Radiology’s morality problem—and how to fix it
As radiologists become increasingly familiar faces on news sites and in police blotters, one Indiana University professor is suggesting the physicians might be prone to law-breaking due to their steep salaries and a professional culture centered around compliance.
“Discussions of professionalism in radiology often focus on ethical principles, codes of conduct and specific topics such as conflicts of interest and sexual harassment,” Richard B. Gunderman, MD, PhD, wrote in Academic Radiology this month. “Although such discussions are helpful, another important domain of professionalism often receives little or no attention: unprofessional conduct that results in prison sentences.”
It’s no longer a rarity to see radiologists in the news. Negligent clinicians have been arrested in connection with MRI-related injuries and death, Johns Hopkins alumni have been sentenced to jail time for fraud and a handful of radiologists have used their positions to prescribe controlled substances to non-patients.
Gunderman said that if more details about these cases were publicized, it would be apparent that soaring financial success and a solid professional reputation don’t protect radiologists from ethical lapses. If anything, he wrote, those factors push radiologists to believe they’re superior to everyone else, further complicating the issue.
That radiologists can convince themselves what they’re doing isn’t wrong or remove themselves emotionally from a situation, Gunderman wrote. But no matter the outcome of these cases, there’s another common denominator—the profession isn’t talking about it.
“Maintaining a culture of silence does nothing to capitalize on the lessons such cases offer for better calibrating the moral compasses of radiologists,” Gunderman said. “For example, we need to understand that most such lapses spring not from midnight ‘sell-your-soul’ encounters with a prince of darkness, but from small and even seemingly innocuous infractions that gradually snowball over time.”
Gunderman said the first step to fostering a more grounded professional environment is to take the focus off financials. The advantages of money are obvious, he wrote, but the benefits of goodness are harder to emphasize in a money-centric medical landscape. And “when the dollars become paramount, fudging the rules can seem a quite justifiable balancing of benefits and risks.”
Highlighting the importance of high ethical standards and professional principles takes the weight off bank statements, Gunderman said. One way radiologists could do that is to speak openly about both the mistakes past clinicians have made and cite examples of professionals they admire.
Leaders in the field should also work to make radiology less about compliance, Gunderman wrote. While professional discussions center largely around things like procedures, policies and codes, that culture of compliance immediately places ethical responsibility on an institution's or organization’s shoulders, rather than on individuals'.
“Virtue exists not in systems of laws and rules but in the hearts of professionals, whose characters represent the crucial locus of goodness,” Gunderman said. “Simply put, a profession can be no better than its best members.”
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.