Burnout and Moral Distress: Testing the Limits of our Compassion

Stephen D. Brown, MD, HEC-C, is a pediatric radiologist and clinical ethicist at Boston Children’s Hospital, and associate professor, part-time, at Harvard Medical School. He serves on the faculty of the Harvard Medical School Center for Bioethics, where he teaches students in the medical and master’s degree programs. He has served as chair of the RSNA Professionalism Committee and the RSNA News Editorial Board. Dr. Brown was the inaugural recipient of the American Roentgen Ray Society Leonard Berlin Scholarship in Medical Professionalism and was a recipient of the GE Healthcare/ RSNA Education Scholar Grant.

From the outset of my medical school clinical experiences, I felt the test of my limits for remaining kind, empathetic and patiently responsive to my patients, amidst powerful countervailing forces that challenged my ability to commit to this foremost professional responsibility.

These forces accompanied me intermittently throughout my career and occasionally led me to similar tests of the limits of my compassion towards my colleagues and even friends and family, whose claims for my time, attention and energy seemed to conflict with the pull of my professional duties. A previously unfamiliar cynicism and impatience sometimes encroached.

What was it that I was experiencing? Was it the residue of moral distress from being unable to do what I felt was right or to speak up against endemic structural or hierarchical gradients about compromised safety or lapsed professionalism? Was it burnout from unrelenting workflow obstructions, work-life conflicts and other stressors that ultimately constricted my empathy and left me cynical and emotionally depleted, with diminished feelings of personal accomplishment?

Burnout and moral injury are not necessarily the same but differentiating them precisely is frustratingly elusive. Conflating them risks false conceptions of one-size-fits-all solutions. Broad-strokes wellness initiatives, however well-intentioned, cannot alone palliate distinct stressors. Mechanisms to cultivate “speaking-up” cultures, for example, differ from those to enhance work-life balance.

And yet, a combined corrosive effect emerges from the convergence of unremitting work-flow inefficiencies and administrative burdens, inadequate time for valued, mission-critical teaching and research activities, lost access to outside interests and loved ones, and skewed reward and promotional systems. These conditions pervade radiology. They erode our workplace satisfaction and professional gratification, undermine our relationships with team members, leaders, and institutions, and exert an insidious toll on our personal and collective well-being.

Radiologists are not alone. Burnout and moral distress are ubiquitous across medicine; high levels are widely reported even among leadership. Still, we radiologists are sometimes removed from the viscera of health care. We often don’t see clinician distress emanating from myriad other challenging spaces, like intensive care, oncology, surgery, psychiatry, gender management and obstetrics. Indeed, many of us deliberately chose to shield ourselves from such intensity. In doing so, we risk losing sight of where burnout and moral injuries may fester most perniciously.

Radiologists’ success in actualizing solutions for ourselves may be most impactful if we engage cooperatively within our institutions.

Our narrow perspective can work against our interests as we appeal for mitigative resources to leaders who must prioritize sources of distress requiring most immediate, targeted attention. Due to absent institutional capacity to solve every problem, ample room exists for empirically substantiated initiatives to broadly promote resilience and self-care. Radiologists can lead these efforts. But as we appeal for solutions to ease our own burdens and to promote our own well-being, our best case resides in emphasizing that we all collectively face deeply entrenched tests to our limits of compassion to our patients, who, ultimately, remain our primary professional concern. 

For More Information

Read the RSNA News series on moral distress:

• The Effects of Moral Injury in Radiology
• Under Pressure: Educators Suffer When Forced To Choose Between Clinical and Teaching Duties