Health Services Research & Policy ■ Clinical Practice Management ■ Training & Education ■ Leadership
Health Services Research & Policy ■ Clinical Practice Management ■ Training & Education ■ Leadership
Health Services Research & Policy
■ Clinical Practice Management
■ Training & Education ■ Leadership

Reframing the Issue

It's not that burnout occurs because radiologists can't handle stress; It's that dysfunctional workplaces are too stressful.

At this year's ACR meeting in Washington, D.C., something many radiologists have been saying behind closed doors is finally out in the open: Workplace stress and burnout are on the rise, but it's not because radiologists lack resilience. Many radiologists have resilience in spades. If a large number of people in an organization are at or over their personal capacity to cope with workplace stress, the problem may lie with the way the workplace runs.

When my husband worked in management at General Motors, he would say, "Right or wrong, it's always management." The workers would feel the consequences of his decisions. If the decisions were good, he might be commended. But if the decision led to a poor outcome, the blame lay squarely at his feet, not the feet of those who reported to him. When the factory floor operations weren't going smoothly, the shop steward would share assembly line worker concerns with my husband. If management created a problem, management had to fix the problem. "Right or wrong, it's always management."

If you have heard someone say, "We either have to cut staff or all do more work" recently at work, who among you has had the audacity to proclaim in a public forum, "Right or wrong, it's always management"? You can try to blame decreased reimbursements and such, but the fact remains that managers make decisions and workers bear the consequences.

My brother used to work for UPS at nights during college. When a driver with a full truck was about to leave, my brother would stop the truck, shove a package through the window, and say "There's always room for one more." I asked him, "Why didn't you ever repeat that and stick yet another one in the truck?" This was answered by a shoulder shrug, as if to say, "I guess I didn't want to find out how the driver would respond to the second package."

What if you were told you had to read five extra studies each day? No big deal, right? Of course you could do five more studies in a day. What sort of a team player are you, if can't handle a mere five extra studies? Now repeat the five-extra-studies-per-day increment each year over the next ten years (so 50 extra studies per day). Each annual increment is so small, you'd seem lazy, petty, and immature to grumble. If you did complain, you'd risk being labeled disruptive (with a scarlet capital D). But if the extra work was 50 studies per day right at the start, your indignation would more likely be perceived as righteous.

No savvy manager would suddenly increase everyone's workload significantly. That manager would risk a mass exodus of workers. Better that the inexorable productivity creep be slow, so it's less noticeable and thus less likely to trigger workers expressing their displeasure.

Perhaps you start cutting corners, albeit very small corners, to shave a few seconds off each dictation. You're praised for faster turn-around time. Perhaps you spend less time reviewing cases but hold your breath, silently worrying you might make more errors. Not because you fear a decline in your "quality metrics" (since such metrics rarely measure how thorough your reports are or how accurate your diagnoses are), but more out of a sense of obligation to do your best work for each patient.

I'm reminded of the "I Love Lucy" episode where Lucy and her best friend Ethel go to work in a chocolate factory. They need to wrap individual chocolates coming down a conveyor belt on their way to the packing room. At first, they keep pace, but the conveyor belt speed gradually increases. In desperation, the duo eats some of the chocolates and stuffs other ones inside their hats and shirts. The supervisor then walks in and is so impressed that she turns up the belt speed again, resulting in more laughter as the scene ends. But health-care facilities are not chocolate factories or TV comedies. There's much more at stake than uniformly-wrapped chocolates.

We are reminded that we must be centered on patients and their families. The problem is that when asked to speed up our work and do more of it, we have to accept that we are mere mortals, unlike robots that can work round the clock for free without fatigue. If the price we pay to do more work faster each year is deterioration of our mental well-being, how can we provide the best care? We can fake it, at least for a while. But then you hear whispers of how a physician with the outward appearance of having it all together, being great at patient care, making a fantastic parent, acting as a committed citizen and active community member, committed suicide.

How many radiologists would feel safe to say, "I'm not doing well" at work? How many would hear in response, "You need better coping skills. Why don't you take this stress management class?" What would happen if a radiologist said, "Something isn't right in this place"? Would that person be taken seriously or be deemed to have an attitude problem? How much responsibility does a dysfunctional organization bear when it either simply does not recognize endemic high stress levels among staff or does not strive to mitigate worker stress? As for workplace surveys about stress and burnout, any place that chooses to conduct surveys has had its organizational head in the sand about these issues for years. If someone committed suicide where you work, what action would your organization take?

Fortunately, the ACR Human Resources Commission, headed by Edward I. Bluth, MD, FACR, is reframing the issue of workplace burnout and stress to emphasize that these are not individual failings. Instead, our workplaces may not be good for our mental health and, thus, our overall well-being. Our workplaces may need assistance in making changes that reduce stress levels. To begin this campaign, Dr. Bluth has started by taking a look back at past human resources articles in JACR, including stress and burnout in the new HR Special Collection, such as this "read and share" article about depression in radiologists


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