Moral Distress, Moral Injury, and Burnout in Radiology Practice

Abstract

Moral distress, which causes burnout, is a growing issue in health care since its initial description in 1984. The relationship among moral distress, moral injury (sustained moral distress), and burnout is critical to understanding the implications for physicians' mental and physical health and the impact on patient care. Moral distress can lead to an increase in medical errors and result in low quality of care for patients. There are five common causes of moral distress in radiology that can affect patient care. These include high workload, lack of leadership support, clinical demands interfering with teaching mission, lack of team communication, and disregard for professional expertise by pressuring radiologists to perform unnecessary or inappropriate imaging. This article analyzes current work environment challenges contributing to these issues, including causes of high workload, staffing crisis in radiology, and lack of time for nonclinical missions (eg, teaching, research, continuing medical education, practice building, reading literature, mentoring, and society volunteering). Moral distress and intention to leave were compared between radiology and other specialties. Concrete solutions to address causes of moral distress are outlined. These solutions include developing guidelines for safe workloads, servant leadership models, and tips for maintaining the teaching mission in a busy academic work environment and improving communication between clinicians. Possible solutions to national problems such as high workload, reduction of inappropriate imaging, seeking reimbursement for noninterpretative tasks, and short staffing are also described.