There are five potential actions radiology leaders should take in the face of morally distressed members of their clinical staff, a noted imaging expert detailed at RSNA 2023 on Monday, Nov. 27.
This phenomenon can be defined as when physicians know the ethically appropriate action to take but are unable to execute it. They’re left to respond to a conundrum in a manner running contrary to personal and professional values. And it’s a common reality in radiology—98% of respondents in one survey said they had experienced some level of moral distress in at least one scenario, while 61% of interventional radiologists said they suffered from “moral injury” according to another poll.
Such a state of mind among physicians can lead to mistakes, patient harm and malpractice complaints. Presenter Frank J. Lexa, MD, MBA, pointed to a 2022 study he co-authored, which found that neuroradiologists were being forced to speed up read times amid burnout, subsequently leading to errors.
“This is wrong,” Lexa, who is professor and vice chair of the Department of Radiology at the University of Pittsburgh, told attendees. “I hope that the pilot who flies me back to Philadelphia tomorrow morning is not cutting corners like this. These are people who are highly trained, who have done 10,000 hours of training or more and they’re admitting that they are deliberately skating. It’s like they are driving drunk.”
“Does leadership matter? You bet,” added Lexa, who also is chief medical officer of the ACR’s Radiology Leadership Institute. Imaging leaders who simply urge physicians to read more to meet quotas “are just shop floor managers” who are likely going to burn their clinical staffs out. He urged others to stop forcing team members to focus solely on the challenges of the day without considering the impact this mindset will have on tomorrow.
“Any psychologist will tell you that one key issue to sanity is being able to continuously balance the past, the present and the future. People who live in only one of those are often mentally ill,” he told attendees. “If you ask what a successful CEO has to do, they have to balance the present and the future. If you’re not teaching, you’re not mentoring, then you’re putting us in the position of training the last generation of radiologists, which is a horrifying thing to say, but it’s something we have to say. Leaders can be part of the problem and they can also be part of the solution.”
Lexa made the case for why leadership is so important in solving moral distress among clinicians. Leaders serve as role models. They set expectations within a radiology practice or department. And leaders act as advocates for the house of radiology within larger institutions, including ensuring physicians’ safety and workplaces’ sustainability. Without them serving as advocates, radiologists are vulnerable to exploitation. One of the aforementioned surveys highlighted ineffective leadership, corporatization of medicine and nonphysician administration as key contributors to moral injury.
“The institutions we work for, whether you’re in academics or private practice, are addicted to the technology component of the imaging we do,” Lexa said. “They want you to read more and they will push you to read more, and we have to advocate in the house of radiology for leadership at a national level to put the brakes on some of this.”
He offered up five things leaders need to do in the face of moral distress. The recommendations are adapted from a paper Lexa and radiologist Jay R. Parikh, MD, published in JACR this past March.
- Lead by example and align values.
- Build consensus on moral and ethical issues.
- Protect members from institutional or extra-institutional drivers of moral distress.
- Work continuously to become a better leader.
- Help radiologists lead at all levels and, where necessary, push back on some of the things standing in the way.
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.