Radiologists Face Deepening Levels of Stress, Burnout
A recent review article describing the shocking behavior of a senior radiologist who “had a meltdown” when a sedated child woke up during an abdominal CT reveals an equally unsettling reason for his behavior: anxiety and trouble sleeping and concentrating.
 Stephen D. Brown, M.D. Children’s Hospital of Boston and Harvard Medical School |
 Carol M. Rumack, M.D. University of Colorado’s Denver School of Medicine |
 Dania Tamimi, B.D.S., D.M.Sc. |
Radiologists facing heavier workloads with decreasing financial rewards, the fear of litigation, exhaustion and the constant struggle of jugging work and family issues are becoming increasingly stressed, burnt out and depressed.
Anxiety and trouble sleeping or concentrating are among symptoms of these conditions that may cause disruptive behaviors in the workplace and lead to conduct commonly seen in drug or alcohol addiction, according to the review published in the July 2009 issue of the Journal of the American College of Radiology (JACR).
“Physicians are in stressful work conditions,” said one of the authors, Stephen D. Brown, M.D., an assistant professor of radiology at Children’s Hospital of Boston and Harvard Medical School. “We need to learn to understand behaviors associated with poor responses to stress and how to manage those behaviors.”
A fictional account based on a real event, the case of the radiologist treating the sedated child is a classic example of a physician unable to manage a stressful situation in an acceptable manner. In the scenario, after the child woke up and the radiologist realized the exam had been rendered nondiagnostic, he denounced the nurse, fellow and technologist in front of the patient and family, threw down the chart and stormed out of the room, according to the review.
Disruptive behavior related to any cause is now understood to adversely affect physician performance and compromise patient safety, according to Dr. Brown’s review.
However, little is known about behavioral problems related to depression, burnout and stress in radiology and whether they may become more frequent or acute as workloads increase and reimbursements decline, he said.
The review addresses a variety of causes of stress, with one of the most common being workflow and volume. “When the worker does not have control of the flow of work—that causes stress,” said Dr. Brown, a member of RSNA’s Professionalism Committee who will present this material at RSNA 2009 with co-authors Marilyn J. Goske, M.D. and Craig M. Johnson, D.O. .
RSNA 2009 Yoga Course Offers Solution
Stress is the body’s response to a real or perceived threat, according to Dania Tamimi, B.D.S., D.M.Sc., who will present, “Yoga for the Stressed Radiologist,” at RSNA 2009, and who regularly speaks and writes on topics related to radiology and yoga. She defined burnout as the constant depletion of mental, physical and emotional energy. “Burnout is a normal response to putting in too much effort without taking in what you need to balance and restore yourself,” she said.
Dr. Tamimi, an oral radiologist, registered yoga trainer and an American Council on Exercise-certified instructor, said some repetitive physical and mental activities can offset stress.
“Often, a person who is burnt out does not realize it or is in denial so as not to appear weak to himself or others,” she said. “Recognizing that you are stressed or burnt out is the first and most important step to healing yourself. One of the first signs of burnout is a lack of interest in things previously found enjoyable, which may apply to work as well.”
Some problems that could deepen stress for radiologists are poor posture, excessive glare from viewing monitors, a cluttered workstation, the inability to create time for themselves, overeating, consumption of stimulants like caffeine and the abuse of alcohol and narcotics, Dr. Tamimi said.
Stress management techniques and exercise may offer greater relief, and yoga is one effective way to reduce stress, according to Dr. Tamimi.
“Yoga massages the musculoskeletal system as the muscles and tendons are stretched,” she said. “The steady, even, diaphragmatic breathing performed in yoga reduces stress by activating the relaxation response. Yoga also massages the internal organs and may temporarily reduce blood pressure by inducing relaxation of the cardiovascular system.”
Stress Impacts Radiologists of all Ages
Radiologists face stress at every stage of their career, experts said. Financial issues related to the faltering economy can increase stress in older physicians who realize they may not be able to retire when scheduled, while a radiologist who is ill or is caring for a sick family member can also experience increased stress levels.
For radiologists in training, sitting for board exams can lead to toxic levels of stress, according to Carol M. Rumack, M.D., a professor of radiology and pediatrics and associate dean for Graduate Medical Education at the University of Colorado’s Denver School of Medicine who developed the presentation, “The Physician with Behavior Problems,” with Alan C. Hartford, M.D., Ph.D., at RSNA 2009, who will make the presentation at RSNA 2009.
Board exams are so stressful that the university has created a program to reduce the tension, said Dr. Rumack.
“Each week, an attending physician meets with about 50 residents to discuss a case,” she said. “About a quarter of the residents are called on so they get used to the idea of talking in front of people. After four years of doing this, residents find the boards much less traumatic.”
Dr. Rumack, president of the American College of Radiology, said something as simple as eating before the exams is effective for alleviating stress.
“Learn how to deal with stress so that it helps you perform,” she said. “When I was a resident, I had no breakfast before my first oral exam in pediatrics. During the one-on-one meeting with the examiner, he offered me an apple when he saw how pale I was. If you don’t think your stomach can take any food, try some ginger ale.”
Finding a work environment that fits your comfort level is another way to reduce stress. If the emergency department is too stressful, stay away from it, cautioned Dr. Rumack.
Working around a stressed, burnt-out or depressed radiologist may cause stress in a fellow colleague hesitant to report the physician’s actions for fear of retribution or destroying a career.
In Colorado, part of the licensing fee goes toward the Colorado Physician’s Health Program, a nonprofit, independent organization that provides peer assistance services for licensed physicians and physician assistants of Colorado, said Dr. Rumack.
About one-third of those doctors in the program enter voluntarily, while others are sent when a program director or chair becomes aware of behavior issues, she said.
After the physician goes through the intake process, assessment and lab testing, the program notifies the department chair that the physician is fit for practice but does not reveal other details, said Dr. Rumack.
More Radiology-focused Research Needed
Dr. Brown said he would like to see future research on how stress, burnout, depression and associated workplace risk factors such as patient volume and disruption in workflow affect the quality of care, patient safety and the incidence of medical errors in radiology.
Specifically, Dr. Brown wants to see radiology-focused research similar to the study published in the February 2008 issue of the British Medical Journal, “Rates of Medication Errors Among Depressed and Burnt Out Residents: Prospective Cohort Study,”demonstrating that depressed physicians were significantly more likely to make medication errors.
In addition, Dr. Brown sees a need for training programs that educate radiologists, especially those at the managerial level, on warning signs that a physician’s behavior is beginning to cross the line. “We need mechanisms that recognize, report and correct behaviors,” he said.