Should doctors go to work if they’re sick?

in Physician | 16 responses

The work ethic instilled in most physicians may actually be a detriment to patient care.

In this piece in Slate, emergency physicians Zachary F. Meisel and Jesse M. Pines write about the culture in medicine where doctors are expected to show up for work (via RangelMD.com), no matter what their malady is: “Sick doctors have been known to do rounds while dragging IV poles and receiving fluids for GI illness. Gross, but it happens. This culture of work-first/self-second may not be such a terrible thing: Patients want dedicated doctors who study hard and won’t sleep unless their patients are tucked in. But this hard-nosed culture can cause problems, especially when overtired doctors make mistakes because a cold has stuffed up that same hard nose.”

I don’t think I’ve ever seen doctors attached to IV poles rounding on patients. But, their point is duly noted.

Part of the problem can be linked to the tightening restrictions of resident work hours, where coverage is already stretched thin. If a resident calls out sick, another has to be pulled, sometimes from their vacation or time off, to fill in. This creates intense pressure for these doctors to show up, regardless of the severity of their illness.

Perhaps as medicine evolves towards a kinder, gentler lifestyle, the stigma of calling in sick can be reduced. That shift, however, has to start in training. Which means that more residents will be needed on hand to cover for those calling in sick.

Are cash-strapped hospitals willing to spend the money to increase the size of their residency programs?

