Published November 14, 2022
Jonathan Kruskal, MD, PhD
Melvin E. Clouse Professor of Radiology, Harvard Medical School
Chair, Department of Radiology, Beth Israel Deaconess Medical Center
Lea Azour, MD
Clinical Assistant Professor, Department of Radiology, NYU Grossman School of Medicine
Director of Wellness, Department of Radiology
Jonathan Goldin, MD, PhD
Professor of Radiology, Medicine, and Biomedical Physics, UCLA David Geffen School of Medicine
Imagine for a moment a lighthouse, perhaps alone among cold, crashing waves casting light and deep, bellowing sounds for passing ships in the foggy night. A beacon of safety, of hope, a navigation pathway, guiding distant faceless and shrouded ships through dark and treacherous passages into safe harbors and beyond. No expressions of gratitude or appreciation for this pillar of rock and time and relief. Sturdily constructed on a foundation of bedrock, built to survive the daily ebbs of moon-pulled tides and cruelly lashing, crashing cold storms. When activated, light-generated heat escapes from the lantern light room through vent balls on top of the cupola. Passing ship horns are spied from the watching gallery deck, which sits atop the cramped living quarters and the kitchen, repair, exercise, and communications rooms. Our tall tower is constructed to meet the many personal needs of the timeless keeper, all alone. Hanging ladders, spiral stairs, a signaling room, escape exits, and tide-safe entrances provide safety nets of protection against battering tides and time and loneliness
So, where are we going with this analogy? In our opinion, the lighthouse symbolizes the four essential ingredients of a wellbeing strategy: foundational elements, safety nets, as well as cultural and personal wellbeing [Fig. 1].
Let’s consider and expand on components and opportunities encapsulated within the four ingredients below. We invite ARRS members and your colleagues to do the same. For those who might not be experiencing optimal fulfillment in work at this time, do you have your proverbial lighthouse? Might you have colleagues who would clearly benefit from you serving in this capacity?
In the clinical imaging realm, foundational elements include a redesign of the work environment itself, as well as reliable assessment tools to provide longitudinal estimates of individual states of wellbeing and the impacts of burnout mitigation efforts. We must recognize that to make real change in individual wellbeing, the foundation must be rebuilt. We are well aware of the impacts of leadership effectiveness (or lack thereof!) on staff morale and burnout , and on the importance of building collaborations and providing opportunities for social connections. We can all easily list those several “pebbles in our shoes” that detract from our professional fulfillment and may result in additional negative impacts. An important foundational component is the ability to identify, then remove these pebbles effectively, and to keep them out. Don’t we all aspire to be pebble-removal scientists? Examples of the many recognized “pebbles” in our radiologist’s shoes include call requirements, compensation plans, staffing challenges, malpractice risks, work isolation, job security, low meaning in work, clerical burdens, and inefficient work environment. This list is much longer.
The stigmas associated with burnout, stress, and mental health among physicians is harmful and underserved.We offer up simple advice: providing top-level care to our patients requires first that we do the same to ourselves. Simply said, always put your own mask on first. Has your practice invested in developing wellbeing peer support? Who really checks in on you at work? Who do you check in on at work, and what training did you receive for this? We’d suggest reminding yourself how to provide stress first aid, both for peer support and self-care . Consider the “first-aid” that a lighthouse provides, correlated with options for managing sources of anxiety in health care professionals during challenging times . We are all experiencing: “hear me, protect me, prepare me, support me, and care for me.”
Personal Dimensions of Wellbeing
An intricate list of dimensions contributes to our overall wellbeing: emotional, psychological, financial, social, spiritual, occupational, physical, intellectual, and environmental. Each of these, while complex and complicated, embraces a wide expanse of opportunities for fostering a state of wellbeing. One cannot just address each individually in isolation, but collectively. For example, the symptoms of burnout include emotional detachment, and might easily overlap those of clinical depression, and both conditions have fundamentally different treatment approaches .
Instilling a Culture of Wellbeing
Finally, instilling a culture of wellbeing is not quite as simple as the title suggests. Instilling this culture implies prioritizing employee wellness, being open and transparent about goals, sharing a roadmap of progress, embracing different opinions—especially from our multigenerational workforce —and commitment from and active participation by leaders. Efforts should be made to align values with those of the larger organization. This helps employees to find and experience meaning and joy in work, to build a sense of community and collegiality, to ensure that employees feel valued, to show compassion and appreciation, to ensure that policies support wellbeing, such as flexible work and transparency, to resource and provide efficient workflow solutions, to enable all employees to be heard. The list goes on, of course.
Above, we have briefly addressed the four components of a radiologist wellbeing strategy, certainly not comprehensively, but intended to stimulate conversation, consideration, and contemplation. We are convinced that there will be as many putative suggestions as there are practices. And we plan to continue this conversation this April 16–18, 2023, during the inaugural ARRS Radiology Wellness Summit in Honolulu, HI . A final thought to consider: Is the House of Radiology ready, willing, and resourced to serve as our wellbeing lighthouse?
- Kadom N. Anything Goes—Is It True for Leadership Styles? ARRS Rad Teams website. RadTeams.org/2022/09/26/leadership-styles-radiology-teams. Published September 1, 2022. Accessed November 9, 2022
- Westphal RJ, Watson P. Stress First Aid for Health Care Professionals. AMA website. edhub.ama-assn.org/steps-forward/module/2779767. Accessed November 9, 2022
- Shanafelt T et al. Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic. JAMA 2020; 323:2133–2134
- Sen S. Is it burnout or depression? expanding efforts to improve physician Well-Being. N Engl J Med 2022; 387:1629–1630
- Kruskal J. Thriving in a Multigenerational Workforce. ARRS InPractice website. ARRSInPractice.org/multigenerational-workforce-radiology-age-diversity-dei. Published January 5, 2022. Accessed November 9, 2022
- Kruskal J, Azour L, Goldin J. Introducing the ARRS Radiology Wellness Summit in Hawaii—Time to Get Serious! ARRS InPractice website. ARRSInPractice.org/radiology-wellness-summit-arrs-2023-hawaii. Published August 1, 2022. Accessed November 9, 2022
The opinions expressed in InPractice magazine are those of the author(s); they do not necessarily reflect the viewpoint or position of the editors, reviewers, or publisher.