causes include pressure to perform an unsafe number of studies, high workloads impeding teaching duties, and lack of administrative support.
Indiana University radiologist Richard B. Gunderman, MD, PhD, said he wanted to share the unnamed individual’s story to help put a face to moral distress and illustrate the impact it has on physicians. He spoke with the person about her troubles during the recent Association of Academic Radiology Annual Meeting, held in Los Angeles March 11–14.
“Most discussions of burnout and moral injury in radiology focus on rates of such afflictions as reported in surveys, presenting the equivalents of diagnostic criteria and recommended preventive strategies and therapies,” Gunderman wrote July 5 in Academic Radiology. “Yet to really understand moral distress in our field, we must look beyond impersonal generalizations and focus on the stories of particular radiologists. If we do not, we fail to elucidate the full depth of the toll it is taking on many of our colleagues.”
The anonymous individual is a “highly respected clinical radiologist and educator,” Gunderman added, noting she has served in leadership roles both locally and nationally. Her story started amid a severe workforce shortage, forcing her to complete the work of two full-time radiologists in four days a week. Amid a “downward spiral of overwork,” she missed a key finding on a CT scan, further impacting her mental health.
“Exhausted and overwhelmed, thoughts of suicide began looming,” she shared with Gunderman. “I actually started planning how I would do it. I had good life insurance, and no one would know that my death had not been accidental. At first, I planned to step out in front of a bus, but then I got to thinking how traumatic that would be for the bus driver. Then I thought of driving my car off a bridge, but I began to worry about injuring pedestrians who might be on the walkway. Eventually, I gave up, discouraged that there was no perfect way to do it. There just didn’t seem to be any way out.”
COVID-19 made things worse, forcing radiologists at her institution to take on “triple the workload” with half as many colleagues. Pleas for additional help only fell on deaf ears, she recalled.
“We told our chiefs that we needed more staff, and they responded that they were making the business case for it. It took us some time to realize that they are rewarded for cutting costs, which helped to explain why they increasingly treated radiologists as disposable commodities. They simply did not care that half the department had resigned.”
One day while meeting with a new department chief, the radiologist experienced chest pains. A visit to the ED showed she had blood pressure at 200/110, and she eventually realized that the problem only seemed to surface while on duty or thinking about work. Eventually, a family physician had warned the radiologist to relieve her stressors or quit, and she encouraged the radiologist patient to tell her colleagues also to also get evaluated for work-related stress.
The radiologist decided to take a 30% pay cut and work only 60% of a full-time equivalent. Gunderman said the changes are making a difference, with just the action of talking about distress “of some help.” Still, the work lists have not diminished, nor have organizational leaders started respecting radiologists’ concerns about burnout.
“People who talk about moral injury are on the right track,” the radiologist said, according to Gunderman. “It hurt deeply to be treated as nothing more than a unit of work, and it hurt even more to feel that there was nothing I could do about it for my colleagues or myself. One of my colleagues kept telling me to stop trying to be a savior, that I cannot protect everyone else, and that I am just making myself sick. But I always thought of myself as a problem solver, someone who would roll up her sleeves and make things better.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.