Comments

Anonymous
one of my colleagues once spent the second half of her shift in the ED drinking oral contrast. when her shift ended and her CT had been read, she went off to the OR to have her appendix removed.
so yes, we’re taught to come in unless we’re literally dying.
Anonymous
when I was a resident, we were allowed to take a few hours off for severe vomiting or diarrhea. Otherwise we were expected to show up
Anonymous
I am extremely annoyed when people in corporations show up for work with colds flu and whatever and infect others. But doctors?
I don’t care about your dedication. What right do you have to infect your patients?
Anonymous
Dragging an IV pole is a bit extreme.
If I’ve waited weeks for an appointment having it cancelled because the Doc has the sniffles probably isn’t going to make me very happy.
I think it probably all depends. Many professionals, medical or otherwise, are expected to produce through thick and thin. That means being judicious about calling in sick.
Anonymous
“what right do you have”
says someone not personally involved at all.
well, friend, if the ED doctor calls in, there is no doctor and the doors close. now you have nowhere to go with your emergency. do you care about our dedication now?
as a resident i’ve vomited between seeing patients on one shift working with a stomach flu- was not happy about it but had no choice because of understaffing. the place would fall apart if down by one doctor.
please propose a better solution rather than just whining about your rights to not be infected by sick doctors.
Anonymous
I would have to agree I’m in a solo practice and if I don’t show up nobody sees the patient’s. I guess I can send all my patients to the emergency room that need to be seen but that seems to be a poor solution.
I would love to not work when I’m sick but where am I going to put these people and who is going to see them.
Anonymous
also I am the guy who delivered babies while I had a IV pole dragging behind me
John
Many people, if they even have a job, have jobs for which it is the headache of their supervisor to find a replacement when they call in sick. They aren’t responsible for finding a replacement. And things may or may not run well in their absence; as long as they get a required doctor’s note (from someone who didn’t call out sick, we can suppose), they are covered. Most people have never started a business for themselves. Still fewer have the kind of job where one person might have to be present to meet with thirty or forty individuals, one at a time, appointments that may have been many weeks in the making and for which all the other parties have made arrangements to be available.
It is very difficult, not to mention expensive to call out when your job is structured that way. A doctor in solo practice doesn’t have someone to fill in when he is sick. He is fortunate to be able to get someone to cover for emergencies. When the doctor is out, the overhead still has to be paid, but there is no work done and billed and thus no income. When you run overhead figures over 60%, one or two days out will hurt the whole month. And it is very difficult to count the cost of lost goodwill from disappointed patients who are inconvenienced twice.
So in the twenty years since I started in medicine, I can recall only once when I called out sick. And I was pretty sick.
As for the poster Anonymous 8:38 P.M., you are so utterly without a clue and self-absorbed; for you, it is all about your “rights.”
Anonymous
Anon 8:48:
I am sick of people from corporations who have never had a significant responsibility in management having nothing to say except about how annoyed they get when someone else is ill in their midst. How rude of them.
I suppose if no one really counts on you for anything, your absence wouldn’t be missed. Who knows, it might even be relished.
But being on a team where others really do count on you to be there to work, where important things would not get done without you and where others’ effectiveness would be compromised, sometimes you have to decide that showing up is necessary even if you don’t feel well.
Explaining that to someone who has never had that kind of responsibility is difficult. You have to have done it to know it.
Anonymous
Won’t delve into this too much, but I just want to confirm that the anecdotes about physicians and IV poles are true. My example, as a med student on my ED rotation, I had an attending with a family history of diabetes over a night shift realize that he was having polyuria and polydypsia. He checked a UA, had 3+ glucose, checked a BMP, and had a blood sugar over 700… I am not kidding. Luckily he didn’t have severe acidosis so he kept working.
As he began to feel sicker he had a nurse hang a bag of normal saline and give him some insulin, and he just stayed in the physician computer room while getting his bolus. All the while, he was the only physician in the ED, not counting the intern and me, the 4th year med student. Personally, I was just hoping nobody coded or needed an emergent procedure. I didn’t like how when I presented my cases to him he kept nodding off, finding it difficult to pay attention.
The fact is, this was unsafe. Luckily, nothing bad happened, and he didn’t need to do any procedures that night… god forbid he try a central line and drop a lung or worse. Point is, when you’re sick enough to compromise patient care, you need to call in reinforcements, whoever they are, and whatever it costs. Are an intern and a 4th year med student sufficient reinforcements? If you’re lucky, and I’m your med student. OK, I’m just kidding about the last part.
Anonymous
When a medical student, I worked with the flu until I collapsed once. I never got that sick on the job again but it was a combination of luck, good health, and supevising physicians who commanded me to go home. Early in my career I never had the sense to make myself stop. I thought those who did were slackers.
Now, decades later, I realize that it is stupid and egocentric not to take off when sick. I have seen enough friends and colleagues literally work themselves to death. In each and every case, the patients who were acutely ill have someone else taking care of them within hours. A solo practitioner friend had a heart attack on morning rounds. The chief of staff had his patients reassigned to other doctors before he got to the CCU. In a rural community where I once practiced several specialties had one-doctor coverage. The primary care docs stepped and filled the gaps when the specialists were out of commission just fine. Transfer a few patients, put off some elective procedures . . . it works out.
You are not that critical. The world will go on without you. Take care of yourself. And take time off to go to the dentist during residency. In 30 years you’ll regret it if you don’t. Don’t neglect that the way I did. Don’t buy the bullshit.
I still work with the sniffles and colds, etc. I am in an office setting around people with generally good constitutional health. On those days, I will reschedule especially vulnerable patients.
But I will not work when I am miserable enough that my ability to attend to the patient is compromised. I don’t leave them on their own–I make arrangements where they need to be made but this suffering hero crap isn’t for the patients, it is for the doctors ego. I grew out of it.
If you die in a car wreck today, your patients will be fine.
Also, I am not going to stay up all day fighting to keep my eyes open if kept awake most of the night before whether by patients or a sick family member. Sure it costs me a lot of money to cancel the afternoon and take a nap but it is the fair thing to do for the patients.
Joseph Sucher, MD FACS
The question asks "should doctors go to work when they are sick?" There is no single answer. There are a million reasons why we simply don't have a good choice. The primary one is either show up sick, or there is noone there to take care of your patients. So given that scenario the answer is yes. Given the scenario when you do have adequate coverage, the answer is no (in day to day practice, this can be a rare occasion).
I think you should separate the issues of residency from the career, as they are two competely different worlds.
You ended with this question->
"Are cash-strapped hospitals willing to spend the money to increase the size of their residency programs?"
To the best of my knowledge, hospitals have nothing to do with determining the size of a residency program. The size of a program is determined by the RRC and ACGME based on the ability for a hospital system to support the training requirements. The hospital recieves governmental support for each residency position. Therefore, the "cash-strapped" hospitals actually are subsidized for each resident.
JFS
Anonymous
well- (i’m the anon that was puking between seeing patients) i should say that in total honesty, if i felt i could not safely take care of patients, then i would call in sick.
unfortunately, that line is pretty blurry. when i was in the ICU as a resident, managing 16 very complicated and critically ill patients and carrying the code beeper for the hospital for 36 hours straight, no sleep, no rest, barely enough time to eat a snack or 2 during that shift, was i safe? guess it’s subject to debate.
Michael Haimson
What about surgeons? Surely no expects a sick surgeon to operate, right?
Anonymous
Surgeons don’t get sick.
Resident Anesthesiologist Guy (RAG)
As a resident, I get a little upset when I hear one of the residents on that rotation has called in sick – because I have to then pick up their work. It especially angers me when they come back to the hospital the next day – clearly they weren’t sick enough. However, that being said, I’d take off a day for my kids being sick, if needed (my wife usually does this) and would call in as being sick. My family is the one thing that trumps any and all of that irritation and feeling of hypocrisy that would be felt.