Radiologists Confront Emotional Challenges of Medicine
AAWR panelists push to reduce the stigma of emotional struggles and break longstanding silences related to shame and litigation
For the American Association of Women Radiologists (AAWR) president’s luncheon at RSNA 2025, AAWR immediate past president Meridith Englander, MD, suggested a topic that isn’t often discussed: how medical practitioners deal with negative emotions, including grief, fear, guilt and especially shame.
“As physicians, we have plenty of good days filled with rewarding and meaningful work, but we also have bad outcomes, missed diagnoses, lawsuits and things happening in our personal lives,” said Dr. Englander, an interventional radiologist and professor of radiology at Albany Medical College in New York. “Yet we must continue providing care to patients. How do we do that?”
Despite a dearth of literature on the topic, there’s growing interest in openly naming and discussing the negative emotions that physicians experience. “Historically, medical education has used shame as a motivator for young trainees,” Dr. Englander said. “It may not be as common now, but it can be devastating to be the victim of shaming.”
The AAWR panelists shared their stories and coping strategies and encouraged audience members to offer solutions as well. “Our goal was to get the conversation going and let people know that if they struggle at work, they aren’t alone,” Dr. Englander said.
Panelist Arthy Sarvannan, MD, said the discussion was especially timely given high levels of burnout and stress among radiologists.
“Being vulnerable can be difficult for everyone, especially physicians, but there should be no shame in admitting tough times,” said Dr. Saravanan, associate chief medical officer at Radiology Partners and assistant professor in the Department of Diagnostic Medicine at Dell Seton Medical Center, University of Texas in Austin. “The more we discuss it, the more normalized it becomes, and the more comfortable people feel about sharing what they're experiencing. They don’t have to be isolated and alone dealing with it.”
Dr. Saravanan discusses the often unspoken emotional toll of medical practice and shares why being vulnerable can be difficult but necessary.Coping With the Human Side of High-Stakes Work
Radiology is one of the medical specialties at highest risk for intense emotional strain, which can place radiologists at increased risk for mental health issues, substance abuse and suicide. But the potential of missed diagnoses and pressure of high-stakes decision making aren’t the only stressors.
Dr. Saravanan said she finds breaking the news of a cancer diagnosis to a patient the most troubling. “We go through a lot of training for this scenario, but we're still human, and there are things that can break us no matter how much resiliency we've built,” she said.
Dr. Englander concurred. “As an interventional radiologist, I know there will be complications,” she said. “What I’ve found throughout my career is that some people are able to weather those complications better than others.”
Panelist Sarah L. Averill, MD, a diagnostic radiologist at University of Rochester Medicine in New York, said that because they are less often engaged in patient-facing work, diagnostic radiologists can be stereotyped as technical and machine-like. “It's easy for the radiologist to be dehumanized, but we look at very traumatic images and experience the same human emotions as our frontline colleagues,” she said.
Dr. Averill discovered early in her career that difficult emotions are only exacerbated in problematic work environments where colleagues are unsupportive, dysregulated and competitive.
“Working in a toxic environment definitely taught me about myself and helped me learn self-advocacy and persistence,” she said. “But also, I became fascinated with understanding what underlies anger and how to communicate when emotions run high. It ended up changing the course of my career.”
After completing a course in difficult dialogues, Dr. Averill went on to further training and became a facilitator for the Center for Courage and Renewal, which trains people in strategies for exploring personal growth and development and enabling tough conversations.
“I use the skills I’ve learned in my everyday life when conflicts arise with my kids or when facilitating conversations with residents and faculty,” Dr. Averill said. “I prepare myself using these principles and practices and strive to create safe spaces for hard conversations.
As the inaugural vice chair of well-being and engagement in the Department of Imaging Sciences at the University of Rochester Medical Center, Dr. Averill is leading appreciation, recognition and bridge-building initiatives, as well as the ‘Pebble in Your Shoe’ project in which workers report chronic irritants that could be addressed to improve their work experience.
In this role, she makes herself available to radiology residents navigating the challenging emotions that come with the added responsibility of being on the night team and dealing with the rare, but inevitable, mistakes all physicians make. “We strive to normalize the fear and anxiety residents feel and let them know their attendings are here and the hospital offers anonymous counseling 24/7,” Dr. Averill said.
Each of the panelists emphasized the importance of having other physicians they can talk to about difficult situations, whether they are co-workers, professional society colleagues or medical school classmates.
“Peer support can be lifesaving. We know that just having someone who is able to receive you with empathy and understanding can make you feel less alone.”
— GITA PENSA, MD
Litigation: A Do Not Talk Zone
Even as radiologists work to manage hidden emotional burdens, the legal pressures tied to radiology practice sit in the shadows, unspoken but deeply felt.
As a practicing emergency department physician who navigated 12 years of litigation and now coaches other physicians through the legal process, Gita Pensa, MD, shared her unique perspective. “It is a ‘lightbulb’ moment for a lot of physicians,” she said. “They realize there are places they can go to learn more, and there are people who can help.”
“For a physician, litigation is a capital ‘T’ traumatic event that creates a very substantial threat to self, to our identity, livelihood and everything we've spent our life building,” said Dr. Pensa, adjunct associate professor in the Department of Emergency Medicine at the Warren Alpert School of Medicine, Brown University in Rhode Island. “And yet physicians are told explicitly and implicitly not to talk about it.”
“This blanket admonition has made litigation a shame-filled event,” she added. “On top of all the other negative emotions that go along with a lawsuit, it’s a real barrier to growing through the experience and coming out in a better place.”
Dr. Pensa instructs physicians on how to talk about their feelings—not the facts—of active legal cases.
“Physicians are good at talking about cases without revealing patient confidentiality; they already know how to navigate and protect health information,” she said. “Similarly, in the case of litigation, physicians can learn how to talk about legal events, and share their feelings about being involved in litigation, without divulging the details of their care in the case.”
Dr. Pensa emphasized that sharing experiences and learning coping strategies is the best way to bring this off-limits subject into the open.
“In the absence of constructive ways to deal with that stress, many of us turn to very maladaptive behaviors and maladaptive patterns of thinking, which is a slippery slope,” she said.
Dr. Pensa also helps institutions create litigation-specific peer support for medical staff. It includes physicians who have been through various stages of litigation and can relate to the emotions involved and offer hope. She noted that although many physicians are sued at some point in their careers, few know colleagues who have been through it, which can create a sense of, “it’s only me.”
Data shows that litigation is a driver of substance abuse, career abandonment and suicide. “Peer support can be lifesaving,” Dr. Pensa said. “We know that just having someone who is able to receive you with empathy and understanding can make you feel less alone.”
“I’ve given talks at organizations where this topic is being openly addressed for the first time,” Dr. Pensa continued. “When the chair of the department stands up and says, ‘You all need to know I’ve been sued three times and anytime you need support, I’m here for you,’ you can feel the whole room really take it in.”
Dr. Pensa’s message is gaining traction. She was recently invited to speak to the American Bar Association and last year, her podcast “Doctors and Litigation: The L Word,” was ranked among Apple’s top 100 with only word-of-mouth promotion.
The AAWR panelists noticed an eagerness to continue the conversation among the 50+ attendees at their session.
“As they were leaving, people were asking for more ways to talk about the topic,” Dr. Saravanan said. “I think that the biggest impact of the program is that it left a hunger for people to share and discuss these things more widely.”
For More Information
Read previous RSNA News stories on radiologist well-being: