Sick doctors who work are doing more harm to their patients than good

Doctors: if you’re sick, don’t go to work.

The stereotype of doctors is that they go to work, despite whatever symptoms ail them. Calling in sick places strain on colleagues. Especially in residency, where team members are expected to pick up the slack.

In a recent column, the New York Times’ Pauline Chen discusses the image of self-sacrifice that a sick doctor going to work portrays:

Hacking, febrile or racked with the sequelae of chronic illnesses, doctors who are sick have continued for generations to see their patients. Although published reports for over a decade have linked patient illnesses like the flu, whooping cough and resistant bacterial infections to sick health care workers, as many as 80 percent of physicians continue to work through their own ailments, even though they would have excused patients in the same condition.

In today’s age of H1N1 influenza and other assorted public health worries, presenteeism is being looked at. Interestingly,

researchers in the business world have begun to question this assumption. Instead of focusing on problems incurred by absenteeism, these researchers have analyzed the impact of what’s been called presenteeism, or working despite being ill. And it turns out, at least in early studies, that those employees who choose to go to work sick are expensive. Presenteeism costs companies more than $150 billion a year in lost worker productivity.

And nowhere is the impact of presenteeism more profound than in the hospital.

Dr. Chen cites a recent study from the Journal of General Internal Medicine describing a norovirus outbreak in a nursing home spread despite stricter infection control measures.

As the lead author states,

“People probably felt they were showing up at work out of empathy for their patients and out of the kindness of their hearts … But they weren’t thinking about the risks.”

Indeed.

This is going to require a culture shift in medical training. During residency, you literally would have to be dying in order to call in sick. Not only to “be there” for your patients, but also not to impose on your colleagues.

That mentality has to stop. Unrestricted paid leave and mandatory time off for sick workers need to happen now.

Doctors are doing more harm than good by coming to work sick.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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  • paul

    i learned in residency that you don’t call in sick… you call in dead. i actually remember working with a gi bug and puking between patients.

    unfortunately that tradition continues as an attending… in my current workplace (a community ed with very tight staffing), i promise you that being short one doc for the day will result in far more bad outcomes than that doc coming in with a cold.

    • http://www.aneurysmsupport.com/ Mike

      In engineering we were required to give two weeks notice before calling in dead. Actually, in practice most engineering offices are a bit more forgiving than that as an ill person generally has a much higher error rate. As a group, Engineers themselves rarely miss work and I have seen some ordered to take their vacation. It is deeply engrained in the engineering culture and many take it very serious. I have known engineers who were discharged from the hospital and headed straight to work.

  • Dr. Dredd

    Agree with paul. You were “weak” if you called in sick during residency. At various times during my residency, I walked around with crutches, a cane, and a holter monitor.

  • ArkyDoc

    Some of us work in rural environments where there is no one to back us up if we are sick. Certainly, if I was killed in a car wreck or sick enough to be in the hospital myself, my employer would call someone in from out of town to finish up care on my patients or possibly transfer them to another hospital. But not just for a “cold” or “gi bug”.

  • jenga

    I agree, I’d rather suffer through a few days than have 60-70 pissed off patients and trying to figure out where to stuff them in the schedule. Being on time and available has more positive effects on your practice than about anything else you do.

    • AnnR

      If I’ve waited 4-5 weeks to see someone and know that if they call in sick that I’ll wait 4-5 more weeks or be quadruple booked into a half-second appointment I might think that a doctor who isn’t puking on me should try hard and show up.

      I’ll take my chances.

  • http://thedocsquawk.com thedocsquawk

    Pediatrics was the worst. If the kids weren’t rubbing their germy hands all over the ward, their parents were ignoring precautions and spreading their kids’ RSV all over the place. I got more respiratory and gastrointestinal illnesses on that rotation than I have in the rest of my medical training put together.

  • Muddy Waters

    Only in medicine are people expected to work through any illness. And this usually only applies to the doctors, as nurses and medical assistants call in all the time. Without the doctor, nothing runs. People have no sympathy for a cancelled appt they have been waiting on for weeks. Doctors are supposed to be superhuman. Oh, and we are also supposed to be MORE extensively trained, HIGHLY regulated, and work for LESS money every passing year. No other industry would EVER submit to this paradigm. Just look at how much more expensive everday items rise every year? It baffles me why anyone goes into medicine anymore. Sacrifice your life AND health for LESS incentive – no thanks.

  • HTorref

    Chen’s NYTimes article is true. Unionized nurses have sick days & use them. I know a doctor who had chest pain, seen in ED, after stress test went back to work. There was the time he hurt his back and went to work in wheelchair. It’s the doctor’s discretion to work with such noncontagious illnesses. However, for infectious diseases such as cold or flu, it is preferable if they rest & drink lots of fluids. LOL People exposed to them would be thankful.

    • Vox Rusticus

      Doubtful. I think they would be annoyed at the cancellation and rescheduling. I had a patient remind me once, months later, about the one single time I was called emergently to assist a colleague at the hospital during my clinic hours. There was no possible way to anticipate that absence.

      Patients are not generally concerned about the health of their doctor. They are concerned about their own health and having their doctor see and treat them promptly.

      • Primary Care Internist

        Most doctors are still voluntary, i believe, rather than employed. Thus no work equals no pay. Conversely, nurses and other lower level hospital employees have rich union-negotiated benefits. Some of the older nurses are pulling in close to six-figure incomes, and on any given day there is about a 30% chance they won’t be at work (sick time, “flex” time, conferences etc.) and i’ll be dealing with a “floating” nurse who doesn’t know or care about the patients.

        Incentives run EVERYTHING. it’s amazing how few people get that.

  • solo dr

    Since becoming a physician in 1999, I have never called in sick. I have puked between patients with a GI bug in 2004, and I seem to get an annual bronchitis. I had pneumonia one time three years ago, soaked clothes/day and night sweats/productive cough/rhonchi and then consolidation. Oral abx and a mask, and I kept going to see my patients. I rounded with a broken 5th metatarsal and my boot the day after I did it on a Sunday.
    In town an ob/gyn in a group of three randomly called off his office for back pain and a psychiatrist called off his schedule multiple times for depression during his divorce. Both of them were fired the next year by their hospital backed practices. The ob/gyn even took a LOA for his back pain treatment for multiple weeks and was told not to come back to work. The psychiatrist had patient complaining to his employers, as they were booked out a month or longer on the rescheduled times.
    As doctors, we are expected to work through all conditions at all times of the day, healthy or sick.

    • Vox Rusticus

      I have not called in sick in over 20 years of practice. I was sick out exactly once in medical school due to being unable to stand. I was back on the job a day later.

      The people who make these recommendations need to come up with something more useful than admonitions.
      There were lots of times I would have liked to go home and rest, but I simply did not have anyone to relieve me and no capacity to change the circumstances of my employment so that someone was available. This isn’t a matter of inflated self-importance; it is a matter of having responsibilities, significant expectations by attending staff, fellow residents and patients and no excess resources to summon to fill in.

      Most people who write these kinds of things telegraph their ignorance of large elements of the medical care system and how it works. Some people are more essential–in fact vital–than others. People whose absence will be accepted if not outright unnoticed seldom seem to appreciate how a different work environment where absence is truly disruptive and damaging could exist. The former usually are salaried by big employers and rarely have metrics of their performance. Billing and collections are one metric that an organization that has to pay its bills cannot escape.

    • Taylor

      What did your patients say?! Certainly I’d be concerned if my doctor came in the room sweating and/or hacking up a lung! People being fired and told not to come back is ridiculous. What if it was something super serious, but you came to work and then died the next day?? I bet the employer would feel bad about that.

      • Vox Rusticus

        Feel bad? Doubtful.

      • Dr. Dredd

        The employer might feel bad if they got sued by the next of kin. Otherwise, forget it.

  • http://www.blackrice.com pinky black

    doctors are also human. they get sick sometimes no matter how careful they’ve been. calling in dead doesn’t mean you are “WEAK”. if that’s the mentality where now is health care and patient concern on that matter? prevention is better than cure, if you feel something different why not go see a specialist immediately. your patients health is at risk if you still want to go to work despite of being sick. being in the medical field is not just about earning money it’s saving lives. how can patients entrust you their lives if you were the one who contributed for their health to worsen. you are not the only doctor running the hospital. let others do their job.

    • Vox Rusticus

      Doesn’t matter if they are “human.” We have developed a nearly pathological devotion to customer service and accommodation to patients that absence is simply not excused, not accommodated and punished when taken.
      The private practitioner is punished thrice: by illness, by loss of income and then again by patient disapproval and loss of reputation. There is a huge pressure to show up, no matter how bad one feels.

  • paul

    i think the bottom line is that if you’re going to make statements like “Doctors: if you’re sick, don’t go to work”
    you’d better back it up with your plan for who will be filling in for the doctor that doesn’t go to work. given that nobody filling in will not be tolerated by the public.

  • stargirl65

    I go to work sick. I have gone with bronchitis, vertigo (took one day off as I could not even sit let along stand). I once finished hospital rounds with a known intrauterine fetal death at 23 weeks. Got procedure done and back to work in 3 days.

    If I don’t work I don’t get paid. I still have to pay staff and overhead so I really lose money.

    If I don’t work then the patients receive no care or go to ER or Urgent Care facility as I am a solo doctor.

    If I don’t work patients get mad. I have had patients transfer out of my care when I missed days due to emergencies, or even if I took a preplanned day and was not available the day they were sick and did not want to wait for the next day.

    • Jo

      Same with my Dr.
      Payroll has to be met, and patients get angry when he has to miss seeing them due to having to check on elderly parents or if he is sick. As one patient put it red in the face as he said it, “I don’t care, I want a doctor to be here anytime I need him.”

  • PAULMD

    If I am cut, do I not bleed?

    College: never missed a day
    Graduate school: never missed a day
    Med school: never missed a day
    Internship: are you !@#$%^& kidding me?
    Residency: came in so sick my program director was notified and he sent me to ER to TB testing. I was told to keep working pending results of PPD. A fellow resident across the hall from my office vomited in his sink in front of a patient @ the VA and was finally sent home after a bag of LR.
    Fellowship: I actually called in sick to my bosses secretary from the toilet in my apartment as I was unable to maintain fecal continence….I came in late.
    Private practice: cancelled a complex surgery because I was encephalopathic and could not remember simple things…like my daughter’s name….patient was pissed.

    I do get upset at the work ethic of some of my employees. Some have taken off more days for “headaches” or fibromyalgia over the last week or two than we docs have over our careers.

    Long story short, If I didn’t own my own shop and my absense didn’t effect my partners….I would have taken a few days off over the last 2 decades.

  • Sarah

    Just curious: Do sick doctors wear masks?

    My mother-in-law, an ICU nurse, describes working sick wearing a mask and gauze taped under her nose. Her patients probably didn’t notice.

  • Ellen

    I went back to work as an Ob/Gyn too soon after knee replacement surgery, due to a partner being pregnant, as well as “the law of the land.” Now, I have been through drug rehab. due to becoming addicted to pain meds, because the more I worked, the more it hurt. I, now don’t have a medical license, due to “sucking it up and going to work,” as I was taught! I hope I can prevent at least one Dr. from falling into the same trap. For all of those thinking, “it couldn’t happen to me” think again!

    • Chris

      Unfortunately calling in sick is not an option even in the laboratory field. Being short staffed is a chronic problem in the health care field, and how to remedy the situation it seems to be frowned upon. In my field we have a situation were our workers are ready to retire and we are struggling to keep staffed 24/7. It’s hard to tell your family that it’s expected of you to show up for work even when you’re sick, had a surgery or a migraine.

  • Maggie

    With a solo practitioner it’s basically impossible to call in sick – not only are you losing necessary revenue to cover overhead (before your salary), you’re having to reschedule patients, some of whom waited up to 12 weeks to get on your schedule. You tough it out.

    My DH, a solo doc with no back-up, has to consider this even to just take a day off – his overhead, before he earns a penny, is greater than $5,000 a day he’s open (310 days a year)….a sick day will cost him a direct hit to his ability to cut himself a check at the end of the month because his overhead doesn’t stop needing to be paid when he’s sick, or when he wants to get a few days off to relax and do something.

    Too bad it’s easy for salaried docs to feel they’re in a position to comment on such issues when they themselves do not have to run the cost-risk-benefit to calling in sick.