Radiology efficiency: from burnout to wellbeing

Radiologists burnout at a higher average rate then doctors that practice in all other medical specialities. There are a variety of factors that lead to symptoms of burnout in the medical profession but for radiologists the major cause is the extreme pressure to do more in less time. Coupled with bureaucratic workload routine, a decreasing sense of autonomy and their compensation directly correlated to the monitoring of production output relative to value, radiologists are in immediate need of new ways to mitigate the pain points and increase job satisfaction.

In a paper published in Current Problems in Diagnostic Radiology the case is made that creating simple strategies for increasing radiologist efficiency may help mitigate burnout through helping radiologists focus their attention on the parts of their work they enjoy and consider most meaningful. 

Whether in radiology or medicine in general the 2018 Medscape National Physician Burnout and Depression Report illustrated that radiologists experience higher than average rates of both burnout and coincident burnout and depression. This increase in burnout rates affect both the physician and the quality of patient care. Similar to other medical specialities, the data showed most common issues contributing to burnout were charting and dealing with electronic medical records, feeling no sense of autonomy and getting compensated less while working more. In radiology, however, there is the added pressure caused by the reduction in imaging reimbursement and practices pushing for more 'production' relative to cost per unit. 

The work addresses the problem of burnout and the need to improve radiologists wellness by focusing on how to maximise efficiency on clinical service as well as in non-interpretive work. By increasing efficiency radiologists will have more time and greater autonomy which will empower professionals to create a job and lifestyle balance that will promotes wellbeing. 

The proposed two strategies to increase efficiency:

Phone calls, emails, connected devices

Minimising distractions outside of work and inside the reading room as they can lead to errors. Phone calls and emails are the most common sources of distraction. To deal with phone call distractions the strategies include using a physician extender that can be trained to respond to commonly asked questions, often described as a reading room assistant, assigning a radiologist who may have  lesser expectations as to reading studies, or developing an educational practice protocol that can address common questions asked by referring physicians.

In the case of email distractions, and often the waste of valuable time, a way to increase efficiency is to apply a simple system to sort through emails immediately to determine which are actionable. When considering the hundreds and maybe thousands go emails accumulating in a radiologists inbox, it's a constant source of stress to have go down the list again and again to find which messages need their immediate attention. The authors propose a popular system from David Allen's Getting Things Done: The Art of Stress-Free Productivity, where the author breaks down the task to the 5 Ds, in a time-conserving strategy to deal with emails:

• Delete it—If you don't need it, delete it!

• Do it—If it can be done quickly (< 2 minutes), do it NOW.

• Delegate it—Often an ignored strategy!

• Deposit it—Create an easily accessible and organised archiving system.

• Defer it—If it is going to take more than a few minutes. Develop a reliable system to schedule and track these tasks.  

The almost universal access to the internet and use of smartphones has completely revolutionised the way we communicate, access media and consume entertainment. This is another distraction, especially for younger radiologists, with text messages, social media notifications, personal calls and emails at their fingertips. A good strategy is to designate time in between a series of several cases to break and mentally relax by way of your smartphone or other connected device. While reading cases devices should be switched to do-not-disturb mode, be kept away or placed faced down to minimise distractions.

Optimising time

Short scheduled breaks are best for increasing productivity, rather than grinding away for hours at a time. The Pomodoro Technique  a known popular method, suggests using a timer to work for 25 minutes and then follow with a 5 minute break. Following four of these 30 minute intervals they recommend a longer 15-30 minute break. Having these short breaks consciously allows you to anticipate responding to a message, making a call, uploading a picture to social media, checking current events or watching cat videos on YouTube- which ultimately increases focus and productivity while applying ones self to the task at hand.

Customised templates to structure reporting can increase efficiency, having "pick lists" or drop down lists which present pre-defined and proofread options for common requests. Being familiar with the layout of a template, straightforward cases can be processed by using a single relevant item on a list of commonly encountered issues such as "normal appendix" or "absent gallbladder". While those in favour of free form reporting may object to this pre-set structure, there has been no added value in dictating statements in uncomplicated cases. The process of dictating is more time-consuming than clicking on a list item or with the help of new voice-to-text technologies selecting it verbally and presents an unnecessary potential source of error.

Being concise is another way to maximise efficiency. Long radiology reports may distract the radiologist from focusing on the clinical question at hand and creating reports with too much irrelevant information and clinical details are also inefficient. 

Workplace ergonomics are examined throughout many professions as computer work and sitting have been deemed the "new smoking" with similar the health risks. For radiologists an important ergonomic consideration is monitor layout. The aim should be to have a shorter distance between the user's eyes and mouse cursor when dictating a study. Dictation software should be close to the displayed images being examined. If PACS users have the option to drag a series to the diagnostic monitors then this should be placed near the primary display monitors.  

  

Implementing relatively small strategic changes in key areas to increase radiologists efficiency both at the reading station and away from it, may help increase a sense of job satisfaction by gaining precious time to spend on aspects of radiology that are more fulfilling like more time with patients.

Source: Current Problems in Diagnostic Radiology

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